Cambios en la presentación clínica de la influenza A H1N1pdm09 después de la pandemia / Changes in the clinical presentation of Influenza A H1N1pdm09 after the pandemic

Background: After the 2009 influenza pandemic the H1N1pdm09 strain circulate seasonally. In 2015, Puerto Montt Hospital in Chile faced a simultaneous outbreak of both seasonal H3N2 and H1N1pdm09 influenza A (IA). Aim: To evaluate the clinical differences between the two viral strains and recent changes in the behavior of H1N1pdm09 IA. Material and Methods: We set up a retrospective study including every adult hospitalized in Puerto Montt Hospital in 2015 due to IA, confirmed by reverse transcription polymerase chain reaction. We compared epidemiological data, clinical presentation, complications, and the outcome of patients with H1N1pdm09 versus those with seasonal influenza. In parallel, we compared 62 cases of thatH1N1 IA from 2015 with 100 cases who were hospitalized and analyzed in 2009. Results: Between July and October 2015, 119 adults with confirmed IA were hospitalized. From 2009 to 2015, the mean age of patients with IAH1N1pdm09 increased from 40.4 ± 17 to 58.8 ± 16 years (p < 0.01). Pneumonia as the cause of hospitalization decreased from 75 to 58% of patients, (p = 0.04). Likewise, the presence of comorbidities increased from 53 to 74%, (p < 0.01). Compared with seasonal H3N2, patients with IAH1N1pdm09 IA were more likely to require intensive care (p < 0.01) and mechanical ventilation (p < 0.01) and developed septic shock (p = 0.03). Their mortality was non-significantly higher (13 and 5% respectively). Conclusions: The clinical presentation of H1N1pdm09 IA has varied over time and now affects an older population, with a greater number of comorbidities. It also appears to be adopting the clinical behavior of a classic seasonal influenza virus.

Infección por virus respiratorios en adultos hospitalizados en un Servicio de Medicina Interna / Respiratory virus infections in adult patients hospitalized in an internal medicine unit

Background: Respiratory viral infections (RVi) can be associated with a wide range of clinical manifestations. Aim: To investigate the frequency and clinical manifestations of RVi among adult patients during winter hospitalizations. Patients and Methods: All patients admitted to the hospital with flu like disease and those with fever or exacerbation of any underlying disease during hospitalization without an evident cause, were prospectively enrolled. A direct immunofluorescence (DIF) of nasopharyngeal aspirate for influenza A (IA) and B, parainfluenza 1, 2 and 3, adenovirus, respiratory syncytial virus (RSV) and metapneumovirus, was performed. Epidemiological and clinical data were recorded. Results: Between May and September 2012, 975 adults were admitted to the Internal Medicine Unit of Puerto Montt Hospital and in 128 (13%) patients, DIF was carried out. DIF was positive in 44 patients (34%) aged 65 ± 20 years, 68.2% females, corresponding to 4.5% of total hospitalizations. Eighty six percent of the latter had at least one co-morbidity, mainly asthma and chronic respiratory diseases in 34.1%, diabetes in 29.5%, cardiac problems in 25% and congestive heart failure in 20.5%. The most common RVi were RSV (n = 21, 48%) and IA (n = 17, 39%). Six patients had a nosocomial RVi. Patients infected with IA had a significantly higher frequency of fever and bronchial hyper reactivity than those infected with RSV. RVi were associated with exacerbation of underlying disease in 62% of cases and pneumonia in 27%. Two patients had a viral pericarditis. Conclusions: RVi are an important cause of adult morbidity and their detection should be routine in adult patients hospitalized during winter.

Estudio descriptivo de 64 pacientes con estructura limítrofe de personalidad / Descriptive analysis of 64 bordeline personality structure patients

Objetivo: Describir un grupo de pacientes desde un punto de vista demográfico, psicopatológico y terapéutico que presentan Estructura Limítrofe de Personalidad. Esta organización de personalidad subyace en varios de los trastornos de personalidad más graves, que demandan altos costos en su atención. Se tomaron 488 fichas de la Unidad de Trastornos de Personalidad del Hospital del Salvador que corresponden a un seguimiento de los pacientes ingresados entre los años 2006 y 2008. De estas se seleccionaron las 256 que presentaron Estructura Limítrofe de Personalidad (diagnóstico clínico) y luego se consideraron las 64 que se encontraban activas. Resultados: Destaca un promedio de edad de 39,3 años. Mayor porcentaje de mujeres (94 por ciento). El 51 por ciento tiene trabajo o está estudiando al momento del ingreso a la Unidad. Estado civil de los pacientes: 19 por ciento casado(a), 11 por ciento convive, 31 por ciento separado(a), 39 por ciento soltero (a). Nivel educacional: 6 por ciento educación básica, 53 por ciento educación media y 14 por ciento nivel universitario. El 56 por ciento ha presentado al menos una hospitalización. Discusión: El reconocimiento clínico de estos pacientes, la precisión de los síntomas más prevalentes que ellos presentan nos permite generar estrategias terapéuticas multidisciplinarias en el corto plazo, y planificar a partir de criterios de selección en algunos pacientes de psicoterapias más prolongadas que permitan un cambio más permanente. Se discuten algunos criterios terapéuticos y desafíos futuros para su tratamiento.

Objective: To describe a group of Borderline Personality Structure patients from demographic, psychopatologic and therapeutic perspectives. This anomalous personality organization behind several more serious personality disorders demanding high cost of its assistance. We consider 488 clinic sheets of the Personality Disorder Unit, Del Salvador Hospital, Santiago, Chile, which corresponded to a follow-up of patients admitted between 2006 to 2008. From these we selected 256 ones who presented Borderline Personality Structure (clinical diagnosis) and then considered the 64 active cases. Results: The group had 39.3 years of average age, with higher women percentage (94 percent). The 51 percent had job or were studying at admission time. Marital status: 19 percent married, 11 percent coexists, 31 percent separated, 39 percent single. Educational level: 6 percent basic, 53 percent secondary and 14 percent university level. The 56 percent had submitted one hospitalization at least. Discussion: The better clinical recognition of these patients, as well as the accuracy of the most prevalent symptoms they presented, the more we could generated multidisciplinary therapeutic strategies in the short time, and to plan selection criteria for more protracted psychotherapy for some of them to allow a more permanent change. Finally we discuss some therapeutic criteria and future challenges for the treatment of these patients.

Sueños y cambio psíquico: contenido manifiesto y función del sueño en el proceso psicoanalítico / Dreams and psychic change: manifest content and dream function in the psychoanalytic process

Los sueños han sido motivo de interés para el hombre desde tiempos remotos. Estos han tenido diversas interpretaciones a través de distintas culturas, han sido usados como fuente de conocimiento para el hombre y su entorno. Freud (1900), le asigna un rol central para conocer el inconsciente. Al iniciar su libro sobre la interpretación de los sueños, dice: demostraré que existe una técnica psicológica que permite interpretar sueños, y que si se aplica este procedimiento, todo sueño aparece como producto psíquico provisto de sentido al que cabe asignar un puesto determinado dentro del ajetreo anímico de la vigilia. Por otra parte, el cambio psíquico es uno de los objetivos que se propone el psicanálisis como técnica de tratamiento psicológico. Este cambio, es posible evaluarlo desde la observación de conductas externas que se modifican a propósito de una intervención terapéutica, hasta cambios internos que se pueden evidenciar en un modo distinto de abordar los conflictos y las angustias, a como ocurría antes de análisis en una persona. El objetivo de la presente monografía es revisar a partir del concepto de cambio psíquico de algunos autores, el cambio que se puede observar durante el proceso analítico, en la estructura del contenido manifiesto de los sueños y la función que estos tienen durante dicho proceso