الملخص
Objetivo: Comprender las barreras a la expresión del sufrimiento, que encuentran algunas personas con esclerosis múltiple, atendidas en el Instituto Neurológico de Colombia de Medellín. Materiales y método: Estudio basado en un paradigma construccionista y hermenéutico, con enfoque narrativo, de tipo polifónico, en el que durante los años 2015 y 2016, se entrevistaron a profundidad a cinco personas con esclerosis múltiple, dos de sus cuidadores y dos profesionales tratantes. Se construyó una narración polifónica para cada participante, se analizaron sus historias de vida y se extrajeron relatos en los que se aprecia exigencia social y personal de ocultar sus sufrimientos. Resultados: En estos relatos se evidenció un pedido constante de fortaleza ante sus di cultades y una tendencia a mostrar que pueden continuar realizando sus actividades cotidianas como lo hacían antes de enfermar, pese al aumento de la discapacidad. Eso se aprecia igualmente en los relatos de sus cuidadores, quienes también ocultan sus sentimientos y el desgaste generados en la labor de cuidar. Conclusiones: Estos pedidos de fortaleza pueden deberse a la tendencia contemporánea de sobrevalorar la tenacidad personal y de buscar constantemente el bienestar y la felicidad, lo cual conlleva una exigencia de mostrarse como individuos capaces en todo momento. Ante esa situación, de quienes presentan condiciones discapacitantes, como la esclerosis múltiple, se espera que sean ejemplo de superación de las adversidades, lo cual re eja un rechazo cultural del sufrimiento y a aceptar la fragilidad humana. Esta situación puede constituirse en un estigma hacia las personas con esclerosis múltiple.
Objective: To understand the barriers to the expression of suffering, found by some people with multiple sclerosis treated at the Instituto Neurológico de Colombia [Neurological Institute of Colombia] in Medellin. Materials and Method: Study based on a constructionist and hermeneutic paradigm, with a polyphonic type narrative approach in which, during 2015 and 2016, ve people with multiple sclerosis, two of their caregivers, and two treating professionals were interviewed in depth. A polyphonic narration was constructed for each participant, their life histories were analyzed, and stories were extracted in which social and personal demand to hide their suffering is visible. Results: In these stories a constant period of strength to dif culties was evidenced and a tendency to show that they can continue doing their daily activities as they did before getting sick despite the increase in disability. This is as well evident in the stories of their caregivers, who also hide their feelings and the exhaustion generated by the caring work. Conclusions: These requests for strength may be due to the contemporary tendency to overvalue personal tenacity and to constantly seek welfare and happiness, which entails a demand of showing themselves as capable individuals at all times. Given this situation for those having disabling conditions such as multiple sclerosis, it is expected that they become an example of overcoming adversity, which re ects a cultural rejection to suffering and to accept human fragility. This situation can become a stigma towards people with multiple sclerosis.
Objetivo: Compreender as barreiras à expressão do sofrimento, que encontram algumas pessoas com esclerose múltipla, atendidas no Instituto Neurológico de Colômbia de Medellín. Materiais e método: Estudo baseado em num paradigma construcionista e hermenêutico, com enfoque narrativo, de tipo polifônico, no que durante os anos 2015 e 2016, se entrevistaram a profundidade a cinco pessoas com esclerose múltipla, dois de seus cuidadores e dois pro ssionais tratantes. Construiu se umas narrações polifônicas para cada participante analisaram se suas historias de vida e se extraíram relatos nos que se aprecia exigência social e pessoal de ocultar seus sofrimentos. Resultados: Nestes relatos se evidenciou um pedido constante de fortaleça ante suas di culdades e uma tendência a mostrar que podem continuar realizando suas atividades cotidianas como o faziam antes de adoecer, a pesar do aumento da de ciência. Isso se observa igualmente nos relatos de seus cuidadores, quem também ocultam seus sentimentos e o desgaste gerados no labor de cuidar. Conclusões: Estes pedidos de fortaleça podem dever- se à tendência contemporânea de sobre valorar a tenacidade pessoal e de buscar constantemente o bem estar e a felicidade, o qual envolve uma exigência de mostrar se como indivíduos capazes em todo momento. Ante essa situação, de quem apresenta condições de cientes, como a escleroses múltiple, se espera que sejam exemplo de superação das adversidades, a qual re exa uma rejeição cultural do sofrimento e aceitar a fragilidade humana. Esta situação pode constituir se em um estigma para as pessoas com esclerose múltipla.
الموضوعات
Humans , Social Stigma , Handicapped Advocacy , Grief , Multiple Sclerosisالملخص
The prediction of meniscus reparability is quite useful for surgeons to optimize surgical planning. The main objective of this study was to evaluate the ability of magnetic resonance imaging (MRI) to predict the suture of meniscal lesions. This was an unicentric retrospective study that included 104 patients who underwent knee joint ligament reconstruction and / or arthroscopy for the treatment of meniscal injury at knee joint level. The MRI images of the meniscus were evaluated and later the arthroscopic findings were used as the gold standard. After the operative procedure, the cases were allocated into two groups according to the necessity of meniscus suture: Sutured Group "MSu" (n = 58) and Non sutured Group "MNSu" (n = 150). Considering the lesion detection capacity in the medial meniscus, the sensitivity, specificity and accuracy of MR were 85.3%, 63.9% and 77.9%, respectively. The positive predictive value (PPV) was 81.7% and the negative predictive value (NPV) was 69.7%. The agreement between MRI and arthroscopy was moderate. For the lateral meniscus, sensitivity, specificity and accuracy of MRI were 80.6%, 89.0% and 86.5%, respectively, with PPV of 75.7% and NPV of 91.5% and a substantial agreement. Regarding suture predictability, the sensitivity, specificity and accuracy were respectively 60.3%, 66.7% and 64.9% with PPV of 41.2% and NPV of 81.3%, with weak agreement. According to the arthroscopy, the 58 meniscal lesions of the MSu group were more frequent in the posterior horn, had the longitudinal pattern and were located in the red-red vascular zone. In our study, MRI was not a good predictor of meniscal suture, although it is an useful tool for the diagnosis of medial and lateral meniscal lesions