Complications of clandestine abortions: a cross-sectional study at the Provincial General Hospital of Kananga in the Democratic Republic of Congo

Introduction: the complications of clandestine abortions are formidable throughout the world, particularly in Africa. This study aims to determine the epidemiological and therapeutic profile of the complications of clandestine abortions in the gynecology service of the Provincial Hospital of Kananga. Methods: this is a cross-sectional study conducted from the medical records of pregnant women who experienced the complications of clandestine abortions in the gynecology department of the Provincial Hospital of Kananga from January 01, 2015, to December 31, 2019. It is based on the no probabilistic sampling of suitability. We recorded 38 cases of 58 patients. Results: the frequency of complications of clandestine abortions is 65.51% with an average age of pregnant women of 27.86 (SD 3.23) years and 70% of pregnant women under 30 years old, nulliparity was more concerned in 34.21% (n=13). Pupil students and unemployed are more affected in 55.26% (n=21). Cervical dilation and curettage practiced by nurses led to more complications from clandestine abortions in 69.07% (n=26). Incomplete abortions are the complications most encountered in 1 case out of 3. The aspiration-curettage is established in 1 out of 3 cases, and the mortality rate linked to complications of clandestine abortion was 21.05% (n=8). Conclusion: complications of clandestine abortions constitute a real public health problem in the town of Kananga, incomplete abortions are most encountered and the mortality rate linked to these complications is serious.

Ferenczi e a clínica psicanalítica contemporânea: uma revisão sobre suas contribuições ao papel do analista / Ferenczi and the contemporary psychoanalytic clinic: a review of his contributions to the role of the analyst / Ferenczi et la clinique psychanalytique contemporaine: une revue de ses contributions au rôle de l'analyste / Ferenczi y la clínica psicoanalítica contemporánea: Una revisión de sus contribuciones al papel del analista

Objetivou-se fazer uma revisão sistemática da produção científica nacional e internacional, no período de 2015 a 2020, sobre a obra de Sándor Ferenczi e suas contribuições à clínica psicanalítica na contemporaneidade, no que concerne ao papel do analista. Os seguintes descritores foram utilizados: "Ferenczi" "clínica psicanalítica" e "analista". As bases de dados pesquisadas foram: P@rthenon, SciELO e Pepsic. Foi utilizada a metodologia da Análise de Conteúdo. O processo de análise levou a leitura dos títulos, resumos e textos completos, e 52 artigos preencheram os critérios. A pesquisa compreendeu que a retomada dos trabalhos de Ferenczi quanto ao papel do analista evidenciam uma nova configuração de relação analítica baseada em uma ética do cuidado. O papel do analista apresenta-se como uma possibilidade de contorno e sustentação às experiências traumáticas, colaborando com o paciente, na produção de sentidos e elaborações dessas experiências

This is a systematic review of national and international scientific papers published between 2015 and 2020 on Sándor Ferenczi's work and his contributions to the contemporary psychoanalytic clinic, mainly regarding the role of the analyst. Search was conducted on the P@rthenon, Scielo and Pepsic databases using "Ferenczi," "psychoanalytic clinic" and "analyst" as search descriptors. After reading the titles, abstracts and full texts a total of 52 articles met the inclusion criteria. Resumption of Ferenczi's work on the role of the analyst reveals a new configuration of analytical relations based on an ethics of care. The analyst presents a possibility of shaping and underpinning traumatic experiences, collaborating with the patient to produce meanings and elaborations of these experiences

Il s'agit d'une revue systématique des articles scientifiques nationaux et internationaux publiés entre 2015 et 2020 sur l'œuvre de Sándor Ferenczi et ses contributions à la clinique psychanalytique contemporaine, notamment en ce qui concerne le rôle de l'analyste. La recherche a été effectuée sur les bases de données P@rthenon, Scielo et Pepsic en utilisant « Ferenczi ¼, « clinique psychanalytique ¼ et « analyste ¼ comme descripteurs. Après la lecture des titres, des résumés et des textes intégraux, 52 articles répondaient aux critères d'inclusion. La reprise des travaux de Ferenczi sur le rôle de l'analyste révèle une nouvelle configuration des relations analytiques fondées sur une éthique du soin. L'analyste offre la possibilité de concevoir et d'étayer les expériences traumatiques, en collaborant avec le patient pour produire de significations et d'élaborations de ces expériences

El objetivo fue realizar una revisión sistemática de la producción científica nacional e internacional, en forma de artículo científico, de 2015 a 2020, sobre la obra de Sándor Ferenczi y sus aportes a la clínica psicoanalítica en la contemporaneidad, en torno al papel del analista. Se utilizaron los siguientes descriptores: "Ferenczi", "clínica psicoanalítica" y "analista". Las bases de datos buscadas fueron: P@rthenon, Scielo y Pepsic. Se utilizó la metodología de Análisis de Contenido. El proceso de análisis condujo a la lectura de títulos, resúmenes y textos completos y 52 artículos cumplieron los criterios. La investigación entendió que la reanudación del trabajo de Ferenczi sobre el rol del analista revela una nueva configuración de relación analítica basada en una ética del cuidado. El rol del analista se presenta como una posibilidad de modelar y sostener experiencias traumáticas, colaborando con el paciente, en la producción de significados y elaboraciones de estas experiencias

Formación con simulación clínica para manejo adecuado de emergencias obstétricas: revisión narrativa / Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review

Las emergencias obstétricas son situaciones críticas que amenazan la salud de la madre y del bebé durante el embarazo o el parto. Este estudio se enfocó en validar la efectividad de la formación con simulación clínica en el manejo de estas situaciones. Realizamos una revisión narrativa de estudios publicados entre 2008 y 2022, recopilados de las bases de datos Scopus, ScienceDirect, MEDLINE/PubMed, Springer, SciELO y Google Scholar. Se recogieron y resumieron los datos de los estudios que cumplían con nuestros criterios de inclusión. Nuestros resultados subrayan que la simulación clínica se posiciona como una herramienta altamente eficaz en la formación de profesionales de la salud. Esta capacitación se traduce en mejoras significativas en diversos aspectos, incluyendo el rendimiento, los conocimientos, la confianza, la satisfacción, las actitudes, la autoeficacia, la capacidad para trabajar en equipo y las habilidades necesarias para enfrentar situaciones obstétricas críticas. Dentro de estas últimas destacan hemorragias posparto, eclampsia, distocia de hombros, paro cardíaco materno, prolapso del cordón umbilical y cesáreas. Esta formación disminuye los riesgos asociados con el aprendizaje en pacientes reales y cumple con los estándares éticos. La colaboración interdisciplinaria en el manejo de emergencias obstétricas se revela efectiva para brindar atención integral a los pacientes. Sin embargo, es fundamental enfatizar que para asegurar la seguridad del paciente y promover un enfoque de trabajo en equipo, es esencial que los profesionales de la salud reciban una formación adecuada y estén debidamente cualificados. A pesar de que la formación en simulación clínica es eficaz, su implementación puede resultar costosa y requerir recursos considerables. No obstante, consideramos que esta estrategia sigue siendo de un valor incalculable para la formación de profesionales en este campo. Investigaciones futuras de alta calidad contribuirán a fortalecer la evidencia sobre las mejores prácticas en la formación con simulación clínica en emergencias obstétricas.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.

Diseño, implementación y evaluación de un programa de aprendizaje de habilidades procedimentales básicas en enfermería utilizando la plataforma C1DO1 durante la pandemia por COVID-19

Introducción: La simulación remota brindó una alternativa concreta para entrenar las habilidades procedimentales básicas durante la pandemia. El objetivo de este artículo es describir el proyecto que mantuvo el entrenamiento de las habilidades procedimentales básicas de enfermería en alumnos de pregrado UC, utilizando la aplicación C1DO1, durante el segundo semestre del 2021. Materiales y Métodos: Se diseñaron cinco etapas en la plataforma C1DO1. Cada etapa consideró un procedimiento clínico básico. Los estudiantes practicaron las técnicas en su hogar y se grabaron ejecutando el procedimiento. El video fue revisado por un docente que proporcionaba una retroalimentación personalizada y medía su aprendizaje de manera formativa. Al finalizar todas las etapas, se aplicó una encuesta para evaluar la percepción y satisfacción con el proyecto. Resultados: 183 estudiantes se inscribieron en el proyecto, de los cuales 122 participaron activamente. El porcentaje de respuesta del instrumento de evaluación fue de un 71%. La satisfacción global alcanzó una nota de 6,1. El grado de acuerdo con la simulación remota fue de un 94%. La percepción de autoeficacia alcanzó un 89%. La retroalimentación personalizada fue considerada como muy importante por el 94% de los participantes y el 98% de los estudiantes aprobó la etapa que efectúo. Discusión: Existe un alto grado de acuerdo con el entrenamiento de habilidades procedimentales mediante la simulación remota, sin embargo, los estudiantes consideran esta metodología como un complemento al aprendizaje motor, aún faltan estudios que midan transferencia.

Introduction: Remote simulation provided a concrete alternative to train basic procedural skills, given the pandemic. This article aims to describe the project that maintained the training of basic nursing procedural skills in UC undergraduate students using the C1DO1 application during the second semester of 2021. Methods: Five stages were designed on the C1DO1 platform. Each stage considered a basic clinical procedure. The students practiced the techniques at home and recorded themselves performing the procedure. The video was reviewed by a teacher who provided personalized feedback and measured their learning in a formative way. At the end of all the stages, a survey was applied to the students to evaluate their perception and satisfaction with the project. Results: The total number of students enrolled in the project was 183 of which 122 actively participated. The response rate of the evaluation instrument was 71%. Global satisfaction with the project obtained a score of 6.1. The degree of agreement with the remote simulation was 94%. The perception of self-efficacy reached 89%. The personalized feedback was considered very important by 94% of the participants and 98% of the students approved the stage they carried out. Discussion: There is a high degree of agreement with the training of procedural skills through remote simulation, however, students see this methodology as a complement to motor learning, and studies that measure transfer are still lacking.

Is the symptom of pain adequately addressed in hospitalization at Internal Medicine? Cross-sectional study / O sintoma dor é abordado adequadamente em internação hospitalar de Clínica Médica? Estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the main reasons for seeking medical care. Thus, the objective of the present study was to evaluate the treatment of pain complaints in a medical clinic ward. METHODS: Cross-sectional and descriptive study at the Santa Lucinda Hospital (Hospital Santa Lucinda - HSL) and Sorocaba Hospital Complex (Conjunto Hospitalar de Sorocaba - CHS). Data was collected by: (1) interviewing the participants using a structured questionnaire drawn up by the researchers, and (2) accessing information such as pain records and drug prescriptions in the medical records. RESULTS: The sample consisted of 85 patients, 11.8% in the HSL and 88.2% in the CHS. More than 80% of patients had already experienced pain at some point in their lives, whether chronic or acute. Forty-one percent of patients had pain during hospitalization, regardless of the reason for admission. A minority of pain events had the complaint recorded in their medical records. Drugs were prescribed for 73.0% of the patients, mostly on demand. There was a mismatch between the type of drug prescribed and the intensity of the pain in 80% of prescriptions. CONCLUSION: The complaint of pain is prevalent in Internal Medicine hospitalizations. In this study, 41.2% of the pain was musculoskeletal, followed by abdominal pain, regardless of the reason for hospitalization. The complaint of pain was medicated in most of the patients' pain reports, but around 23% of the patients complaining of pain did not receive drugs. Most patients (80%) with pain received drugs that were inconsistent with the intensity of the pain; however, the recording of the complaint of pain in the medical records remains insufficient.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dor é um dos principais motivos por assistência ao serviço médico-hospitalar. Desta forma, o objetivo deste estudo foi avaliar o atendimento de queixas dolorosas em enfermaria de clínica médica. MÉTODOS: Estudo transversal e descritivo nos hospitais Santa Lucinda (HSL) e Conjunto Hospitalar de Sorocaba (CHS). A coleta de dados foi realizada por: (1) entrevista com os participantes direcionada por um questionário estruturado elaborado pelos pesquisadores, e (2) acesso a informações como registro de dor e prescrição de fármacos no prontuário. RESULTADOS: A amostra foi composta por 85 pacientes, sendo 11.8% no HSL e 88,2% no CHS. Mais de 80% dos participantes relataram experiência prévia de dor aguda ou crônica em algum momento da vida. Quarenta e um por cento dos participantes relatou dor durante a internação independente da causa da internação. A minoria dos eventos de dor constava nos registros da queixa em seu prontuário. Houve fármaco prescrito para 73% dos pacientes, sendo em sua maioria, por demanda. Houve uma inadequação entre o tipo de fármaco prescrito e a intensidade da dor em 80% das prescrições. CONCLUSÃO: A queixa de dor é um sintoma prevalente entre pacientes internados de Clínica Médica. Neste estudo, 41,2%; das dores foram musculoesqueléticas, seguida de dores abdominais, independente do motivo da internação. A queixa de dor foi medicada na maior parte dos relatos de dor dos pacientes, porém cerca de 23% dos pacientes com queixa de dor não receberam fármacos. A maior parte dos pacientes (80%) com dor recebeu fármacos incoerentes à intensidade da dor; porém o registro da queixa de dor nas evoluções dos prontuários permanece insuficiente.

Relato de Experiência: Escuta Clínica, HIV/AIDS e Covid-19 / Experience report: Clinical Listeling, HIV/AIDS and Covid-19 / Experience Report: Clinical Listening, HIV/AIDS and Covid-19

O artigo compartilha um relato de experiência de atendimento psicológico a pessoas que vivem com HIV/AIDS na pandemia causada pela covid-19, da Campanha Voluntariado pelas Américas Covid-19 e HIV/AIDS. A proposta busca colaborar com a tessitura de elaborações teóricas e técnicas sobre a escuta clínica, especialmente em sua forma remota. O atendimento psicológico virtual, de curta duração, foi realizado por 14 psicólogas voluntárias, a maioria ancorada na Psicanálise. A escuta orientou-se pela avaliação da angústia central a partir da queixa-sintoma, avaliando riscos, fatores estressantes e apoios. Amparou-se na noção de clínica ampliada, na articulação com as ações da campanha relacionadas à falta de medicamentos e à carência de alimentos, com encaminhamentos para a rede de atenção à saúde. Considerou o sofrimento psíquico associado a vulnerabilidades socioeconômicas a partir do dispositivo da necropolítica. O sofrimento emocional foi atravessado pelo adoecimento físico, por questões relativas à covid-19, e pela atualização de sentimentos vivenciados com o HIV, tais como: não aceitação do diagnóstico, medo da morte, abandono, isolamento e estigmas. Conclui-se que a escuta psicológica deu suporte emocional às pessoas em momento de intenso sofrimento psíquico. A empatia, o afeto e a solidariedade foram teias de resistência no momento de crise sanitária.

The article shares an experience report of psychological care for people living with HIV/AIDS in the pandemic caused by covid-19, from the Campaign Volunteering for the Americas Covid-19 and HIV/AIDS. The proposal seeks to collaborate with the fabric of theoretical and technical elaborations on clinical listening, especially in its remote form. The virtual psychological care, of short duration, was carried out by 14 volunteer psychologists, the majority referenced by Psychoanalysis. The listening was guided by the assessment of the central anguish based on the symptom-complaint, assessing risks, stressors and supports, based on the notion of an expanded clinic, in articulation with the actions of the campaign related to the lack of medication and the lack of food, with referrals to the health care network. It considered psychic suffering associated with socioeconomic vulnerabilities from the necropolitics device. Emotional suffering was crossed by physical illness, by issues related to covid-19, and by updating feelings experienced with HIV, such as non-acceptance of the diagnosis, fear of death, abandonment, isolation and stigma. In conclusion, psychological listening provided emotional support to people in times of intense psychic suffering. Empathy, affection and solidarity were webs of resistance in times of health crisis.

El artículo comparte un relato de experiencia de atención psicológica a personas viviendo con VIH/SIDA durante la pandemia de covid-19, de la Campaña Voluntariado por las Américas Covid-19 y VIH/SIDA. Busca colaborar con la construcción de elaboraciones teóricas y técnicas sobre la escucha clínica, especialmente en su modalidad a distancia. La atención psicológica virtual, de corta duración, estuvo a cargo de 14 psicólogas voluntarias, la mayoría ancladas en el Psicoanálisis. La escucha considerada la valoración de la angustia central a partir del síntoma-queja, valorando riesgos y soportes, sustentada en la noción de clínica ampliada, junto con el apoyo a la falta de alimentos e de medicamentos. Considerado el sufrimiento psíquico asociado a las vulnerabilidades socioeconómicas a partir del dispositivo de la necropolítica. El sufrimiento emocional estuvo atravesado por la enfermedad física, relacionadas con el covid-19, y por la actualización de sentimientos vividos con el VIH, como la no aceptación del diagnóstico, el miedo a la muerte, el abandono, el aislamiento y el estigma. Se concluye que la escucha psicológica brindó apoyo emocional a las personas en momentos de intenso sufrimiento psíquico. La empatía, el cariño y la solidaridad fueron redes de resistencia en momentos de crisis sanitaria.

Cincuenta años del Departamento de Medicina del Dolor y Paliativa del Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ / Fifty anniversary of the department of pain and palliative medicine at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼

Resumen: Introducción: En México, la primera clínica especializada en el alivio del dolor fue fundada en 1972 por el Dr. Ramón De Lille Fuentes en el Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ (INCMNSZ). Material y métodos: Se realizó una búsqueda histórica documental y entrevistas a quienes han colaborado con el Departamento de Medicina del Dolor y Paliativa del INCMNSZ desde su fundación. Resultados: Nuestra visión es ofrecer atención del dolor, cuidados paliativos y apoyo continuo. Para ello, documentamos nuestra historia y los logros del departamento. Conclusiones: A 50 años de su fundación, el Departamento de Medicina del Dolor y Paliativa del INCMNSZ es un foro de desarrollo científico y de formación de capital humano con un enfoque humanista.

Abstract: Introduction: In Mexico, the first clinic specializing in pain relief was founded in 1972 by Dr. Ramón De Lille Fuentes at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ (INCMNSZ). Material and methods: A historical documentary search and interviews were carried out with those who have collaborated with the Department of Pain and Palliative Medicine of the INCMNSZ since its foundation. Results: Our vision is to offer pain management, palliative care, and ongoing support. To do this, we document the history and achievements of the department. Conclusions: 50 years after its foundation, the INCMNSZ Department of Pain and Palliative Medicine is a forum for scientific development and human capital training with a humanistic approach.

Ferenczi e a mutualidade expressiva / Ferenczi and the expressive mutuality / Ferenczi et la mutualite expressive

O propósito deste artigo é apresentar uma nova "terminologia" que organize, torne inteligível e lance luz sobre algumas experiências clínicas empreendidas por Sándor Ferenczi quando do tratamento de sujeitos com histórico de trauma. Propomos designar, sob o termo "mutualidade expressiva", o gesto do analista de se permitir expressar o impacto dos afetos que lhe são provocados pelas expressões emocionais do analisando, produzindo repercussões profundas neste último. A mutualidade expressiva coloca em relevo três pontos trabalhados por Ferenczi, e que serão discutidos ao longo deste artigo: i) a construção da confiança e o remanejamento da dinâmica da clivagem; ii) o desenvolvimento do afeto que foi interrompido quando do desmentido; iii) a reconsideração crítica da postura técnica de neutralidade e indiferença do analista.

The purpose of this article is to present a new "terminology" that organizes, makes intelligible and sheds light on some clinical experiences undertaken by Sándor Ferenczi when treating individuals with a history of trauma. We propose to designate, under the term "expressive mutuality", the analyst's gesture of allowing himself to express the impact of the affects that are provoked by the patient's emotional expressions, producing profound repercussions in the latter. The expressive mutuality highlights three points worked on by Ferenczi, which will be discussed throughout this article: i) the construction of trust and the reorganization of the dynamics of the splitting; ii) the development of the affect that was interrupted when denied; iii) the critical reconsideration of the analyst's technical principle of neutrality.

Le but de cet article est de présenter une nouvelle «terminologie¼ qui organise, rend intelligible et met en lumière certaines expériences cliniques entreprises par Sándor Ferenczi lors du traitement de sujets ayant des antécédents de traumatisme. Nous proposons de désigner, sous le terme de «mutualité expressive¼, le geste de l'analyste de se permettre d'exprimer l'impact des affects provoquées par les expressions émotionnelles de l'analysant, produisant chez celui-ci de profondes répercussions. La mutualité expressive met en évidence trois points travaillés par Ferenczi, qui seront abordés tout au long de cet article: i) la construction de la confiance et la réorganisation de la dynamique du clivage; ii) le développement de l'affect qui a été interrompue lorsque refusée; iii) le réexamen critique de la position technique de neutralité et d'indifférence de l'analyste.

Uma leitura psicanalítica sobre o consumo de manipulações corporais na contemporaneidade / Une lecture psychanalytique sur la consommation des manipulations corporelles à l'époque contemporaine / A psychoanalytical reading on the consumption of body manipulations in contemporary times

O presente artigo visa abordar o fenômeno contemporâneo do consumo de manipulações corporais do tipo estético a partir da teoria e da clínica psicanalíticas. Nossa hipótese de pesquisa é que a menor potência do ideal do eu em sua vertente de interdito afeta a consistência da imagem corporal, culminando em um sofrimento psíquico provocado pelo desregramento pulsional. Indagamos se a intervenção no corpo poderia apaziguar a relação imaginária através de uma idealização do corpo vendida como mercadoria

Cet article vise à aborder le phénomène contemporain de consommation de manipulations corporelles de type esthétique en s'appuyant sur la théorie et la clinique psychanalytiques. Notre hypothèse de recherche est que la puissance inférieure de l'Idéal du Moi dans son aspect d'interdit affecte la cohérence de l'imagecorporelle, culminant dans la souffrance psychique causée par le trouble instinctif. Nous nous sommes demandé si l'intervention sur le corps pouvait apaiser la relation imaginaire par une idéalisation du corps vendu comme une marchandise

This article aims to address the contemporary phenomenon of consumption of body manipulations of the aesthetic type based on psychoanalytic theory and clinics. Our research hypothesis is that the lower power of the ego ideal in its interdict aspect affects the consistency of the body image, culminating in psychic suffering caused by instinctual disorder. We asked whether intervention in the body could appease the imaginary relationship through an idealization of the body sold as a merchandise.

"Lá onde Isso era, [eu] devo devir": comentário sobre a Lição 21 do Seminário 6, de Lacan / Là où C'était, [je] dois devenir": commentaire de la leçon 21 du Séminaire 6 de Lacan / "Where Id was, [I] must become": commentary on Lesson 21 of Lacan's Seminar 6

O presente trabalho é um comentário da Lição 21 do Seminário sobre O desejo e sua Interpretação de Jacques Lacan. Nessa lição, intitulada. A forma do corte, Lacan percorre a ideia de que a psicanálise se interessa pelo efeito-sujeito, indicando-a a partir da expressão freudiana " Wo Es war, soll Ich werden" e de seus desenvolvimentos a propósito da noção de fantasia, o que inclui o objeto a. O texto percorre essas noções para pensar o trabalho que se realiza numa análise

Cet article est un commentaire de la leçon 21 du séminaire de Jacques Lacan sur Le désir et son interprétation. Dans cette leçon, intitulée La forme de la coupure, Lacan développe l'idée que la psychanalyse s'intéresse à l'effet-sujet, en l'indiquant à partir de l'expression freudienne " Wo Es war, soll Ich werden" et de ses développements sur la notion de fantasme, qui inclut l'objet a. Le texte passe en revue ces notions afin de réfléchir au travail qui s'opère dans une analyse

This paper is a commentary on Lesson 21 of Jacques Lacan's Seminar on "Desire and its Interpretation". In this lesson, entitled "The form of the cut", Lacan goes through the idea that psychoanalysis is interested in the subject-effect, indicating this from the Freudian expression "Wo Es war, soll Ich werden" and its developments with regard to the notion of fantasy, which includes the object a. The text goes through these notions in order to think about the work that takes place in an analysis

CLINICO-DEMOGRAPHIC PROFILE AND SEROPREVALENCE OF DENGUE AT A TERTIARY CARE HOSPITAL - CENTRAL INDIA

Background: Dengue virus infection has been a major public health problem over the past decades. The disease is endemic in many parts of India. Mortality is high when dengue manifests as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Early diagnosis and treatment greatly help prevent complications. The study was aimed to determine the clinic-demographic, and seroprevalence of dengue infection among Aim: patients attending Government Medical College and Hospital, Nagpur, Maharashtra during the period from January 2021 to December 2021. In a retrospective study from Jan 2021-December 2021 blood samples were withdrawn from patients Methods: with fever. Samples were tested with BeneSphera Dengue NS1 and Dengue IgG/IgM Rapid card test (Lateral ?ow). Results: Serodiagnosis of dengue at tertiary care hospitals was 23.44% (1062/4530). The most affected group was 21-30 years old. Men (64.08%) were more affected. Common features were fever 1062 (100%), headache 508 (52%), body aches 205 (21%), vomiting 205 (21%), itching 68 (7%), rash 29 (3%). Of the 1062 dengue-positive cases, 998 (93.97%) were NS-1 positive, 18 (1.69%) were IgM positive, 21 (1.97%) were IgG positive, and 25 (2.35%) were NS1+. was IgM positive. Dengue cases peaked in August. Conclusions: The dependability of Immunochromatographic test makes it an excellent tool for early diagnosis and treatment. Dengue cases were more during August, so it is useful to plan special preventive strategies to prevent the outbreaks

Prevalencia y análisis de factores de infección de sitio quirúrgico en clínica de heridas / Prevalence and Analysis of Surgical Site Infection Factors in Wound Clinic

Introducción: La infección de herida quirúrgica causa altas tasas de morbilidad y repercute sobre los índices de mortalidad. Constituye la primera infección intrahospitalaria entre pacientes quirúrgicos del total de infecciones nosocomiales y la primera entre los pacientes quirúrgicos. Existen factores de riesgo como la clasificación ASA, la diabetes mellitus, la hipertensión arterial y los días de estancia hospitalaria, los cuales influyen en su desarrollo. Objetivo: Determinar la prevalencia de infecciones de sitio quirúrgico por cirugías realizadas en el Hospital Dr. Carlos Canseco de Tampico, ciudad del estado mexicano de Tamaulipas. Métodos: Diseño observacional, analítico, transversal y retrospectivo de 54 pacientes con diagnóstico de infección de sitio quirúrgico. Las variables de estudio se clasificaron como dependientes (género, edad, lugar de origen, días de estancia hospitalaria, peso, índice de masa corporal) e independientes (diagnóstico, procedimiento quirúrgico realizado y clasificación ASA otorgada). Resultados: La población de 40 a 50 años fue la más afectada, con mayor predominancia sobre el género femenino. La Clasificación ASA II y III presentaron mayor prevalencia de infección de sitio quirúrgico, sobre todo en cirugías electivas (28 por ciento). Mientras mayor fue la estancia hospitalaria, mayor fue la probabilidad de desarrollar infección de sitio quirúrgico. Conclusiones: La prevalencia de infección en el sitio quirúrgico en pacientes operados por los distintos servicios quirúrgicos no es similar a la reportada por otros autores. La Clasificación ASA II y III presentaron infección del sitio quirúrgico con más frecuencia, mientras que la comorbilidad más llamativa de este estudio fue el índice de masa corporal como factor de riesgo que no debe pasar desapercibido(AU)

Introduction: Surgical wound infection causes high morbidity rates and impacts mortality rates. It is the first in-hospital infection among surgical patients of all nosocomial infections and the first among surgical patients. There are risk factors that influence its development, such as the ASA classification, diabetes mellitus, arterial hypertension and days of hospital stay. Objective: To determine the prevalence of surgical site infections from surgeries performed at Hospital Dr. Carlos Canseco, of Tampico, a city in the Mexican state of Tamaulipas. Methods: An observational, analytical, cross-sectional and retrospective study was carried out with 54 patients with a diagnosis of surgical site infection. The study variables were classified as dependent variables (gender, age, place of origin, days of hospital stay, weight and body mass index) and independent variables (diagnosis, surgical procedure performed, and given ASA classification). Results: The population aged 40 to 50 years was the most affected, with a greater predominance of the female gender. ASA classification II and III had a higher prevalence of surgical site infection, above all in elective surgeries (28 %). The longer the hospital stay, the higher the probability of developing surgical site infection. Conclusions: The prevalence of surgical site infection in patients operated on by the different surgical services is not similar to that reported by other authors. ASA Classification II and III presented surgical site infection more frequently, while the most remarkable comorbidity in this study was body mass index as a risk factor that should not go unnoticed(AU)

Virtual keratoconus monitoring clinic in a tertiary university hospital in the United Kingdom

Purpose: To describe a new pathway for virtual keratoconus (KC) monitoring in the corneal department of a tertiary referral center in the UK during the coronavirus disease 2019 (COVID?19) pandemic. Methods: A virtual outpatient clinic to monitor KC patients (KC PHOTO clinic) was created. All patients from the KC database in our department were included. At each hospital visit, patients’ visual acuity and tomography (Pentacam; Oculus, Wetzlar, Germany) were collected by a health?care assistant and an ophthalmic technician, respectively. The results were virtually reviewed by a corneal optometrist to identify stability or progression of KC and discussed with a consultant if needed. Those with progression were contacted by telephone and listed for corneal crosslinking (CXL). Results: From July 2020 until May 2021, 802 patients were invited to attend the virtual KC outpatient clinic. Of them, 536 patients (66.8%) attended and 266 (33.2%) did not attend. After corneal tomography analysis, 351 (65.5%) were stable, 121 (22.6%) showed no definite evidence of progression, and 64 (11.9%) showed progression. Forty?one (64%) patients with progressive KC were listed for CXL and the remaining 23 patients deferred treatment after the pandemic. By converting a face?to?face clinic to a virtual clinic, we were able to increase our capacity by nearly 500 appointments per year. Conclusion: In pandemic times, hospitals have developed novel methods of delivering safe patient care. KC PHOTO is a safe, effective, and innovative method of monitoring KC patients and diagnosing progression. In addition, virtual clinics can increase the clinic capacity tremendously and reduce the need of face?to?face appointments, which is beneficial in pandemic conditions.

A Study on Sexually Transmitted Infections Using Syndromic Approach among Patients Attending Suraksha Clinic at a Tertiary Care Hospital of West Bengal

Introduction : A proper understanding of different aspects of Sexually Transmitted Infections (STIs) in different regions of a country like India is very essential for STI control. Objectives : To assess pattern of STIs using Syndromic approach among patients attending at Suraksha Clinic and to find out treatment seeking behaviour among them. Material and Method : A cross-sectional study was conducted at a Tertiary Care Hospital of West Bengal. This retrospective study was done selecting all patients who attended the Clinic for first time from 1st May, 2020 to 30th April, 2021. Relevant records were reviewed. Descriptive statistics and chi-square test were used. Observations : In present study Suraksha Clinic attendees were mainly comprised of female (95.8%); while 65.8% and 64.2% of patients were suffering from Lower abdominal pain and Cervicovaginal discharge respectively. Nearly one-third of them (37.9%) were suffering from more than one disease. About one-fourth of patients (28.2%) accessed the STI/RTI/Suraksha Clinic directly. The treatment seeking behaviour was significantly associated with gender and education of patients. Conclusions : This Tertiary Care Hospital based study highlighted higher prevalence of certain STIs among attendees to Suraksha Clinic as well as lower proportion of male and directly walk-in patient

Changes in visual acuity using low vision devices in patients with Leber hereditary optic neuropathy: A retrospective study

Purpose: This study was conducted to estimate the visual acuity improvement in patients with Leber hereditary optic neuropathy (LHON) with the help of low vision devices (LVDs) and to analyze the types of distant and near LVDs prescribed to the patients with LHON. Methods: A retrospective case review of 74 subjects with LHON who were referred to a low vision care clinic at a tertiary eye center from 2016 to 2019 were recruited. The reason for referral was assessed from the patients’ electronic medical records (EMR). Demographic data of the patients, visual acuity status, type of LVD prescribed, and visual acuity improvement with LVD were documented. Results: Out of 74 patients, 91.9% (n = 68) were male, and the median age of patients was 21 (16) years. A 4× monocular telescope was prescribed for 2.7% of patients (n = 2) and SEETV binocular telescope for 1.4% (n = 1) was advised for distance. The most commonly prescribed near LVD was the 6× cutaway stand magnifier for 22 patients (29.7%). Four patients (5.4%) were prescribed with Notex, the most commonly prescribed non?optical LVD. Niki CCTV (12.2%, n=9) was the most commonly prescribed assistive device. The subjects were divided into three groups based on age: group I consisted of those <18 years of age, group II 18–40 years, and group III >40 years for the interpretation of visual improvement. There was a statistically significant improvement (group I: P < 0.001, group II: P < 0.0001, group III: P < 0.003) in near vision with help of LVDs in all three groups. Conclusion: The use of LVDs and rehabilitation can help patients with LHON to lead a better life and will be more beneficial

Control de historias clínicas clasificadas por patologías a través de una aplicación web

Introducción: Las aplicaciones web actualmente son indispensables para el manejo de los datos en toda organización, permite al usuario acceder y utilizar la información desde cualquier parte del mundo. El uso de las aplicaciones web ha propiciado la agilización de varios procesos. Objetivo: Emplear una aplicación web desarrollada mediante software libre para el control y clasificación de historias clínicas por diferentes patologías del Centro Médico Salud y Vida de Ibarra, Ecuador. Método: Se aplicó una investigación de modalidad mixta cualitativa-cuantitativa la misma que permitió identificar necesidades reales de los pacientes y de los profesionales de esta casa de salud. El uso de la investigación histórica ayudó a conocer cada uno de los procesos que fueron tomados en cuenta en la generación de la historia clínica y cómo poder clasificarlas por patologías. Con ayuda de la investigación bibliográfica se logró recopilar definiciones necesarias para argumentar la base teórica del artículo; a través de la encuesta y entrevista se identificó la disconformidad de los pacientes por factores como el tiempo de espera, la deficiencia de búsqueda y peor aún no encontrarse registrados. Resultados: La agilidad en los procesos de registro de los pacientes y cada uno con su respectiva historia clínica permite que en las próximas citas los especialistas continúen con su diagnóstico. Conclusiones: La aplicación web agiliza de manera efectiva los procesos relacionados a las historias clínicas, lo que contribuye al control y clasificación de dicha documentación.

Introduction: Web applications are currently essential for data management in any organization, they allow the user to access and use information from anywhere in the world. The use of web applications has led to the streamlining of several processes. Objective: To use a web application developed using free software for the control and classification of medical records for different pathologies in the Health and Life Medical Center of Ibarra, Ecuador. Method: A qualitative-quantitative mixed modality research was applied, which allowed us to identify the real needs of the patients and professionals of this health home. The use of historical research helped to know each of the processes that were taken into account in the generation of the clinical history and how to classify them by pathologies. With the help of bibliographic research, it was possible to compile the necessary definitions to argue the theoretical basis of the article; Through the survey and interview, patient dissatisfaction was identified due to factors such as waiting time, search deficiency and, even worse, not being registered. Results: The agility in the patient registration processes and each one with their respective medical history allows the specialists to continue with their diagnosis in the next appointments. Conclusions: The web application effectively streamlines the processes related to medical records, which contributes to the control and classification of said documentation.

Introdução: As aplicações web são atualmente essenciais para a gestão de dados em qualquer organização, pois permitem ao usuário acessar e utilizar informações de qualquer lugar do mundo. A utilização de aplicações web tem levado à agilização de diversos processos. Objetivo: Utilizar uma aplicação web desenvolvida em software livre para o controle e classificação de prontuários de diferentes patologias no Centro Médico Saúde e Vida de Ibarra, Equador. Método: Foi aplicada uma pesquisa quali-quantitativa de modalidade mista, que permitiu identificar as reais necessidades dos pacientes e profissionais desta casa de saúde. A utilização da pesquisa histórica ajudou a conhecer cada um dos processos que foram levados em consideração na geração da história clínica e como classificá-los por patologias. Com o auxílio da pesquisa bibliográfica foi possível compilar as definições necessárias para argumentar a base teórica do artigo; Por meio da pesquisa e entrevista, foi identificada a insatisfação dos pacientes devido a fatores como tempo de espera, deficiência na busca e, pior ainda, não estar cadastrado. Resultados: A agilidade nos processos de cadastramento de pacientes e cada um com seu respectivo histórico permite que os especialistas continuem com seu diagnóstico nas próximas consultas. Conclusões: A aplicação web agiliza eficazmente os processos relacionados com os registos médicos, o que contribui para o controlo e classificação da referida documentação.

O lugar do sonho e da temporalidade para povos indígenas: uma questão preliminar ao tratamento decolonial do inconsciente / The place of dreams and temporality for indigenous peoples: a preliminary question to the decolonial treatment of the unconscious

RESUMO: Levantamos neste trabalho uma questão preliminar à perspectiva ética de uma possível clínica psicanalítica com povos indígenas. Esta questão é tratada em dois planos; através de um reposicionamento dos psicanalistas frente à dimensão hegemônica da branquitude colonial e, por outro, circunscrita a partir das noções da temporalidade em psicanálise; seja por meio da atemporalidade do inconsciente freudiano, seja pelo manejo inédito do tempo lógico introduzido por Lacan. Avançamos perguntando sobre o estatuto do inconsciente experienciado pelo compartilhamento coletivo dos sonhos por diferentes etnias indígenas e, em paralelo, por meio da leitura do extermínio e apagamento da língua, da cultura e dos sujeitos indígenas, autênticos donos dessas terras, em uma interpretação da história colonial do país através da repetição presente no famoso slogan: "Brasil; o país do futuro". O que a assertiva de Ailton Krenak - "o futuro é ancestral" - nos ensina em relação à ideia de retomada como possibilidade de um futuro para o Brasil?

ABSTRACT: In this work, we raised a preliminary question regarding the ethical perspective of a possible psychoanalytic clinic with indigenous peoples. This issue is addressed on two levels through a repositioning of psychoanalysts toward the hegemonic dimension of colonial whiteness and, on the other, circumscribed by the notions of temporality in psychoanalysis, whether through the timelessness of the Freudian unconscious or through the unprecedented management of logical time introduced by Lacan. We advance by asking about the status of the unconscious experienced by the collective sharing of dreams by different indigenous ethnicities and, in parallel, through the reading of the extermination and erasure of language, culture, and indigenous subjects, authentic owners of these lands, in an interpretation of the colonial history of the country through the repetition present in the famous slogan: "Brazil; the country of the future". What does Ailton Krenak's statement - "the future is ancestral" - teach us about the idea of recovery as a possibility of a future for Brazil?

O vínculo terapêutico na clínica fonoaudiológica: uma reflexão necessária / The therapeutic link in the speech therapy clinic: a necessary reflection

RESUMO Objetivo Compreender os sentidos que o vínculo terapêutico assume para fonoaudiólogos clínicos. Método A pesquisa foi aprovada por Comitê de ética, sendo de caráter transversal, de abordagem quanti-qualitativa, pautada na Análise do Conteúdo. A pesquisa contou com a participação de 96 profissionais fonoaudiólogos clínicos, inscritos no Conselho de Fonoaudiologia da 3ª região (CRFa 3), o qual abrange os Estados do Paraná e de Santa Catarina. Resultados Dos 96 fonoaudiólogos incluídos, parte significativa dos participantes definiram o vínculo terapêutico como sendo relação/interação. Referente ao papel do vínculo para o trabalho clínico fonoaudiológico, a maioria dos profissionais o descreveu como base fundamental e outra parte deles afirmou que tal vínculo é necessário para a evolução/desenvolvimento do paciente. Conclusão É possível compreender que, de acordo com os participantes, a relação terapêutica é essencial para a sustentação e manutenção do trabalho clínico fonoaudiológico, impactando na ressignificação da queixa e na minimização do sofrimento dos usuários.

ABSTRACT Purpose To understand the meanings that the therapeutic bond assumes for clinical speech therapists. Methods The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. Results Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. Conclusion It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.

Threats to health and conservation of free-living sloths (Bradypus and Choloepus) under anthropic influence in the city of Manaus, Amazonas state, Brazil / Ameaças à saúde e conservação de preguiças (Bradypus e Choloepus) de vida livre sob influência antrópica em Manaus, Estado do Amazonas, Brasil

Abstract Anthropogenic disturbances affecting forest areas can increase disease prevalence and susceptibility in several species of arboreal mammals, such as sloths. Thus, this study aimed to evaluate the most common conditions in body systems of free-ranging sloths admitted at the Wildlife Triage and Rehabilitation Center of Amazonas of the Institute of Environment and Renewable Natural Resources. A total of 227 individuals (139 retrospective cases from 2015 to 2019, and 88 prospective cases from July 2020 to July 2021) were evaluated over a six-year period. Cases from the genus Bradypus showed involvement of the following body systems: 44% respiratory, 29% integumentary, 15% musculoskeletal, 5% digestive, 3% visual, 2% auditory, 1% circulatory and 1% genitourinary, while that distribution in the genus Choloepus was: 39% musculoskeletal, 27% integumentary, 19% respiratory, 9% digestive, 3% circulatory, 1% visual, 1% auditory and 1% genitourinary. The results reveal significant differences between the condition detected and the genus (Bradypus and Choloepus), age and case outcome. These results can provide data for future investigations of sloth diseases, confirming lesions, as well as motivating and suggesting adequate management methods.

Resumo Distúrbios antrópicos que afetam áreas florestais podem aumentar a prevalência de afecções e a suscetibilidade às doenças em diversas espécies de mamíferos arborícolas, como as preguiças. Desta forma, este estudo teve como objetivo avaliar as condições mais comuns nos sistemas orgânicos de preguiças de vida livre admitidas no Centro de Triagem e Reabilitação de Animais Silvestres do Amazonas. Um total de 227 indivíduos (139 casos retrospectivos de 2015 a 2019 e 88 casos prospectivos de julho de 2020 a julho de 2021) foram avaliados durante um período de seis anos. Para o gênero Bradypus foram diagnosticadas 44% de afecções do sistema respiratório, 29% tegumentar, 15% musculoesquelético, 5% digestório, 3% visual, 2% auditivo, 1% circulatório e 1% genitourinário. Por sua vez, para o gênero Choloepus foram detectadas 39% de afecções do sistema musculoesquelético, 27% tegumentar, 19% do sistema respiratório, 19% do sistema respiratório, 9% digestório, 3% circulatório, 1% visual, 1% auditivo e 1% genitourinário. Os resultados mostraram diferenças significativas na prevalência da afecção e gênero das preguiças (Bradypus e Choloepus), a faixa etária e desfecho do caso. Esses resultados podem fornecer subsídios para investigar as doenças de preguiças, confirmando afecções, motivo e sugerir métodos adequados de manejo.

George W. Crile (1864-1943); excepcional cirurgião americano / George W. Crile (1864-1943); excepcional cirujano estadounidense / George W. Crile (1864-1943); exceptional American surgeon

George W. Crile (1864-1943); excepcional cirurgião americano, que serviu no Corpo Médico do Exército durante a Guerra Hispano-Americana. Durante a Primeira Guerra Mundial, foi diretor cirúrgico do American Ambulance Hospital em Neuilly, na França. Ajudou fundar o American College of Surgeons em 1913, foi membro e diretor não apenas dessa organização, mas também da American Medical Association, da American Surgical Association, da Royal Academy of Surgeons e da Royal Academy of Medicine (Reino Unido). Em 1921, foi cofundador da Cleveland Clinic em Cleveland, Ohio, EUA. Foi um importante médico cujas pesquisas e escritos incluíam choque cirúrgico, função glandular, pressão arterial e transfusões, neurose de guerra e os efeitos da cirurgia em tempos de guerra. Ele também foi um cirurgião extraordinário e prolífico que introduziu inovações no tratamento cirúrgico de muitas patologias. Embora sua pesquisa tenha sido publicada há muito tempo, suas contribuições para a medicina continuam sendo fundamentais para a prática clínica nas salas de cirurgia e unidades de terapia intensiva atuais.

George W. Crile (1864-1943) fue un excepcional cirujano estadounidense que sirvió en el Cuerpo Médico del Ejército durante la Guerra Hispanoamericana. Durante la Primera Guerra Mundial fue director quirúrgico del American Ambulance Hospital de Neuilly (Francia). Ayudó a fundar el Colegio Americano de Cirujanos en 1913 y fue miembro y director no sólo de esta organización, sino también de la Asociación Médica Americana, la Asociación Quirúrgica Americana, la Real Academia de Cirujanos y la Real Academia de Medicina (Reino Unido). En 1921 fue cofundador de la Cleveland Clinic de Cleveland (Ohio, EE.UU.). Fue un importante médico cuyas investigaciones y escritos abarcaron el shock quirúrgico, la función glandular, la presión arterial y las transfusiones, la neurosis de guerra y los efectos de la cirugía en tiempos de guerra. También fue un cirujano extraordinario y prolífico que introdujo innovaciones en el tratamiento quirúrgico de muchas patologías. Aunque sus investigaciones se publicaron hace mucho tiempo, sus aportaciones a la medicina siguen siendo fundamentales para la práctica clínica en los quirófanos y unidades de cuidados intensivos actuales.

George W. Crile (1864-1943) was an exceptional American surgeon who served in the Army Medical Corps during the Spanish-American War. During the First World War, he was surgical director of the American Ambulance Hospital in Neuilly, France. He helped found the American College of Surgeons in 1913 and was a member and director not only of this organization, but also of the American Medical Association, the American Surgical Association, the Royal Academy of Surgeons and the Royal Academy of Medicine (UK). In 1921, he co-founded the Cleveland Clinic in Cleveland, Ohio, USA. He was an important physician whose research and writings included surgical shock, glandular function, blood pressure and transfusions, war neurosis and the effects of wartime surgery. He was also an extraordinary and prolific surgeon who introduced innovations in the surgical treatment of many pathologies. Although his research was published long ago, his contributions to medicine remain fundamental to clinical practice in today's operating rooms and intensive care units.