Psicanálise aplicada ao contexto hospitalar: intervenções em tempos de pandemia Covid-19 / Psychanalyse appliquée em contexte hospitalier: interventions em période de pandémie de Covid-19 / Applied psychoanalysis in the hospital context: interventions in times of Covid-19 pandemics

Este artigo apresenta o relato de experiência de psicólogas clínicas de hospitais privados, localizados na cidade do Rio de Janeiro,durante a pandemia do novo coronavírus. Essa prática é alicerçada nos princípios teórico-clínicos da psicanálise aplicada às práticas em instituições hospitalares. Há mais de uma década faz parte dos projetos de psicanálise aplicada do Instituto Sephora de Ensino e Pesquisa de Orientação Lacaniana. Essa experiência aqui relatada é inédita pois, pela primeira vez, foi necessário efetuar o acompanhamento psicanalítico através de recursos virtuais. A potência do dispositivo analítico, ancorado no campo da fala e da linguagem, precisou ser reinventada para alcançar pacientes com Covid-19 e seus familiares. Através de vinhetas clínicas serão apresentadas algumas das dificuldades encontradas nesta nova prática em tempos de pandemia. Esperamos dar testemunho de que zelamos para que a ética e o desejo do analista nos orientassem para fazer bom uso do novo dispositivo

Cet article présente le rapport d'expérience de psychologues cliniciens des hôpitaux privés, principes théorico-cliniques de la psychanalyse et fait partie des projets de psychanalyse appliquée de l'Institut Sephora pour l'Enseignement et la Recherche d'Orientation Lacanienne,depuis plus d'une décennie. A travers des vignettes cliniques seront présentées quelques impasses face à et comment, en temps de pandémie, l'éthique et le désir de l'analyste ont été maintenus

This article reports on the experience of clinical psychologists in private hospitals located in the city of Rio de Janeiro during the covid-19 pandemic. This practice is based on the theoretical-clinical principles of psychoanalysis and has been incorporated into the applied psychoanalysis projects of the Instituto Sephora de Ensino e Pesquisa de Orientação Lacaniana (ISEPOL) for over a decade. Through clinical vignettes, the article will present the impasses faced, in times of pandemic, and how the psychoanalyst's ethics and desires were preserved

Prognostic impact of diffuse large B-cell lymphoma subgroups in patients undergoing autologous SCT.

A total of 53 patients aged 18-60 years with high-intermediate or high-risk diffuse large B-cell lymphoma (DLBCL) were evaluated to analyze the impact of the cell of origin. Of 53 patients, 16 underwent autologous SCT (ASCT) in first remission and the rest received conventional chemotherapy. Immunohistochemistry was evaluated in 47 cases: 17 were of germinal center (GC) origin and 30 were of non-GC origin. There was no survival difference between the two groups. Overall survival (OS) and disease-free survival (DFS) at 3 years were 93 and 83%, respectively, for the 14 patients who underwent ASCT. Their DFS was significantly better than that of patients who achieved CR but did not undergo ASCT. We conclude that ASCT is safe and improves the DFS of high-intermediate and high-risk DLBCL, regardless of the cell of origin. This observation should be confirmed in a larger study.

Addition of low-dose busulfan to cyclophosphamide in aplastic anemia patients prior to allogeneic bone marrow transplantation to reduce rejection.

Busulfan was added at the dose of 4 mg/kg to 200 mg/kg cyclophosphamide in 81 patients (3-53 years, median 24) with aplastic anemia to reduce graft rejection. Graft-versus-host disease (GVHD) prophylaxis comprised cyclosporine-methotrexate. The number of prior transfusions was 0-276 (median 26), and 48% had received prior immunosuppressive therapy. Two patients experienced primary graft failure, and 10 secondary rejection at 28-1001 days (median 317 days). The cumulative incidence of rejection was 22%; for heavily transfused patients (>/=50 U) it was 43% compared to 16% for the rest (P=0.06). Overall survival rate at 8 years was 56%; patients who received 15 transfusions was 78 and 50%, respectively (P=0.01), whereas it was 67 and 28% for 50 transfusions, respectively (P=0.002). In multivariate analysis, higher number of prior transfusions, shorter period of immunosuppression with cyclosporine and GVHD were associated with inferior survival; moreover, a higher risk of graft rejection were associated with a higher number of prior transfusions and a trend was observed for a shorter cyclosporine administration. Low-dose busulfan is feasible and may be helpful in patients exposed to <50 transfusions. However, rejection remains a significant problem, mainly in heavily transfused patients.

Phialemonium curvatum infection after bone marrow transplantation.

We report a case of cutaneous infection caused by Phialemonium curvatum GAMS et COOKE, 1983, after bone marrow transplantation. The genus Phialemonium was created by GAMS & MCGINNIS in 1983 including three new species: Ph. obovatum, Ph. curvatum and Ph. dimorphosporum, and represents an intermediate genus between Acremonium and Phialophora. Nowadays, the genus Phialemonium is considered to be a pheoid fungus which may cause the eventual lesions observed in pheo- and hyalohyphomycosis. Species of this genus have been described as opportunistic agents in humans and animals, mainly as a result of immunosuppression. In the present case, the patient had multiple myeloma and received an allogenic bone marrow transplant from his HLA-compatible brother. Two months after transplantation, he developed purplish and painful nodular lesions on the right ankle. Some of these lesions drained spontaneously and apparently hyaline mycelial filaments were observed, whose culture was initially identified as Acremonium sp. Subsequent studies showed that the fungus was Phialemonium curvatum. The infection was treated with amphotericin B, followed by ketoconazole. The patient was submitted to surgical debridement followed by two skin grafts to repair the bloody area. The duration of the treatment was 4 months and secondary prophylaxis with ketoconazole alone was maintained for one additional month. No recurrence was observed after discontinuation of treatment. The authors comment on the pathogenicity of the genus Phialemonium.

CMV pneumonia in allogeneic BMT recipients undergoing early treatment of pre-emptive ganciclovir therapy.

The incidence, treatment and outcome of CMV interstitial pneumonia (CMV-IP) were reviewed in 139 consecutive allogeneic BMT patients undergoing extended CMV antigenemia surveillance and two different ganciclovir (GCV) strategies to control CMV infection. Nineteen cases of CMV-IP were reviewed, 16 of 63 patients (25.4%) who received early GCV treatment (ET) and three of 76 patients (3.9%) who received preemptive (PE) GCV therapy. In the ET group, the median time for occurrence of CMV-IP was 55 (range 36 to 311) days. Two patients had three episodes of CMV-IP recurrences after day +100. CMV-IP-related death occurred in two patients (15.4%). In the PE group, 41 patients received pre-emptive GCV therapy prompted by the appearance of positive antigenemia > or =2 cells. The median time for the occurrence of CMV-IP was 92 (range 48 to 197) days. Response to therapy was observed when GCV was introduced within 6 days of antigenemia positivity. The use of IVIg in association with GCV did not play a major role in response to therapy. The median time for occurrence of CMV-IP was delayed during PE strategy and the cost-effectiveness of CMV surveillance after day +100 should be investigated in this population.