A dimensão viva da experiência de supervisão didática / The living dimension of the didactic supervision experience / La dimensión viva de la experiencia de supervisión didáctica / La dimension vivante de l'expérience de supervision didactique

As autoras abordam uma experiência de supervisão, para fins de formação analítica, em um instituto de psicanálise, desenvolvida pela analista e pela supervisora implicadas na tarefa. Partindo de uma retrospectiva histórica da supervisão no tripé da formação psicanalítica, propõem uma reflexão sobre seu lugar e sua importância no exercício do vir a ser analista. O estudo leva as autoras a acreditarem que, assim como a própria análise é uma tarefa interminável, as forças intrapsíquicas que estão permanentemente em jogo no encontro do analista com o paciente geram uma demanda que convoca o diálogo na supervisão, o qual parece conter o paradoxo do descobrimento sem colonização. Em conclusão, entendem que, ao mesmo tempo que a tarefa da supervisão promove novos significados, ela não deve se tornar um exercício de doutrinamento.

supervisão didática

formação psicanalítica

história da supervisão

descobrimento sem colonização

This paper regards a supervisory experience for analytical specialization purposes in an Institute of Psychoanalysis, developed by the analyst and supervisor involved in the task. The authors, based on an analysis of the historical dimension of supervision on the tripod of psychoanalytic training, propose a reflection on the supervision's role in the process of becoming an analyst. The study leads the authors to believe that, just as the analysis itself is an endless task, the intrapsychic forces that are permanently at stake in the encounter of the analyst with the patient generate a demand that calls for the dialogue in the supervision, which seems to contain the paradox of discovery without colonization. In conclusion, the authors consider that, while the task of supervision promotes new meanings, it should not become an exercise of indoctrination.

El trabajo trata de una experiencia de supervisión, con fines de formación analítica en un Instituto de Psicoanálisis, desarrollada por el analista y el supervisor involucrado en la tarea. Los autores, partiendo de una retrospectiva histórica de la supervisión sobre el trípode de la formación psicoanalítica, proponen una reflexión sobre su lugar e importancia en el ejercicio de convertirse en analista. El estudio lleva a los autores a creer que, así como el análisis en sí es una tarea sin fin, las fuerzas intrapsíquicas que están permanentemente en juego en el encuentro del analista con el paciente generan una demanda que llama al diálogo en la supervisión, que parece contener la paradoja de descubrimiento sin colonización. En conclusión, se entiende que, si bien la tarea de supervisión promueve nuevos significados, no debe convertirse en un ejercicio de adoctrinamiento.

L'article aborde une expérience de supervision, à des fins de la formation analytique dans un Institut de Psychanalyse, développée par une analyste et une superviseuse qui sont impliquées dans la tâche. Les autrices, à partir d'une rétrospective historique de la supervision sur le trépied de la formation psychanalytique, proposent une réflexion sur leur place et leur importance dans l'exercice de devenir analyste. L'étude conduit les autrices à croire que, de la même manière que l'analyse elle-même est une tâche sans fin, les forces intrapsychiques, qui sont en permanence en jeu dans la rencontre de l'analyste avec le patient, génèrent une demande qui appelle au dialogue dans la supervision, lequel semble contenir le paradoxe de la découverte sans colonisation. En conclusion, on comprend que, lors même que la supervision promeuve de nouvelles significations, elle ne doive pas devenir un exercice d'endoctrinement.

Épidémiologie des candidoses systémiques dans les services à haut risque au CHU et au centre anti cancer de Batna ­Algérie / Epidemiology of systemic candidiasis in high-risk departments at the university hospital and cancer center of Batna -Algeria

Introduction : Les candidoses systémiques sont des affections graves responsables d'une mortalité élevée. L'objectif de ce travail est de décrire l'épidémiologie des candidoses systémiques dans les services à haut risque au CHU et au CAC de BATNA. Patients et méthodes : Il s'agit d'une étude prospective descriptive durant une période de trois ans (1er janvier 2016 au 31 décembre 2018). Les patients inclus sont ceux ayant au moins un prélèvement profond positif á Candida spp. Résultats : Un total de 69 cas de candidoses systémiques correspondant à 75 isolats et concernant 63 patients a pu être analysé. L'incidence globale était de 2,62 cas pour 1000 admissions. Les principaux motifs d'hospitalisation étaient les hémopathies malignes et le choc septique. La présence d'une colonisation ( 2 sites), une antibiothérapie á large spectre, d'un cathéter intra vasculaire, une corticothérapie, une chimiothérapie, une neutropénie étaient les facteurs de risque les plus retrouvés. L'analyse des souches isolées a montré la prédominance des espèces non albicans. L'index de colonisation ≥ 0,5 a été significativement associé au risque de candidose systémique. L'utilisation des Azolés a été associée á un taux de mortalité le plus élevé (19%). Le taux de mortalité est significativement élevé 51%. Conclusion : Les facteurs de risque et un index de colonisation ≥ 0,5 dans les services á haut risque constituent un facteur prédictif de candidose systémique. La prise en charge thérapeutique doit être instaurée pour réduire le taux de mortalité et éviter les complications liées á ces infections.

Background: Systemic candidiasis are serious conditions responsible for high mortality. The objective of this work is to describe the epidemiology of systemic candidiasis in high-risk departments at the UHC and the ACC of BATNA. Patients and methods: This is a descriptive prospective study over a period of three years (January 1, 2016 to December 31, 2018). The patients included are those with at least one positive deep sample for Candida spp. Results: 69 cases of systemic candidiasis corresponding to 75 isolates and concerning 63 patients could be analyzed. The overall incidence was 2.62 cases per 1,000 admissions. The main reasons for hospitalization were hematologic malignancies and septic shock. The presence of colonization ( 2 sites), broad-spectrum antibiotic therapy, an intravascular catheter, corticosteroid therapy, chemotherapy, neutropenia were the most common risk factors. Analysis of the isolated strains showed the predominance of nonalbicans species. Colonization index ≥ 0.5 was significantly associated with the risk of systemic candidiasis. Azole's use was associated with the highest mortality rate (19%). The mortality rate is significantly high 51%. Conclusion. Risk factors and a colonization index ≥ 0.5 in high-risk wards are a predictor of systemic candidiasis. Therapeutic care must be instituted to reduce the mortality rate and avoid complications linked to these infections

¿Colonización de subjetividades en el sub-desarrollo? / Colonization of subjectivities in sub-development? / Colonização de subjetividades em subdesenvolvimento? / ¿Colonisation des subjectivités dans le sous-développement?

Nuestros países presentan singularidades contradictorias y complejas que devienen en un conjunto de enfoques y acciones hacia la modernidad en la invención del sujeto llamado Ciudadano. Esa construcción simbólica del sujeto, produce subjetividades que hacen a la institucionalización de ciertas prácticas sociales, políticas, culturales. El ciudadano se definió en lógicas heterónomas que lo constituyen como tal y, en ese sentido, construir gobernabilidad ha sido un constante problema de nuestras sociedades, transitando procesos no siempre dialécticos entre la búsqueda casi frenética por el progreso y el desarrollo, con un desprendimiento del pasado identificado con el atraso y la barbarie. Pretendemos en este trabajo reflexionar sobre esa idea de desarrollo, sus implicaciones para la Independencia dependiente y las producciones de subjetividad colonizadas, desde conceptos sustantivos de la Psicología de la Liberación de Martín-Baró como la naturalización y la ideologización.

Our countries have become singularities as a set of approaches and actions towards modernity contradictory and complex in the invention of the subject called “Citizen”. We think that this symbolic construction of the subject, produces specific subjectivities that make the institutionalization of social practices, political, cultural. The “citizen” was defined in heteronomous logics that constitute as such and, in that sense, build governance has been a problem in our societies dialectical processes are not always traveling between almost frantic search for “progress” and “development” with detachment of the past, identified with backwardness and “barbarism”. We aim in this work reflect on the idea of development, its implications for Independence Productions dependent and colonized subjectivity, from substantive concepts of the Psychology of Liberation of Martín-Baró as naturalization and ideologization.

Nossos países apresentam singularidades contraditórias e complexas que se tornam um conjunto de abordagens e ações em direção à modernidade na invenção do sujeito chamado Cidadão. Essa construção simbólica do sujeito produz subjetividades que fazem a institucionalização de certas práticas sociais, políticas e culturais.O "cidadão" foi definido em lógicas heteronomas que constituem, como tal, e, nesse sentido, a construção de uma governação tem sido um problema em nossas sociedades, em trânsito de processos não sempre dialéticos, viajando entre a busca quase frenética de "progresso" e "desenvolvimento" com desapego do passado, identificado com atraso e "barbárie". Nosso objetivo neste trabalho e refletir sobre a idéia de desenvolvimento, suas implicações para a independência dependente e as produções de subjetividades colonizadas, a partir de conceitos substantivos da Psicologia da Libertação de Martín-Baró como naturalização e ideologização.

Nos pays présentent des singularités complexes et contradictoires qui deviennent un ensemble d'approches et d'actions vers la modernité dans l'invention du sujet appelé Citizen. Cette construction symbolique du sujet produit des subjectivités que font-ils a l'institutionnalisation de certaines pratiques sociales, politiques et culturelles. Le citoyen s'est défini dans des logiques hétéronomes qui le constituent en tant que tel et, en ce sens, la construction de la gouvernance a été un problème constant de nos sociétés, en transit processus pas toujours dialectiques entre la recherche presque frénétique du progrès et le développement, avec un détachement du passé, identifié avec le retard et la barbarie. Dans cet article, nous avons l'intention de réfléchir à cette idée de développement, à ses implications pour les productions d'indépendance-dépendante et de subjectivité colonisée, à partir des concepts de fond de la psychologie de la libération de Martín-Baró comme la naturalisation et l' idéologisation.

A study of the prevalence of group B streptococci in the third trimester of pregnancy

Background: Group B Streptococci (GBS) is an important cause of early onset neonatal sepsis and the maternal colonization of this organism is a key factor in the occurrence of GBS associated morbidity and mortality in the newborns. Timely recognition of its presence in the genital tract of a pregnant women and intrapartum antibiotic prophylaxis can significantly bring down the burden of the disease in neonates. A cross sectional study was conducted on  antenatal women during 35-37weeks of gestation to evaluate the prevalence of Group B Streptococci in third trimester of pregnancy and explore the feasibility of including GBS screening in the routine antenatal investigation protocol.Methods: 200 antenatal women satisfying the exclusion/inclusion criteria were recruited for the study. Vaginal and perianal swabs were collected using sterile swab sticks and inoculated using the specified media. Beta hemolysis and typical colonies were looked for under microscope. Positive cases were subjected to intrapartum antibiotic prophylaxis and the neonates were observed for 72 hours to look for any signs of sepsis.Results: It was found that 2% of the women screened were positive for GBS .While none of the newborns of the 4 positive cases showed any signs of sepsis.Conclusions: Prophylactic intrapartum prophylaxis against GBS has shown to decrease the chances of neonatal sepsis but more detailed and robust studies are required before incorporating routine screening in our antenatal care system.

To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre

Background: Surgical site infection is a common cause of morbidity for the operated patients. Hence a cost effective and simple method was formulated and studied on cases of laparotomy and appendicectomy patients which can be categorized as dirty and contaminated wounds. Materials and methods: 25 cases and adequately matched controls were selected from patients who underwent laparotomy or appendicectomy which can be categorized as dirty or contaminated wounds. Cases were given local application Inj. Amikacin over the subcutaneous plane preoperatively and for the subsequent three post-operative days through a subcutaneously placed feeding tube along with systemic iv antibiotics. The control patients only received systemic IV antibiotics. ASEPSIS scoring was used to grade the post-operative surgical site infection in the cases and the corresponding controls, at the end of the first and second week after surgery. Various criterions were specifically evaluated such as the isolation of microbe from the wound site or the requirement of change of antibiotic at the end of the 1st or 2nd week and the tendency of prolonged stay in the hospital for more than 2 weeks. Results: It was observed that the cases that received the local Amikacin application as an adjuvant to systemic antibiotic showed significantly lesser incidence and/ or grading of SSIs in the first week and A.K. Rajendran, C. Arun Babu, Gnana Sezhian. To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre. IAIM, 2018; 5(2): 64-71. Page 65 also lesser, but not statistically significant reduction of SSIs in the second week. The incidence of antibiotic change, hospital stay and isolation of microbe from the wound site was statistically found be to lesser in the study group compared to their controls. Conclusion: It is observed that the local therapy as an adjuvant is cost effective and without any significant local or systemic adverse effects in the prevention of SSIs in dirty and contaminated patients. But it was also observed that it did not have sustained effect for prolonged period beyond its time of administration (as evidenced by its lesser effect in the second week after surgery). It may be suggested that a further combination of suction drainage of the subcutaneous DT along with local antibiotic treatment may have added advantage in further preventing SSIs.

Contribution of flagella and motility to gut colonisation and pathogenicity of Salmonella Enteritidis in the chicken

ABSTRACT Salmonella Enteritidis causes fowl paratyphoid in poultry and is frequently associated to outbreaks of food-borne diseases in humans. The role of flagella and flagella-mediated motility into host-pathogen interplay is not fully understood and requires further investigation. In this study, one-day-old chickens were challenged orally with a wild-type strain Salmonella Enteritidis, a non-motile but fully flagellated (SE ΔmotB) or non-flagellated (SE ΔfliC) strain to evaluate their ability to colonise the intestine and spread systemically and also of eliciting gross and histopathological changes. SE ΔmotB and SE ΔfliC were recovered in significantly lower numbers from caecal contents in comparison with Salmonella Enteritidis at early stages of infection (3 and 5 dpi). The SE ΔmotB strain, which synthesises paralysed flagella, showed poorer intestinal colonisation ability than the non-flagellated SE ΔfliC. Histopathological analyses demonstrated that the flagellated strains induced more intense lymphoid reactivity in liver, ileum and caeca. Thus, in the present study the flagellar structure and motility seemed to play a role in the early stages of the intestinal colonisation by Salmonella Enteritidis in the chicken.

Genotyping and serotyping of macrolide and multidrug resistant Streptococcus pneumoniae isolated from carrier children.

Aims: Streptococcus pneumoniae, an opportunistic pathogen commonly carried asymptomatically in the nasopharynx of children, is associated with increasing rates of treatment failures due to a worldwide increase in drug resistance. We investigated the carriage of S. pneumoniae in children 5 years or younger, the identity of prevalent serotypes, the rates of resistance to macrolides and other antimicrobial agents and the genotypes responsible for macrolide resistance. Materials and Methods: Nasopharyngeal swabs were collected from 157 children under 5 years for cultural isolation of S. pneumoniae. Antibiogram of isolates was determined using the disk diffusion test, and the minimal inhibitory concentration to macrolides was determined using the E‑test. Isolate serotypes and macrolide resistance genes, erm(B) and mef(E), were identified using multiplex polymerase chain reactions. Results: S. pneumoniae was recovered from 33.8% of children; 41.9% among males and 21.9% among females (P = 0.009). The highest carriage rate occurred among age groups 7–12 months and 49–60 months. Most frequent serotypes were 19F, 6A/B, 11A, 19A, 14 and 15B/C. Resistance to macrolides was 60.4%. Resistance to oxacillin, trimethoprim/ sulfamethoxazole and clindamycin was present among 90.6%, 54.7% and 32.1% of isolates, respectively. All isolates were susceptible to chloramphenicol, levofloxacin and vancomycin. Isolates resistant to one or more macrolide drugs were more likely to be multidrug resistant. Resistance to clindamycin or oxacillin coexisted with macrolide resistance. Among the erythromycin‑resistant isolates, erm(B), mef(E) and erm(B) and mef(E) genes were present at rates of 43.8%, 37.5% and 6.3%, respectively. Erm(B) and mef(E) were associated with very high level and moderate‑to‑high level resistance to macrolides, respectively. Conclusion: A significant proportion of children harboured macrolide and multidrug‑resistant S. pneumoniae.

Staphylococcus aureus carriage in selected kindergartens in Klang Valley

Introduction: Nasal colonisation of S. aureus in healthy children was 18% to 30%. One to three percent of them were colonised by Methicillin-resistant Staphlycoccus aureus (MRSA). Although MRSA infection has become increasingly reported, population-based S. aureus and MRSA colonisation estimates are lacking. The main objective of this study was to determine the prevalence of S. aureus carriage among children. Methods: Nasal samples for S. aureus culture were obtained from 250 children from three kindergartens in the Klang Valley, after consent was obtained from the children and their parents. Swabs were transported in Stuart medium, and inoculated on mannitol-salt agar within four hours of collection. Identification and disk diffusion test were done according to guidelines. Polymerase chain reaction was done on MRSA isolates for the presence of mecA and lukS/FPV genes. Results: Overall prevalence of S. aureus and MRSA carriage were 19.2% (48/250) and 1.6% (4/250) respectively. mecA gene was present in all isolates, 50% isolates carried Panton-Valentine leucocidin (PVL) gene. Sccmec type I was found in 2 isolates and the remaining isolates has Sccmec type V. Conclusion: The prevalence of S. aureus and MRSA carriage were similar to other studies. However, risk of contracting severe infection might be higher due to presence of PVL gene in half of the MRSA isolates.

Prevention of perinatal group B streptococcal infections: A review with an Indian perspective.

Group B Streptococcus (GBS) is an important cause of maternal and neonatal morbidity and mortality in many parts of the world. Asymptomatic colonisation of the vagina and rectum with Group B streptococci is common in pregnancy. Maternal colonisation of GBS can vary depending on ethnicity and geographical distribution. Vertical transmission of this organism from mother to foetus may lead to neonatal GBS disease. Intra-partum use of antibiotics in these women has led to a decrease in the rate of early onset but not late onset GBS disease. Identifi cation of women with GBS is the key factor in the prevention of perinatal GBS disease. There are different screening strategies available to identify women at risk of perinatal GBS disease. Clinicians continue to face the challenge of choosing between preventive strategies to reduce the impact of perinatal GBS disease. Controversy exists regarding the ideal preventive strategy. In India, the mortality and morbidity associated with the GBS disease remains largely a under-recognised problem. This comprehensive review summarises the salient features of GBS disease and discusses the epidemiology, risk factors, screening strategies, intra-partum antibiotic prophylaxis with an Indian perspective and how it compares with the Western nations.

The persistence of multifocal colonisation by a single ABC genotype of Candida albicans may predict the transition from commensalism to infection

Candida albicans is a common member of the human microbiota and may cause invasive disease in susceptible populations. Several risk factors have been proposed for candidaemia acquisition. Previous Candida multifocal colonisation among hospitalised patients may be crucial for the successful establishment of candidaemia. Nevertheless, it is still not clear whether the persistence or replacement of a single clone of C. albicans in multiple anatomical sites of the organism may represent an additional risk for candidaemia acquisition. Therefore, we prospectively evaluated the dynamics of the colonising strains of C. albicans for two groups of seven critically ill patients: group I included patients colonised by C. albicans in multiple sites who did not develop candidaemia and group II included patients who were colonised and who developed candidaemia. ABC and microsatellite genotyping of 51 strains of C. albicans revealed that patients who did not develop candidaemia were multiply colonised by at least two ABC genotypes of C. albicans, whereas candidaemic patients had highly related microsatellites and the same ABC genotype in colonising and bloodstream isolates that were probably present in different body sites before the onset of candidaemia.

Spatial patterns of a tropical tree species growing under an eucalyptus plantation in South-East Brazil / Padrões espaciais de uma espécie arbórea tropical crescendo sob o dossel de um plantio de eucalipto no Sudeste brasileiro

The objectives of this study were to evaluate the influence of propagules source and the implication of tree size class on the spatial pattern of Xylopia brasiliensis Spreng. individuals growing under the canopy of an experimental plantation of eucalyptus. To this end, all individuals of Xylopia brasiliensis with diameter at soil height (dsh) > 1 cm were mapped in the understory of a 3.16 ha Eucalyptus spp. and Corymbia spp. plantation, located in the municipality of Lavras, SE Brazil. The largest nearby mature tree of X. brasiliensis was considered as the propagules source. Linear regressions were used to assess the influence of the distance of propagules source on the population parameters (density, basal area and height). The spatial pattern of trees was assessed through the Ripley K function. The overall pattern showed that the propagules source distance had strong influence over spatial distribution of trees, mainly the small ones, indicating that the closer the distance from the propagules source, the higher the tree density and the lower the mean tree height. The population showed different spatial distribution patterns according to the spatial scale and diameter class considered. While small trees tended to be aggregated up to around 80 m, the largest individuals were randomly distributed in the area. A plausible explanation for observed patterns might be limited seed rain and intra-population competition.

Os objetivos deste estudo foram avaliar a influência da fonte de propágulo e a implicação de diferentes classes de tamanho sobre o padrão de distribuição espacial de indivíduos de Xylopia brasiliensis Spreng. crescendo sob o dossel de um plantio experimental de eucalipto. Para isso, todos os indivíduos de X. brasiliensis com diâmetro à altura do solo (das) > 1 cm foram mapeados em uma área de 3,16 ha no sub-bosque de um plantio de Eucalyptus ssp. e Corymbia spp., localizado no município de Lavras, MG. O maior e mais próximo indivíduo reprodutivo de X. brasiliensis foi considerado como fonte de propágulos. Foram utilizadas regressões lineares para avaliar a influência da fonte de propágulos sobre parâmetro populacionais (densidade, área basal e altura). O padrão de distribuição espacial das árvores foi avaliado por meio da função K de Ripley. O padrão geral demonstrou que a distância da fonte de propágulo teve forte influência sobre a distribuição espacial das árvores, principalmente as menores, indicando que quanto mais próximo à fonte de propágulos, maior a densidade e menor a altura das árvores. A população demonstrou diferentes distribuições espaciais de acordo com a escala analisada. Enquanto árvores menores tenderam a estar agregadas até uma escala de 80 m, os maiores indivíduos estavam aleatoriamente distribuídos na área. Uma explicação plausível para os padrões observados poderia ser a limitação espacial da chuva de sementes e a competição intraespecífica.

Characterisation of methicillin resistant S. aureus strains and risk factors for acquisition in a teaching hospital in northeast India.

Purpose: A point prevalence study was carried out in a teaching hospital in Assam to characterise S. aureus strains, establish the rate of colonisation of methicillin resistant S. aureus (MRSA) and associated risk factors for its acquisition. Materials and Methods: Antibiogram-Resistogram profile was done by BSAC standardized disc sensitivity method; Phage and RFLP typing were carried out by the PHLS, London. Results: Single MRSA strain resistant to multiple classes of anti-staphylococcal antibiotics dominated the hospital. The MRSA colonisation rate was found to be 34% (n=29) and 18% (n=80) in orthopaedics and surgery, respectively and only ~1% (n=73) in the medical units. Exposure to ciprofloxacin and surgery were risk factors but duration of hospital stay was not. In contrast, meticillin sensitive S. aureus (MSSA) strains were usually distinct strains and sensitive to most of the anti-staphylococcal antibiotics including 18% to penicillin. Conclusions: The MRSA strain prevalent in the hospital phenotypically resembles the predominant Asian strain viz., Brazilian/Hungarian strains (CC8-MRSA-III). Duration was not a risk factor, which suggests that in absence of exposure to specific antimicrobials, even in a hospital with no or little infection control intervention, a vast majority remain free from MRSA. This underlines the importance of rational prescribing empirical antibiotics.