Simulating drifting fish aggregating device trajectories to identify potential interactions with endangered sea turtles.

Purse-seine fishers using drifting fish aggregating devices (dFADs), mainly built with bamboo, plastic buoys, and plastic netting, to aggregate and catch tropical tuna, deploy 46,000-65,000 dFADs per year in the Pacific Ocean. Some of the major concerns associated with this widespread fishing device are potential entanglement of sea turtles and other marine fauna in dFAD netting; marine debris and pollution; and potential ecological damage via stranding on coral reefs, beaches, and other essential habitats for marine fauna. To assess and quantify the potential connectivity (number of dFADs deployed in an area and arriving in another area) between dFAD deployment areas and important oceanic or coastal habitat of critically endangered leatherback (Dermochelys coriacea) and hawksbill (Eretmochelys imbricata) sea turtles in the Pacific Ocean, we conducted passive-drift Lagrangian experiments with simulated dFAD drift profiles and compared them with known important sea turtle areas. Up to 60% of dFADs from equatorial areas were arriving in essential sea turtle habitats. Connectivity was less when only areas where dFADs are currently deployed were used. Our simulations identified potential regions of dFAD interactions with migration and feeding habitats of the east Pacific leatherback turtle in the tropical southeastern Pacific Ocean; coastal habitats of leatherback and hawksbill in the western Pacific (e.g., archipelagic zones of Indonesia, Papua New Guinea, and Solomon Islands); and foraging habitat of leatherback in a large equatorial area south of Hawaii. Additional research is needed to estimate entanglements of sea turtles with dFADs at sea and to quantify the likely changes in connectivity and distribution of dFADs under new management measures, such as use of alternative nonentangling dFAD designs that biodegrade, or changes in deployment strategies, such as shifting locations.

Simulación de las trayectorias de dispositivos de concentración de peces a la deriva para identificar las interacciones potenciales con las tortugas marinas en peligro de extinción Resumen Los pescadores que usan redes de cerco con dispositivos de concentración de peces a la deriva (dFADs), hechos principalmente con bambú, boyas de plástico y redes de plástico, para concentrar y capturar atún, instalan entre 46,000 y 65,000 dFADs al año en el Océano Pacífico. Algunas de las problemáticas principales asociadas con este dispositivo de pesca de uso extenso son el enredamiento potencial de tortugas marinas y otras especies marinas en las redes de los dFADs; los desechos marinos y la contaminación; y el potencial daño ecológico por el varamiento en los arrecifes de coral, playas y otros hábitats esenciales para la fauna marina. Realizamos experimentos lagrangianos de deriva pasiva con la simulación de perfiles de deriva de los dFADs y los comparamos con áreas conocidas de importancia para las tortugas marinas. Esto fue con el objetivo de evaluar y cuantificar la conectividad potencial (número de dFADs instalados en un área que llegan a otra área) entre las áreas de instalación de dFADs y los hábitats oceánicos o costeros importantes para la tortuga laúd (Dermochelys coriacea) y la tortuga de carey (Eretmochelys imbricata), ambas en peligro crítico de extinción, en el Océano Pacífico. Hasta el 60% de los dFADs de las áreas ecuatoriales llegaron a los hábitats esenciales para las tortugas marinas. La conectividad fue menor sólo cuando se usaron áreas en donde actualmente hay dFADs instalados. Nuestras simulaciones identificaron regiones potenciales de interacción entre los dFADs y los hábitats de migración y alimentación de la tortuga laúd en el sureste tropical del Océano Pacífico; los hábitats costeros de ambas especies en el Pacífico occidental (p. ej.: zonas de archipiélagos en Indonesia, Papúa Nueva Guinea y en las Islas Salomón); y en el hábitat de forrajeo de la tortuga laúd en una gran área ecuatorial al sur de Hawái. Se requiere de mayor investigación para estimar el enredamiento de las tortugas marinas con los dFADs en el mar y para cuantificar los cambios probables en la conectividad y la distribución de los dFADs bajo nuevas medidas de manejo, como el uso alternativo de diseños que eviten el enredamiento y sean biodegradables, o cambios en las estrategias de instalación, como la reubicación.

TELEPHYSIOTHERAPY FOR THE TREATMENT OF PHANTOM LIMB PAIN: A QUASI-EXPERIMENTAL STUDY / TELEFISIOTERAPIA PARA O TRATAMENTO DA DOR NO MEMBRO FANTASMA: UM ESTUDO QUASI-EXPERIMENTAL

Background and objective: Phantom Limb Pain (PLP) is a common complication of extremity amputation, with a prevalence between 41% and 46% of cases. Despite its uncertain pathophysiology, evidence suggests multifactorial mechanisms to explain the painful phenomenon, which directly affects the individual's quality of life. The objective of the study was to analyze the effect of a telephysiotherapy protocol for PLP on the quality of life, intensity and perception of pain in individuals with extremity amputees. Method: Quasi-experimental study with a qualitative-quantitative approach, with a sample consisting of nine individuals. The instruments used were the McGill Pain Questionnaire, the Verbal Pain Scale, the Short-Form Health Survey (SF-36) and an assessment form prepared in an interview format, all applied before and after the treatment protocol. The intervention consisted of an adaptation to the Graduated Motor Imagery (GMI) protocol; held online via the GoogleMeet platform. Quantitative analysis was performed using the paired Wilcoxon test for non-parametric variables and Pearson correlation. The qualitative approach was analyzed using the content analysis method. Results: There was no significant difference in quality of life parameters and pain intensity before and after treatment, but there was a significant decrease in the perception of total pain and emotional components, which was also evidenced in the qualitative reports. Conclusion: The adapted IMG protocol significantly reduced the perception of pain, especially in the emotional aspect, without significant results in the intensity of pain and quality of life of the individual.

Justificativa e objetivo: A dor fantasma (DF) é uma complicação comum da amputação de extremidades, com prevalência entre 41% e 46% dos casos. Apesar de sua fisiopatologia incerta, evidências sugerem mecanismos  multifatoriais para explicar o fenômeno doloroso, que afeta diretamente a qualidade de vida do indivíduo. O objetivo do estudo foi analisar o efeito de um protocolo de telefisioterapia para DF na qualidade de vida, intensidade e percepção da dor de indivíduos amputados de extremidades. Método: Estudo quasi-experimental com abordagem quali-quantitativa, com amostra composta por nove indivíduos. Os instrumentos utilizados foram o Questionário de Dor de McGill, a Escala Verbal de Dor (EVD), o Short-Form Health Survey (SF-36) e ficha de avaliação elaborada no formato de entrevista, todos aplicados antes e após o protocolo de tratamento. A intervenção constituiu de uma adaptação ao protocolo de Imagens Motoras Graduadas (IMG); realizado de forma on-line pela plataforma GoogleMeet. A análise quantitativa se deu através do teste de Wilcoxon pareado para variáveis não paramétricas e correlação de Pearson. A abordagem qualitativa foi analisada pelo método de análise de conteúdo. Resultados: Não houve diferença significativa nos parâmetros de qualidade de vida e intensidade da dor pré e pós tratamento, porém houve diminuição significativa da percepção de dor total e nos componentes emocionais, o que também foi evidenciado nos relatos qualitativos. Conclusão: O protocolo adaptado de IMG diminuiu significativamente a percepção de dor, especialmente no aspecto emocional, sem resultados significativos na intensidade da dor e qualidade de vida dos indivíduos.

Transcranial magnetic stimulation in the treatment of phantom limb pain: a systematic review / Estimulação magnética transcraniana no tratamento da dor do membro fantasma: uma revisão sistemática

Abstract Background Phantom limb pain (PLP) occurs after amputations and can persist in a chronic and debilitating way. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation method capable of influencing brain function and modulating cortical excitability. Its effectiveness in treating chronic pain is promising. Objective To evaluate the evidence on the efficacy and safety of using rTMS in the treatment of PLP, observing the stimulation parameters used, side effects, and benefits of the therapy. Methods This is a systematic review of scientific articles published in national and international literature using electronic platforms. Results Two hundred and fifty two articles were identified. Two hundred and forty six publications were removed because they were duplicated or met the exclusion criteria. After selection, six studies were reviewed, those being two randomized clinical trials and four case reports. All evaluated studies indicated some degree of benefit of rTMS to relieve painful symptoms, even temporarily. Pain perception was lower at the end of treatment when compared to the period prior to the sessions and remained during patient follow-up. There was no standardization of the stimulation parameters used. There were no reports of serious adverse events. The effects of long-term therapy have not been evaluated. Conclusion There are some benefits, even if temporary, in the use of rTMS to relieve painful symptoms in PLP. High-frequency stimulation at M1 demonstrated a significant analgesic effect. Given the potential that has been demonstrated, but limited by the paucity of high-quality studies, further controlled studies are needed to establish and standardize the clinical use of the method.

Resumo Antecedentes A dor do membro fantasma (DMF) ocorre após amputações e pode persistir de forma crônica e debilitante. A estimulação magnética transcraniana repetitiva (EMTr) é um método de neuromodulação não invasivo capaz de influenciar a função cerebral e modular a excitabilidade cortical. Sua eficácia no tratamento da dor crônica é promissora. Objetivo Avaliar as evidências sobre a eficácia e segurança do uso da EMTr no tratamento da DMF, observando os parâmetros de estimulação utilizados, efeitos colaterais e benefícios da terapia. Métodos Trata-se de uma revisão sistemática de artigos científicos publicados na literatura nacional e internacional utilizando plataformas eletrônicas. Resultados Foram identificados 252 artigos. Duzentas e quarenta e seis publicações foram removidas por estarem duplicadas ou atenderem aos critérios de exclusão. Após a seleção, foram revisados seis estudos, sendo dois ensaios clínicos randomizados e quatro relatos de caso. Todos os estudos avaliados indicaram algum grau de benefício da EMTr no alívio dos sintomas dolorosos, mesmo que temporariamente. A percepção da dor foi menor ao final do tratamento quando comparada ao período anterior às sessões e permaneceu durante o acompanhamento do paciente. Não houve padronização dos parâmetros de estimulação utilizados. Não houve relatos de eventos adversos graves. Os efeitos da terapia a longo prazo não foram avaliados. Conclusão Existem alguns benefícios, mesmo que temporários, no uso da EMTr para alívio dos sintomas dolorosos na DMF. A estimulação de alta frequência em M1 demonstrou um efeito analgésico significativo. Dado o potencial demonstrado, mas limitado pela escassez de estudos de alta qualidade, são necessários mais estudos controlados para estabelecer e padronizar o uso clínico do método.

Reinervación muscular dirigida diferida en el manejo del dolor neuropático tras amputación de extremidad inferior / Delayed targeted muscle reinnervation in the management of neuropathic pain after lower limb amputation

Introducción y objetivo: El dolor neuropático es una de las complicaciones más comunes en la cirugía de amputación de extremidad inferior. En este contexto surge la Reinervación Muscular Dirigida (TMR) como técnica con resultados prometedores en el tratamiento del dolor neuropático tras amputación. En este artículo presentamos la técnica quirúrgica y nuestra experiencia clínica. Material y método: Entre enero de 2021 y diciembre de 2022 registramos los pacientes intervenidos para TMR diferida de extremidad inferior en el Servicio de Cirugía Plástica del Hospital Universitario Miguel Servet (Zaragoza, España) evaluando su capacidad de portar prótesis a los 6 meses de la intervención. Asimismo, exponemos la técnica quirúrgica empleada. Resultados: Intervenimos 9 pacientes, 7 amputaciones infracondíleas y 2 supracondíleas. A los 6 meses, 7 eran capaces de deambular con prótesis y en 2 persistía dolor de componente mixto que impedía la protetización. Ambos pacientes habían sido amputados por causas vasculares. Conclusiones: En nuestra serie clínica obtuvimos resultados prometedores que permitieron la protetización en una gran proporción de casos, si bien la selección de pacientes es un punto crucial en la aplicación de esta técnica.(AU)

Background and objective: Neuropathic pain is one of the most common complications in lower extremity amputation surgery. In this context, Targeted Muscle Reinnervation (TMR) emerges as a technique with promising results in the treatment of neuropathic pain after amputation and phantom limb.In this article we describe the surgical technique and our clinical experience. Methods: Between January 2021 and December 2022, we registered the patients operated on for delayed TMR of the lower extremity in the Plastic Surgery Service of the Miguel Servet University Hospital (Zaragoza, Spain) evaluating their ability to wear prostheses 6 months after the intervention. Likewise, we expose the surgical technique used. Results: A total of 9 patients were operated, being 7 infracondylar and 2 supracondylar amputations. Six months after surgery, 7 patients could walk with the prosthesis, while the other 2 ones still experienced pain that prevented fitting the prosthesis. Both patients had been amputated for vascular causes. Conclusions: In our clinical series, we obtained promising results which allow ambulation in a large proportion of patients although we consider that patient selection is a crucial point in the application of this technique.(AU)

Chasing the Numinous: Hungry Ghosts in the Shadow of the Psychedelic Renaissance.

In recent years a renewed scientific, public and commercial interest in psychedelic medicines can be observed across the globe. As research findings have been generally promising, there is hope for new treatment possibilities for a number of difficult-to-treat mental health concerns. While honouring positive developments and therapeutic promise in relation to the medical use of psychedelics, this paper aims to shine a light on some underlying psycho-cultural shadow dynamics in the unfolding psychedelic renaissance. This paper explores whether and how the multi-layered collective fascination with psychedelics may yet be another symptom pointing towards a deeper psychological and spiritual malaise in the modern Western psyche as diagnosed by C. G. Jung. The question is posed whether the West's feverish pursuit of psychedelic medicines-from individual consumption to entheogenic tourism, from capitalist commodification of medicines and treatments to the increasing number of ethical scandals and abuse through clinicians and self-proclaimed shamans-is related to a Western cultural complex. As part of the discussion, the archetypal image of the Hungry Ghost, known across Asian cultural and religious traditions, is explored to better understand the aforementioned shadow phenomena and point towards mitigating possibilities.

Ces dernières années, on peut observer à travers le monde un regain d'intérêt scientifique, public et commercial pour les médecines psychédéliques. Comme les résultats de la recherche ont été dans l'ensemble prometteurs, il y a l'espoir que de nouvelles possibilités de traitement voient le jour pour certains problèmes de santé mentale difficiles à traiter. Tout en respectant avancées positives et promesses thérapeutiques en ce qui concerne l'utilisation médicale des psychédéliques, cet article vise à éclairer certaines dynamiques psychoculturelles d'ombre, qui sont sous-jacentes dans la renaissance psychédélique en cours. Cet article explore si et comment la fascination collective et à plusieurs niveaux pour les psychédéliques pourrait être encore un symptôme indicatif d'un malaise psychologique et spirituel plus profond dans la psyché occidentale moderne, tel que diagnostiqué par C. G. Jung. La question est posée de savoir si la poursuite fébrile des médicaments psychédéliques par l'Occident - de la consommation individuelle au tourisme lié aux substances enthéogènes - de la marchandisation capitaliste des médicaments et des traitements au nombre croissant de scandales éthiques et d'abus par des praticiens et des chamans autoproclamés - serait liée à un complexe culturel occidental. Dans le cadre de la discussion, l'image archétypale du Spectre Affamé, connue à travers les traditions culturelles et religieuses asiatiques, est étudiée afin de mieux comprendre les phénomènes d'ombre mentionnés ci-dessus et de suggérer des possibilités d'atténuation.

En los últimos años se ha observado en todo el mundo un renovado interés científico, público y comercial por las medicinas psicodélicas. Como los resultados de las investigaciones han sido en general prometedores, hay esperanzas de nuevas posibilidades de tratamiento para una serie de problemas de salud mental difíciles de tratar. A la vez que se reconocen los avances positivos y las promesas terapéuticas en relación con el uso médico de los psicodélicos, este artículo pretende arrojar luz sobre algunas dinámicas psico-culturales subyacentes en el renacimiento psicodélico que se está produciendo. Este artículo explora si la fascinación colectiva por los psicodélicos puede ser otro síntoma que apunte hacia un malestar psicológico y espiritual más profundo en la psique occidental moderna, tal y como lo diagnosticó C. G. Jung. Se plantea la cuestión de si la febril búsqueda de medicinas psicodélicas en Occidente -desde el consumo individual hasta el turismo enteogénico, desde la mercantilización capitalista de medicinas y tratamientos hasta el creciente número de escándalos éticos y abusos por parte de clínicos y autoproclamados chamanes- está relacionada con un complejo cultural occidental. Como parte del debate, se explora la imagen arquetípica del Fantasma Hambriento, conocida en todas las tradiciones culturales y religiosas asiáticas, para comprender mejor los fenómenos de sombra mencionados y apuntar hacia una posible mitigación de los mismos.

Dolor de miembro fantasma una complicación frecuente en el paciente amputado / Phantom pain, a frequent complication in amputee patients

Introducción: La amputación de la extremidad con frecuencia da lugar a alteraciones sensoriales, dolorosas o no, tales como el síndrome del miembro fantasma, que dificulta el proceso de rehabilitación y afecta el estado psicológico del paciente. El dolor de miembro fantasma ha sido descrito como una condición en la que los pacientes experimentan una sensación dolorosa en el miembro ausente. Objetivo: Describir aspectos esenciales del dolor fantasma como complicación en los pacientes amputados Métodos: Se realizó una búsqueda de la literatura publicada durante el período comprendido entre enero de 2015 y diciembre de 2021 que hiciera referencia al dolor en miembro fantasma en paciente amputado. Resultados: Entre las causas que conllevan a la amputación de una extremidad se encuentran los problemas vasculares, trauma, cáncer y alteraciones congénitas, es importante tenerlas en consideración debido a los efectos psicológicos y socioeconómicos que puede tener en el paciente. El síndrome del miembro fantasma se divide en miembro o sensación fantasma, dolor de miembro fantasma y muñón doloroso. Es importante hacer distinciones entre ellos, lo que ayuda a evaluar la magnitud del problema y el tratamiento que es diferente. El tratamiento convencional no ha sido muy efectivo. Conclusiones: Se describieron los aspectos esenciales del dolor fantasma como complicación en los pacientes amputados, el manejo y tratamiento del dolor de miembro fantasma en miembros amputados, constituye una prioridad a vencer dentro de las pautas de la medicina moderna(AU)

Introduction: Limb amputation often gives rise to sensory alterations, painful or not, such as phantom limb syndrome, which hinders the rehabilitation process and affects the patient's psychological state. Phantom limb pain has been described as a condition in which patients experience a painful sensation in the missing limb. Objective: To describe essential aspects of phantom pain as a complication in amputee patients. Methods: A search of the literature published between January 2015 and December 2021 that referred to phantom limb pain in amputee patients was carried out. Results: Among the causes that lead to the amputation of a limb are vascular problems, trauma, cancer and congenital alterations, it is important to take them into consideration due to the psychological and socioeconomic effects that they can have on the patient. Phantom limb syndrome is divided into phantom limb or sensation, phantom limb pain, and painful stump. It is important to make distinctions between them, which helps to assess the magnitude of the problem and the treatment that is different. Conventional treatment has not been very effective. Conclusions: The management and treatment of phantom limb pain in amputated limbs is a priority to be overcome within the guidelines of modern medicine, which is why care intervention is necessary in order to improve the quality of life of the amputated patient and their better rehabilitation(AU)

Effectiveness of mirror therapy in phantom limb pain: a literature review.

INTRODUCTION: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP. DEVELOPMENT: We performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases using the descriptors "phantom limb" and "mirror therapy." We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis. CONCLUSIONS: MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP.

Efectividad de la terapia de espejo en el dolor del miembro fantasma. Una revisión actual de la literatura / Effectiveness of mirror therapy in phantom limb pain: A literature review

Introducción: El dolor del miembro fantasma (DMF) es un dolor de tipo neuropático que afecta al territorio de una extremidad amputada o a otras partes del cuerpo extirpadas quirúrgicamente. El 60-90% de los amputados sufren DMF durante el seguimiento. Se han descrito opciones terapéuticas para DMF, farmacológicas (gabapentina, amitriptilina, antidepresivos tricíclicos...) y no farmacológicas (TENS, hipnosis, acupuntura...). Una hipótesis predominante considera este fenómeno consecuencia de la reorganización cortical postamputación, y, tras investigaciones innovadoras de Ramachandran en los 90, se han desarrollado nuevos enfoques de tratamiento como la terapia de espejo (TE). En la presente revisión se analiza la evidencia actual publicada sobre la eficacia de la TE para el tratamiento del DMF.DesarrolloSe realizó una revisión bibliográfica, abarcando desde 2012 a 2017, de publicaciones registradas en las bases de datos Cinahl, Cochrane, Scopus y Pubmed (incluyendo Medline). Los descriptores utilizados para la búsqueda fueron los términos Phantom Limb y Mirror Therapy. Se identificaron 115 publicaciones que abordaban TE en DMF. De estas, 17 (15%) aportaban información útil para el análisis conjunto.ConclusionesLa TE parece ser efectiva en el alivio del DMF, reduciendo la intensidad y duración de los episodios de dolor diarios. Por otra parte, constituye un método válido, sencillo y muy económico. La calidad metodológica de la mayoría de las publicaciones en este campo es muy limitada, destacando la necesidad de estudios adicionales de alta calidad para desarrollar protocolos clínicos que puedan maximizar los beneficios de TE en pacientes con DMF. (AU)

Introduction: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP.DevelopmentWe performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases Using the descriptors “phantom limb‿ and “mirror therapy.‿ We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis.ConclusionsMT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP. (AU)

La fantasma de Valencia y las comedias de Fiestas del jardín de Alonso de Castillo Solórzano: hipótesis de datación y circunstancias de representación.

Alonso de Castillo Solórzano, prolific cultivator of the novelistic genre, gathered and published his work in miscellaneous volumes or colectáneas all along the XVII century. In these volumes, mainly formed by novels assembled in a narrative framework, dramatic pieces appear from time to time. This is the case of Fiestas del Jardín (1634), which alternates four plays written in prose and three comedies. We know about the last ones that they were brought to the stage by renowned authors of the time. However, the date of their composition remains unknown as well as the circumstances in which they were staged. It is our goal to shed light on these questions following the study of La fantasma de Valencia, one of the three aforementioned comedies.

Intervenções não farmacológicas na gestão de fenómenos sensoriais: Experiência da pessoa amputada / Non-pharmacological interventions in the management of sensory phenomena: Experience of the amputee

A dor é uma das principais causas de sofrimento humano, comprometendo a qualidade de vida das pessoas, interferindo no seu bem-estar físico e psicossocial. Estudos realizados indicam que os fenómenos sensoriais experienciados no membro fantasma são sentidos de forma diferente de pessoa para pessoa, constituindo um desafio na abordagem clínica e terapêutica. Torna-se pertinente estudar a experiência da pessoa amputada em relação à gestão dos fenómenos sensoriais dolorosos, com recurso a medidas não farmacológicas. Realizou-se um estudo fenomenológico, descritivo, transversal de abordagem qualitativa, cujo objetivo geral foi conhecer a experiência da pessoa amputada na gestão dos fenómenos sensoriais dolorosos no membro amputado, recorrendo a intervenções não farmacológicas. O instrumento de colheita de dados foi a entrevista semiestruturada. A amostra foi não probabilística, do tipo acidental, ficando constituída por 16 participantes. Da análise de conteúdo, realizada segunda a metodologia de Laurence Bardin, surgiram quatro categorias temáticas: fenómenos sensoriais experienciados no membro amputado, intervenções não farmacológicas utilizadas na gestão dos fenómenos sensoriais dolorosos, fonte de conhecimento das intervenções não farmacológicas e influência dos fenómenos sensoriais dolorosos no quotidiano. Os resultados obtidos revelam que as pessoas amputadas sentem dificuldades em conceitualizar os diferentes fenómenos sensoriais, procurando de forma autodidata, as intervenções não farmacológicas mais eficazes no alívio da dor, nomeadamente a massagem, as técnicas de distração, o posicionamento, a gestão do ambiente, entre outras. O impacto destes fenómenos sensoriais é percecionado no estado emocional e no padrão/qualidade do sono e repouso da pessoa amputada. Foi ainda visível que esta área de conhecimento carece de maior investimento e sensibilização com a formação dos profissionais de saúde e eventuais programas de melhoria contínua de qualidade para com a pessoa sujeita a amputação, de forma a muni-la de conhecimento relativamente à gestão dos fenómenos sensoriais através de medidas não farmacológicas e consequentemente para uma melhor qualidade de vida.

Quiste odontogénico calcificante asociado a odontoma complejo en la región posterior del maxilar. Reporte de caso clínico y revisión de la literatura / Calcifying odontogenic cyst associated with complex odontoma in the posterior litera of the maxilla. A case report and review of the literature

El quiste odontogénico calcificante (QOC) es raro y representa <1% de todos los quistes odontogénicos, pertenece a las lesiones conocidas como "tumores de células fantasma", estos son una familia de lesiones que varían en presentación clínica de quiste o neoplasia sólida, en su comportamiento biológico de benigno a localmente agresivo o metastásico, esta diversidad ha generado extenso debate sobre la clasificación, terminología, manejo y pronóstico de estas patologías. Presentamos el caso clínico de un paciente masculino de 17 años de edad con diagnóstico de quiste odontogénico calcificante asociado a odontoma complejo situado en la región posterior del maxilar, en la literatura existen reportados solo 27 casos de QOC en esa zona. Fue tratado mediante enucleación quirúrgica, curetaje, rotación de almohadilla grasa bucal y colocación de malla de titanio para reconstruir la pared anterior del seno maxilar. El control postoperatorio clínico y radiográfico a 12 meses no muestra recidiva de la lesión además exhibe un excelente resultado funcional y estético, esto nos permite concluir que el tratamiento fue adecuado. Realizamos una revisión de la literatura en Science Direct, PubMed y Biblioteca Cochrane, con objeto de informar las características clínicas, histopatológicas, radiográficas y el tratamiento de estas lesiones.

The calcifying odontogenic cyst (COC) is rare and represents <1% of all odontogenic cysts, it belongs to the lesions known as "ghost cell tumors", these are a family of lesions that vary in clinical presentation of cyst or solid neoplasia, in their behavior biological from benign to locally aggressive or metastatic, this diversity has generated extensive debate on the classification, terminology, management and prognosis of these pathologies. We present the clinical case of a 17-year-old male patient with a diagnosis of calcifying odontogenic cyst associated with a complex odontoma located in the posterior region of the maxilla, in the literature there are only 27 reported cases of (COC) in that area, he was treated by surgical enucleation, curettage, rotation of the buccal fat pad and placement of titanium mesh to reconstruct the anterior wall of the maxillary sinus. The clinical and radiographic postoperative control at 12 months does not show recurrence of the lesion, in addition it exhibits an excellent functional and aesthetic result, this allows us to conclude that the treatment was adequate. We conducted a review of the literature in Science Direct, PubMed and Cochrane, in order to report the clinical, histopathological, radiographic characteristics and the treatment of these lesions.

Effectiveness of mirror therapy in phantom limb pain: A literature review. / Efectividad de la terapia de espejo en el dolor del miembro fantasma. Una revisión actual de la literatura.

INTRODUCTION: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP. DEVELOPMENT: We performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases Using the descriptors "phantom limb‿ and "mirror therapy.‿ We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis. CONCLUSIONS: MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP.

Contingencias, restos y invenciones / Contingências, restos e invenções / Contingences, restes et inventions / Contingencies, rests and inventions

La cultura supone un tratamiento del resto por parte de los seres hablantes. Actualmente, lejos de deshacerse de desechos, ella los incorpora bajo la forma reciclada de la basura, reintroduciéndo-les en el mercado como materias primas que dan lugar a nuevos productos. ¿Cuál es el lugar del resto en psicoanálisis y qué tratamiento reserva este a aquel? La contingencia en el uso del resto y la invención tienen aquí su lugar. Con Lacan, el psicoanálisis se sirve del objeto resto de un análisis para hacer un uso de él. Los objetos (a) toman consistencia en el análisis como modalidades de la relación al Otro a partir de la confrontación del sujeto con su "fantasma fundamental", que "atravesado deviene la pulsión". El analista sabrá encarnar este objeto para los analizantes para llevarlos hasta el punto que él mismo ha alcanzado en su propio análisis. Saber hacer algo con este resto en tanto analista y proponerse como objeto (a) para otros no supone un saber hacer previo. Es una invención en el sentido que, con cada analizante, se trata de acomodarse al su objeto plus-de-gozar. Eso imponeal analista un acierta dosis de creatividad, de invención, de algo absolutamente nuevo.

A cultura supõe um tratamento do resto por parte dos seres falantes. Atualmente, longe de desfazer-se dos dejetos, ela os incorpora sob a forma reciclada do lixo, reintroduzindo-os no mercado como matérias primas que dão lugar a novos produtos. Qual é o lugar do resto na psicanálise e que tratamento ela lhe reserva? A contingência no uso do resto e a invenção têm aqui seu lugar. Com Lacan, a psicanálise se serve do objeto resto de uma análise para fazer uso dele. Os objetos (a) ganham consistência na análise como modalidades da relação com o Outro a partir da confrontação do sujeito com seu "fantasma fundamental" que "atravessado se torna pulsão". O analista saberá encarnar este objeto para os analisantes para leva-los até o ponto que ele mesmo alcançou na sua própria análise. Saber fazer algo com esse resto enquanto analista e propor-se como objeto (a) para os outros não supõe um saber fazer prévio. É uma invenção no sentido de que, com cada analisante, se trata de acomodar-se ao objeto mais-de-gozar dele. Isso impõe ao analista uma certa dose de criatividade, de invenção, de algo absolutamente novo.

La culture suppose un traitement du reste par des êtres parlants. Aujourd'hui, loin de se débarrasser des déchets, elle les incorpore sous forme de déchets recyclés, les réintroduisant sur le marché comme des matières premières donnant naissance à de nouveaux produits. Quelle est la place du reste dans la psychanalyse et quel traitement lui réserve-t-elle ? LA contingence dans l'utilisation du déchet et l'invention ont leur place ici. Avec Lacan, la psychanalyse utilise l'objet restant d'une analyse pour s'en servir. Les objets (a) prennent consistance dans l'analyse comme modalités de la relation à l'Autre à partir de la confrontation du sujet avec son " fantasme fondamental " qui " traversé devient la pulsion ". L'analyste saura incarner cet objet pour les analysants afin de les amener au point qu'il a lui-même atteint dans sa propre analyse. Savoir faire quelque chose de ce repos en tant qu'analyste et se proposer comme objet pour les autres ne présuppose pas un savoir-faire préalable. C'est une invention dans le sens où, avec chaque analysant, il s'agit de s'accommoder de son objet de plus-de-jouir. Cela impose à l'analyste une certaine dose de créativité, d'invention, de quelque chose d'absolument nouveau

The existence of culture entails an ability in talking beings to treat the rest. Nowadays, far from discarding waste, it is incorporating it under the form of recycled garbage, reintroducing it to the market as raw materials that give rise to new products. Where must we situate the rest in psychoanalysis and what treatment does it reserve for it? Contingency in the use of the leftover and invention have their place here. With Lacan, psychoanalysis uses the object that remains from an analysis to make use of it. The objects (a)gain consistency in the analysis as modalities of the relationship with the Other from the confrontation of the subject with his or her "fundamental phantasm" that "crossed through, becomes a drive. The analyst will know how to incarnate this object for the analyzing subjects in order to take them to the point that he himself has reached in his own analysis. Knowing how to do something with that remainder as an analyst and proposing himself as an object for others does not presuppose a previous know-how. It is an invention in the sense that, with each analyzing person, it is a question of accommodating oneself to the object of more-than-enjoyment of that person. This imposes on the analyst a certain dose of creativity, of invention, of something absolutely new

Contingências, restos e invenções / Contingences, restes et inventions / Contingencies, rests and inventions

A cultura supõe um tratamento do resto por parte dos seres falantes. Atualmente, longe de desfazer-se dos dejetos, ela os incorpora sob a forma reciclada do lixo, reintroduzindo-os no mercado como matérias primas que dão lugar a novos produtos. Qual é o lugar do resto na psicanálise e que tratamento ela lhe reserva? A contingência no uso do resto e a invenção têm aqui seu lugar. Com Lacan, a psicanálise se serve do objeto resto de uma análise para fazer uso dele. Os objetos (a) ganham consistência na análise como modalidades da relação com o Outro a partir da confrontação do sujeito com seu "fantasma fundamental" que "atravessado se torna pulsão". O analista saberá encarnar este objeto para os analisantes para leva-los até o ponto que ele mesmo alcançou na sua própria análise. Saber fazer algo com esse resto enquanto analista e propor-se como objeto (a) para os outros não supõe um saber fazer prévio. É uma invenção no sentido de que, com cada analisante, se trata de acomodar-se ao objeto mais-de-gozar dele. Isso impõe ao analista uma certa dose de criatividade, de invenção,de algo absolutamente novo.

La culture suppose un traitement du reste par des êtres parlants. Aujourd'hui, loin de se débarrasser des déchets, elle les incorpore sous forme de déchets recyclés, les réintroduisant sur le marché comme des matières premières donnant naissance à de nouveaux produits. Quelle est la place du reste dans la psychanalyse et quel traitement lui réserve-t-elle ? LA contingence dans l'utilisation du déchet et l'invention ont leur place ici. Avec Lacan, la psychanalyse utilise l'objet restant d'une analyse pour s'en servir. Les objets (a) prennent consistance dans l'analyse comme modalités de la relation à l'Autre à partir de la confrontation du sujet avec son " fantasme fondamental " qui " traversé devient la pulsion ". L'analyste saura incarner cet objet pour les analysants afin de les amener au point qu'il a lui-même atteint dans sa propre analyse. Savoir faire quelque chose de ce repos en tant qu'analyste et se proposer comme objet pour les autres ne présuppose pas un savoir-faire préalable. C'est une invention dans le sens où, avec chaque analysant, il s'agit de s'accommoder de son objet de plus-de-jouir. Cela impose à l'analyste une certaine dose de créativité, d'invention, de quelque chose d'absolument nouveau.

The existence of culture entails an ability in talking beings to treat the rest. Nowadays, far from discarding waste, it is incorporating it under the form of recycled garbage, reintroducing it to the market as raw materials that give rise to new products. Where must we situate the rest in psychoanalysis and what treatment does it reserve for it? Contingency in the use of the leftover and invention have their place here. With Lacan, psychoanalysis uses the object that remains from an analysis to make use of it. The objects (a) gain consistency in the analysis as modalities of the relationship with the Other from the confrontation of the subject with his or her "fundamental phantasm" that "crossed through, becomes a drive. The analyst will know how to incarnate this object for the analyzing subjects in order to take them to the point that he himself has reached in his own analysis. Knowing how to do something with that remainder as an analyst and proposing himself as an object for others does not presuppose a previous know-how. It is an invention in the sense that,with each analyzing person, it is a question of accommodating oneself to the object of more-than-enjoyment of that person. This imposes on the analyst a certain dose of creativity, of invention, of something absolutely new

Uso de toxina botulínica en el dolor tras amputación / Use of botulinum toxin for pain after amputation

Introducción: Una amputación es un suceso demoledor para todo paciente que lo sufre, puesto que presenta un cambio importante, interfiriendo en la esfera física, psíquica y social del individuo, requiriendo una adap­tación y reacondicionamiento progresivo. Uno de los puntos más importantes a controlar ante esta situación es el dolor del muñón, puesto que en muchas ocasiones será aquello que realmente determine la calidad de vida del paciente. En los últimos años, se ha estudiado la utilidad de la toxina botulínica para el tratamiento del dolor con resultados esperanzadores. Objetivo: Realizar una revisión sistemática de la litera­tura científica existente, sin restricción de año de publicación, sobre el empleo de la toxina botulínica en el dolor de los pacientes amputados, para agrupar los datos existentes. Métodos: La literatura se extrajo de PubMed, EMBASE, Cochrane, Clinical Key, Science Direct, Medes, Dialnet, Scielo y Google Schoolar. Se definió como único criterio de exclusión estudios realizados en no humanos. Se incluyeron todos los documentos relacionados con el objetivo de la búsqueda, independientemente de año, idioma, sexo, edad, tipo de amputación o toxina botulínica. De los 1795 estudios hallados tras la búsqueda inicial, se seleccionaron 19. Los niveles de evidencia corresponden a 2B, grado de recomendación B (2 estudios piloto, aleatorizados, doble ciego, con grupo control) y 4C (2 estudios observacionales longitudinales prospectivos, 15 casos clínicos). Resultados: Se estima una mejoría para el dolor resi­dual del muñón ± sensación del miembro fantasma del 80,43 % (74 pacientes) y un alivio del dolor del miembro fantasma ± dolor residual del 65,22 % (60). Se describe una ausencia de modificación del dolor del miembro fantasma para 32 pacientes (34,7 %) y ausencia de alivio del dolor residual en 18 pacientes (19,57 %). En ningún estudio se refleja un empeoramiento de la clínica...(AU)

Introduction: An amputation is a devastating event for all patients who suffer it. It introduces significant chan­ges in the patient's physical, psychic and social spheres. It requires progressive adaptation and reconditioning. Stump pain is one of the most important points in order to control this situation as, on many occasions, it will be what truly determines the patient's life quality. In the recent years, the usefulness of botulinum toxin was stu­died for pain treatment with encouraging results. Objetive: Provide a systematic review on existing scien­tific literature, with no restrictions on publication year, about the use of botulinum toxin for the pain of amputa­ted patients in order to compile the existing data. Methodology: Literature was retrieved from PubMed, EMBASE, Cochrane, Clinical Key, Science Direct, Medes, Dialnet, Scielo and Google Schoolar. The only exclusion criterium was studies carried out on non-human. All do­cuments related to the objective of this research were included independently of year, language, sex, age, type of amputation or botulinum toxin. From 1795 studies found after initial research, 19 studies were selected. The levels of evidence are pertained to 2b, degree of recommendation B (2 pilot studies, randomised, double-blind, with control group) and 4C (2 observational and longitudinal prospective studies, 15 clinical cases). Results: It is estimated that an 80.43 % (74 patients) improvement of stump residual pain and/or of the sensation on the phantom limb and a 65.22 % (60 patients) relief of the phantom limb pain and/or of the residual pain. An absence of change of the phantom limb pain was described by 32 patients (34.7 %) and an absence of relief of residual pain was reported on 18 patients (19.57 %). No studies reflect a deterioration of the disease...(AU)

Go Set a Watchman: revealing phantom narratives and shattering projections in the era of Black Lives Matter.

Harper Lee's novels, To Kill a Mockingbird and Go Set a Watchman, are examined through the lens of reader-response theory and the Jungian concept of the cultural complex or phantom narratives. Socio-historical context includes the American civil rights movement of the 60's as well as Black Lives Matter. The clinical and institutional implications are briefly considered.

Les romans de Harper Lee, Ne tirez pas sur l'oiseau moqueur et Va et poste une sentinelle, sont étudiés sous l'angle de la théorie de la réception (reader-response theory) et du concept Jungien de complexe culturel, ou narratifs fantômes. Le contexte historico-social inclut le mouvement américain pour les droits civiques dans les années 60 ainsi que Black Lives Matter. Les implications cliniques et institutionnelles sont envisagées succinctement.

Las novelas de Harper Lee, 'Matar a un Ruiseñor y 'Ve y Pon un Centinela', son exploradas a través de la teoría de la respuesta social del lector y el concepto Junguiano de complejo cultural o las narrativas fantasmales. El contexto sociocultural incluye al movimiento por los derechos civiles en América de los años 60, así como también al movimiento Black Lives Matter. Son consideradas brevemente las implicancias clínicas e institucionales.

Phantom sensation and quality of life among patients with lower-limb amputations in the region of Juiz de Fora, Minas Gerais: a cross-sectional study / Qualidade de vida e sensação fantasma em pacientes amputados em membro inferior da região de Juiz de Fora, Minas Gerais: um estudo transversal

ABSTRACT. An amputation is an irreversible event that causes social, psychological, and functional consequences that reduces the quality of life of the amputee. Phantom pain generally is reported by 50 to 80% of amputees. Objective: To describe the pain and phantom sensation and quality of life among lower-limb amputees. Methods: This was a cross-sectional study carried out in the region of Juiz de Fora, state of Minas Gerais, Brazil. Inclusion criteria were being a patient in one of two hospitals in the region at the time of the interview and having at least one lower-limb amputation. A total of 20 amputees were included in the analysis. The interview questionnaire had items adapted from the Groningen Questionnaire Problems After Leg Amputation - describing the frequency and discomfort of phantom pain and sensation, causes and the level of the amputation, as well as the WHOQOL-BREF, for assessing quality of life. Results: Most participants were women (55%) and had a mean age of 55.6 years (SD=14.8). Femoral amputation was the most prevalent (65%), and diabetes (40%) was the main reason for amputation. 29% of amputees classified the phantom pain as moderate or severe, and 15% claimed daily frequency of this phenomenon. As for phantom pain, only 6% stated daily frequency. The mean quality of life was 4.1 (SD=1.1, five score means very satisfied), the physical domain of quality of life had the lowest mean (3.4, SD=0.7). Conclusions: Phantom sensation and pain were prevalent among lower-limb amputees who were, in general, less satisfied with their physical domain of quality of life.

RESUMO. A amputação é um procedimento irreversível que gera consequências sociais, psicológicas e funcionais. A dor do membro fantasma ocorre entre 50 e 80% dos amputados, apresentando implicações na qualidade de vida. Objetivo: Avaliar a sensação, dor fantasma e qualidade de vida entre pacientes amputados. Métodos: Trata-se de um estudo transversal retrospectivo realizado na região de Juiz de Fora, Minas Gerais, Brasil. Os critérios de inclusão foram possuir pelo menos uma amputação de membro inferior e ser paciente de um dos hospitais referência para região. Vinte participantes foram incluídos nas análises. O questionário da pesquisa consistiu em itens, adaptados do Groningen Questionnaire Problems After Leg Amputation, que descrevem frequência e incômodo da sensação fantasma, dor fantasma, causas e nível da amputação, e questões sobre os tratamentos além do questionário qualidade de vida WHOQOL-BREF. Resultados: A maioria dos participantes era do sexo feminino (55%) com idade média de 55,6 (DP=14,8) anos. A maior frequência de amputação foi transfemural (65%), e o principal motivo da amputação foi o diabetes mellitus (40%). Com relação ao incômodo da sensação fantasma, 29% a classificou como moderado ou severa, e 15% alegou frequência diária desse fenômeno. Quanto {a dor fantasma, apenas 6% afirmou frequência diária. A qualidade de vida média dos participantes foi de 4,1 (DP=1,1) em 5 (cinco significa muito satisfeito), de acordo com a primeira questão do WHOQOL-BREF; o domínio físico apresentou a menor média 3,4 (DP=0,7). Conclusão: A sensação e dor fantasmas foram prevalentes nos entrevistados que apresentaram menor satisfação com o domínio físico da qualidade de vida.

Phantom eye syndrome. Case report / Síndrome de ojo fantasma. Reporte de caso

Abstract A frequent complication after limb amputation is the appearance of phantom limb syndrome, a phenomenon that has also been studied in the amputation of different body parts. Cases reported in relation to ophthalmologic surgery are few and evidence is limited in terms of specific management, which makes this a very important study. We report the case of a patient diagnosed with phantom eye syndrome in the post-operative period of an orbital exenteration surgery. A comprehensive approach was taken with multimodal symptom management, including intervention treatment. Significant improvement regarding the pain was achieved; however, non-painful phantom sensations persisted. Upon reviewing the available literature on the subject, its pathophysiology is not fully elucidated. Its incidence is highly variable, as well as the symptoms' appearance. The presence of headache and eye pain prior to surgery seem to be risk factors. Climate and psychological stress are exacerbating factors of the symptomatology. No high-quality evidence was found in terms of management guidelines, with the use of antidepressants, anticonvulsants and opioids being the most recommended. Interventional management is an option according to the characteristics of the pain and associated symptoms.

Resumen Una complicación frecuente luego de la amputación de alguna extremidad es la aparición del síndrome de miembro fantasma, fenómeno que también se ha descrito en la amputación de diferentes partes del cuerpo. Los casos reportados en relación con cirugía oftalmológica son pocos y la evidencia es limitada en cuanto a manejo específico, lo cual justifica la descripción de este caso de interés. Reportamos el caso de una paciente a quien se diagnosticó síndrome de ojo fantasma en el periodo posoperatorio de una cirugía de exenteración orbitaria. Se realizó un enfoque integral con manejo multimodal de los síntomas, incluyendo tratamiento intervencionista. Se logró una notable mejoría del dolor; sin embargo, las sensaciones fantasma no dolorosas persistieron. Al revisar la literatura disponible sobre el tema, la fisiopatología no está totalmente dilucidada. La incidencia es muy variable, así como el tiempo de aparición de los síntomas. La presencia de cefalea y dolor ocular previos a la cirugía parecen ser factores de riesgo. El clima y el estrés psicológico son factores exacerbantes de la sintomatología. No se encontró evidencia de alta calidad en cuanto a pautas de manejo, siendo lo más recomendado el uso de antidepresivos, anticonvulsivantes y opioides. El manejo intervencionista es una opción de acuerdo a las características del dolor y síntomas asociados.

Comportamiento del dolor fantasma en pacientes amputados en Cárdenas. Periodo 2015-2019 / Phantom pain behavior in amputated patients in Cardenas. Period 2015-2019

RESUMEN Introducción: la amputación es un procedimiento quirúrgico y la incapacidad como consecuencia se puede considerar una entidad clínica. Toda respuesta a la amputación es altamente individual. Entre el 40 y 80 % de los amputados manifiestan dolor de la zona amputada o dolor de miembro fantasma. Entre todos los problemas que se pueden presentar tras la cirugía este es uno de los más graves. Objetivo: determinar el comportamiento del dolor fantasma en la población amputada en Cárdenas y la mejoría clínica de los síntomas con los diferentes tratamientos. Periodo comprendido entre 1-1-2015 al 31-12-2019. Materiales y métodos: se realizó un estudio descriptivo de corte transversal en el Hospital General "Julio Miguel Aristegui Villamil" de Cárdenas, en el período comprendido del 1-1-2015 al 31-12-2019. Con el fin de evaluar las variables clínicas y demográficas de pacientes con antecedentes de amputación unilateral de miembro y que acudieron al cuerpo de guardia y/o consultas externas de Ortopedia y Traumatología, de Angiológica y Cirugía Vascular por presentar dolor fantasma. Resultados: con respecto a la mejoría de los síntomas y del propio dolor fantasma, según la escala de evaluación del dolor (EVA), se demostró que hubo alivio muy discreto y en un 96 % de los pacientes se presentó persistencia de los mismos. Conclusiones: los resultados fueron insatisfactorios, a pesar de los tratamientos utilizados en el estudio (AU).

ABSTRACT Introduction: amputation is a surgical procedure and disability as its consequence can be considered a clinical entity. Any response to amputation is highly individual. Between 40 and 80% of amputees refer pain in the amputated area or phantom limb pain, and among all the problems that can occur after surgery, this is one of the most serious. Objective: to determine the behavior of phantom pain in the amputated population in Cárdenas from January 1st 2015 to December 31st 2019 and the clinical improvement of symptoms with the different treatments applied. Materials and methods: a descriptive cross-sectional study was conducted in the General Hospital Julio Miguel Aristegui Villamil of Cárdenas in the period from January 1st 2015 to December 31st 2019, with the aim of evaluating the clinical and demographic variables of patients with antecedents of unilateral limb amputation who attended the emergency department or outpatient Orthopedics and Traumatology, and Angiology and Vascular Surgery consultations for presenting phantom pain. Results: regarding the improvement of the symptoms and the phantom pain itself, according to the pain evaluation scale (VAS), it was shown that there was very discreet relief and its persistence in 96% of the patients. Conclusions: unsatisfactory results are observed instead of the treatments used in the study (AU).

Danger beyond the catches: a review of conservation threats posed by commercial and non-commercial fisheries in Guaratuba Bay, southern Brazil / Perigo além das capturas: uma revisão das ameaças à conservação pelas pescas comercial e recreativa na Baía de Guaratuba, sul do Brasil

Comparisons between the implications of commercial and recreational fisheries for estuarine conservation have been a topic of debate. A review on the available data from Guaratuba Bay, Southern Brazil, identifies six threats for conservation, other than those concerning the fishing effort on target resources. Differing from the popular view that fishing for pleasure could be innocuous for the environment, the identified threats concern both commercial and non-commercial fisheries: (1) catching of reproductive individuals; (2) catch of big old fat fecund females; (3) loss and abandonment of fishing gears; (4) use of natural baits; (5) bycatch of rays, turtles and non-target finfish; and (6) bad practices associated with catch-and-release or discarding. Environmental disturbances and fauna depletion are detected as potential impacts. Recommended actions for estuary conservation include fishing closures in mangrove and shallow waters areas, release of fish larger than the critical size, and measures against abandoned, lost or otherwise discarded fishing gears.

As implicações das pescas comercial e recreativa para conservação dos estuários têm sido largamente discutidas. Uma revisão das informações disponíveis para a Baía de Guaratuba, sul do Brasil, identifica seis ameaças à conservação, que extrapolam aquelas concernentes ao esforço de captura sobre as espécies-alvo. Contrariando a visão comum de que a pesca de lazer seria inócua para o ambiente, as ameaças identificadas referem-se tanto à pesca comercial como à não-comercial: (1) captura de indivíduos em atividade reprodutiva; (2) captura de fêmeas grandes e mais fecundas; (3) perda e abandono de materiais de pesca; (4) uso de iscas naturais; (5) captura incidental de raias, tartarugas e peixes não-alvo; e (6) práticas inadequadas associadas a pesque-e-solte e descarte. Impactos potenciais são perturbações ambientais e depleção de fauna. Ações recomendadas para conservação do estuário incluem interdição de pesca no manguezal e áreas rasas, soltura de peixes com tamanho superior ao crítico, e medidas contra abandono, perda e outras formas de descarte de materiais de pesca.