Evaluative research of a mental health urgences protocol for the primary care level / Investigación evaluativa de un protocolo para urgencias de salud mental en el primer nivel de atención.

Introducción: Materiales y métodos: Resultados: Introduction: This research stems from certain obstacles in the implementation of the National Mental Health Law, especially at the primary care level and regarding emergency management, with or without certain and imminent risk. The scarcity of mental health intervention protocols and the perception that they could limit the clinical understanding of each critical situation are challenges identified in practice. However, protocols can be valuable organizational tools in complex circumstances. The literature emphasizes the need to accompany their implementation with training to prevent exclusively bureaucratic and dehumanized approaches. Materials and methods: The purpose of this work was to address this gap, by developing an emergency mental health action protocol and training for first-level healthcare personnel in a territory of the metropolitan area of Buenos Aires. The research aimed to evaluate its effectiveness. Qualitative and quantitative methods were used to characterize interventions before the protocol's implementation, comparing them with those after training and protocol application. Results: It was found that this device facilitated more appropriate responses in critical contexts and improved knowledge about resolution strategies that can be implemented within the framework of the National Mental Health Law. Additionally, it strengthened protective factors for the mental health of healthcare workers, such as the possibility to access to a strategy that aids in task organization, and teamwork.

Introducción: Esta investigación parte de algunos obstáculos en la implementación de la Ley Nacional de Salud Mental, especialmente en el primer nivel de atención y en lo relativo al manejo de urgencias, con o sin riesgo cierto e inminente. La escasez de protocolos de intervención en salud mental y la percepción de que podrían limitar la lectura singular de cada situación crítica son desafíos identificados en la práctica. No obstante, los protocolos pueden ser herramientas organizativas valoradas en circunstancias complejas. En la bibliografía se destaca la necesidad de acompañar su implementación con capacitación para evitar enfoques exclusivamente burocráticos y deshumanizados. Materiales y métodos: Para abordar esta brecha, se realizó esta investigación,en la que se diseñó un protocolo de actuación en urgencias de salud mental y una capacitación acorde para el personal de salud del primer nivel de atención de un  territorio del área metropolitana de Buenos Aires. Objetivo: El objetivo de la investigación fue evaluar su efectividad. Se utilizaron métodos cuali-cuantitativos con el fin de caracterizar las intervenciones previas a la implementación del protocolo, comparándolas con las posteriores a la capacitación y aplicación del protocolo. Resultados: Se halló que su implementación favoreció respuestas más adecuadas en contextos críticos y mejoró el conocimiento acerca de las estrategias de resolución que pueden efectuarse en el marco de la Ley Nacional de Salud Mental, reforzando asimismo factores protectores de la salud mental de los trabajadores de la salud, tales como el acceso a una estrategia que colabore en la organización de la tarea y el trabajo en equipo.

[Use of Information and Communication Technologies and health personnel from Argentine during COVID-19 pandemic]. / Uso de Tecnologías de la Información y la Comunicación y personal de salud en Argentina durante la pandemia por COVID-19

INTRODUCTION: Since the beginning of the COVID-19 pandemic, the importance of mental health actions for health personnel was emphasized and the use of Information and Communication Technologies (ICTs) was recommended. Given this unprecedented panorama, the objective of this research was to evaluate the effectiveness of an intervention with ICTs for health personnel from first-level care networks in Berazategui, Buenos Aires, Argentina. METHOD: It was an exploratory qualitative research and evaluative design. The selection of subjects included intervened health personnel who agreed to participate. Satisfaction surveys were implemented, records of the intervening team and their meetings were analyzed. RESULTS: The intervention was effective: improvements in communication and interaction, self-care and a change to a proactive and creative attitude at work, decreased anxiety and stress were detected. As a protective factor, the fact of having a solid socio-affective network was highlighted. The effectiveness was characterized by influencing a repositioning of the health personnel with respect to the context, the task and the work ties. CONCLUSION: The use of ICTs was advantageous, enabled access to mental health care and generated the feeling of continuous support, strengthening the socio-affective network.

Perpetual past: psychoanalytic effects on the temporal logic in a case of psychosis / Passado perpétuo: efeitos psicanalíticos da lógica temporal em um caso de psicose

ABSTRACT: In this paper, our aim is to study a specific clinical case taking the temporal dimension as the main angle of analysis. We explore the effects of psychoanalysis on time's representation of a patient showing psychotic symptoms. We analyze the different moments of the therapy that made possible an original integration of the temporal dimension by working on the local coordinates of the therapeutic setting. The "subjective effects" that guided the cure are stipulated and articulated to the different interventions to show the logical foundation of the psychoanalytic clinical practice in this case.

Resumo: Neste artigo, apresentamos um caso clínico especial considerando a dimensão temporal como perspectiva privilegiada. Examinamos os efeitos da psicanálise na representação do tempo de um paciente que apresenta uma sintomatologia psicótica. A partir de um trabalho centrado nas coordenadas locais do quadro terapêutico, analisamos os diferentes momentos da terapia ligados a uma nova integração da dimensão temporal. Consideramos os "efeitos subjetivos" específicos que orientam o tratamento como ligados às diversas intervenções, a fim de destacar os fundamentos lógicos da prática psicanalítica neste caso.

Spinal anesthesia in a patient with Charcot-Marie-Tooth disease undergoing orthopedic surgery: case report / Anestesia raquídea en un paciente con enfermedad de Charcot-Marie-Tooth sometido a cirugía ortopédica: reporte de caso

Abstract Introduction: It is uncommon to come across patients with neuromuscular diseases in the daily practice of anesthesia, given the low prevalence of those conditions. Charcot-Marie-Tooth (CMT) disease is the most frequently, caused by an inherited abnormal myelin structure pattern. In view of the low prevalence of this condition (1:25,000), there is little information, derived mostly from case reports, about the use of neuroaxial anesthesia in these patients. Case presentation: Description of a patient with underlying CMT disease compromising lower limb mobility, who comes to the emergency service due to lower limb pain. After being diagnosed with an acetabular fracture, the patient underwent orthopedic surgery under spinal anesthesia, selected based on patient comorbidities, and the immediate postoperative follow-up. Results: The anesthetic and surgical procedures proceeded uneventfully and no neuropathic worsening was observed during the next 24 hours. Conclusion: Uneventful neuroaxial anesthesia is reported in a patient with neuromuscular disease. The case contributes to show the benefits and safety of this form of anesthesia when compared with other options.

Resumen Introducción: En la práctica anestésica diaria es raro enfrentarse a pacientes con patologías neuromusculares, dada la poca pre-valencia de dichas patologías. La más frecuente de ellas es la enfermedad de Charcot-Marie-Tooth, en la cual se hereda un patrón alterado en la estructura de la mielina. Debido a la baja prevalencia de esta patología (1:25000), el uso de anestesia neuroaxial en dichos pacientes no cuenta con mucha información, y mucha de ella proviene de reportes de casos. Presentación del caso: Se describe el caso de un paciente con enfermedad de Charcot-Marie-Tooth, de base, con compromiso de la movilidad en miembros inferiores, y quien asiste a urgencias por dolor en miembro inferior. Tras ser diagnosticado con fractura de acetábulo, fue sometido a cirugía ortopédica bajo anestesia raquídea, indicada a la luz de sus comorbilidades, y el posterior seguimiento inmediato. Resultados: Se realiza el procedimiento anestésico y quirúrgico sin complicaciones, y no se presenta empeoramiento de la neuropatía en las 24 horas posteriores. Conclusiones: Se reporta un caso de anestesia neuroaxial en paciente con enfermedad neuromuscular sin incidencias, que ayuda así a ir mostrando los beneficios de la mencionada anestesia y su seguridad frente a otras opciones.

Metabolic Syndrome in Very Low Birth Weight Young Adults and Controls: The New Zealand 1986 VLBW Study.

OBJECTIVE: To assess the physical well-being and components of the metabolic syndrome in a national cohort of very low birth weight (VLBW) young adults and same age controls. STUDY DESIGN: The New Zealand VLBW Study cohort prospectively included all infants with birth weight <1500 g born in 1986, with 338 (82%) surviving to discharge home. Height and weight were measured at age 7-8 years. The VLBW cohort (n = 229; 71% alive) and term-born controls (n = 100) aged 27-29 years were clinically assessed in a single center over 2 days, including assessment for components of the metabolic syndrome. RESULTS: Compared with controls, both male and female VLBW adults were significantly shorter (P < .001), but only females were lighter (P < .001) and had lower mean body mass index (P = .044), fat mass, and body fat percentage. Males, but not females, had significantly higher systolic blood pressure (P = .028), but there were no significant differences in other components of the metabolic syndrome. There was no difference in the prevalence of the metabolic syndrome in VLBW adults compared with controls (males, 22.2% vs 11.1%; P = .15: females, 12.8% vs 13.1%; P = .95). Examining the VLBW cohort with logistic regression, male sex, gestational age <28 weeks, Maori/Pacific Island ethnicity, and body mass index >90th percentile at age 7-8 years were significant predictors for the metabolic syndrome at age 27-29 years, with ORs of 2-4. CONCLUSIONS: Systolic blood pressure in males was the only component of the metabolic syndrome that was significantly elevated in VLBW adults compared with controls. Extreme prematurity (<28 weeks) and body mass index >90th percentile at age 7-8 years were significant predictors of the metabolic syndrome at age 27-29 years. TRIAL REGISTRATION: Registered at the Australian Clinical Trials Registry: ACTRN12612000995875.

Enlaces y desenlaces de las psicosis: enseñanzas de Pizarnik / Bonds and outcomes of psychosis: lessons from Pizarnik

Este trabajo presenta algunos avances de una investigación sobre las psicosis y el lazo social. En esta ocasión presentaremos los hallazgos parciales del estudio del caso de la poeta Alejandra Pizarnik. El mismo estará construido a partir de fuentes publicadas en el que se han privilegiado datos convergentes y recurrentes, que presentaremos en los siguientes ejes: los enlaces con Bajarlía, su maestro, con Ostrov, su analista; el vínculo entre su escritura y la experiencia del sentimiento de la vida; y el desenlace. La orientación metodológica se sustenta en lo que Lacan formuló al proponer que el artista y el psicoanalista trabajan con el material de la condición humana, pero en esta tarea el artista precede al psicoanalista, para avanzar en la indagación sobre las formas en que un psicótico logra sostenerse en el lazo social, y en qué condiciones puede caer. Finalmente, cabe mencionar que nuestro estudio no se pretende exhaustivo sino que se propone presentar un esbozo de formalización de la experiencia subjetiva del lazo social en las psicosis desde una perspectiva no deficitaria, aún en construcción.

This paper presents some advances of a research on psychosis and the social bond. We will present the partial findings of the study of the case of the poet Alejandra Pizarnik. It will be constructed from published sources in which convergent and recurrent data have been privileged, which we will present in the following axes: the bonds with Bajarlía, her teacher, with Ostrov, his analyst; the link between his writing and the experience of the feeling of life; and the final outcome. The methodological orientation is based on what Lacan formulated when proposing that the artist and the psychoanalyst both work with the material of the human condition, but in this task the artist precedes the psychoanalyst, to advance in the investigation on the forms in which a psychotic manages to hold on to the social bond, and under what conditions he may fall. Finally, it is worth mentioning that our study is not intended to be exhaustive but rather to present an outline of formalization of the subjective experience of the social bond in psychoses from a non-deficit perspective, still under construction.

La construction de l'auteur. L'enjeu de l'écrit dans la psychose à partir d'un cas clinique / A construção do autor. A aposta da escrita na psicose a partir de um caso clínico / The construction of an author. Writing as a possibility in psychosis based on a clinical case / La construcción del autor. La apuesta de la escrita en la psicosis a partir de un caso clínico

A partir de la parole d'un patient psychotique, et en nous référant à théorie psychanalytique, nous interrogeons la valeur différentielle de la parole, de l'écrit et de la signature d'auteur dans le suivi d'un patient dans une institution de santé mentale. Les interventions du psychologue permettront une stabilisation symptomatique qui implique une limitation de la souffrance et une possibilité d'aménager un lien à l'autre et à la «réalité¼ qui soit moins envahissant.

A partir da palavra de um paciente psicótico, e aplicando conceitos psicanalíticos, questionamos o valor diferencial da palavra, da escrita e da assinatura do autor no tratamento de um paciente em uma instituição de saúde mental. as intervenções do psicólogo permitirão uma estabilização sintomática que implica uma limitação do sofrimento e a possibilidade de uma ligação a outros e a "realidade" menos intrusiva.

Based on a psychotic patient's words — and on applying psychoanalytic concepts —, we question the differential value of words, of writing and of the author's signature in the psychological treatment of a patient in a mental health institution. The psychologist's interventions allow for symptomatic stabilization, resulting in the limitation of suffering, in the possibility of bonding with other people, and to a less intrusive "reality".

A partir de la palabra de un paciente psicótico, y mediante la aplicación de conceptos psicoanalíticos, interrogamos el valor diferencial de la palabra, de la escrita y de la firma de autor en el tratamiento de un paciente dentro de una institución de salud mental. Las intervenciones del psicólogo permitirán una estabilización sintomática que implica una limitación del sufrimiento y la posibilidad de un lazo, menos invasivo, con los otros y con la "realidad".

Aufgrund des schriftlichen Ausdrucks eines psychotischen Patienten und der psychoanalytischen Konzepte, untersucht dieser Artikel den differenziellen Wert des Wortes, des schriftlichen Ausdrucks und der Unterschrift des Autors während der Behandlung eines Patienten in einer psychiatrischen Anstalt. Die Interventionen eines Psychologen erlaubten es, eine symptomatische Stabilisierung herzustellen, die zu einer Begrenzung des Leidens führte, zur Herstellung von Kontakten zu Anderen, sowie zu einer weniger intrusiven „Realität".

Clinica en transferencia y diagnóstico diferencial: debates actuales sobre las obsesiones en la Sra. G. / Clinic under transference and diferential diagnosis: current debates on obsessions in Mme. G.

El presente artículo aborda la complejidad que plantea el diagnóstico diferencial en psicoanálisis, a partir de un caso mencionado en diversas ocasiones en la obra de Freud, considerado por él como "neurosis obsesiva grave", cuestión que es objeto de debate de actualidad. Para ello se pondrá en tensión la relación fenómeno-estructura considerando el problema de la dirección de la cura y la envoltura formal del síntoma. Se desarrollará la discusión contemporánea sobre las razones del fracaso de este tratamiento, así como el cuestionamiento del diagnóstico que se basa en diferentes hallazgos historiográficos, proponiéndolo como una melancolía. Se introducirá como novedad en dicho debate el carácter ineludible de la articulación entre la presentación del síntoma y la dimensión de la transferencia, que se produce en esta ocasión en una dirección de la cura de parte de Freud que contribuye al agravamiento del caso.

This article approaches the complexity implied in differential diagnosis in psychoanalysis, by taking a case mentioned in diverse occasions in the work of Freud. This case was considered by him as a "serious obsessional neurosis", affirmation that is object of current debates. For this purpose, relationship phenomenon-structure will be put in tension with the problem of the direction of the cure and the formal envelope of the symptom. The contemporary discussion will be developed, taking into account the reasons of the failure of this treatment, as well as the questioning of the diagnosis that is based on different historiographic findings, proposing it as a melancholy. It will be introduced as newness in this debate the inescapable character of the joint between the presentation of the symptom and the dimension of the transference, produced in this occasion in a direction of the cure conducted by Freud that contributes to the worsening of the case.

Evaluation of equipment performance, patient dose, imaging quality, and diagnostic coincidence in five Mexico City mammography services.

BACKGROUND: Regulations concerning the use of x-rays in medical diagnoses were published in Mexico in 1997. In this work, we evaluate technical aspects of mammography services in the Mexico City area and radiation dose and coincidence between the radiological interpretation by the institution radiologist and by a panel of experts. METHODS: Following methodology proposed by the American College of Radiology and the European Community among others, we have evaluated the performance of six mammography systems in Mexico City public and private services. The studied services carry out approximately one half of the mammography studies in the capital's metropolitan area. RESULTS: The systems comply with 53-82% of a total of 31 applied quality control tests and measurements, which include the mammography unit, x-ray generation, collimation, automatic exposure control, compression devices, grid and image receptor, film processing, darkroom, viewboxes, dose, film rejection, and image quality. The elements that most frequently fail are film processing, darkroom, and light boxes; average ACR phantom score is 11.2 (9.5, 12.0); mean average glandular dose measured with the phantom is 1.00 (0.71-1.15) mGy, and measured in patients is 1.75 (0.3, 4.9) mGy; coincidence between radiologic reports (BI-RADS) by the institution radiologist and a panel of experts is obtained in 35% of studied cases. CONCLUSIONS: Statistical analysis of results indicated that the level of equipment performance is correlated with image quality, image quality estimated by the panel of radiologists is correlated with phantom score, and coincidence in clinical mammography reports is not correlated with equipment performance and appears to depend on the radiologist's experience.

Utilidad de la medición del ángulo rectoanal. Metodología y valores normales en México / Use of rectoanal angle measurement. Methodology and normal values in Mexico

Se efectuaron mediciones radiológicas y manométricas de la función rectoanal en 17 pacientes y nueve sujetos normales. Las mujeres multíparas mostraron correlación lineal inversa entre los valores del ángulo rectoanal y la presión en reposo del canal anal (r=0.8, p=0.01) y el grado de descenso perineal fue mayor en los pacientes de con el síndrome de úlcera rectal solitaria comparado con los controles (-1.5 vs -0.01+-0.3 cm, p=0.03). En conclusión, estos hallazgos evidencían la importancia del ángulo rectoanal el cual como factor determinante de la continencia anal debe ser incluido en la evaluación de los pacientes con alteraciones del piso pélvico (AU)._

Fisiología del transplante intestinal: progresos recientes; parte 1 / Physiology of intestinal transport: recent advances (I)

La fisiología del transporte intestinal de electrolitos es de suma importancia para la compresión de las enfermedades diarréicas. El sistema nervioso entérico desempeña un papel relevante en la regulación neural del transporte intestinal de iones, y varias sustancias paracrinas, endócrinas y neurohumorales, así como el sistema renina-angiotensina, el balance sistémico ácido-básico, y los segundo mensageros, también parecen estar relacionados. Los propósitos de esta revisión son considerar los hallazgos recientes en la fisiologia del transporte intestinal de electrolitos

Evaluación del método del brazelete de la salud / Evaluation of the cuff method of health

Realizamos un dobel estudio del estado nutricional de 1027 niños, valorandolos mediante el método Edad-Peso-Talla y comparándolo con la valoración obtenida por el Método del Brazalete de la Salud que se introduce a través de UNICEF. Encontramos un grado de acierto en 67.5% y un error de 31.5% y debemos destacar en su totalidad a los niños como Desnutridos cuando según la valoración por edad-Peso-Talla son normales. En ningún caso se da el error de considerar Normal a un niño Desnutrido