RESUMO
Vaccination is considered the most important measure to control the COVID-19 pandemic. Extensive follow-up studies with distinct vaccines and populations are able to promote robust and reliable data to better understand the effectiveness of this pharmacologic strategy. In this sense, we present data regarding binding and neutralizing (achieved by surrogate ELISA assay) antibodies throughout time, from vaccinated and previously infected (PI) health care workers (HCW) in Portugal. We analyzed serum samples of 132 HCW, who were vaccinated and with previous SARS-CoV-2 infection. Samples were collected before vaccination (baseline, M1), at second dose vaccine uptake (M2), and 25-70 days (M3) and 150-210 days (M4) after the second dose for vaccinated individuals. The IgG (anti-RBD/S) antibody geometric mean titers found on vaccinated HCW at M2 (GM = 116.1 BAU/mL; CI: 92.3-146.1) were significantly higher than those found on PI HCW at recruitment (M1) (GM = 35.9 BAU/mL; CI:15.4-83.4), and the neutralizing antibodies (nAb) were similar between these groups, of 93.2 UI/mL (95% CI 73.2-118.5) vs. 84.1 UI/mL (95% CI 40.4-155.9), respectively. We detected around 10-fold higher IgG (anti-RBD/S) antibodies titers in M3 when compared with M2, with a slight but significant decrease in titers from 36 days after the second dose vaccine uptake. The increase of nAb titers was correlated with IgG (anti-RBD/S) antibodies titers; however, in contrast to IgG (anti-RBD/S) antibodies titers, we did not detect a decrease in the nAb titer 36 days after a second vaccine dose uptake. At M4, a decrease of 8-fold in binding IgG (anti-RBD/S) and nAb was observed. No significant differences in antibody titers were observed by sex, age or chronic diseases. Our results suggest that IgG (anti-RBD/S) antibodies titers and nAb titers could be correlated, but an ongoing follow up of the cohort is required to better understand this correlation, and the duration of the immune response.
RESUMO
O presente artigo constitui o relato do atendimento clínico, por Fátima Flórido, de um paciente com queixas de vazio e apatia, sendo que, no decorrer do processo, configurou-se uma transferência negativa sob a forma de ataques raivosos. A partir de leituras sobre as escutas em psicanálise e as modalidades de adoecimento psíquico e do exame de sua contratransferência; a autora propôs uma reflexão sobre o manejo clínico necessário, a violência apresentada e a alternância entre estados de silêncio e fúria.
This paper reports the clinical treatment of a patient suffering from symptoms of emptiness and apathy. During his treatment, a negative transference came up in the form of anger and accesses of fury. Based on references from the field of psychoanalysis and the modalities of psychic illnesses, as well as by analyzing an occurred countertransference, the author proposes a reflection on how to clinically deal with such cases, on the encountered violence and on the alternation between states of silence and fury.
Cet article rapporte le cas clinique d'un patient qui présente des symptômes de vide intérieur et d'apathie et qui, au cours du processus, a manifesté un transfert négatif sous forme d'attaques de colère. À partir de références sur l'écoute en psychanalyse et des modalités de la maladie psychique, ainsi que d'une analyse de son propre contre-transfert, l'auteur propose une réflexion sur la façon nécessaire de gérer la pratique clinique, sur la violence qui s'est présentée et sur l'alternance entre les états de silence et de fureur.
Este artículo constituye la historia de la consulta clínica de un paciente con quejas de vacío y apatía, siendo que, en el transcurso del proceso, se configuró una transferencia negativa en forma de ataques violentos y furiosos. A partir de lecturas sobre escuchas, en el psicoanálisis, y sobre las modalidades de la enfermedad psíquica y el examen de su contratransferencia, el autor propuso una reflexión sobre la gestión clínica necesaria, la violencia presentada y la alternancia entre estados de silencio y furia.
Der vorliegende Artikel stellt den Fall eines Patienten dar, der an Symptomen von Sinnlosigkeit und Apathie leidet, wobei sich im Verlauf des Behandlungsversuchs eine negative Übertragung in Form von Wutanfällen manifestierte. Anhand der Fachliteratur über das Zuhören in der Psychoanalyse und über die verschiedenen Modalitäten psychischer Erkrankungen, sowie der Analyse ihrer eigenen Gegenübertragung, stellt die Autorin abschließend Betrachtungen an über den notwendigen Umgang mit solchen Situationen in der klinischen Praxis, der manifestierten Gewalt und den Wechselzuständen zwischen Stille und Wut.
RESUMO
O presente artigo visa apresentar a ideia de congelamento como metáfora para a insensibilidade e a anestesia diante de "traumatismos precoces", no contexto da clínica da clivagem, de adoecimentos por "apassivação" e "patologias narcísico-identitárias". Para discutir o tema, é relatado brevemente o caso de uma paciente, aqui chamada Cecília, descrevendo seu adoecimento e defesas ativadas e destacando a "neutralização energética" diante de uma situação de desamparo extremo vivenciado na primeira infância. A aqui denominada clínica da cisão e dos adoecimentos por apassivação tem convocado os analistas a refletir acerca de outras estratégias terapêuticas, de modo que acompanhe não apenas as partes amortecidas, mas também os recursos egoicos de cada paciente.
The present article proposes the presentation of the idea of freezing as a metaphor for insensitivity and anesthesia against early trauma, understanding it within the context of a clinic of cleavage, deterioration due to apassivation and narcissistic pathologies. As an illustration, we present the report of a case of a patient, here called Cecília, describing her illness and activated defenses, highlighting the "energetic neutralization" of Roussillon, facing a situation of extreme helplessness experienced in early childhood. Faced to what we call the scission clinic and the illnesses by apassivation, we are called to reflect on the necessary therapeutic strategies that accompany not only the cushioned parts but also the egoic resources of the patient.
El presente artículo propone la presentación de la idea de congelación como metáfora de la insensibilidad y la anestesia contra el traumatismo temprano, entendiéndola en el contexto de una clínica de escisión, deterioro por apassivación y patologías narcisistas. A modo de ejemplo, presentamos el relato de un caso de una paciente, aquí llamada Cecília, describiendo su enfermedad y las defensas activadas, destacando la "neutralización energética" del Roussillon, frente a una situación de extrema indefensión experimentada en la primera infancia. Frente a lo que llamamos la clínica de la cisión y las enfermedades por apassivación, estamos llamados a reflexionar sobre las estrategias terapéuticas necesarias que acompañan no sólo las partes amortiguadas sino también los recursos egoicos del paciente.
Cet article est de proposer la présentation de l'idée de gel comme une métaphore de l'insensibilité et l'anesthésie avant au début du traumatisme, le comprendre dans le contexte d'un clivage clinique des maladies par passivation et pathologies narcissiques identité.Comme illustration, nous présentons le rapport de cas d'un patient ici nommé Cecília, décrivant sa maladie et les défenses ont permis, en vedette dans la "neutralisation de l'énergie" du Roussillon, par rapport à une situation extrême d'impuissance vécu dans la première enfance. Transférer à ce que nous nommons que la répartition et les maladies cliniques par passivation, nous sommes appelés à réfléchir sur les stratégies thérapeutiques nécessaires qui accompagnent non seulement les parties, mais aussi les amorties caractéristiques egoic du patient.