Evaluation of BDNF levels in patients hospitalized for physical trauma at an emergency hospital in Porto Alegre, southern Brazil / Avaliação dos níveis de BDNF em pacientes hospitalizados por trauma físico em um hospital de emergência de Porto Alegre, sul do Brasil

Abstract Objective To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. Methods Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. Results We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). Conclusions The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.

Resumo Objetivo Verificar a associação entre os níveis de fator neurotrófico derivado do cérebro (brain-derived neurotrophic factor [BDNF]) e transtorno de estresse agudo (TEA) em pacientes que sofreram trauma físico. Métodos Os dados foram coletados em um hospital de emergência de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes eram maiores de 18 anos, vítimas de trauma físico e estavam hospitalizados por um período mínimo de 48 horas. Um total de 117 pacientes hospitalizados que concordaram em participar da pesquisa foram agrupados de acordo com o turno de realização da coleta de sangue (38 sujeitos no turno da manhã e 79 sujeitos no turno da tarde), tiveram seus níveis de BDNF medidos e responderam a outros questionários. Os entrevistados também foram agrupados por idade em três faixas etárias: 18-30, 31-50 e 51-70 anos. Resultados Encontramos uma diferença significativa na distribuição de BDNF entre os turnos, sendo que o grupo da tarde apresentou níveis maiores de BDNF (U = 1906,5, p = 0,018). Houve diferença entre o grupo de 18-30 anos e o de 51-70 anos no turno da tarde (Umanhã = 1107, pmanhã = 0,575; Utarde = 7175, ptarde = 0,028). Conclusões A população cuja coleta ocorreu à tarde apresentou valores significativamente maiores de BDNF em relação à coleta do turno da manhã. Esta mesma população apresentou menores níveis dessa neurotrofina quando associada com os subtipos A1, A2 e A de TEA. É possível hipotetizar que os menores valores de BDNF aferidos na coleta do turno da manhã se devam a uma resposta ao ciclo circadiano do cortisol, cuja ação inibe a expressão de neurotrofinas séricas.

Traditional Healing – At What Cost ?: A Case Report from Rural India

In rural parts of India still the “magico-religious beliefs” regarding the occurrence of the psychiatric disordersand “magico-religious treatments” of the psychiatric disorders often seen and prevail. Such beliefs andtreatments many times lead to physical as well as psychological trauma to an individual suffering from anypsychiatric disorder and may lead to delay in seeking an appropriate professional help in time. The presentcase report attempts to depict what kind of physical and psychological trauma a person with psychiatricdisorder suffered at the hands of faith healer in absence of lack of awareness about the psychiatric disordersamong family members and other villagers.

Chronic diseases and trauma among low-income workers of Karachi, Pakistan.

Background: The self-efficacy of individuals is influenced by experiences in the community, the workplace, and in broader civil society, all of which exert a collective influence on attitudes and behaviors. The low-income population is more likely to suffer from many chronic health problems and trauma. This study was done to assess the prevalence of chronic diseases and workplace physical trauma among low-income workers in Karachi, Pakistan. Methods: A descriptive cross sectional study was conducted in Karachi, Pakistan. Trained interviewers used a structured questionnaire to interview 707 workers and collected information on socio-demographic characteristics, chronic health problems and physical trauma among them. The data were analysed using SPSS version 18. Results: Majority (72%) of the participants were aged between 15 and 35 years. More than one-third (35.1%) were educated up to secondary level only. Half of the participants (50.8%) had a household comprising 6-10 people, while 34.8% of the respondents were the only breadwinners in their family. Two fifths (39.5%) reported a household income between Rs11000 and Rs 20000 per month. A significant number (21%) of workers reported being diagnosed with a chronic disease including Diabetes Mellitus, Asthma, Hepatitis, Arthritis, Hypertension, Hyperlipidemia, Hypothyroidism, Epilepsy, Chronic obstructive pulmonary disorder, whereas three fourths (75%) reported physical trauma history at their work place during the past year, while majority (95.2%) of them looked apparently healthy. Conclusions: These chronic health conditions not only affect their productivity but play a vicious role in poverty and poor health cycle. The findings of the present study cannot be generalized due to the limited sample. Still, the study supports the notion that factors such as low socioeconomic status may lead to the poor management of physical trauma and course of chronic diseases. Future research should direct attention toward workers' health and working conditions to improve the effectiveness of the interventions to reduce the disparities in provision of health services for the low-income workers.

Cambios de condcctas adherentes en el contexto ospitalario a partir de una terrapia psicológica basada en aceptación y conducta orientada a los valores en pacientes heridos en combtte / Adhesionbehaviorr change in the hospitalsetting from a psychological thherapy based on acceptance and values oriented behavior in wounded in combat patients / Câmbios de cnduttas aderentes no contexto hospitalar a parti de uma terapiaa psicológica baseada na aceitação e conduta orientada aos valores em pacientes feridos em combate

El presente artículo presenta los datos con respecto a la conducta adherente, como una conducta que puede permitir el ajuste al contexto hospitalario y que puede fortalecerse a partir de una intervención terapéutica basada en aceptación y conducta orientada a los valores. Se implementó un diseño de caso único tipo A-B con seguimiento, se determinó la línea base por medio de la aplicación de cuestionarios y entrevistas, se realizó el proceso de intervención mencionado y se tomaron medidas repetidas con algunos instrumentos para establecer el efecto del tratamiento. Los resultados muestran que los pacientes durante la ejecución del tratamiento presentaron cambios en las conductas adherentes al tratamiento médico derivados de la implementación de la intervención mencionada.

This article presents data regarding the adherent behavior as one that may allow adjustment to the hospital setting and can be strengthened through a therapeutic intervention based on acceptance and value-oriented behavior. A single case type A-B design with follow-up was used; the baseline was determined through questionnaires administration and interviews; subsequently, the procedure of treatment was implemented and repeated measurements were taken with some instruments to establish the effect of treatment. The results show that during treatment execution patients became more adherent to medical procedures secondarily to the implementation of the above-mentioned intervention.

O presente artigo apresenta os dados com respeito à conduta aderente, como uma conduta que pode permitir o ajuste ao contexto hospitalar e que pode se fortalece a partir de uma intervenção terapêutica baseada em aceitação e conduta orientada a os valores. Se implementou um desenho de caso único tipo A-B com seguimento, se determinou a linha base por meio da aplicação de questionários e entrevistas, se realizou o processo de intervenção mencionado e se tomaram medidas repetidas com alguns instrumentos para estabelecer o efeito do tratamento. Os resultados mostram que os pacientes durante a execução do tratamento apresentaram câmbios nas condutas aderentes ao tratamento médico derivados da implementação da intervenção mencionada.

Figuras psíquicas do trauma: uma leitura lacaniana / Trauma’s psychic figures: a lacanian interpretation / Les figures psychiques du traumatisme: une lecture lacanienne

A partir da escuta psicanalítica a pacientes vítimas de traumatismos corporais, este artigo interroga as figuras psíquicas que se inscreveriam para esses sujeitos, para além do trauma físico. Discute-se a definição do trauma para a medicina e para a psicanálise e de que modo esta noção convoca uma discussão sobre a urgência subjetiva. Algumas hipóteses são esboçadas: se o trauma psíquico se inscreve nesta situação, de trauma físico, poderíamos considerá-lo na ordem da repetição, da fantasia ou do gozo? Como os sujeitos respondem a essa inscrição física permeada pelo psíquico? Podemos dizer que o trauma é um conceito eminentemente freudiano, na medida em que adquire importância considerável em sua obra. Em Lacan é, sobretudo, o conceito de real que nos fornece o enquadre teórico a partir do qual podemos pensar o trauma como inassimilável.

From the psychoanalytic listening patients victim of physical trauma, this article researches what psychic figures would arise for these subjects, beyond the physical trauma. Discusses the definition of trauma for medicine and for psychoanalysis and in which way this notion convenes a discussion about the subjective urgency. Some hypotheses are sketched: if the psychic trauma inscribes itself in this situation of physical trauma, we could consider it in the order of repetition, fantasy or of enjoyment? How the subjects respond to this physical inscription permeated by the psychic? We can say that the trauma is a eminently freudian concept, in the extent that it acquires considerable importance in his work. In Lacan it is, especially, the concept of real that provides us with the theoretical framework from which we can think trauma as non-assailable.

De l'écoute psychanalytique de patients souffrant de lésions corporelles, cet article examine les chiffres psychiques qui s'inscrivent pour ces sujets, au delà des traumatismes physiques. Il traite de la définition d'un traumatisme à la médecine et pour la psychanalyse et comment cette notion engendre un débat d'urgence subjective. Quelques hypothèses sont présentées: le traumatisme psychique est inscrit dans cette situation, les traumatismes physiques, nous pourrions considérer de l’ordre de la répétition, fantaisie ou la jouissance? Comment les sujets répondent à cette inscription physique envahie par le psychique? Nous pouvons dire que le traumatisme est un concept éminemment freudien, en ce sens qu'il revêt une importance considérable dans son travail. Chez Lacan, c’est, avant tout, la notion de réel qui nous donne le cadre théorique à partir de duquel nous pouvons penser à un traumatisme comme étant inassimilable.

Todo mundo se quebra de vez em quando: um estudo sobre os processos de subjetivação em idosas hospitalizadas por fratura de fêmur / Everybody breaks occasionally: a study of the subjectivation processes in older hospitalized for femur fracture

Para compreender o impacto do trauma físico na subjetivação de mulheres idosas e entender a produção de efeitos da hospitalização na subjetivação, foi realizada uma pesquisa qualitativa, de caráter exploratório com quatro mulheres com mais de 60 anos, hospitalizadas por fratura de fêmur em um hospital em Porto Alegre (RS). Foram entrevistadas durante e após o período de internação hospitalar. Destacam-se a evidência do sofrimento gerado pelo poder instituído, a submissão às rotinas hospitalares e o constrangimento pela exposição do seu corpo...

To understand the impact of physical trauma of subjectivation in older women and to understand the effect of the subjectivation in the hospital, was conducted a qualitative and exploratory research, with four women over 60 years, hospitalized for femur fracture at a hospital in Porto Alegre (RS). Have been interviewed during and after the hospitalization period. Most notable are the evidence of the suffering caused by institutional power, submission to hospital routines and embarrassment from exposure of his body...

Retronychia, a Proximal In-growth of the Nail Plate / 대한피부과학회지

Retronychia is a process of a nail embedding itself into the proximal nail fold due to an incomplete shedding of the nail, and this usually occurs after physical trauma. Retronychia causes persistent paronychia and defective nail growth on the patients. Simple avulsion of the superimposed nail is curative. A 17-year-old man presented with tender erythema and swelling on the proximal nail fold of the right 3rd and 4th fingers for 2 months after an operation that was performed due to metacarpal bone fracture. The second patient was a 25-year-old male who presented with a 1-month history of persistent paronychia on his right great toe after blunt trauma. For both patients, simple avulsion of the damaged nail was curative and underlying new nails were revealed. We report here on two cases of retronychia that could be easily overlooked and such cases have not been previously reported in the Korean dermatologic literature.