ABSTRACT
Pediatric patients have particularities in the clinical manifestations and complications of snakebite envenomation (SBEs), and few studies have examined this population. The objective of this paper was to study snakebites in a pediatric age group treated at a reference hospital and to evaluate factors associated with unfavorable evolution. A cross-sectional study with a clinical-epidemiological description and identification of the factors related to unfavorable evolution in patients aged <19 years old seen from January, 2018 to November, 2019 was performed. Complications related to the SBE, such as compartment syndrome, secondary infection, extensive necrosis, hemorrhage, and kidney damage, were considered unfavorable evolution. From the 325 patients in the sample, 58 were aged <19 years old; 40 (69%), 0-12 years old; and 18 (31%), 13-18 years old. All patients had local manifestations (mild, moderate, and severe), and 36 (62%) had an unfavorable evolution. Fourteen (24.1%) patients had compartment syndrome, with a significant risk association between 0 and 12 years old (p = 0.019). Two factors significantly contributed to unfavorable evolution: the timing from the bite to medical care being ≥6 hours and additional antivenom therapy needed. We conclude that the younger the patient, the smaller body segment affected, leading to disproportionality between the affected area and the amount of inoculated venom, contribute to more frequent local manifestations and complications in children rather than adults. Because of the relationship between body area and vascular volume in children differs from that in adults, the same volume of venom inoculated by snakes will be disproportionate in these two groups. Therefore, in the treatment of pediatric patients, increasing the volume of antivenom therapy is possibly necessary. Furthermore, as in adults, six hours between the bite to medical care increases the risk of complications and mortality.
Subject(s)
Humans , Child , Snake VenomsABSTRACT
O objetivo deste artigo foi o de compreender o fenômeno da identificação projetiva que se originou em um processo de avaliação-intervenção sob a orientação psicanalítica, no atendimento de uma criança e sua família. A análise do material teve como eixo primevo as concepções de Klein e Winnicott a fim de descrever as aproximações e distanciamentos no decorrer dos encontros, sustentando as reflexões sobre a relação construída. A totalidade dos atendimentos foi marcada pela comunicação não-verbal do paciente. Sobretudo os gestos, as poucas vocalizações e os sentimentos despertados no autor tornaram-se as vias possíveis de uma comunicação. Com o holding oferecido pelo setting, o menino começou a fazer atividades por iniciativa própria, espalhando tintas e cola, fazendo montagens com papeis, uns sobre outros. O rolo de papeis servia para uma montagem no próprio corpo, tal como o fio da seda, na busca de um continente para sua mente nascente, emergente no encontro com um ego auxiliar, mente-casulo para abrigar. A experiência do atendimento e as discussões na supervisão mostraram a importância do vínculo com o paciente que favoreceu a identificação da dor mental e abertura com vistas à expansão do espaço mental a partir da dupla.(AU)
This paper aims at understanding the phenomenon of projective identification that originated in an assessmentintervention process in the treatment of a child and his family from a psychoanalytic point of view. Material analysis had Kleins and Winnicotts conceptions as a primary axis for describing the approaches and distances that took place throughout the meetings, providing the basis for the reflections on the relationship built between analyst and patient. All the encounters were characterized by the patients non-verbal communication. Notably, the gestures, the few vocalizations and the feelings that emerged in the intern became the possible means of communication. With the holding offered by the setting, the boy started doing activities on his own initiative, spreading paints and glue, creating assemblies with papers, one on top of another. The roll of paper for cleaning was used for an assembly wrapped around his own body, like a silkworm weaving threads in its metamorphosis. The encounter with an auxiliary ego allowed for a felling of continuity, a cocoon-mind for sheltering at that moment. The experience of the treatment process and the discussions with a supervisor demonstrate the importance of the bond with the patient, which favored the identification of pain and openness with a view to expanding the mental space on the duo.(AU)
El objetivo de este artículo fue comprender el fenómeno de identificación proyectiva que se originó en un proceso de evaluación-intervención bajo una orientación psicoanalítica, en la atención psicológica de un niño y su familia. El análisis del material tuvo como eje primario las concepciones de Klein y Winnicott para describir las aproximaciones y distancias durante los encuentros, sustentando las reflexiones sobre la relación construida. Todas las visitas fueron marcadas por la comunicación no verbal del paciente. Sobre todo, los gestos, las pocas vocalizaciones y los sentimientos que fueron despertados en el interno se convirtieron en un medio posibles de comunicación. Con el holding ofrecido por el setting, el niño empezó a realizar actividades por iniciativa propia, esparciendo pinturas y pegamentos, haciendo montajes con papel, uno arriba del otro. El rollo de papel de limpieza sirvió para un montaje, al envolverlo al alrededor del cuerpo, así como el gusano de seda que produce el hilo en su metamorfosis. El encuentro con un ego auxiliar permitió la sensación de continuidad, un capullo-mente para refugiarse en ese momento. La experiencia de esta atención psicológica y de las discusiones en la supervisión mostraron la importancia del vínculo con el paciente, lo que favoreció la identificación del dolor y una apertura al buscar ampliar el espacio mental de la dupla.(AU)
Subject(s)
Psychoanalysis , Child , CountertransferenceABSTRACT
O objetivo deste estudo foi investigar as relações entre o peso corporal e as medidas corporais altura de garupa (ag), comprimento de garupa (cg), comprimento corporal (cc) e perímetro torácico (pt), em bovinos oriundos principalmente do cruzamento das raças Holandês e Gir. Foram utilizados dados de 483 vacas, 469 novilhas e 62 machos, de três rebanhos distintos, analisados separadamente para cada categoria a fim de estabelecer equações polinomiais dos pesos em relação às medidas corporais. As correlações simples do peso corporal com pt, cc, cg e ag foram respectivamente 0,807; 0,440; 0,187 e 0,504 para vacas; 0,928; 0,735; 0,819 e 0,880 machos, e 0,942; 0,748; 0,902 e 0,573 para novilhas. Embora as regressões de peso corporal em relação ao cc e cg tenham sido significativas (P<0,05), o aumento da porcentagem de explicação das variações do peso corporal obtido com a inclusão destas medidas, em adição ao pt, não parece justificar o custo das medições. As equações de predição do peso corporal em função do pt foram as seguintes: para vacas, peso = 12.174 - 187,410 pt + 0,97196960 pt² - 0,00162382 pt³, para novilhas, peso= 1.717-35,167 pt + 0,238978 pt² - 0,00046260 pt³ e, para machos, peso = -3.862+76,014 pt-0,488837 pt²+ 0,00109755 pt³.
The objective of this study was to investigate the relationship between hip height (ag), rump length (cg), body length (cc) and heart girth (pt) with live body weight of crossbred animals, mainly from the cross between Holstein and Gir breeds. Data on 483 cows, 469 heifers and 62 males in three herds were analyzed for each category using polynomial regression equations of body weight on measurements. The correlations between body weight and pt, cc, cg and ag were, respectively 0.807, 0.440, 0.187 and 0.504 for cows, 0.928, 0.735, 0.819 and 0.880 for males and 0.942, 0.748, 0.902 and 0.573 for heifers. Although the regressions of body weights on cc and cg were significant (P<0.05), the additional goodness of fit of a model that includes these two traits in addition to heart girth does not justify the extra cost for recording these traits. The prediction equations were: for cows, body weight = 12174-187.410 pt+0.97196960 pt²-0.00162382 pt³, for heifers, body weight = 1717-35.167pt+0.238978pt²-0.00046260pt³ and for males, body weight = -3862+76.014pt-0.488837pt²+0.00109755pt³.