Traditional and Geometric Morphometry Analyses of Lutzomyia cruciata (Diptera: Psychodidae: Phlebotominae) Populations of Chiapas, Mexico.

The presence of Lutzomyia (Tricholateralis) cruciata (Coquillett 1907) species complex has been suggested by morphological analysis of eggs and genetic studies of females. The present work aimed to compare the diversity in morphology of four populations of Lu. cruciata from the Coast of Chiapas, Mexico, using traditional (TM) and geometric (GM) methods. Several morphological characteristics that were analyzed provided consistency to differentiate at least, three populations of Lu. cruciata. Both methods were effective to detect morphological differences associated with the geographical sites of capture. In both sexes, three and four groups were detected by TM and GM, respectively. These results suggest marked morphological differences in both sexes of Lu. cruciata that make these methods potentially useful to identify the geographical origin of any specimen of this species captured in the study region. Although the results produced by both methods are coincident, geometric morphometrics turned out to be most advantageous with respect to traditional morphometry, since the latter requires more time and effort. The consistency of our results shows that the variability of environmental conditions on the coast of Chiapas determines a high degree of phenotypic plasticity in Lu. cruciata, with the possibility of prezygotic isolation and the formation of species complex.

Antioxidant effect of exercise: Exploring the role of the mitochondrial complex I superassembly.

Mitochondrial respiratory complexes become assembled into supercomplexes (SC) under physiological conditions. One of the functional roles of these entities is the limitation of reactive oxygen species (ROS) produced by complex I (CI) of the respiratory chain. We sought to determine whether the systemic antioxidant effect of exercise is mediated by the assembly of mitochondrial CIs into SCs in rats. Male Wistar rats were exercise trained or remained sedentary for ten weeks; then, blood samples were collected, and the gastrocnemius muscle was isolated. The assembly of mitochondrial SCs and the lipid peroxidation of the mitochondrial and plasmatic fractions were assessed. Our results demonstrate that exercise induced the assembly of CI into SCs in the gastrocnemius and induced a systemic decrease in lipid peroxidation. We also found an inverse association between the superassembly of CIs and mitochondrial lipid peroxidation (p < 0.01) and protein carbonyls (p < 0.05). We conclude that exercise induces the chronic assembly of CIs into SCs, which provide mitochondrial protection against oxidative damage, at least in the studied muscle. Given the relevant role that mitochondria play in health and disease, these findings should help to elucidate the role of exercise as a therapeutic approach for metabolic diseases.

Presence of Putative Male-Produced Sex Pheromone in Lutzomyia cruciata (Diptera: Psychodidae), Vector of Leishmania mexicana.

Lutzomyia cruciata (Coquillet) is a vector of cutaneous leishmaniasis in Mexico and Central America. However, several aspects of its ecology and behavior are unknown, including whether a male pheromone partially mediates the sexual behavior of this sand fly. In this study, we evaluated the behavioral response of females to male abdominal extracts in a Y-tube olfactometer. The volatile compounds from male abdominal extracts were identified by gas chromatography-mass spectrometry and compared with those of female abdominal extracts. Finally, the disseminating structures of the putative sex pheromone were examined by scanning electron microscopy in the male abdomen. Females were more attracted to male abdominal extract than to the hexane control, suggesting the presence of male-produced sex pheromone. The male abdominal extracts were characterized by the presence of 12 sesquiterpene compounds. The major component, an unknown sesquiterpene with an abundance of 60%, had a mass spectrum with molecular ion of m/z 262. In contrast, the abdominal female extracts contained saturated fatty acids. Finally, we detected the presence of small "papules" with a mammiform morphology distributed on the abdominal surface of tergites IV-VII of male Lu. cruciata These structures are not present in females. We conclude that Lu. cruciata males likely produce a pheromone involved in attracting or courting females.

Patterns and inferred processes associated with sea turtle strandings in Paraíba State, Northeast Brazil.

This study analysed sea turtle strandings on the coast of Paraíba State, Northeastern Brazil, from August 2009 to July 2010. A total of 124 strandings were recorded in this period: green turtle Chelonia mydas (n = 106), hawksbill Eretmochelys imbricata (n = 15), olive ridley Lepidochelys olivacea (n = 2) and loggerhead Caretta caretta (n = 1). Of all turtles for which the Curved Carapace Length (CCL) was measured (n = 122), only 12 individuals (9.7%) were adults. Twenty individuals had synthetic anthropogenic debris in the gastrointestinal tract. Other traces of human interactions were observed in 43 individuals, such as injuries caused by entanglement in fishing lines or nets, collisions with vessels, direct contact with oil spills and lesions caused by sharp or spiked objects. Moreover, in 28.5% of the stranded turtles, the presence of external tumors was noticed, suggestive of fibropapillomatosis and in 9.7%, shark bite marks were observed. Of the 107 individuals that were sexed, 76 were females and 31 were males. Most turtles (72.6%) became stranded during the spring/summer (between October and March). We found evidence of human interactions (injuries) in half of the strandings, but in most cases it was not possible to determine if such interactions were the cause of death. A logistic regression found a significant relationship between CCL, ingestion of debris and lesions caused by sharks or spiked objects. Systematic data collection from stranded sea turtles can provide useful biological information, such as seasonal and spatial patterns in their occurrence and mortality, age structure, sex ratio and diet, as well as possible mortality causes.

Effect of a multistage ultraendurance triathlon on aldosterone, vasopressin, extracellular water and urine electrolytes.

Prolonged endurance exercise over several days induces increase in extracellular water (ECW). We aimed to investigate an association between the increase in ECW and the change in aldosterone and vasopressin in a multistage ultraendurance triathlon, the 'World Challenge Deca Iron Triathlon' with 10 Ironman triathlons within 10 days. Before and after each Ironman, body mass, ECW, urinary [Na(+)], urinary [K(+)], urinary specific gravity, urinary osmolality and aldosterone and vasopressin in plasma were measured. The 11 finishers completed the total distance of 38 km swimming, 1800 km cycling and 422 km running within 145.5 (18.8) hours and 25 (22) minutes. ECW increased by 0.9 (1.1) L from 14.6 (1.5) L prerace to 15.5 (1.9) L postrace (P < 0.0001). Aldosterone increased from 70.8 (104.5) pg/mL to 102.6 (104.6) pg/mL (P = 0.033); vasopressin remained unchanged. The increase in ECW was related neither to postrace aldosterone nor to postrace vasopressin. In conclusion, ECW and aldosterone increased after this multistage ultraendurance triathlon, but vasopressin did not. The increase in ECW and the increase in aldosterone were not associated.

The Arabidopsis thaliana putative sialyltransferase resides in the Golgi apparatus but lacks the ability to transfer sialic acid.

A common feature of the animal sialyltransferases (STs) is the presence of four conserved motifs, namely large (L), small (S), very small (VS) and motif III. Although sialic acid (SA) has not been detected in plants, three orthologues containing sequences similar to the ST motifs have been identified in the Arabidopsis thaliana L. database. In this study, we report that the At3g48820 gene (Gene ID: 824043) codes for a Golgi resident protein lacking the ability to transfer SA to asialofetuin or Galbeta1,3GalNAc and Galbeta1,4GlcNAc oligosaccharide acceptors. Restoration of deteriorated motifs S, VS and motif III by constructing chimeric proteins consisting of the 28-308 amino acid region of the A. thalianaAt3g48820 ST-like protein and the 264-393 amino acid region of the Oryza sativa L. AK107493 ST-like protein, or of the 28-240 amino acid region of the At3g48820 protein and the 204-350 amino acid region of the Homo sapiens L. alpha2,3-ST (NP_008858) was not able to recover sialyltransferase activity. Altering the appropriate amino acid regions of the A. thalianaAt3g48820 ST-like protein to those typical for the mammalian motif III (HHYWE) and VS motif (HDADFE) also did not have any effect. Our data, together with previous results, indicate that A. thaliana in particular, and plants in general, do not have transferases for SA. Substrates for the plant ST-like proteins might be compounds involved in secondary metabolism.

Human CoQ10 deficiencies.

Coenzyme Q10 (CoQ10 or ubiquinone) is a lipid-soluble component of virtually all cell membranes and has multiple metabolic functions. A major function of CoQ10 is to transport electrons from complexes I and II to complex III in the respiratory chain which resides in the mitochondrial inner membrane. Deficiencies of CoQ10 (MIM 607426) have been associated with four major clinical phenotypes: 1) encephalomyopathy characterized by a triad of recurrent myoglobinuria, brain involvement, and ragged-red fibers; 2) infantile multisystemic disease typically with prominent nephropathy and encephalopathy; 3) cerebellar ataxia with marked cerebellar atrophy; and 4) pure myopathy. Primary CoQ10 deficiencies due to mutations in ubiquinone biosynthetic genes (COQ2, PDSS1, PDSS2, and ADCK3 [CABC1]) have been identified in patients with the infantile multisystemic and cerebellar ataxic phenotypes. In contrast, secondary CoQ10 deficiencies, due to mutations in genes not directly related to ubiquinone biosynthesis (APTX, ETFDH, and BRAF), have been identified in patients with cerebellar ataxia, pure myopathy, and cardiofaciocutaneous syndrome. In many patients with CoQ10 deficiencies, the causative molecular genetic defects remain unknown; therefore, it is likely that mutations in additional genes will be identified as causes of CoQ10 deficiencies.

Antimicrobial activity of immobilized lysozyme on plasma-treated polyethylene films.

In this study we tested the antimicrobial activity of polyethylene films modified by means of plasma processes that were followed by the chemical immobilization of lysozyme, an antimicrobial enzyme. To chemically immobilize the enzyme in its active form at the surface of polyethylene, substrates that had been plasma treated under different experimental conditions were soaked in lysozyme solutions at different concentrations. The immobilization of the enzyme was checked, and the antimicrobial activity of the films was investigated by observing the death rate of Micrococcus lysodeikticus cells suspended in phosphate buffer in contact with the films. The results clearly indicate that plasma-treated films loaded with lysozyme are active against the selected microorganism. A modified version of the Gompertz equation was used to quantitatively valuate the dependence of the antimicrobial activity of the films under both plasma treatment conditions and lysozyme concentrations.

Melatonin administration prevents cardiac and diaphragmatic mitochondrial oxidative damage in senescence-accelerated mice.

Cardiac and diaphragmatic mitochondria from male SAMP8 (senescent) and SAMR1 (resistant) mice of 5 or 10 months of age were studied. Levels of lipid peroxidation (LPO), glutathione (GSH), GSH disulfide (GSSG), and GSH peroxidase and GSH reductase (GRd) activities were measured. In addition, the effect of chronic treatment with the antioxidant melatonin from 1 to 10 months of age was evaluated. Cardiac and diaphragmatic mitochondria show an age-dependent increase in LPO levels and a reduction in GSH:GSSG ratios. Chronic treatment with melatonin counteracted the age-dependent LPO increase and GSH:GSSG ratio reduction in these mitochondria. Melatonin also increased GRd activity, an effect that may account for the maintenance of the mitochondrial GSH pool. Total mitochondrial content of GSH increased after melatonin treatment. In general, the effects of age and melatonin treatment were similar in senescence-resistant mice (SAMR1) and SAMP8 cardiac and diaphragmatic mitochondria, suggesting that these mice strains display similar mitochondrial oxidative damage at the age of 10 months. The results also support the efficacy of long-term melatonin treatment in preventing the age-dependent mitochondrial oxidative stress.

New PVDF membranes: The effect of plasma surface modification on retention in nanofiltration of aqueous solution containing organic compounds.

New nanofiltration membranes were prepared by non-solvent-induced phase inversion from a PVDF/DMF/water system. The effect of exposure time before coagulation on the membrane characteristics (morphology, thickness, overall porosity, tensile strength) was investigated. PVDF membrane prepared at a fixed exposure time of 45s (PF45) was further plasma surface modified (RF 13.56 MHz) (PF45psm), introducing amino groups on the membrane. The performances of PF45, PF45psm and of a commercial nanofiltration membrane (N30F) were tested in the removal of two dyes from aqueous solution, characterized by different charge and molecular weight (congo red and methylene blue). The observed rejections depended more on the charge of the compound than on their molecular weights and results were optimized for the plasma modified membrane (PF45psm) with respect to unmodified (PF45) and commercial N30F membranes. In particular, methylene blue was retained for 100% by PF45psm with a relative flux of 65% compared to 38% of rejection and 59% of relative flux observed for N30F.

Incontinencia urinaria de esfuerzo en la mujer. Comparación de la técnica de Raz y de la técnica de Bologna / Comparison of Raz bladder neck suspension and the Bologna procedure for the treatment of urinary stress incontinence

Nuestra situación es la de comparar las complicaciones y los resultados sobre la incontinencia de esfuerzo de 2 técnicas de suspensión cervicouretral: la técnica de Raz y la técnica de Bologna. Se ha evaluado retrospectivamente a 199 pacientes que se han beneficiado de un tratamiento de incontinencia urinaria de esfuerzo, bien mediante la técnica de Bologna (grupo 1, 99 pacientes), bien por la técnica de Raz (grupo 2, 100 pacientes). Los datos clínicos preoperatorios, los parámetros urodinámicos y las complicaciones postoperatorias se han comparado en cada uno de los 2 grupos. El margen entre el tratamiento de la incontinencia urinaria y la recidiva se ha comparado con los 2 grupos por un test logarítmico. Se fabricó un modelo multivariante con la ayuda de un modelo de Cox, a fin de exponer los parámetros explicativos del fracaso quirúrgico. La duración de la curación en el grupo 1 es significativamente más larga que en el grupo 2 (p = 0,00001). La mediana de duración del intervalo libre sin incontinencia (éxito) es de 51 meses en el grupo 1 y de 21 meses en el 2 (p = 0,00001). La frecuencia de las complicaciones operatorias (lesión vesical y hemorragia) y postoperatorias (hemorrágicas, infecciosas y embólicas) no difieren en los 2 grupos. El análisis multivariante según el modelo de Cox muestra que la única variable preoperatoria explicativa de las recidivas es la técnica de colposuspensión realizada: Raz y Bologna. Después de este estudio comparativo, la técnica de Bologna debe preferirse a la de Raz para tratar los pacientes con IUE por el hecho de la presencia de suficiente pared vaginal anterior para confeccionar las cinchas vaginales. Si tal no es el caso, la técnica de Raz, tal y como nosotros la habíamos practicado, se debe abandonar en beneficio de otros métodos de colposuspensión (AU)

The aim of this study was to evaluate and compare perioperative morbidity and the long-term results of Raz colposuspension and the Bologna procedure in the treatment of urinary stress incontinence in women. Data from 199 women who underwent either the Bologna procedure (group 1; n = 99) or Raz colposuspension (group 2; n =100) for urinary stress incontinence were retrospectively analyzed. Preoperative clinical data, urodynamic parameters and postoperative complications were compared between the two groups. Logarithmic analysis was used to compare time to recurrence of stress incontinence between the two groups. Multivariate analysis using a Cox proportional hazards regression model was performed to identify possible outcome predictors. The success rate was significantly higher in group 1 than in group 2 (p = 0.00001). The median incontinence- free interval was 51 months in group 1 and was 21 months in group 2 (p = 0.00001). No differences were found between the two groups in the frequency of intraoperative complications (inadvertent cystotomy, hemorrhage) and postoperative complications (hemorrhagic, infectious and embolic complications). Multivariate analysis using the Cox regression model showed that the only variable correlated with the surgical cure rate was the type of surgical anti-incontinence procedure adopted: Bologna or Raz (p = 0.00001). The results of this study indicate that the Bologna procedure should be preferred over Raz colposuspension in the treatment of urinary stress incontinence when sufficient anterior vaginal tissue is available to create vaginal bands. When this is not the case, Raz colposuspension, as performed in the present study, should be abandoned in favor of other colposuspension methods (AU)

Liposarcoma de mama / Liposarcoma of the breast

El liposarcoma de mama es una lesión rara, pudiendo afectar a la mujer de 45 a 55 años de promedio de edad y que presenta las características clínicas y radiológicas de una lesión benigna. Aportamos en este trabajo el caso de una paciente de 52 años bajo tratamiento hormonal sustitutivo de la menopausia, en la cual una exploración rutinaria de mama individual descubrió un nódulo duro. La exéresis de este nódulo y su análisis anatomopatológico han permitido el diagnóstico de un liposarcoma de mama. Después de dos años de la intervención la evolución después de realizar solamente cirugía es satisfactoria. Más allá del carácter poco frecuente de esta patología, el caso subraya la posibilidad del diagnóstico precoz de este tipo de tumor, gracias a los exámenes mamográficos de vigilancia del tratamiento hormonal sustitutivo de la menopausia, así como el excelente pronóstico después de practicar solo cirugía

Liposarcoma of the breast is an unfrequent tumor that can be found in 45-55-year- old women, ussually with benign clinical and radiological characteristics. We report the case of a 52 –year- old patient treated with menopausal hormonal replacement therapy, for whom mammografic screening revealed a solid tumor. Lumpectomy was perfomed and histology reported liposarcoma of the breast. Two years after surgery alone no relapse was observed. Our case report underlines the possibility of discovering this type of tumor by means on mammographic examination performed during menopausal hormonal replacement therapy. It suggest good prognosis after surgery alone

Enfermedad severa de inclusiones citomegálicas en un feto de una mujer inmunizada antes de la gestación / Severe cytomegalic inclusion disease in the fetus of a woman with preconceptional immunity

El descubrimiento de una microfelalia durante la gestación nos ha incitado a practicar una punción de líquido amniótico para análisis cromosómico y la búsqueda viral por reacción en cadena de la polimerasa (PCR). El análisis realizado ha confirmado una infección fetal por citomegalovirus (CMV) en una madre inmunizada antes de la concepción. El feto presentaba una clásica enfermedad de inclusiones citomegálicas. Se han publicado observaciones similares. Publicaciones recientes explican tales observaciones por la variabilidad de las cepas virales. Estos hechos incitan a estar atentos con los signos ecográficos evocadores de una infección viral en una mujer encinta ya inmunizada: se puede tratar de una reinfección por CMV

Due to detection of fetal microcephaly at 24 weeks' gestation, we performed an amniocentesis at 29 weeks with chromosomal analysis and polymerase chain reaction (PCR) to investigate the presence of viral contamination. Cytomegalovirus (CMV) infection was confirmed by PCR, although the mother had preconceptional CMV immunity. The fetus showed classical CMV inclusion disease. Recent publications explain similar observations by the variability of viral strains. These findings highlight the importance of being alert to ultrasonographic signs of CMV reinfection in pregnant women with preconceptual immunity

Leptina, embarazo y reproducción / Leptin, pregnancy and reproduction

No disponible

Analgo-sedación consciente con midazolam y fentanilo oral transmucosa (OTFC) en niños / Conscious analgo-sedation with midazolam and fentanyl (OTFC) in children

Con elevada frecuencia, a los niños afectos de leucemias y otras enfermedades neoplásicas se les deben realizar una seriede pruebas diagnósticas y de tratamientos (punciones demédula ósea, administración intratecal de medicamentos…) que producen dolor y que aumentan considerablemente el disconforty sufrimiento o impiden la realización de las técnicas.La realización de técnicas de sedación consciente con fármacos utilizados por vía oral como el fentanilo (Citrato de Fentanilo Oral Transmucosa -OTFC-) junto con midazolam, y el empleo de anestésico local en el lugar de punción, puedehacer que estas técnicas dolorosas sean bien toleradas por parte del paciente, evitando así el dolor y disminuyendo la angustia, el miedo y sufrimiento que representa para los niñosla realización de cualquier prueba o tratamiento (AU)

Multiple bone marrow aspirations and lumbar punctures are performed on children with leukaemia and other neoplastic disorders during the course of their illnesses. These procedures may give rise to considerable pain and distress inchildren.Fentanyl, a short-acting potent synthetic opioid, can produce sedation through oral transmucosal (Oral Transmucosal Fentanyl Citrate -OTFC-) administration. The combination of OTFC and oral midazolam was a useful conscious sedation technique for painful procedures, such as lumbar punctures and bone marrow aspirations in this patients (AU)

Iniencefalia / Iniencephaly

La iniencefalia es una malformación rara de la charnela cervicooccipital, de pronóstico grave. Pertenece al espectro de anomalías del cierre del tubo neural. En la actualidad se han documentado 200 casos en la literatura científica. El diagnóstico, desde ahora posible mediante la ecografía morfológica, justifica proponer a la pareja la posible interrupción de la gestación. Aportamos tres nuevos casos, recogidos entre 1990 y 2000, y revisamos las publicaciones dedicadas a esta malformación. También se describe el caso de una paciente cuyo diagnóstico temprano de iniencefalia a las 13 semanas de amenorrea permitió realizar una interrupción voluntaria del embarazo al término de la semana 14 (AU)

Iniencephaly is a rare malformation of the base of the skull and prognosis is almost invariably lethal. This entity belongs to the group of neural tube closure defects. To date, 2000 reports have been published in the literature. Diagnosis can now be made using ultrasound morphology examination, allowing pregnancy termination to be proposed. We report 3 cases of iniencephaly diagnosed between 1990 and 2000 and review the literature on this malformation. We describe the case of a patient in whom early ultrasonographic diagnosis of iniencephaly at 13 weeks of gestation allowed induced abortion at 14 weeks (AU)

Carcinoma tubárico primitivo y polimiositis / Primary primitive fallopian tube carcinoma and polymiositis

Los autores aportan un caso de asociación de un carcinoma tubárico primitivo a una polimiositis. Se trata de una paciente de 53 años, que consultó por dolores pelvianos, metrorragias y leucorreas amarillentas, con una masa pelviana de difícil movilización y móvil a la exploración clínica, y una masa laterouterina derecha con hidrosálpinx en la ecografía pelviana. El diagnóstico definitivo lo aportó el examen ana tomoclínico de la pieza de anexectomía derecha. La histerectomía total sin conservación anexial no dejó residuo tumoral. La paciente perdió contacto con nosotros sin tratamiento complementario y reconsultó 3 años después por una impotencia funcional de los miembros superiores, seguida de los inferiores, mialgias, alteraciones de la deglución y aparición de una adenopatía supraclavicular izquierda. Los exámenes clínicos, paraclínicos y anatomopatológicos mostraron que se trataba de un adenocarcinoma tubárico derecho con recaída ganglionar pelviana y metastásica supraclavicular izquierda, con polimiositis paraneoplásica. La paciente se ha beneficiado de 6 sesiones de quimioterapia, después de radioterapia en el hueco subclavicular izquierdo, a la dosis de 45 Gy. La respuesta al tratamiento ha sido excelente, y la paciente está en remisión completa después de un margen de 50 meses tras el diagnóstico. La asociación de cáncer de la trompa con una polimiositis es excepcional, y es necesaria una terapia antineoplásica rápida para tratar el cáncer y la polimiositis paraneoplásica (AU)

We report a case of a primitive fallopian tube carcinoma associated with polymyositis. A 53­year-old woman consulted for pelvic pain, metrorrhagia, and leukorrhea. Physical examination revealed a renitent and mobile mass in the pelvis. Ultrasonography showed a right lateral uterine mass with hydrosalpinx. Pathological examination of the right annexectomy specimen provided the definitive diagnosis. No residual tumor was found at total hysterectomy with bilateral annexectomy. The patient was lost to follow-up for 3 years without complementary treatment and then consulted again for functional disability first of the upper limbs and subsequently of the lower limbs with myalgia, swallowing disorders and left supraclavicular node enlargement resulting from pelvic relapse of the right fallopian tube adenocarcinoma and left supraclavicular metastasis with paraneoplastic polymyositis. The patient was given 6 courses of chemotherapy with radiotherapy (45 Gy) centered on the left clavicular region. The patient showed excellent response to treatment, and remains in complete remission 50 months after diagnosis. The association of fallopian tube carcinoma with polymyositis is exceptional, requiring rapid treatment effective against the cancer and paraneoplastic polymyositis (AU)

Síndrome de Munchausen y gestación / Syndrome of Munchausen and pregnancy

Las metrorragias en el tercer trimestre de la gestación que parecen un cuadro de placenta previa pueden corresponder a una llamada de atención del paciente hacia el médico. Esta situación clínica nace de alteraciones facticias que permiten al paciente adoptar el papel de enfermo. Ello puede conducir a una intervención quirúrgica inútil: cesárea por metrorragias, por ejemplo. La principal dificultad de la situación es diagnóstica. El tratamiento está basado en la psicoterapia, dirigida a mejorar la relación ulterior madre-hijo y puede prevenir actos de automutilación (AU)

Metrorrhagia during the third trimester of pregnancy, simulating placenta previa, may be a sign of the patient calling for help to the doctor. This clinical situation is one where the woman mimics an illness, in order to play the role of sick patient. The risk is that this may lead to unnecessary surgical procedures, in this case caesarean section. The main difficulty in caring for these patients is to make the diagnosis. Treatment is based on psychotherapy, which can contribute to an improved mother-infant relationship and perhaps prevent acts of self-mutilation (AU)

Aproximación psicológica a la hiperemesis gravídica / The psychological approach in hyperemesis gravidarum

Los vómitos incoercibles gravídicos son un fenómeno que no atañe más que al 1-2% de las mujeres encintas, hospitalizadas en caso de conducta anoréxica que no cede. El tratamiento consiste en un aislamiento completo, rehidratación y medicación antiemética. La práctica del aislamiento, instituida más o menos hacia 1914, está en consonancia con la creencia según la cual estas mujeres eran simuladoras que esperaban el derecho a un aborto gracias a este síntoma. Al aislarlas de su entorno conyugal y familiar, los equipos médicos indagan sobre la revelación de su deseo abortivo. Trata este trabajo de evaluar la actualidad de este análisis. Dos entrevistas psicológicas semidirigidas, realizadas a 40 mujeres encintas hospitalizadas por vómitos incoercibles gravídicos en un servicio ginecoobstétrico de nivel 3 y tratadas según el protocolo establecido, entre los años 2001-2003. Entre las 40 pacientes, se han establecido 4 grupos. El primero (n = 10) estaba formado por pacientes consideradas con un conflicto consciente frente a la gestación sin, por otra parte, desear el aborto, conflicto que es resuelto con rapidez. El segundo (n = 14) estaba formado por pacientes con diversos antecedentes obstétricos, confrontándoles al vacío del niño perdido y a la dificultad de aceptar el niño que ellas mismas portan. El tercer grupo (n = 9) lo formaban pacientes que creían o temían vivir un drama obstétrico que su madre había vivido, episodio a menudo lejos de su consciente, que aflora en la entrevista. El cuarto grupo (n = 7) lo constituían pacientes para las que la unión temprana madre-niño de pecho fue de mala calidad, y caen en la misma repetición de las mismas actitudes fragilizadoras que su madre con respecto a su futuro hijo. Una sola interrupción voluntaria del embarazo fue realizada en una mujer de este grupo. El tratamiento con aislamiento se corresponde con la posibilidad de evitar una interrupción involuntaria del embarazo, entre otros aspectos, fuera de la presión familiar, y contribuye a la posibilidad de elaboración de maniobras ambivalentes fuertes, sin reclamar necesariamente la interrupción de la gestación. Se adjunta un anexo (anexo I) como modelo de cuestionario (AU)

Hyperemesis gravidarum is a phenomenon that only affects 1 or 2% of pregnant women, who require hospitalization if their anorexic behaviour does not cease. Treatment consists of isolation, anti-vomiting drugs, and rehydration therapy. The practice of isolation was instituted in approximately 1914, and was based on the belief that they were pretending to have this symptom in order to be given an abortion. By isolating them from their husband and family, the medical staff hoped that this desire would be revealed. We have tried to evaluate the reality of this analysis. Two psychological interviews were carried out using a questionnaire on 40 pregnant women at the time of their admission for hyperemesis gravidarum in a level 3 Gynaecology/Obstetric unit from 2001-2003. All received the treatment described. Four groups were established amongst the 40 patients. The first group (n=10) were patients with a conscious conflict about their pregnancy, who did not want an abortion, this conflict was resolved rapidly. The second group (n=14): were patients with diverse obstetric antecedents, confronting the previous loss of a child and the difficulty of accepting the child that they were now carrying. The third group (n=9) were women who were afraid of a dramatic obstetric event, which the mother had experienced. Although they were not conscious of it, it surfaced during interview. The fourth group (n=7): patients whose own early mother-child relationship was poor feared that they would have the same attitude towards their babies. In this group, only one termination of pregnancy was carried out. Isolation treatment may help in avoiding an involuntary termination of pregnancy, away from family pressure. It may possibly contribute to the elaboration of strongly ambivalent manoeuvres without termination of pregnancy being sought (AU)