Diagnóstico y formulación de casos en terapia psicodinámica: una revisión sobre herramientas actuales.

En las últimas dos décadas, diversos grupos de trabajo de la comunidad psicoanalítica internacional se han interesado por el desarrollo de herramientas sistemáticas para el diagnóstico, la formulación de los casos y la planificación del tratamiento psicodinámico. Este tipo de manuales diagnósticos psicodinámicos son esfuerzos de integración sistemática de una enorme y rica cantidad de información históricamente parcializada y dispersa, pero que constituye el aporte sustancial del psicoanálisis al campo de la salud mental. El objetivo del presente artículo es ofrecer una revisión actualizada sobre esta clase de herramientas sistemáticas de diagnóstico, formulación del caso y planificación terapéutica, diseñadas para el campo de los abordajes psicodinámicos. A estos fines, se describe la estructura y los objetivos de: 1) el Manual Diagnóstico Psicodinámico 2 (PDM-2), 2) el Diagnóstico Psicodinámico Operacionalizado (OPD-2/OPD-3) y 3) el Diagnóstico Psicodinámico Operacionalizado Infanto-Juvenil 2 (OPD-IJ-2).Se discuten las contribuciones de estas herramientas actuales para la práctica clínica y la investigación empírica, así como la necesidad de difundir este tipo de instrumentos en nuestro contexto regional.

The Development of the Municipal Registry of People with Diabetes in Porto Alegre, Brazil.

Background/Objective: Diabetes registries that enhance surveillance and improve medical care are uncommon in low- and middle-income countries, where most of the diabetes burden lies. We aimed to describe the methodological and technical aspects adopted in the development of a municipal registry of people with diabetes using local and national Brazilian National Health System databases. Methods: We obtained data between July 2018 and June 2021 based on eight databases covering primary care, specialty and emergency consultations, medication dispensing, outpatient exam management, hospitalizations, and deaths. We identified diabetes using the International Classification of Disease (ICD), International Classification of Primary Care (ICPC), medications for diabetes, hospital codes for the treatment of diabetes complications, and exams for diabetes management. Results: After data processing and database merging using deterministic and probabilistic linkage, we identified 73,185 people with diabetes. Considering that 1.33 million people live in Porto Alegre, the registry captured 5.5% of the population. Conclusions: With additional data processing, the registry can reveal information on the treatment and outcomes of people with diabetes who are receiving publicly financed care in Porto Alegre. It will provide metrics for epidemiologic surveillance, such as the incidence, prevalence, rates, and trends of complications and causes of mortality; identify inadequacies; and provide information. It will enable healthcare providers to monitor the quality of care, identify inadequacies, and provide feedback as needed.

Genomic diversity and evolutionary dynamics of Influenza A viruses in Colombian swine: implications for one health surveillance and control.

Influenza A viruses (IAV) impose significant respiratory disease burdens in both swine and humans worldwide, with frequent human-to-swine transmission driving viral evolution in pigs and highlighting the risk at the animal-human interface. Therefore, a comprehensive One Health approach (interconnection among human, animal, and environmental health) is needed for IAV prevention, control, and response. Animal influenza genomic surveillance remains limited in many Latin American countries, including Colombia. To address this gap, we genetically characterized 170 swine specimens from Colombia (2011-2017). Whole genome sequencing revealed a predominance of pandemic-like H1N1 lineage, with a minority belonging to H3N2 and H1N2 human seasonal-like lineage and H1N1 early classical swine lineages. Significantly, we have identified reassortant and recombinant viruses (H3N2, H1N1) not previously reported in Colombia. This suggests a broad genotypic viral diversity, likely resulting from reassortment between classical endemic viruses and new introductions established in Colombia's swine population (e.g. the 2009 H1N1 pandemic). Our study highlights the importance of a One Health approach in disease control, particularly in an ecosystem where humans are a main source of IAV to swine populations, and emphasizes the need for continued surveillance and enhanced biosecurity measures. The co-circulation of multiple subtypes in regions with high swine density facilitates viral exchange, underscoring the importance of monitoring viral evolution to inform vaccine selection and public health policies locally and globally.

Mayaro Virus as the cause of Acute Febrile Illness in the Colombian Amazon Basin.

Introduction: Mayaro Fever (MF) is a tropical disease caused by the Mayaro virus (MAYV), with outbreaks documented in Latin America. Methods: A hospital-based fever surveillance in Leticia, Colombian Amazon, collected sera from 1,460 patients aged 5-89 between December 2020 and April 2023. Results: Dengue and malaria were the main diagnoses (19.4 and 5.8%, respectively), leaving 71.4% of cases unidentified after testing. Metagenomic sequencing and real-time RT-qPCR testing identified MAYV in two patients (25-year-old male and an 80-year-old female) exhibiting typical symptoms, of MF including rash, joint pain, and fever. Phylogenetics analysis of these two viruses revealed a close relationship to Peruvian strains within the MAYV D genotype. Discussion: The study of AFI in Leticia, Colombia, identified dengue as prevalent, with malaria, COVID-19, Influenza, and Zika viruses also detected. Despite extensive testing, most cases remained unexplained until metagenomic sequencing revealed MAYV, previously unseen in Colombia but known in neighboring countries. Conclusion: This study presents the first near full-length genomes of MAYV in Colombia, highlighting the need for further seroprevalence studies and enhanced surveillance to understand and control the spread of the virus in the region.

Use of oral fluids for efficient monitoring of influenza viruses in swine herds in Colombia

Background: Influenza A virus (IAV) surveillance in swine is critical not only due to the direct impact of the disease in the pork industry but also because IAV are prone to interspecies transmission (from human to pigs and vice versa); therefore, its monitoring is fundamental from a public and animal health perspective. Several diagnostic techniques have been used to detect IAV infection from nasal samples in swine, while samples of oral fluids (OF) are in use as novel alternatives for pathogen detection. The OF allow for efficient and feasible low-cost disease detection at the herd level, with low risk of stress for the animals. Objective: To describe a surveillance strategy of IAV at the herd level during respiratory disease outbreaks in swine farms at tropical settings using porcine oral fluids. Methods: An active surveillance strategy was conducted in several farms with past records of respiratory disease. The IAV detection was conducted in five purposively selected swine farms from years 2014 to 2017. We investigated a total of 18 respiratory outbreaks of the disease. Swine OF were collected for IAV testing. An OF sample is described as a pen-based specimen collected from a group of >20 pigs per pen and/or per barn (stall-housed individually with close contact among them). The IAV infection was investigated in OF by rRT-PCR testing and confirmed by viral isolation in cell culture Results: We found 107 (7.4%) positives to IAV by rRT-PCR from a total of 1,444 OF samples tested. Additionally, 9 IAV isolates were all further identified as H1 subtype. Conclusions: Our results demonstrate that OF can be easily implemented as a novel, user-friendly, welfare-friendly, accurate and cost-effective sampling method for active surveillance and monitoring of IAV infections in swine farms in tropical settings.

Antecedentes: La vigilancia del Virus Influenza A (IAV) en los cerdos es fundamental debido al impacto directo de la enfermedad en la industria porcina, pero también porque los IAV son propensos de transmisión entre especies (humanos a cerdos y viceversa), y por lo tanto su monitoreo es crítico desde las perspectivas de salud pública y animal. Actualmente existen varias técnicas de diagnóstico disponibles para detectar la infección por IAV a partir de muestras nasales en cerdos, sin embargo, se han implementado otras muestras como los fluidos orales (OF) como nuevas alternativas para la detección de patógenos. El OF permite una detección eficiente y factible de enfermedades a menor costo a nivel de rebaño, con menor riesgo de estrés para los animales. Objetivo: Describir una estrategia de vigilancia de IAV a nivel de hato por medio de fluidos orales porcinos durante brotes de enfermedades respiratorias en granjas porcinas en entornos tropicales. Métodos: Se llevó a cabo una estrategia de vigilancia activa en cinco granjas porcinas seleccionadas con antecedentes de enfermedades respiratorias. Se recolectaron OF porcinos para la prueba de IAV. Una muestra de OF se describió como una muestra grupal recolectada de un grupo de >20 cerdos por corral y/o por establo (si estaban alojados individualmente, pero tenían un contacto cercano entre ellos). La infección por IAV se investigó probando OF mediante rRT-PCR y la confirmación mediante aislamiento viral en cultivo celular. Resultados: La detección de IAV se llevó a cabo en cinco granjas seleccionadas intencionalmente entre 2014- 2017. Investigamos un total de 18 eventos de brotes de enfermedades respiratorias. Del total de 1.444 OF muestras analizadas, encontramos 107 (7,4%) positivos a IAV mediante rRT-PCR. Además, solo se obtuvieron 9 aislamientos de IAV y todos se identificaron además como subtipo H1. Conclusiones: Los resultados de nuestro estudio demostraron cómo la OF puede implementarse fácilmente como un método de muestreo novedoso, fácil de usar, amigable con el bienestar animal, preciso y rentable para la vigilancia activa y el monitoreo de infecciones por IAV en granjas porcinas en entornos tropicales.

Antecedentes: A vigilância do vírus Influenza A (IAV) em suínos é crítica devido ao impacto direto da doença na indústria de suínos, mas também porque os IAV são propensos a transmissão interespécies (de humanos para porcos e vice-versa) e, portanto, seu monitoramento é crítico do ponto de vista da saúde pública e animal. Atualmente, existem várias técnicas de diagnóstico disponíveis para detectar a infecção por IAV em amostras nasais de suínos, no entanto, outras amostras, como fluidos orais (OF), têm sido implementadas como novas alternativas para a detecção de patógenos. O OF permite uma detecção eficiente e viável de doenças com menor custo em nível de rebanho, com menor risco de estresse para os animais. Objetivo: Descrever uma estratégia de vigilância de IAV em nível de rebanho durante surtos de doenças respiratórias em granjas de suínos em ambientes tropicais por meio de fluidos orais suínos. Métodos: A estratégia de vigilância ativa foi conduzida em cinco granjas de suínos selecionadas com histórico de doenças respiratórias. Suínos OF foram coletados para teste de IAV. Uma amostra OF foi descrita como um espécime baseado em curral coletado de um grupo de >20 porcos por curral e/ou por celeiro (se eles foram alojados individualmente, mas tendo contato próximo entre eles). A infecção IAV foi investigada testando OF por rRT-PCR e confirmada por isolamento em cultura de células. Resultados: A detecção do IAV foi realizada em cinco fazendas selecionadas propositalmente entre 2014-2017. Nós investigamos um total de 18 eventos de surto de doença respiratória. Do total de 1.444 amostras de OF testadas, encontramos 107 (7,4%) positivas para IAV por rRT-PCR. Além disso, apenas 9 isolados de IAV foram obtidos, e todos foram posteriormente identificados como subtipo H1. Conclusão: Os resultados de nosso estudo demonstraram como o OF pode ser facilmente implementado como um método de amostragem novo, amigável, amigável com o bem-estar, preciso e de baixo custo para vigilância ativa e monitoramento de infecções IAV em fazendas de suínos em ambientes tropicais.

Validez y reproducibilidad de un método para estimar la capacidad cardiorrespiratoria en adultos universitarios / Validity and reproducibility of a method to estimate cardiorespiratory fitness in college adults

Introducción. La capacidad física cardiorrespiratoria es un predictor de mortalidad por enfermedad cardiovascular y por todas las causas. Su diagnóstico en diferentes grupos tiene utilidad clínica y en salud pública. Objetivo. Evaluar la validez y reproducibilidad de un método sin ejercicio implementado por la NASA (National Aeronautics and Space Administration), para estimar el volumen máximo de oxígeno (VO2máx) consumido en adultos universitarios. Materiales y métodos. Estudio de validación de una prueba que incluyó 94 individuos sanos de ambos sexos (18 a 55 años). La prueba de referencia fue la ergoespirometría. La validez y la reproducibilidad se evaluaron mediante el coeficiente de correlación intraclase (Intraclass Correlation Coefficient, CCI) y el método de Bland-Altman. Resultados. Del total de los individuos incluidos en el estudio, 48,9 % fueron mujeres. La media de edad de los participantes fue de 30,54 ± 9,33 años y, la del VO2máx, fue de 41,29 ± 9,54 mlO2.kg-1.min-1. Se encontró una diferencia de medias de VO2máx entre la ergoespirometría y el estimado por el método implementado por la NASA de 3,41 ± 5,64 mlO2.kg-1.min-1. La concordancia entre los dos métodos fue buena, con un coeficiente de correlación intraclase de 0,858 (IC95% 0,672-0,926). El porcentaje de error fue del 29,70 %. La reproducibilidad de las dos estimaciones por el método implementado por la NASA fue excelente, con un coeficiente de correlación intraclase de 0,986 (IC95% 0,927-0,995). Conclusiones. El método NASA es válido y reproducible para estimar el VO2máx en adultos universitarios; además, es seguro y de fácil aplicación. Se recomienda la estimación de la capacidad física cardiorrespiratoria para mejorar la tamización en los programas de riesgo cardiometabólico e implementar intervenciones oportunas.

Introduction: Cardiorespiratory fitness is a predictor of cardiovascular and all-cause mortality. Its assessment in different groups has clinical and public health usefulness. Objective: To evaluate the validity and reproducibility of a no-exercise method [National Aeronautics and Space Administration (NASA) method] to estimate the maximum oxygen consumption (VO2máx) in college adults. Materials and methods: This study included 94 healthy individuals of both sexes (1855 years). The gold standard was ergospirometry. The validity and reproducibility were evaluated with the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results: Among the participants, we found a mean age of 30.54 ± 9.33 years and a VO2máx of 41.29 ± 9.54 ml O2kg-1-min-1; 48.9 % were women. A mean difference of VO2máx between ergospirometry and that estimated by the NASA method of 3.41 ± 5.64 ml O2.kg-1. min-1 was found. The concordance between the two methods was good, with an ICC of 0.858 (CI95% 0.672-0.926). The percentage of error was 29.70 %. The reproducibility of the two estimates by the NASA method was excellent, with an ICC of 0.986 (CI95% 0.927-0.995). Conclusions: The NASA method is valid and reproducible to estimate VO2máx in college adults. In addition, it is safe and easy to apply. Estimating cardiorespiratory fitness is recommended to improve screening in cardiometabolic risk programs and to implement timely interventions.

Indicadores de carga física de trabajo en exposición intermitente crónica a gran altura / Indicators of physical work load in chronic intermittent exposure at high altitude

Se han establecido regulaciones para la exposición ocupacional a cargas físicas del trabajo, y a hipoxia intermitente crónica (HIC). También se ha indicado incorporar los riesgos asociados a HIC a un sistema de gestión de seguridad y salud en el trabajo. Dado que las cargas físicas de trabajo (CFT) en HIC pueden condicionar riesgos de trabajo pesado y fatiga física, se considera oportuno revisar el efecto de la CFT a gran altitud, entre 3000 y 5500 m de altura, sobre el riesgo de trabajo pesado, por lo cual se procede a recopilar estudios de campo de la capacidad aeróbica, mediciones de los signos que permiten evaluar el % de Carga Cardiovascular (%CCV) ocupado a gran altura. El %CCV se calcula mediante las frecuencias cardíacas (FC) de reposo, la máxima y la de trabajo. El monitoreo continuo de la FC y mediciones directas de la capacidad aeróbica máxima muestran que en HIC se modifican las tres FC de %CCV, también se muestra que cuando la FC de trabajo en altitud está por sobre 110 latidos/minuto hay mayor riesgo de fatiga y trabajo pesado. Adicionalmente se encontró que la capacidad aeróbica, VO2máx, medido a nivel del mar se reduce en trabajadores aclimatados a HIC con una reducción del 7% de la FC máxima. Este efecto, entendido como frenación fisiológica protectora, se puede perder durante una desaclimatación a nivel de mar por más de 10 días. En vista de una mayor probabilidad de trabajo pesado en HIC se proponen intervenciones para prevenir, controlar y mitigar riesgos de fatiga, cansancio y trabajo pesado que afecten la salud, conducta segura y productividad. En conclusión, en faenas a gran altitud, la CFT se puede evaluar mediante medición del %CCV basada en registros de la FC de reposo, máxima y de trabajo, en cada cota donde se ejecuta la actividad laboral, porque la hipoxia hipobárica modifica los tres componentes de esa ecuación.

Regulations have been established for the occupational exposition to physical loads from work, and chronic intermittent hypoxia (HIC). Also, it has been indicated to include the associated HIC risks to a security and health management system at work. Since physical workload (CFT) in HIC can condition risks of hard work and physical fatigue, it is considered appropriate to review the CFT effect at high altitude, between 3000 and 5500m of altitude, over the risks of hard work, which is why is proceeding to compile field studies about the aerobic capacity, measures of signs that allows assessing the % of Cardiovascular load (%CCV) used at great altitudes. The % CCV is estimated by cardiac frequencies (FC) at rest, maximum, and from work. The FC continuous monitoring and direct measures of the maximum aerobic capacity displays that the three FC of %CCV are modified in HIC is also displayed that when the work FC in altitude is over 110 heartbeats/minute there is major fatigue and hard work risk. Moreover, it was determined that aerobic capacity, VO2 max, measured at sea level is reduced in acclimated workers to HIC with a 7% reduction of maximum FC. This effect, known as physiological protective restrain, can be lost during a deacclimation at sea level for more than 10 days. At the sight of a greater probability of hard work in HIC, interventions are proposed to prevent, control, and reduce fatigue risks, tiredness, and hard work that affects health, safe-conduct, and productivity. In conclusion, in chores at high altitudes, CFT can be assessed by measuring the %CCV based on date from the FC in rest, maximum and from work, in each height where work activities are performed, because the hypobaric hypoxia modifies the three components of that equation.

Contributions of Operationalized Psychodynamic Diagnosis (OPD-2) in Colombia: training, practice and research

In this paper we summarize some experiences with Operationalized Psychodynamic Diagnosis (OPD-2) in the colombian context, and put into perspective other possibilities for its implementation grounded on our teaching and clinical practice. Given OPD-2 develops as a modular system for diagnosis and treatment planning, it has been used in different areas of both clinical practice and empirical research. Based on this, we have chosen different application scenarios to illustrate OPD-2'susefulness, focusing on different axes or modules of the instrument, reharding Colombia's interculturality, clinical work at the general hospital, teaching and practice integration, and OPD-2's contributions to dynamic psychology. The possibilities of OPD-2 related to each application area are discussed and gathered into a final conclusion.(AU)

Prevalence and trends of mental disorders requiring inpatient care in the city of Porto Alegre: a citywide study including all inpatient admissions due to mental disorders in the public system from 2013-2017 / Prevalência e tendências temporais de transtornos mentais necessitando de tratamento de internação na cidade de Porto Alegre: um estudo de toda a cidade incluindo todas as internações por motivo de saúde mental no sistema público de 2013-2017

Abstract Objectives To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. Methods All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. Results There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. Conclusions Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

Resumo Objetivos Investigar a prevalência de 5 anos de pacientes internados no sistema público de saúde por motivo de saúde mental, estratificando-os por grupo etário e diagnóstico, e avaliar tendências temporais nas admissões nesse período em Porto Alegre. Métodos Todas as admissões no sistema público de saúde mental reguladas pelo sistema eletrônico da cidade, denominado Administração Geral dos Hospitais (AGHOS), foram incluídos na análise. A população total foi obtida a partir de estimativas da Fundação de Economia e Estatística (FEE). Informações gerais sobre a prevalência de 5 anos de admissões, tendências das séries temporais e prevalência por grupo etário e por diagnóstico foram apresentadas. Resultados Ocorreram 32.608 admissões no período de 5 anos analisado. A prevalência global de pacientes foi de 1,62% na população total, 0,01% em crianças, 1,12% em adolescentes, 2,28% em adultos e 0,93% em idosos. Os diagnósticos mais comuns foram relacionados ao uso de drogas, seguidos de transtornos de humor, relacionados ao álcool e transtornos psicóticos. Houve uma tendência linear mostrando um aumento no número de admissões de 2013 a meados de 2014, que caíram em 2015. Conclusões Admissões por transtornos mentais são relativamente comuns, principalmente entre adultos e relacionados ao uso de drogas e transtornos de humor. Tendências lineares variaram levemente nos últimos 5 anos. Estimativas de prevalência no mundo real podem ser úteis para formuladores de políticas interessados em planejar o sistema público de saúde mental em grandes cidades brasileiras.

Vólvulo gástrico, abordaje por laparotomía y laparoscopia. Revisión de la literatura a raíz de dos casos / Gastric volvulus, laparotomy and laparoscopic approach. Literature review pertaining two cases

El vólvulo gástrico es una condición potencialmente mortal, consistente en la rotación anormal del estómago sobre un eje sostenido por dos partes fijas. Produce síntomas inespecíficos, lo cual, junto con su baja incidencia, hace difícil el diagnóstico. Se hizo una revisión bibliográfica y se presentan dos pacientes con diagnóstico de vólvulo gástrico. En ambos, la presentación clínica fue aguda, pero con diferentes manifestaciones. El abordaje quirúrgico, en uno, fue mediante técnica abierta y, en el otro, mediante laparoscopia (gastrectomía vertical); esta última, con menor morbimortalidad y repercusión en las funciones fisiológicas y anatómicas del paciente. La vía laparoscópica permite abordajes mínimamente invasivos, poco reportada en la literatura, la cual puede ser una opción adecuada para el abordaje en estos pacientes.

Gastric volvulus is a life-threatening pathology characterized by the abnormal rotation of the stomach on an axis formed by two fixed parts, which causes nonspecific symptoms. Together, the low incidence and clinical presentation, makes it a challenging diagnosis. The aim of this article is to review the literature and to present two patients with acute gastric volvulus with different clinical presentation. The first was treated by an open technique and the second one by laparoscopic technique (vertical gastrectomy) which resulted in a lower morbidity and mortality with less impact on the physiological and anatomical functions. Few cases have been reported in the literature and it may be considered an appropriate option for the approach on these patients

Operacionalización psicodinámica del eje estructura en un paciente drogodependiente / Psycho-dynamic Operationalization of the Structure Axis in Drug Addicted Patients / Operacionalização psicodinâmica do eixo estrutura num paciente drogo-dependente

Resumen Objetivo. Comprender la relación entre el perfil psicodinámico y la adicción a las drogas en pacientes internos en una comunidad terapéutica, considerando la operacionalización del eje estructura según el Diagnóstico Psicodinámico Operacionalizado (OPD-2). Método. Se implementó el estudio cualitativo de cuatro procesos individuales de psicoterapia psicodinámica. Cada caso fue analizado por separado y se operacionalizaron los ejes diagnósticos del OPD-2; instrumento validado internacionalmente para la investigación, evaluación, focalización e indicación del tratamiento. Resultados. El análisis de caso permitió concluir que las limitaciones en las capacidades cognitivas, emocionales y vinculares corresponden a un nivel estructural medio-bajo. Discusión. Para la intervención psicoterapéutica es importante comprender la dinámica psíquica que sostiene la conducta adictiva con base en un acertado diagnóstico dimensional.

Abstract Objective. To understand the relation between the psychodynamic profile and drug addiction in patients hospitalized in a therapeutic community, taking into account the operationalization of the structure axis based on the OperationalizationPsychodynamic Diagnostic (OPD-2). Method. A multi-case method was implemented consisting of the qualitative study of four individual processes of psychodynamic psychotherapy. Each case was analyzed individually and the diagnostic axes proposed by the OPD-2 were operationalized, this being an instrument of psychodynamic orientation, validated internationally through research, evaluation, focalization and treatment indication. The case of a drug-addicted patient in the process of rehabilitation was chosen for the purpose of multi-axial evaluation. Results. The case analysis concluded that limitations in cognitive, emotional and bonding abilities correspond to a middle-low structural level. Discussion. In psychotherapeutic interventions, it is important to understand the psychological dynamic present in addictive behavior starting with an appropriate dimensional diagnosis.

Resumo Escopo . Compreender a relação entre o perfil psicodinâmico e a adição às drogas em pacientes internos numa comunidade terapêutica, considerando a operacionalização do eixo estrutura com base no Diagnóstico Psicodinâmico Operacionalizado (OPD-2). Metodologia . Foi implementado um método multicaso, que consiste no estudo qualitativo de quatro processos individuais de psicoterapia psicodinâmica. Cada um dos casos foi analisado por separado e foram operacionalizados os eixos propostos pelo OPD-2, que é um instrumento de orientação psicodinâmica validado internacionalmente para a pesquisa, avalição, focalização e indicação do tratamento. Para o propósito da avaliação multiaxial, foi elegido o caso de um paciente drogo-dependente em processo de reabilitação. Resultados . A análise de caso permitiu concluir que as limitações nas capacidades cognitivas, emocionais e vinculares correspondem a um nível estrutural médio-baixo. Discussão . Para a intervenção psicoterapêutica é importante compreender a dinâmica psíquica que sustenta o comportamento aditivo com base num acertado diagnóstico dimensional.

La función del padre en la dinámica relacional de los núcleos monoparentales femeninos / Father's role in a relationship with female single parent

This paper shows the results of a qualitative research approach. It aims to characterize a father's role in a relationship with a female single parent. This research process was conducted based on theoretical references with a dynamic psychology basis, and founded on psychoanalytic, relational theory. Social risks, as well as an increase in the number of these cases in Colombian households and the need to understand the relational system of these family groups justified this study with semi-structured interviews, and projective tests, which were applied to a sample of 20 couples, (with a pre-existing mother-son relationship). As a result, it was found that within these family groups, the mother enabled the paternal role, thus ensuring the physical and psychological survival of the family through support and its ability to coexist with other people.

Este artículo presenta los resultados de una investigación de enfoque cualitativo. Su objetivo principal consistió en caracterizar la función paterna en la dinámica relacional de los núcleos monoparentales femeninos. Los referentes teóricos que iluminaron el proceso investigativo pertenecen a la psicología dinámica, escuela fundamentada en la teoría psicoanalítica relacional. Los riesgos sociales, el aumento de esta tipología familiar en Colombia y el aporte a una mayor comprensión del sistema relacional de estos grupos familiares justificaron el estudio. Se trabajó con una muestra de 20 díadas (madre-hijo), a las que se realizaron entrevistas semiestructuradas y se aplicaron pruebas proyectivas. Se encontró que en estos núcleos familiares la madre habilita las funciones paternas a través de la matriz de apoyo y que la convivencia del núcleo monoparental con otras personas asegura la supervivencia física y psíquica de la díada.

Acclimatization to chronic intermittent hypoxia in mine workers: a challenge to mountain medicine in Chile

In the past two decades, Chile has developed intense mining activity in the Andes mountain range, whose altitude is over 4,000 meters above sea level. It is estimated that a workforce population of over 55,000 is exposed to high altitude hypobaric hypoxia. The miners work under shift systems which vary from 4 to 20 days at the worksite followed by rest days at sea level, in a cycle repeated for several years. This Chronic Intermittent Hypoxia (CIH) constitutes an unusual condition for workers involving a series of changes at the physiological, cellular and molecular levels attempting to compensate for the decrease in the environmental partial pressure of oxygen (PO2). The mine worker must become acclimatized to CIH, and consequently undergoes an acute acclimatization process when he reaches the worksite and an acute reverse process when he reaches sea level. We have observed that after a period of 3 to 8 years of CIH exposure workers acclimatize well, and evidence from our studies and those of others indicates that CIH induces acute and chronic multisystem adjustments which are effective in offsetting the reduced availability of oxygen at high altitudes. The aims of this review are to summarize findings of the physiological responses to CIH exposure, highlighting outstanding issues in the field.

Desarrollo de u poxvirus recombinante que exprsa la glicoproteína d del herpeesvirus bovino-1 / Development of a Recombinant Poxvirus Expressing Bovine Herpesvirus-1 Glycoprotein D

El herpesvirus bovino-1 (BHV-1) es un virus de genoma DNA perteneciente a la familia Herpesviridae, el cual afecta al bovino en el que provoca un amplio espectro de manifestaciones clínicas y pérdidas económicas. El principal componente inmunogénico de su envoltura es la glicoproteína D (gD), la cual ha sido caracterizada y utilizada como inmunógeno en distintos sistemas de expresión. El objetivo de este trabajo fue generar un poxvirus recombinante (Raccoonpox [RCN]) que expresara una versión truncada de la gD del BHV-1 para ser usado como inmunógeno. Para ello, se amplificó el gen que codifica para la versión truncada de la gD, la cual se clonó en el plásmido de transferencia pTK/ IRES/tpa que posee sitios de homología a la timidinakinasa del poxvirus, un sitio interno de entrada al ribosoma (IRES) y una señal secretoria (tPA), generando el constructo pTK/gD/IRES/tpa. Para generar el RCN recombinante, se tomaron células BSC-1, se infectaron con una cepa Silvestre del RCN (CDC/V71-I-85A) a un índice de multiplicidad de infección de 0,05 y se transfectaron con el constructo pTK/gD/IRES/tpa; generándose diferentes poblaciones virales con y sin el gen de interés. Para seleccionar los virus recombinantes que expresaban el gen de interés, se realizó una selección de recombinantes negativos para timidina kinasa y positivos para la gD por tres rondas de purificación de placas en monocapas de células RAT-2 las cuales son mutantes para timidina kinasa y en presencia de bromodeoxiuridina. Los virus recombinantes se confirmaron por PCR y secuenciación de nucleótidos y se denominaron RCN-gD.

Bovine Herpesvirus-1 is a DNA virus belonging to the family Herpesviridae, which affects cattle, causing a wide spectrum of clinical manifestations and economic losses. The main immunogenic component is its envelope glycoprotein D (gD), which has been characterized and used as immunogen in different expression systems. The aim of this work was to generate a recombinant poxvirus (Raccoonpox [RCN]) expressing a truncated version of BHV-1 gD to be used as a vaccine. To do this, it was amplified the gene for a truncated version of gD which subsequently was cloned in transfer plasmid PTK/IRES/tpa which has homology to sites of poxvirus thymidine kinase, an internal site of ribosome entry (IRES) and a secretory signal (tPA), generating the construct PTK/gD/IRES/tpa. To generate the recombinant RCN, we took BSC-1 cells and we infected with a wild type RCN (CDC/V71-I-85A) at a multiplicity of infection of 0.05, then cells were transfected with the construct PTK/gD/IRES/tpa, generating different viral populations with and without the gene of interest. To select recombinant viruses expressing the gene of interest, we performed a selection of recombinant thymidine kinase negative and positive for gD by three rounds of plaque purification on RAT-2 cells monolayers which are thymidine kinase null and using bromodeoxyuridine. Recombinant viruses were recovered and confirmed by PCR and nucleotide sequencing and so called RCN-gD.

La dinámica vincular celos-infidelidad / The dynamic linking jealousy-infidelity

En el conflicto celos-infidelidad subyacen motivaciones intrapsíquicas tan fuertes como el temor de pérdida del objeto, necesidades de satisfacciones narcisistas, búsqueda de la diferenciación y relaciones de poder. Lo que comparten, tanto el celoso como el infiel, son sentimientos tales como: dolor, odio, tristeza, miedo, desconcierto, desconfianza, arrepentimiento, comportamiento errático, dudas, disociación constante y culpa. Los significados de la infidelidad tienen que ver con escapar del objeto invasivo, obligarse a la reparación, negar la desidealización del objeto de amor o salvaguardarse del abandono. La frecuencia de este conflicto en las parejas y su recurrencia como motivo de consulta obliga a los psicoterapeutas una mayor profundización de la complejidad que subyace a la dinámica del vínculo. La orientación teórica para presentar este tema lo integran básicamente la dinámica inconsciente de las relaciones objetales, la identificación proyectiva y la colusión.

The jealousy-infidelity conflict has an underlying current of interpsyche motivations as strong as fear of object loss, narcissistic need satisfaction, differentiation search, and power relationships. Feelings such as pain, hatred, sadness, fear, uncertainty, lack of trust, repentance, erratic behavior, doubts, constant dissociation, and blame are felt as much by the jealous party as by the unfaithful party. The significance of infidelity has to do with escaping the invasive object, forcing oneself to reparation, denial of the de-idealization of the love object or protecting oneself against abandonment. The frequency of this conflict in couples and its recurrence as a motive for consultation obligates psychotherapists to greater depth analysis of the complexity which underlies the dynamics of this link. The orientation theory for the presentation of this theme is basically integrated by the unconscious dynamics of object relationships, projective identification and collusion.

No conflito ciúmes-infidelidade estão presentes motivações intrapsíquicas tão fortes como o medo à perdida do objeto, necessidades de satisfações narcisistas, procura da diferenciação e relações de poder. O que compartem tanto o ciumento quanto o infiel são sentimentos tais como: dor, ódio, tristeza, medo, desorientação, desconfiança, arrependimento, comportamento errático, dúvidas, dissociação constante e culpa. Os significados da infidelidade têm a ver com escapar do objeto invasivo, se obrigar à reparação, negar a desidealização do objeto de amor ou se cuidar do abandono. A frequência de este conflito em casais e sua recorrência como motivo de consulta obriga aos psicoterapeutas a um maior estudo da complexidade que está presente na dinâmica do vínculo. A orientação teórica para apresentar este tema o integram basicamente a dinâmica inconsciente das relações objetais, a identificação projetiva e a colusão.

Fístulas carótido-cavernosas: resultados clínico y angiográfico de los pacientes tratados por el Grupo de Neurorradiología del Hospital Universitario San Vicente de Paúl, 1995-2007, Medellín, Colombia / Carotid-cavernous fistulae: Clinical and angiographic results in patients treated by the Neuro-radiology Group at a third-level University Hospital in Medellín, Colombia, 1995-2007

Introducción: las fístulas carótido-cavernosas son frecuentes en Medellín, Colombia, y su tratamiento quirúrgico se asocia a tasas elevadas de complicaciones debido a las características anatómicas peculiares de esta zona; por ello la terapia endovascular ha surgido como la primera opción de tratamiento para los pacientes con este trastorno. Objetivo: describir las principales características de un grupo de pacientes con fístulas carótido-cavernosas, el procedimiento terapéutico empleado y los resultados clínicos y angiográficos obtenidos. Pacientes y métodos: se revisaron retrospectivamente las historias clínicas de 51 pacientes tratados por el grupo de Neurorradiología del Hospital Universitario San Vicente de Paúl, entre los años 1995 y 2007. Se tuvieron en cuenta algunas variables demográficas, la etiología de la fístula, el estado clínico inicial y final, el tipo de fístula, el método terapéutico empleado y los resultados angiográficos. Resultados: se encontró un total de 51 pacientes, tres de ellos con fístulas bilaterales para un total de 54 fístulas; sin embargo, las fístulas de dos pacientes se resolvieron espontáneamente y la de otro se resolvió con masaje carotídeo. Por ello el tratamiento endovascular se hizo en solo 48 pacientes. El promedio de edad fue de 35 años, con predominio del sexo masculino (74,5%). Las fístulas fueron traumáticas en 47 pacientes (92,2%), y espontáneas en cuatro (7,8%); de los 47 pacientes con fístulas traumáticas, en 33 (70,2%) se originaron por trauma cerrado, en 12 (25,5%) por heridas con arma de fuego, y en dos (4,3%) por herida con arma cortopunzante. Las manifestaciones clínicas encontradas en orden descendente de frecuencia fueron: quemosis, proptosis, soplo, dolor, disminución de la agudeza visual y sangrado intracraneal. Según la clasificación de Barrow, las fístulas fueron de tipo A en el 86,0% de los casos, de tipo B en el 9,8%, de tipo C en el 1,9% y de tipo D en el 1,9%...

Introduction: Carotid-cavernous fistulae are frequently found in Medellín, Colombia and their surgical treatment associates with a high rate of complications due to the peculiarities of this anatomic zone. Endovascular therapy has become the first option in patients with these lesions. Objective: to describe the main demographic, clinical and angiographic features of a group of patients with carotid-cavernous fistulae, the therapeutic approach used in them, and the results obtained from the clinical and angiographic standpoints. Patients and methods: We reviewed the clinical charts of 51 patients treated by the Neuro-radiology Group at Hospital Universitario San Vicente de Paúl, in Medellín, Colombia, between 1995 and 2007. The following information was taken into account: demographic variables, etiology, initial and final clinical situation, therapeutic procedures, and angiographic results. Results: A total of 51 patients were found, three of which had bilateral lesions. Two patients had spontaneous resolution of their fistulae and in one more it resolved with carotid massage. Endovascular treatment was therefore carried out in only 48 patients. Average age was 35 years, and 74.5% of the patients were males. Fistulae were traumatic in 47 patients (92.2%) and spontaneous in four (7.8%). Out of the 47 traumatic fistulae, 33 (70.2%) were due to closed cranio-encephalic trauma. In 12 they were produced by firearm wounds and in two they were due to wounds with sharp instruments. In decreasing order of frequency clinical manifestations were: chemosis, proptosis, murmur, pain, decreased visual acuity and intracranial bleeding. Concerning the type of fistula (Barrow classification), they were type A in 86.0%, type B in 9.8%, type C in 1.9% and type D in 1.9%...

Calidad de vida de los adultos mayores de Medellín / Quality of life in institutionalized elderly people of Medellín

Introducción. Varios aspectos en el adulto mayor deterioran su calidad de vida, como son las relaciones familiares y de amigos, la soledad e, incluso, el mismo centro geriátrico. Objetivo. Explorar las condiciones asociadas con la calidad de vida de los ancianos en hogares geriátricos. Materiales y métodos. Estudio transversal de 276 ancianos de 39 Centros de Bienestar del Anciano de Medellín. Se excluyeron aquellos con grave deterioro cognitivo y los que no residían de forma permanente en la institución. La calidad de vida se evaluó mediante el World Health OrganizationQuality of Life of Older Adults (WHOQOL-OLD) de la Organización Mundial de la Salud; se utilizaron la escala de depresión de Yesavage, la de ansiedad de Goldberg, la de funcionalidad de Pfeffer, la minivaloración nutricional y, además, se evaluaron aspectos demográficos y sociales. La información se analizó con pruebas U de Mann-Whitney, Kruskal-Wallis, la correlación de Pearson y un modelo de regresión lineal múltiple. Resultados. El 59,4 % eran mujeres, la edad promedio fue de 79,2 ± 8,0 años, 71 % se consideraron independientes para realizar actividades de la vida diaria, 45,7 % presentaba sintomatología depresiva y 33 % mostraron riesgo de ansiedad, 28,3 % deterioro funcional y, 54,3 %, posible malnutrición. Se encontró una asociación negativa con la calidad de vida el ser mujer, presentar diabetes, altos puntaje sen las escalas de capacidad funcional, depresión y ansiedad; el ir voluntariamente a la institución mostró una asociación positiva. Conclusión. Se halló deterioro en la calidad de vida cuando las condiciones de funcionalidad y autonomía limitaban la realización de actividades de la vida diaria, agravado por el hecho de ser mujer, tener sintomatología depresiva y de ansiedad, y sentirse maltratado por sus familiares.

Introduction. Many factors contribute to the deteriorating quality of life of elderly people living in care institutions. Some of these problems are a consequence of few contacts with relatives and friends, and being alone with a feeling of isolation. Objective. The conditions of quality of life are explored for elderly people living in care institutions. Materials and methods. In a cross sectional study, 276 subjects were selected from 39 long term institutions located in the city of Medellín, Colombia. The sex ratio was female: male 60:40% with a mean age of 79.2±8.0. Elderly subjects with cognitive problems or not living in the institution were excluded. The World Health Organization Quality of Life of Older Adults (WHOQOL-OLD) questionnaire was applied; in additional, capacity and cognitive functional scales of Pfeffer, the anxiety scale of Goldberg, and the Geriatric Depression Scale of Yesavage were administered. Mininutritional assessment scalesand complementary questionnaires about demographics, health perception, social support system were also included. The information was analyzed using the Mann Whitney U test, Kruskal Wallis test, Pearson correlation and multiple linear regression method. Results. Most (71%) considered themselves autonomous for undertaking daily, habitual activities. Other statistics included the following: 45.7% with depression, 33.0% with anxiety, 28.3% with functional problems, and 54.3% at risk of malnutrition. A negative quality-of-life assessment was associated with the following factors: female, diabetes, depression, anxiety and high functional capacity. A positive quality-of-life assessment was associated with individuals who voluntarily came to the institution. Conclusion. Quality of life for elderly people living in care institutions can become deteriorated when they are not capable to do the usual activities necessary for daily living. Exacerbating factors included sex, symptoms of depression, anxiety, or perceived mistreatment by their families.