ABSTRACT
Resumen El objetivo de este trabajo es analizar las experiencias de búsqueda y acceso a procedimientos para la reconstrucción física, social y psicológica de mujeres atacadas con agentes químicos en la ciudad de Bogotá. A partir un diseño etnográfico se recolectó información observacional y discursiva en escenarios de intervención formal y no formal sobre los cuerpos y se realizaron entrevistas en profundidad a sobrevivientes y a profesionales de la salud. Los datos fueron analizados a partir de un enfoque narrativo-crítico. Los hallazgos evidencian interpretaciones divergentes dentro de los sistemas cuidado de la salud sobre lo que constituye la reconstrucción de un cuerpo atacado con agentes químicos en un contexto marcado por grandes desigualdades en el acceso a la salud.
Abstract O objetivo deste trabalho é analisar as experiências de busca e acesso a procedimentos de reconstrução física, social e psicológica de mulheres agredidas com agentes químicos na cidade de Bogotá. Com base em um delineamento etnográfico, recolheu-se informação observacional e discursiva em cenários formais e não formais de intervenção sobre os corpos e realizaram-se entrevistas em profundidade a sobreviventes e profissionais de saúde. Os dados foram analisados a partir de uma abordagem narrativa-crítica. Os achados mostram interpretações divergentes nos sistemas de saúde sobre o que seria a reconstrução de um corpo agredido com agentes químicos em um contexto marcado por grandes desigualdades no acesso à saúde.
Abstract This article explores experiences of care-seeking for the physical, social and psychological reconstruction of women attacked with chemical agents in the city of Bogotá, Colombia. Based on an ethnographic design, observational and discursive information was collected in formal and nonformal therapeutic settings, and in-depth interviews were conducted with survivors and health professionals. The data was analyzed from a narrative-critical approach. The findings show divergent interpretations within health care systems on what constitutes the reconstruction of a body attacked with chemical agents in a context marked by profound inequalities in access to health.
ABSTRACT
A proposta deste trabalho é relatar e comentar uma experiência clínica na qual o estado mental invejoso, como manifestação externa da pulsão de morte, teve lugar de destaque. O fio condutor escolhido pela autora destaca o predomínio dos impulsos destrutivos, os quais, além de causarem muito sofrimento à analisanda, se manifestaram através de ataques ao vínculo psicanalítico. A autora conjectura que o malogro da continuidade da relação terapêutica decorreu da intolerância à dependência receptiva, uma vez que a ligação era experimentada como humilhação. Discorre sobre a implicância e a obscuridade do conceito de pulsão de morte, subjacente aos conceitos utilizados para a compreensão do caso.
The purpose of this paper is to report and comment on a clinical experience in which the envious mental state, as an external manifestation of the death drive, had a prominent place. The common thread chosen by the author highlighted the predominance of destructive impulses, which, in addition to causing much suffering to the analysand, manifested themselves through attacks on the psychoanalytic bond. She conjectured that the failure of the continuity of the therapeutic relationship was due to an intolerance to receptive dependence, since the connection was experienced as humiliation. The author commented on the implication and obscurity of the concept of death drive, underlying the concepts used to understand the case.
El propósito de este trabajo es informar y comentar una experiencia clínica en la que el estado mental envidioso, como manifestación externa de la pulsión de muerte, tuvo un lugar destacado. El hilo conductor elegido por el autor destacó el predominio de los impulsos destructivos, que además de causar mucho sufrimiento al analizando, se manifestaron a través de ataques al vínculo psicoanalítico. Conjeturó que el fracaso de la continuidad de la relación terapéutica se debía a una intolerancia a la dependencia receptiva, ya que la conexión se vivía como una humillación. La autora comentó sobre la implicación y oscuridad del concepto de pulsión de muerte, subyacente a los conceptos utilizados para entender el caso.
Le but de cet article est de narrer et de commenter une expérience clinique dans laquelle létat mental envieux, en tant quune manifestation externe de la pulsion de mort, a pris une place prépondérante. Le fil conducteur choisi par lautrice a mis en évidence la prédominance des pulsions destructrices, ce qui, en plus de causer beaucoup de souffrance à lanalysant, sest manifesté par des atteintes au lien psychanalytique. Lautrice a conjecturé que léchec de la continuité de la relation thérapeutique a été dû à une intolérance à la dépendance réceptive, puisque la connexion était vécue comme une humiliation. Elle a commenté limplication et lobscurité du concept de pulsion de mort, sous-jacent aux concepts utilisés pour comprendre le cas.
Subject(s)
Humans , Female , Death , Psychological Distress , Jealousy , Masochism/psychology , Mother-Child Relations/psychologyABSTRACT
Resumo Na entrevista, Marco Américo Lucchesi, professor Titular de Literatura Comparada da Universidade Federal do Rio de Janeiro (UFRJ), professor convidado da Fundação Oswaldo Cruz (Fiocruz), membro e presidente da Academia Brasileira de Letras, apresenta sua percepção da crise atual e do impacto sobre a consolidação da democracia brasileira. Com base em suas experiências como intelectual crítico e atuante, comenta os ataques que assistimos, no Brasil, à cultura e à produção de conhecimento. Ao mesmo tempo, lembra que nenhuma democracia se configura como uma realidade ontológica terminada e ressalta o papel das escolas e universidades na mobilização da cidadania e na difusão de valores republicanos. Frente à constatação de que vivemos uma profunda mudança de registro cultural, aponta algumas conquistas que se expressam, por exemplo, pela presença de índios e negros nas universidades. Reconhecendo o pedido de socorro imerso em todas as crises,convoca-nos a reavivar o sonho e a coragem, combustíveis da utopia, e defende a suspensão das distinções em favor da formação de uma frente democrática e solidária. São análises e convocações que se pautam, o tempo todo, numa firme confiança na potência e na capacidade de resistência da cultura.
Abstract In this interview, Marco Américo Lucchesi, Tenured Professor of Comparative Literature at the Federal University of Rio de Janeiro (UFRJ), visiting professor of the Oswaldo Cruz Foundation (Fiocruz), and member and president of the Brazilian Academy of Letters, outlines his perception of the current crisis and the impact on the consolidation of Brazilian democracy. Based on his experiences as a critic and intellectual, he comments on the attacks on culture and the production of knowledge that we have witnessed in Brazil. He reminds us that no democracy is a fully-fledged ontological reality and highlights the role of schools and universities in mobilizing citizenship and spreading republican values. He highlights some achievements that are expressed by the presence of Indians and African Brazilians in universities. Acknowledging the call for help inherent in every crisis, he calls upon us to revive the dream and courage and advocates the suspension of distinctions in favor of forming a front of democracy and solidarity. These are analyses and convocations that are based, at all times, on a firm confidence in the power and capacity of resilience of culture.
ABSTRACT
Los ataques cerebrovasculares (ACV), representan un problema mayor en salud y son una causa importante de discapacidad en todo el mundo. La estenosis u oclusión carotídea aterosclerótica causa alrededor del 20% de las isquemias cerebrovasculares.¹ Los ACV en los enfermos con estenosis carotídea se producen, en la mayoría de los casos, por la aparición de embolismos distales de trombo formado en la placa, oclusión trombótica aguda debido a rotura de la placa, o bien secundarios a las alteraciones hemodinámicas atribuibles a la estenosis, la cual produce disminución de la perfusión cerebral por el hipoflujo, en casos de estenosis críticas o suboclusivas. El tratamiento de la patología carotídea ha evolucionado de forma considerable a lo largo de los últimos años. Existen dos tratamientos invasivos para la estenosis carotídea significativa, que consisten en el abordaje quirúrgico con endarterectomía o tratamiento por vía percutánea con angioplastia y colocación de stent. En nuestra institución se realizaron, en el periodo comprendido entre marzo de 2013 y junio de 2017, aproximadamente 100 angioplastias carotídeas con colocación de stent. Todas fueron valoradas con ecografía Doppler color (EDC) al mes, a los seis meses y al año (en casos no complicados). En esta revisión bibliográfica es nuestra intención desarrollar las indicaciones, aplicaciones, hallazgos normales y patológicos en el examen de EDC en la evaluación de un paciente con stent carotídeo.
Acute stroke represents a major problem in health and is a major cause of disability worldwide. Atherosclerotic carotid stenosis or occlusion causes around 20% of cerebrovascular ischemias.¹ Stroke in patients with carotid stenosis occurs, in most cases, due to embolisms of thrombus formed in the plaque, acute thrombotic occlusion due to rupture of the plaque, or secondary to hemodynamic alterations, attributable to stenosis, which produces decreased cerebral perfusion by low flow, in cases of critical or sub occlusive stenosis. The treatment of carotid disease has evolved considerably over recent years. There are two invasive treatments for significant carotid stenosis, which consist of the surgical approach with endarterectomy or percutaneous treatment with angioplasty and stenting. In our institution, in the period between March 2013 and June 2017, ~100 carotid angioplasties with stent placement were performed. All were assessed with color Doppler ultrasound (DUS) at month, six months and one year (in non complicated cases). In this literature review it is our intention to develop the indications, applications, normal and pathological findings in the DUS examination in the evaluation of a patient with carotid stent.
Subject(s)
Humans , Carotid Stenosis/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Stents , Carotid Stenosis/drug therapy , Angioplasty , Stroke/complicationsABSTRACT
O papel das reações vivenciadas durante experiências traumáticas tem sido alvo de interesse nos estudos sobre etiologia e prognóstico do transtorno de estresse pós-traumático. Essa tese avaliou a estrutura dimensional do instrumento mais utilizado para mensurar a dissociação peritraumática, o Peritraumatic Dissociative Experience Questionnaire (PDEQ). Adicionalmente, desenvolveu-se e avaliou-se as propriedades psicométricas do instrumento Peritraumatic Reactions Questionnaire (PTRQ), proposto para mensurar as três principais reações peritraumáticas (RP) no contexto do TEPT: dissociação peritraumática (DP), imobilidade tônica peritraumática (ITP) e reações físicas peritraumáticas (RFP). Os dados utilizados são originários de um estudo transversal realizado entre junho de 2007 e julho 2008 com amostras representativas da população acima de 15 anos das duas maiores cidades brasileiras. A amostra foi de 1.074 participantes no Rio de Janeiro e 2.145 em São Paulo que reportaram ao menos um evento traumático durante a vida. O primeiro artigo investigou a validade estrutural da versão brasileira do PDEQ. Análises de componentes principais indicaram a solução unidimensional corroborada por análises fatoriais confirmatórias (AFC) e de tipo exploratórias realizadas no Mplus. A adequação de ajuste dos modelos foi aceita para valores de CFI, TLI maiores que 0,95 e de RMSEA abaixo de 0,06. Os índices de modificação indicaram uma alta correlação residual entre os itens 9 ('dificuldade para entender o que estava acontecendo') e o item 10 ('desorientação') que foi corroborada nas duas amostras por AFC e sugere redundância de conteúdo. Análises de escalabilidade utilizando H de Loevinger e a hipóstese de dupla monotonicidade indicaram boas propriedades escalares. A versão reduzida com exclusão do item 9 foi proposta para utilização em estudos epidemiológicos. O segundo artigo reportou o processo de desenvolvimento de um instrumento integrado para avaliar RP. A etapa qualitativa avaliou a validade de conteúdo de 36 itens, sendo 30 provenientes das principais escalas utilizadas para mensurar as três principais RP e mais 6 itens elaborados por especialistas. O conjunto de 34 itens resultantes do processo qualitativo teve sua estrutura configural e métrica avaliadas a partir de AFC e de tipo exploratória para as duas amostras no Mplus. Modelos com CFI e TLI acima de 0,95 e de RMSEA menores que 0,06 foram considerados com ajuste satisfatório. A versão proposta do PTRQ conta com 29 itens distribuídos nas três dimensões (DP, ITP e RFP) mostrou boa estrutura fatorial e métrica, sendo recomendado para uso em estudos epidemiológicos. Espera-se que os resultados desta tese contribuam para o refinamento do processo de mensuração das RP, necessário para se avançar o conhecimento sobre o seu papel no desenvolvimento do TEPT, assim como nas propostas de intervenção precoce em indivíduos sob maior risco de desenvolvimento desse transtorno mental
The role of reactions occurring in the course of traumatic experiences has been of interest in studies regarding the etiology and prognosis of the posttraumatic stress disorder (PTSD). This thesis evaluated the dimensional structure of the most used instrument for measuring peritraumatic dissociation (PD) - the Peritraumatic Dissociative Experience Questionnaire (PDEQ). Additionally, we developed and evaluated the psychometric properties of the instrument denominated Peritraumatic Reaction Questionnaire (PTRQ), proposed for evaluating the three main peritraumatic reactions (PR) in the context of PTSD: dissociation (PD), tonic immobility (TIP) and physical panic reaction (PPR). Data were obtained from a cross-sectional study developed between June 2007 and July 2008, including a representative sample of people aged 15 or more from the two largest Brazilian cities. A sample of 3,229 participants reported at least one traumatic event during their lifetime, 1,074 in Rio de Janeiro and 2,145 in São Paulo. The first article investigated the structural validity of the Brazilian version of the PDEQ. Principal component analyzes indicated the one-dimensional solution corroborated by confirmatory and exploratory factor analysis (CFA) performed in Mplus. The models were fit if CFI, TLI values greater than 0.95 and RMSEA values below 0.06. Modification indices indicated a high residual correlation between item 9 ('difficulty understanding what was happening') and item 10 ('disorientation') which was corroborated in both samples by AFC and suggests content redundancy. Scalability analyzes using Loevinger H and double monotonicity hypothesis indicated good scalar properties. The shortened version excluding item 9 has been proposed for use in epidemiological studies. The second article reported on the process of developing an integrated instrument to assess PR. The qualitative stage evaluated the content validity of 36 items, 30 of them from the main scales used to measure the three main PR and 6 more items prepared by experts. The set of 34 items resulting from the qualitative process had their configuration and metric structure evaluated from CFA and exploratory type for both samples in Mplus. Models with CFI and TLI above 0.95 and RMSEA less than 0.06 were considered with satisfactory fit. The proposed version of the PTRQ has 29 items distributed in the three dimensions (PD, ITP and RFP) presented good factorial and metric structure, and is recommended for use in epidemiological studies. We expect that the findings from this thesis may contribute to the refinement of PR measurement necessary to advance the knowledge about its role in PTSD development, as well as proposals for early intervention in individuals at higher risk of developing this mental disorder
Subject(s)
Humans , Psychometrics , Factor Analysis, Statistical , Panic Disorder , Immobility Response, Tonic , Dissociative Disorders , Psychological TraumaABSTRACT
O objetivo é caracterizar o Transtorno do Pânico (TP) com ênfase em seu diagnóstico e tratamento. O TP é um dos transtornos de ansiedade, caracterizado por ataques de pânico recorrentes acompanhados por uma persistente preocupação com ataques adicionais e alterações mal adaptativas do comportamento (Associação Americana de Psiquiatria - DSM-V). Sua etiologia ainda não é conhecida, mas deve envolver uma interação de fatores genéticos, de desenvolvimento e ambientais que resultam em altera- ções no funcionamento de algumas áreas cerebrais. O tratamento farmacológico de primeira escolha é com o uso de antidepressivos inibidores seletivos da recaptação de serotonina, os quais apresentam uma latência de 20 a 30 dias para o início do efeito. (AU)
The aim of this paper is to characterize the Panic Disorder (PD) with an emphasis on diagnosis and treatment. PD is one of the anxiety disorders, characterized by recurrent panic attacks accompanied by a persistent preoccupation with additional attacks and maladaptive behavioral changes (American Psychiatric Association DSM-V). Its etiology is not known, but should involve an interaction of genetic, developmental and environmental factors that result in changes in the functioning of some brain areas. The pharmacological treatment of choice is with the use of selective serotonin reuptake inhibitors, which has a latency of 20 for 30 days for the beginning of the therapeutic effect. (AU)
Subject(s)
Humans , Panic Disorder/diagnosis , Panic Disorder/therapy , Anxiety Disorders , Selective Serotonin Reuptake Inhibitors , Agoraphobia/diagnosisABSTRACT
Desde las observaciones de Quincke y Osler, que refirieron pacientes con una "tumefacción" diferente de las que provocaban habitualmente los mecanismos alérgicos hasta el descubrimiento de un nuevo mediador responsable de esos edemas dolorosos y deformantes, se han sucedido los aportes de los investigadores en el esclarecimiento de la patogenia y el tratamiento del AEH hasta la actualidad, en que el arsenal terapéutico se ve notablemente enriquecido por medicamentos altamente eficaces y específicos. Intentaremos describirlos. (AU)
From the observations of Quincke and Osler, who referred patients with a "swelling" different from those that usually provoked the allergic mechanisms until the discovery of a new mediator responsible for these painful and deforming edemas, have been the contributions of researchers in the Clarification of the pathogenesis and treatment of HAE to date, where the therapeutic arsenal is remarkably enriched by highly effective and specific drugs. We will try to describe them.(AU)
Subject(s)
Humans , Angioedemas, Hereditary/physiopathology , Angioedemas, Hereditary/drug therapy , Argentina , Pharmaceutical PreparationsABSTRACT
A pesar de que el angioedema hereditario es un padecimiento raro, tiene una amplia bibliografía que ratifica que la fisiopatología de esta enfermedad es compleja. La constante investigación de la industria farmacéutica no solo ha aportado nuevos recursos terapéuticos sino que ha logrado despertar un inusitado interés en la comunidad médica, permitiendo que tengamos una mayor comprensión sobre los mecanismos que presiden la aparición de las crisis. El Comité de Angioedema Hereditario de la AAAeIC ha desarrollado una puesta al día sobre esta entidad, que, por las características de sus síntomas, es abordada principalmente por los especialistas en alergia e inmunología clínica(AU)
Although hereditary angioedema is a rare condition, it has a large number of references that confirm that the pathophysiology of this disease is complex. The constant research of the pharmaceutical industry has not only brought new therapeutic resources, but also aroused an unusual interest in the medical community, allowing us to have a better understanding of the mechanisms that perform the onset of crises. The AAA e IC Hereditary Angioedema Committee has developed an update on this entity, which, due to the characteristics of its symptoms, is mainly addressed by specialists in allergy and clinical immunology.(AU)
Subject(s)
Humans , Female , Adult , Angioedemas, Hereditary/physiopathology , Angioedemas, Hereditary/genetics , Respiratory System , Skin , Bradykinin , Gastrointestinal Tract , Allergy and ImmunologyABSTRACT
Attacks by big cats on livestock are one of the major causes of human-felid conflicts and, therefore, an important factor in the conservation of these species. It has been argued that a reduction in natural prey abundance promotes attacks on domestic species, but few studies have tested this statement, and some have delivered contradictory results. We investigated whether the occurrence of attacks to livestock by jaguar and puma relates to the abundance and richness of their natural prey. In the rainy season 2009, we tracked potential prey species counting signs of presence along linear transects in 14 non-attacked cattle farms (control) and in 14 attacked cattle farms in NW Costa Rica. There was a negative relationship between the occurrence of attacks and both species richness (p=0.0014) and abundance (p=0.0012) of natural prey. Our results support the establishment of actions to promote support and recovery of natural prey, in order to diminish attacks on livestock, while maintaining jaguar and puma populations. Rev. Biol. Trop. 62 (4): 1459-1467. Epub 2014 December 01.
Los ataques de grandes felinos al ganado son una de las principales causas de conflicto entre humanos y felinos, siendo por ello un tema prioritario para la conservación de estas especies. Se ha argumentado que la reducción en abundancia de presas naturales incrementa la ocurrencia de ataques a las especies domésticas. Sin embargo son pocos los estudios que han evaluado esta afirmación, algunos con resultados contradictorios. Nosotros investigamos cómo la ocurrencia de ataques al ganado, por parte de puma o jaguar, se relaciona con la abundancia y la riqueza de sus presas naturales. Muestreamos las presas potenciales contando los rastros de presencia a lo largo de transectos lineales en 14 fincas sin ataques (control) y en 14 fincas con ataques en el Noroeste de Costa Rica durante la temporada lluviosa de 2009. Encontramos una relación negativa entre la ocurrencia de ataques al ganado y la riqueza (p=0.0014) y abundancia (p=0.0012) de presas naturales. Nuestros resultados respaldan la aplicación de medidas que promuevan el mantenimiento y recuperación de las presas naturales como medida para reducir los ataques al ganado y conservar las poblaciones de puma y jaguar.
Subject(s)
Animals , Cattle , Panthera/physiology , Predatory Behavior/physiology , Puma/physiology , Costa Rica , Population DensityABSTRACT
Se presenta el caso clínico de un paciente a quien la caída de un coco y el consecuente traumatismo sobre su cara. produjo una fractura del piso orbitario con atrapamiento muscular, diplopía no diagnosticada y confundida con un aneurisma cerebral. Se hacen consideraciones sobre este tipo de accidentes en playas arenosas donde abundan cocoteros. La comparación de su frecuencia con ataques de tiburón y acerca de cómo un artículo médico puede ser tergiversado por el autor y convertido en noticia de prensa como para obtener el Ig Premio Nobel de Medicina con base a "una investigación que no puede o no debe ser duplicada" logros que primero hacen reir y después pensar e intertan celebrar lo inusual, imaginativo y espolear el interés por la ciencia, la medicina y la tecnología
We present the clinical case of a patient who, after being hit the face by a falling coconut, with consequent trauma to his face, fractured his orbital floor with muscle entrapment and undiagnosed diplopia which was mistaken for a brain aneurysm. We make considerations about such accidents on sandy beaches where coconut trees abound, compare its frequency with shark attacks and discuss how a medical article can be misrepresented by its autor and become news in order to obtain the nomination for the Ig Nobel Prize for medicine based on "research that cannot or should not be duplicated; achievements that first make you laugh and then make you and try to celebrate the unusual, imaginative and spur interest in science, medicine and technology
Subject(s)
Aged , Diplopia/etiology , Enophthalmos/etiology , Facial Bones/injuries , Cocos/ultrastructure , Orbital Fractures/complications , Tomography/methodsABSTRACT
Discute-se a dimensão paradoxal e o sentido intersubjetivo dos comportamentos suicidas e de risco no adolescente. O corpo adolescente é, muitas vezes, objeto de sofrimento intenso. Trata-se de lutar contra tensões que se lhes colam à pele. Esses vividos estão ligados a múltiplas fontes traumáticas reveladas pela efração pubertária. Formula-se também a hipótese de que esses ataques corporais estejam ligados a mecanismos paradoxais, porque se são indicadores tanto de desafios pulsionais quanto da fragilização dos laços intersubjetivos, podem também revelar-se como sinal de reconstrução dos envoltórios, evidenciando trabalho de intersubjetividade em ação entre o adolescente e seus grupos de referência.
We wish to discuss the paradoxical dimension and the intersubjective sense of the suicidal and risky behaviors of adolescents. The adolescent body is often an object of intense sufering. It's about fighting the tensions that stick to their skin. Such experiences are linked to many traumatic sources revealed by pubertal breaking in. We also hypothesize that these bodily attacks are linked to paradoxical mechanisms, for if they are evidence both of drive challenges and of the enfeeblement of intersubjective bonds, they are likely to reveal themselves as a sign of reconstruction of the envelopes evidencing intersubjectivity at work between the adolescent and their reference groups.
Subject(s)
Adolescent , Self-Injurious Behavior , Stress, PsychologicalABSTRACT
In recent years, attacks by piranhas have become a common problem in dammed portions of rivers and streams in the State of Sao Paulo, Southeastern Brazil. In two outbreaks recorded in two neighboring counties in the Northwest region of the state, 74 bathers were bitten. Only one bite per person was recorded during a short period of the year. The bites were related to parental care and/or defense of spawning territory, which confirms previous studies and demystify the attacks by these legendary fish, as they are perceived by most people. Placement of fine mesh nets and removal of aquatic vegetation stopped the attacks.
Ataques por piranhas vêm se tornando um problema comum em trechos represados de rios e córregos no estado de São Paulo, Sudeste do Brasil. Em dois surtos ocorridos em dois municípios vizinhos no noroeste do estado, 74 banhistas foram mordidos. Uma mordida por pessoa foi registrada, em curto período do ano. As mordidas estão relacionadas a cuidado parental e/ou defesa do território de desova, o que reforça estudos anteriores e desmistifica os ataques por este peixe lendário, da maneira como são popularmente percebidos. A colocação de redes de malha fina e a remoção de vegetação aquática cessaram os ataques.
Subject(s)
Animals , Female , Humans , Male , Bites and Stings/epidemiology , Fishes , Brazil/epidemiology , Fresh Water , Fishes/classification , Incidence , RecreationABSTRACT
El angioedema hereditario (AEH) es una enfermedad rara, autosómica dominante, caracterizada por episodios de angioedema que comprometen la piel, el tracto gastrointestinal y la laringe. Analizamos las características epidemiológicas y clínicas en una serie de 58 pacientes, 53 (91%) con diagnóstico de AEH tipo I y 5 (9%) con tipo II. La edad media al inicio fue de 10.8 ± 9.5 años (0.1 a 59) y de 25.8 ± 16.2 años (2 a 77) en el momento del diagnóstico, con un retraso diagnóstico de 15.3 ± 14.3 años. El promedio de ataques en los 6 meses previos a la consulta fue de 7.4 ± 7.6 (0 a 40). Cincuenta y cuatro (93%) presentaron ataques cutáneos, 50 (86%) abdominales, 24 (41%) laríngeos y 24 (41%) cutáneos y abdominales combinados. Veintisiete (46.5%) nunca utilizaron medicación preventiva para la enfermedad y 17 (29%) recibieron danazol en diferentes dosis por diferentes periodos de tiempo. Durante los ataques, 15 (26%) pacientes recibieron C1 inhibidor endovenoso alguna vez, 7 (12%) recibieron plasma fresco y 40 (69%) tratamiento sintomático. Ansiedad o situaciones de estrés y traumatismos fueron los desencadenantes más frecuentes. Identificamos a 6 (10%) pacientes como primera mutación y a 52 (90%) con historia familiar previa. Analizamos 20 troncos familiares identificando 205 individuos en riesgo de heredar la enfermedad, 109 (53%) de ellos con síntomas o diagnóstico AEH. El total de individuos con síntomas de AEH fue de 145, de los cuales 19 (13%) murieron por asfixia. Disminuir el retraso diagnóstico y ofrecer una terapéutica adecuada son desafíos a afrontar en el AEH.
Hereditary angioedema (HAE) is a rare autosomal dominant disease, characterized by episodes of edema typically involving the skin, gastrointestinal tract and larynx. We here describe the epidemiologic and clinical characteristic of a series of 58 patients with diagnosis of HAE, 53 (91%) type I and 5 (9%) type II. The mean age at first symptom was 10.8 ± 9.5 years and the mean age at diagnosis was 25.8 ± 16.2 years old, with a diagnosis delay of 15.3 ± 14.3 years. The mean number of attacks in the previous 6 months was 7.4 ± 7.6 range 0 to 40. Fifty four (93%) had cutaneous attacks, 50 (86%) abdominal attacks, 24 (41%) laryngeal attacks and 24 (41%) combined cutaneous and abdominal attacks. Twenty seven (46.5%) patients never received preventive treatments and 17 (29%) received danazol in different doses for different periods of time. During the attacks, 15 (26%) patients were treated with C1 inhibitor at least once, 7 (12%) with fresh frozen plasma and 40 (69%) received only supportive treatment. Stress and trauma were identified as attacks triggers. Six (10%) patients were first mutation and 52 (90%) had HAE ancestors. We reconstructed 20 kindred, identifying 205 individuals at risk of inheriting the disease, 109 (53 %) of them had signs or laboratory diagnosis of HAE. The total number of identified HAE individuals was 145, 19 (13%) died with asphyxia. So, shortening of diagnosis delay and appropriate treatment of HAE are a challenge to be fulfilled.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Hereditary Angioedema Types I and II , Age of Onset , Argentina/epidemiology , Asphyxia/mortality , Complement C1 Inhibitor Protein/genetics , Hereditary Angioedema Types I and II/complications , Hereditary Angioedema Types I and II/drug therapy , Hereditary Angioedema Types I and II/epidemiology , Hereditary Angioedema Types I and II/geneticsABSTRACT
Diaemus youngi é um morcego hematófago obrigatório que se alimenta preferencialmente do sangue de aves. Este morcego é considerado o menos freqüente entre as três espécies hematófagas ao longo de toda a sua distribuição geográfica. Entre 2000 e 2006, foram realizadas campanhas para a captura de morcegos hematófagos em sete localidades do Estado do Rio de Janeiro, onde ataques a aves haviam sido reportadas por proprietários de terra. Morcegos foram capturados em redes de neblina abertas durante duas ou três noites em cada localidade, geralmente próximas às aves atacadas. Um total de oito espécimes de D. youngi foi coletado nas sete localidades estudadas, e dois registros feitos por outros pesquisadores em outras duas localidades foram confirmados para o Estado do Rio de Janeiro. Diaemus youngi prefere, aparentemente, restringir seus ataques a aves domésticas e selvagens que apresentam o comportamento de se empoleirar. Esta espécie de morcego pode apresentar abundância e área de distribuição maiores do que as aqui descritas, a julgar pelo número de relatos de ataques em criatórios comerciais de aves ornamentais que criam animais em regime de semi-liberdade no Sudeste do Brasil.
Diaemus youngi is a vampire bat that feeds preferentially on bird blood. This bat is considered as the least frequent among the three hematofagous species throughout its geographical distribution. From 2000 to 2006, surveys for vampire control were carried out in seven localities from the State of Rio de Janeiro where attacks to birds were reported by land owners. Bats were captured in mist nets opened during two or three nights in each locality, usually in the vicinity of attacked birds. A total of eight specimens of D. youngi were collected in the seven studied localities and two records from two other localities made by other researchers were confirmed for the State of Rio de Janeiro. Apparently, D. youngi prefers to prey on domestic and wild birds that rest on high perches. This bat species may present higher abundance and larger distribution range those described here, judging by the number of reports of attacks in commercial houses of ornamental birds that raise animals in semi-freedom in Southeastern Brazil.
Subject(s)
Feeding Behavior/classification , Fauna , Ecosystem/analysis , Ecosystem/classification , Ecosystem/adverse effects , Chiroptera/classification , Chiroptera/growth & developmentABSTRACT
This article aims to describe important points in the history of panic disorder concept, as well as to highlight the importance of its diagnosis for clinical and research developments. Panic disorder has been described in several literary reports and folklore. One of the oldest examples lies in Greek mythology - the god Pan, responsable for the term panic. The first half of the 19th century witnessed the culmination of medical approach. During the second half of the 19th century came the psychological approach of anxiety. The 20th century associated panic disorder to hereditary, organic and psychological factors, dividing anxiety into simple and phobic anxious states. Therapeutic development was also observed in psychopharmacological and psychotherapeutic fields. Official classification began to include panic disorder as a category since the third edition of the American Classification Manual (1980). Some biological theories dealing with etiology were widely discussed during the last decades of the 20th century. They were based on laboratory studies of physiological, cognitive and biochemical tests, as the false suffocation alarm theory and the fear network. Such theories were important in creating new diagnostic paradigms to modern psychiatry. That suggests the need to consider a wide range of historical variables to understand how particular features for panic disorder diagnosis have been developed and how treatment has emerged.