Alumbramiento patológico por presencia de T de cobre en membranas ovulares. Informe de caso / Pathological delivery due to the presence of copper T in ovular membranes. Case Report

Los dispositivos intrauterinos de cobre son utilizados como métodos anticoncepcionales y es uno de los métodos más utilizados por su seguridad, reversibilidad y eficacia en la prevención de embarazos, que es superior al 97 %. Se presenta un caso de falla en la anticoncepción con dispositivos intrauterinos de cobre después de 5 años de uso en gestante de 26 años, que acudió al área de emergencias cursando con embarazo de 38 semanas y 4 días en periodo expulsivo; se obtuvo recién nacido a término sano. El periodo de alumbramiento patológico (prolongado) por presencia de dispositivo intrauterino de cobre en membranas ovulares(AU)

Copper intrauterine devices are used as contraceptive methods and are one of the most used methods due to their safety, reversibility and effectiveness in preventing pregnancy, which is greater than 97%. A case of failure in contraception with a copper intrauterine devices is presented after 5 years of use in a 26-year-old pregnant woman, who went to the emergency room with a pregnancy of 38 weeks and 4 days in the expulsive period; a healthy term newborn was obtained.The pathological (prolonged) delivery period due to the presence of copper intrauterine devices in ovular membranes(AU)

Interplay between alexithymia, emotion regulation, and positive and negative affect as predictors of gambling and gaming disorders in adolescents and young adults

Introduction/Objectives: Gambling and gaming disorder are usually comorbid addictive behaviours in which alexithymia and emotional regulation have been proved to be of relevance. The present study aimed to analyse the relationship between those variables and their differences depending on the presence or absence of gambling and gaming behaviours. Method: The sample consisted of 1,219 people between 12 and 20 years of age (M = 15.55, SD = 2.07; 51.8% females). Results: The results showed significant differences between players and non-players in gambling disorder, alexithymia and emotional regulation. The findings also indicated that there were differences in alexithymia, emotional regulation, negative affect, gambling disorder and gaming disorder among the different profiles of video game players. The comparison of participants with gaming disorder, gambling disorder, both, or neither of them, showed differences in alexithymia, emotional regulation, negative affect, gambling disorder and gaming disorder. Furthermore, correlations between gambling disorder and age, gaming disorder, negative affect, alexithymia and emotional regulation were found. Similarly, gaming dis-order was associated with gambling disorder, negative affect, alexithymia, emotional regulation and age. Conclusions: The hierarchical regression analyses demonstrated the predictive role of alexithymia and age in gambling disorder as well as the predictive role of age, sex and negative affect in gaming disorder.

Introducción/Objetivos: Los trastornos de juego y videojuego son conductas adictivas habitualmente comórbidas en las que se ha demostrado la relevancia de la alexitimia y la regulación emocional. Este estudio analiza la relación entre dichas variables y sus diferencias en función de la presencia o ausencia de conductas de juego y videojuego. Método: La muestra estuvo formada por 1219 personas de entre 12 y 20 años (M = 15.55, SD = 2.07; 51.8 % mujeres). Resultados: Los resultados mostraron diferencias significativas entre jugadores y no jugadores en el juego patológico, la alexitimia y la regulación emocional. Los resultados también indicaron que había diferencias en alexitimia, regulación emocional, afecto negativo, trastorno de juego y videojuego entre los distintos perfiles de jugadores de videojuegos. La comparación de los participantes con trastorno de juego y videojuego, con ambos o con ninguno de ellos, mostró diferencias en la alexitimia, la regulación emocional, el afecto negativo, el trastorno de juego y videojuego. Además, se encontraron correlaciones entre el juego patológico y la edad, el trastorno por videojuego, el afecto negativo, la alexitimia y la regulación emocional. Del mismo modo, el trastorno por videojuego se asoció con el juego patológico, el afecto negativo, la alexitimia, la regulación emocional y la edad. Conclusiones: Los análisis de regresión jerárquica demostraron el papel predictivo de la alexitimia y la edad en el trastorno de juego y el papel predictivo de la edad, el sexo y el afecto negativo en el trastorno por videojuego.

Body Shape Questionnaire (BSQ) en jóvenes universitarios limeños: Evidencias Iniciales de Validez y Confiabilidad / Body Shape Questionnaire (BSQ) in young university Metropolitan Lima: Initial Evidence of Validity and Reliability

Resumen Con la finalidad de evaluar la presencia de insatisfacción corporal en jóvenes varones, resulta importante contar con instrumentos adecuados que midan esta insatisfacción y que garanticen resultados válidos. En el Perú y en diversos países, no se cuenta con gran variedad de herramientas apropiadas que midan la insatisfacción de la imagen corporal en varones, por lo que el propósito de la investigación fue adaptar lingüística y psicométricamente el BSQ en un grupo de jóvenes varones universitarios (n=320) de Lima Metropolitana con un rango de edad de 18 a 30 años. Se obtuvo una explicación del 50.72% sobre la variabilidad del instrumento y los resultados mostraron una excelente consistencia interna en ambos factores: 1) Malestar Corporal Normativo (α= .88) y 2) Malestar Corporal Patológico (α= .87). Respecto a la validez convergente y divergente, el BSQ demostró una buena capacidad para determinar la presencia de insatisfacción de la imagen corporal denotando una convergencia positiva y significativa entre ambos factores del BSQ con el Afecto Negativo del SPANAS, explicando como todos estos sentimientos negativos se encuentran presentes e influyen con la aparición de esta incomodidad. Se discuten las limitaciones y recomendaciones del estudio, y la dirección de futuras investigaciones.

Abstract In order to evaluate the presence of corporal dissatisfaction in young men, it is important to have adequate instruments to measure this dissatisfaction and guarantee valid results. However, in Peru and several countries, there is not a great variety of appropriate tools to assess body image dissatisfaction. The present research aimed to adapt the Body Shape Questionnaire (BSQ) to a group of young male university students (N = 320) from Metropolitan Lima with an age range of 18 to 30 years. Results showed a 2-factor structure that explained 50.72% of the total variance. An excellent internal consistency was obtained in both factors: 1) Normative Body Uncomfort (α = .88) and 2) Pathological Body Uncomfort (α = .87). Regarding convergent and divergent validity, the BSQ showed good ability to determine the presence of body image dissatisfaction, denoting a positive and significant convergence between both BSQ factors with the PANAS Negative Affect, explaining how all these negative feelings are present and influence with this discomfort. Finally, the limitations and recommendations of the study, as well as the direction of future research are discussed.

Evaluación del sistema vestibular: examen oculomotor y vestíbulo-ocular / Assessment of the vestibular system: oculomotor and vestibulo-ocular examination

RESUMEN Una completa evaluación vestibular y oculomotora es la llave para diferenciar las causas periféricas o centrales de vértigo agudo. El/la kinesiólogo/a debe estar capacitado para realizar una evaluación especializada del paciente. El objetivo de esta guía paso a paso es detallar al lector el procedimiento e interpretación de las herramientas de evaluación más relevantes del examen físico, dentro de la evaluación con y sin fijación visual, para realizar un diagnóstico diferencial de un paciente que ingresa a la consulta kinésica.

ABSTRACT A complete vestibular and oculomotor assessment is key to differentiate between peripheral and central causes of acute vertigo. Physical therapists must be trained to perform a proper assessment. The objective of this study is to describe the procedure and interpretation of the most relevant physical assessment tools, with and without visual fixation, to reach a differential diagnosis in patients attending for physiotherapy consultation.

Factores asociados a falla terapéutica con maniobras de reposición canalicular en pacientes con diagnóstico de vértigo posicional paroxístico benigno en la Clínica de Otorrinolaringología de Antioquia, Medellín, Colombia / Factors associated with therapeutic failure with canalicular repositioning maneuvers in patients diagnosed with benign paroxysmal positional vertigo at Antioquia Otorhinolaryngology Clinic, Medellin, Colombia"

Introducción: múltiples factores se han relacionado con el desarrollo de la recurrencia del vértigo posicional paroxístico benigno (VPPB). Objetivo: determinar la asociación entre la falla terapéutica de las maniobras de reposición canalicular (MRC) y las variables sociodemográficas y clínicas en los pacientes con diagnóstico de VPPB. Diseño: estudio observacional de cohorte retrospectiva. Materiales y métodos: revisión de historias clínicas de la consulta de vértigo de la Clínica Orlant, Medellín, Colombia. Resultados: se incluyeron 41 pacientes con diagnóstico de VPPB a quienes se les realizó MRC y seguimiento clínico entre 1 y 8 semanas. El 90,2 % eran de sexo femenino, con una mediana de edad de 58 (±183) años; se encontró uso de vestibulosupresores en un 68,3 %, y es la betahistina el más consumido (43,9 %). El 51,2 % de pacientes presentaron falla terapéutica y se identificó una asociación con el número total de MRC realizadas y el uso de vibrador mastoideo (p < 0,001), teniendo en cuenta que los pacientes mejoraron clínicamente al final del seguimiento con una media de 77 % (p < 0,001). No se encontraron asociaciones estadísticamente significativas con el resto de variables. Conclusión: no hubo asociación entre la falla terapéutica y las variables estudiadas, excepto número de MRC, el uso del vibrador mastoideo y la mejoría clínica final, posiblemente porque el vibrador mastoideo se aplica a los pacientes en quienes hay persistencia de síntomas y signos con las maniobras desencadenantes, y por factores fisiopatológicos no esclarecidos; con esto finalmente se logra una mejoría clínica con más de dos MRC

Introduction: Multiple factors have been related to the development of recurrence of benign paroxysmal positional vertigo (BPPV). Objective: To determine the association between therapeutic failure of canalicular repositioning maneuvers (CRM) with sociodemographic and clinical variables in patients with a diagnosis of BPPV. Design: Observational retrospective cohort study. Materials and methods: Review of medical records of the vertigo clinic of the Orlant Clinic, Medellín - Colombia. Results: 41 patients with a diagnosis of BPPV who underwent CRM and clinical follow-up between 1 and 8 weeks were included. 90.2% were female, with a median age of 58 (± 18.3) years, use of vestibulosuppressants was found in 68.3%, betahistine being the most consumed (43.9%). 51.2% of patients presented therapeutic failure, identifying an association with the total number of CRMs performed and the use of a mastoid vibrator with (p < 0.001), taking into account that the patients improved clinically at the end of follow-up with a mean of 77% (p < 0.001). No statistically significant associations were found with the rest of the variables. Conclusion: There was no association between therapeutic failure and the variables studied except number of CRM, use of the mastoid vibrator and final clinical improvement, possibly because the mastoid vibrator is applied to patients in whom there are persistence of symptoms and signs with the triggering maneuvers for unclear pathophysiological factors, finally achieving clinical improvement with more than two CRMs.

Interpretación de resultados de las pruebas oculomotoras, posicionales y calóricas de la videonistagmografía. Revisión documental / Interpretation of the results of the oculomotor, positional and caloric test of the videonistagmography. Documentary review

Introducción: en la actualidad, se reconocen cuadros vestibulares periféricos y centrales que pueden ser diagnosticados mediante la videonistagmografía (VNG). Los avances en la tecnología han provocado en los profesionales una constante actualización en el uso e interpretación de las distintas pruebas que conlleven, en su lectura cruzada, un diagnóstico acertado y a tratamientos de rehabilitación exitosos. El objetivo fue describir las interpretaciones de los resultados de las pruebas oculomotoras, posicionales y calóricas de la VNG para lograr un diagnóstico detallado de las disfunciones vestibulares. Materiales y métodos: revisión documental obtenida de 40 fuentes reportadas en la literatura científica entre 2010 a 2020 tomadas de bases de datos, tesis de grado y libros. Discusión: dentro de la revisión se encontraron tres categorías (pruebas oculomotoras, posicionales y calóricas) y siete subcategorías (nistagmo espontáneo, nistagmo evocado por la mirada, rastreo, sacadas, optocinético, Dix-Hallpike y roll test). Conclusión: los diversos elementos encontrados en la presente revisión son relevantes ya que precisan no solo el tipo de vértigo, sino también su localización topográfica, lo que favorece el proceso de evaluacióndiagnóstico en la población en general.

Introduction: At present, peripheral and central vestibular frames are recognized that can be diagnosed by videonystagmography (VNG). Advances in technology have caused professionals to constantly update the use and interpretation of the different tests that lead, in their cross-reading, to an accurate diagnosis and successful rehabilitation treatments. The objective was to describe the interpretations of the results of the oculomotor, positional and caloric tests of the VNG, for a detailed diagnosis of the vestibular dysfunctions. Materials and method: Documentary review obtained from 40 sources reported in the scientific literature between 2010 and 2020, taken from databases, thesis and books. Discussion: Within the review, three categories were found (oculomotor, positional and caloric tests) and seven subcategories (spontaneous nystagmus, gaze-evoked nystagmus, tracking, saccades, optokinetic, Dix-Hallpike and roll test). Conclusion: The various elements found in this review are relevant in that they specify not only the type of vertigo but also its topographic location, favoring the evaluation-diagnosis process in the general population.

Transtorno de Jogo: contribuição da abordagem psicodinâmica no tratamento / Gambling Disorder: contributions of the psychodynamic approach to treatment / Jeu Pathologique: contributions de l'approche psychodynamique au traitement / Trastorno de Juego: contribución del enfoque psicodinámico al tratamiento

Resumo Jogos de azar podem ser uma atividade de lazer, mas sua prática em excesso pode levar a consequências adversas, como o Transtorno de Jogo. Apesar dos sérios prejuízos provocados por esse quadro, tanto o Transtorno de Jogo em si quanto estratégias de tratamento são pouco conhecidos no Brasil. Este trabalho aborda o Transtorno de Jogo e seu tratamento, tendo como objetivo explicitar a contribuição da abordagem psicodinâmica. São apresentadas as principais hipóteses psicodinâmicas existentes na literatura e tecidas considerações sobre a psicoterapia psicodinâmica realizada em um serviço que atende jogadores em São Paulo, o Programa Ambulatorial do Jogo Patológico (PRO-AMJO) do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IPq HC-FMUSP). Por fim, alguns exemplos de perfis de jogadores patológicos são apresentados.

Abstract Gambling may be a leisure activity, but overdoing it can lead to adverse consequences such as Gambling Disorder. Despite the serious damage caused by the disorder, both Gambling Disorder and its treatment strategies are little known in Brazil. This study investigates Gambling Disorder and its treatment, emphasizing the contributions of the psychodynamic approach. The paper presents the main psychodynamic hypotheses in the literature and comments on the psychodynamic psychotherapy carried out in facilities treating pathological gamblers in São Paulo, such as the Pathological Gambling Outpatient Program (PRO-AMJO) of the Psychiatric Institute of Hospital das Clínicas (IPq HC-FMUSP). Finally, some examples of pathological gambler profiles are discussed.

Résumé Le jeu de hasard peut être un loisir, mais l'excès peut avoir des conséquences néfastes, comme le Jeu Pathologique. Malgré les graves consequences causés par ce trouble, le Jeu Pathologique et ses stratégies de traitement sont peu connus au Brésil. Cettte étude porte sur la Dépendence au jeu et son traitement, en mettant l'accent sur les contributions de l'approche psychodynamique. L'article présente les principales hypothèses psychodynamiques dans la littérature et reflète sur la psychothérapie psychodynamique réalisée dans les services qui s'occupent de joueurs à São Paulo, telles que le Programma ambulatoire sur la dépendance au jeu (PRO-AMJO) del'Institut de psychiatrie de l'Hospital das clínicas (IPq HC-FMUSP). Enfin, quelques exemples de profils de joueurs pathologiques sont discutés.

Resumen Los juegos de azar pueden ser una actividad de diversión, pero su práctica excesiva puede traer consecuencias adversas como el Trastorno de Juego. A pesar de los graves daños causados por este comportamiento, tanto el Trastorno de Juego en sí como las estrategias de tratamiento son poco conocidos en Brasil. Este trabajo aborda el Trastorno de Juego y su tratamiento, con el objetivo de hacer explícito la contribución del enfoque psicodinámico. Se presentan las principales hipótesis psicodinámicas en la literatura y se hacen consideraciones sobre la psicoterapia psicodinámica realizada en un servicio que atiende a jugadores en São Paulo, como el Programa del Hospital das Clínicas de la Facultad de Medicina de la Universidad de São Paulo (IPq HC-FMUSP). Finalmente, se presentan algunos ejemplos de perfiles de jugadores patológicos.

Um problema que não podemos deixar passar: relato de um caso de luto patológico / A problem that we cannot let go of: report of a case of pathological grief

Este trabalho apresenta o relato de um atendimento clínico de um caso de luto patológico após perda de um familiar, desencadeado pela perda de um objeto. A partir disso, a paciente passa por um processo de luto, que tende a ser subestimado pelos profissionais de saúde, mas que necessita intervenção e acompanhamento. Destaca-se que o atendimento aconteceu em uma UBS que dispunha de um serviço psiquiátrico semanal de acompanhamento e auxílio para a região. No caso estudado, conclui-se que a intervenção farmacológica demonstrou grandes avanços, mesmo com a situação de escassez de recursos da saúde pública e opções terapêuticas. Dessa forma, considera-se que todos devemos ficar atentos para essa patologia, que passa despercebida e é subestimada como ocorre com o luto.

This paper reports the clinical care delivered in a case of pathological grief after the loss of a family member triggered by the loss of an object. From this, the female patient goes through a grieving process, which tends to be underestimated by health professionals, but which requires intervention and monitoring. It is noteworthy that the patient was attended to in a UBS that had a weekly psychiatric service for monitoring and assistance for the region. In the case studied, it can be concluded that pharmacological intervention has shown great advances despite the scarcity of public health resources and therapeutic options. Thus, it is considered that we should all be aware of this pathology that goes unnoticed and is underestimated, as it happens with grief.

Valor del estudio patológico intraoperatorio de tiroides. Comparación con la punción aspiración preoperatoria y la patología diferida / Value of the intraoperative pathology in thyroid surgery: comparison with preoperative aspiration puncture and deferred pathology

Resumen Para evaluar la utilidad diagnóstica del estudio patológico intraoperatorio (EPI) en cirugía tiroidea se realizó una revisión retrospectiva de sus resultados en 350 pacientes en comparación con la biopsia preoperatoria por punción con aguja fina (PAAF) y el est udio patológico diferido (EPD). Los resultados de la PAAF se clasificaron según el sistema de Bethesda en categoría II (91 casos, 26.0%), III (21 casos, 6.0%), IV (73 casos, 21.9%), V (54 casos, 15.4%) y VI (111 casos, 31.7%). El EPI mostró lesiones benignas en 137 casos (39.1%), malignas en 169 (48.2%), y resultados no definitivos en 44 (12.6 %). El EPD informó patología benigna en 161 casos (46%) y carcinoma en 189 (54%); se encontró carcinoma en 8 pacientes (5.8%) en quienes el EPI había informado lesión benigna y en 12 (27.2%) en quienes había informado no definitivo; 13 de estos 20 casos fueron microcarcinomas incidentales. El EPI no informó ningún falso positivo (especificidad 100%, sensibilidad 89.4%, valor predictivo positivo 100%, valor predictivo negativo 90.0%, exactitud 94.2%). Los resultados de malignidad con EPI y EPD, según categorías de Bethesda fueron respectivamente: II 3 (3.3%) y 7 (7.7%); III 8 (38.1%) y 10 (47.6%); IV 3 (4.1%) y 10 (13.7%); V 47 (87.0%) y 52 (96.3%); VI 108 (97.3%) y 110 (99.1%). El EPI no dio información adicional a la biopsia por PAAF en la mayoría de los casos ni detectó microcarcinomas en otros, por lo que no parece justificado indicarlo rutinariamente.

Abstract To evaluate the usefulness of intraoperative pathology (IP) in thyroid surgery, a retrospective review of its results in 350 patients was performed in comparison with the results of the preoperative fine-needle biopsy (FNB) and the surgical pathology report (SPR). The FNB was reported according to the Bethesda system as type II in 91 cases (26.0%), type III in 21 (6.0%), type IV in 73 (21.9%), type V in 54 (15.4%), and type VI in 111 (31.7%). The IP showed benign lesions in 137 cases (39.1%), malignancy in 169 (48.2%), and inconclusive results in 44 (12.6%). The SPR results were benign pathology in 161 cases (46%) and carcinoma in 189 (54%); carcinoma was found in 8 patients (5.8%) in whom the IP had reported benignity, and in 12 (27.2%) with IP inconclusive results; 13 of those 20 cases were incidental microcarcinomas. The IP did not report any false positive result (specificity 100 %, sensitivity 89.4%, positive predictive value 100%, negative predictive value 90.0%, and accuracy 94.2%). When discriminated by Bethesda types, the malignant lesions detected by IP and SPR were, respectively: II 3 (3.3%) and 7 (7.70%); III 8 (38.1%) and 10 (47.6%); IV 3 (4.1%) and 10 (13.7%); V 47 (87.0%) and 52 (96.3%); VI 108 (97.3%) and 110 (99.1%). In most cases, the IP did not provide additional information to the FNB report nor did it detect microcarcinomas in others, so it does not seem justified to perform it routinely.

Neuropsiquiatría del síndrome de Susac: a propósito de un caso / Neuropsychiatry of Susac Syndrome: a Case Report

RESUMEN El síndrome de Susac es una entidad clínica poco frecuente, posiblemente mediada por un proceso autoinmune; la tríada clásica se compone de retinopatía, disminución en la agudeza auditiva y síntomas neuropsiquiátricos (encefalopatía). Hay pocos casos descritos con sintomatología neuropsiquiátrica como la sintomatología principal. Presentamos un caso de síndrome de Susac, que corresponde a una mujer de 34 arios, con predominio de sintomatologia neuropsiquiátrica, caracterizada por un síndrome de Klüver-Bucy parcial, un síndrome apático, risa y llanto patológico y alteraciones cognitivas de predominio atencional; dichos síntomas mejoraron cualitativamente con el uso de terapia inmunológica. Este caso revela la importancia de las manifestaciones neuropsiquiátricas como presentación clínica en pacientes con entidades neurológicas.

ABSTRACT Susac syndrome is a rare clinical condition, possibly mediated by an autoimmune process; the classic triad is composed of retinopathy, decreased hearing acuity and neuropsychiatric symptoms (encephalopathy). There are few cases reported with neuropsychiatric symptoms as the main manifestation. We present a case of Susac syndrome in a 34-year-old female with a predominance of neuropsychiatric symptoms, characterised by partial Klüver-Bucy syndrome, apathy syndrome, pathological laughter and crying, and cognitive dysfunction predominantly affecting attention, which showed a qualitative improvement with the use of immunological therapy. This case report highlights the importance of neuropsychiatric manifestations as clinical presentation in patients with neurological conditions.

Visual outcomes of audio-luminous biofeedback training for a child with idiopathic nystagmus / Desfechos visuais de treinamento de biofeedback audioluminoso em criança com nistagmo idiopático

ABSTRACT Microperimetry biofeedback training is a vision rehabilitation method that involves the training of attention and oculomotor control, and the rehabilitation of poorly located and non-functional preferred retinal loci. It can significantly improve distance and near visual acuity in age-related macular degeneration. Previous studies have shown that biofeedback training using electrical nystagmography can reduce nystagmus amplitude and increase foveation time. However, these improvements have not been sustained following training sessions. We hereby report a pediatric case of idiopathic nystagmus in an 11-year old patient treated with microperimetric biofeedback to improve visual acuity and fixation stability. The training had a beneficial impact, positively affecting fixation stability as well as distance and near reading vision. Subjectively, improvement in quality of life was also reported. Conversely to previous studies, the positive effects in this case were maintained for as long as twelve months following therapy. To the best of our knowledge, this is the first case with long-term benefits to be reported in the literature.(AU)

RESUMO O treinamento de biofeedback por microperimetria é um método de reabilitação da visão que envolve treinamento de atenção, controle oculomotor e reabilitação do locus preferencial de fixação da retina. Esse treinamento pode melhorar significativamente a acuidade visual para longe e perto na degeneração macular relacionada à idade. Estudos anteriores mostraram que o treinamento de biofeedback usando a nistagmografia elétrica pode reduzir a amplitude do nistagmo e aumentar o período de foveação. Entretanto, os resultados não se mantiveram após o término das sessões. Aqui é relatado um caso de tratamento com biofeedback por microperimetria para melhorar a acuidade visual e a estabilidade de fixação em uma criança de 11 anos de idade. O treinamento teve impacto benéfico e afetou positivamente a estabilidade da fixação e a visão para longe, para perto e de leitura. Subjetivamente, foi relatada melhoria da qualidade de vida. Em contraste com estudos anteriores, os efeitos positivos foram mantidos até 12 meses após a terapia. Até onde sabemos, este é o primeiro caso na literatura que relata benefícios de longo prazo.(AU)

Does coping mediate the relationship between competitive anxiety and eating disorders in athletes? / O Coping medeia a relação entre ansiedade competitiva e transtornos alimentares em atletas? / Coping media la relación entre la ansiedad competitiva y los trastornos de la alimentación en los atletas?

The competitive anxiety shows positive and linear relationship with risk behaviors for eating disorders (RBED). The competitive anxiety shows negative and linear relationship with coping strategies. Perhaps the coping strategies can mediate the relationship between competitive anxiety and RBED in athletes. The aim of this study was to analyze the coping mediation between competitive anxiety and RBED in Brazilian male athletes. 739 athletes from various sports participated. To assess the RBED frequency, the Disordered Eating in Sports Scale was adopted. The Brazilian version of the Competitive State Anxiety Inventory was used to evaluate competitive anxiety. Athletic Coping Strategies Inventory was used to evaluate coping strategies. The findings revealed a direct relationship between competitive anxiety and RBED (p = .01). The results indicated that coping strategies potentiated the relationship between competitive anxiety and RBED (p = .01). It was concluded that coping can be considered a psychological determinant in the relationship between competitive anxiety and RBED.

A ansiedade competitiva possui relação positiva e linear com a frequência de comportamentos de risco para os transtornos alimentares (CRTA). A ansiedade competitiva apresenta relação negativa e linear com as estratégias de coping. Talvez o coping possa mediar a relação entre a ansiedade competitiva e a frequência de CRTA em atletas. O objetivo do estudo foi analisar a mediação do coping entre a ansiedade competitiva e os CRTA em atletas brasileiros do sexo masculino. Participaram 739 atletas. Para avaliação da frequência de CRTA, foi adotada a Disordered Eating in Sports Scale. Utilizou-se a versão brasileira do Competitive State Anxiety Inventory (CSAI-2R) para avaliar a ansiedade competitiva. Foi utilizado o Athletic Coping Strategies Inventory para avaliar as estratégias de coping. Os achados revelaram relação direta entre a ansiedade competitiva e os CRTA (p = .01). Os resultados indicaram que as estratégias de coping potencializaram a relação entre a ansiedade competitiva e os CRTA (p = .01). Concluiu-se que o coping pode ser considerado uma variável psicológica determinante na relação entre a ansiedade competitiva e os CRTA.

No se sabe si el afrontamiento media la relación entre la ansiedad y los comportamientos de riesgo para los trastornos de la alimentación (CRTA) en atletas. El objetivo del estudio fue analizar la mediación de afrontamiento entre la ansiedad competitiva y CRTA en los atletas masculinos brasileños. Participaron 739 atletas. Para evaluar la frecuencia de los CRTA se adoptó Disordered Eating in Sports Scale. Se utilizó la versión brasileña del Competitive State Anxiety Inventory para evaluar la ansiedad competitiva. Se utilizó el Athletic Coping Strategies Inventory para evaluar las estrategias de afrontamiento. Los resultados revelaron una relación directa entre la ansiedad competitiva y CRTA (p = .01). Los resultados indicaron que las estrategias de afrontamiento potenciaron la relación entre la ansiedad competitiva y CRTA (p = .01). Se concluyó que el afrontamiento se puede considerar una variable psicológica decisiva en la relación entre la ansiedad competitiva y CRTA.

Diagnóstico Patológico en Mora de Castilla Rubus glaucus Bentham (Rosales:Rosaceae) / A pathological diagnosis of Rubus glaucus Bentham Andean blackberry (Rosales:Rosaceae) / Diagnóstico patológico em amora preta de Castilla Rubus glaucus Bentham (Rosales:Rosaceae)

Resumen Se realizó un diagnóstico patológico de un cultivo de Mora de Castilla en la vereda Pascote, municipio de Gutiérrez Cundinamarca, Colombia. Las muestras vegetales se tomaron de las hojas, tallo, flor, fruto y raíz; las cuales, se procesaron en identificaron en el laboratorio de fitopatología de la Universidad de los Llanos. En el campo se evaluó incidencia de cada síntoma. Se encontraron cuatro patógenos fungosos Colletrotrichum . gloesporoides (Penz.) Penz. con 40.00% de incidencia, Peronospora sparsa Berk con una incidencia del 20.00 %, Oidium sp, con 12.50% de incidencia y Botrytis cinérea Perms., con una incidencia del 7.50 %.

Abstract A pathological diagnosis was made of an Andean blackberry crop (Rubus glaucus Bentham) in the rural area of Pascote, in the municipality of Gutiérrez, Cundinamarca, Colombia. Samples were taken from blackberry leaves, stems, flowers, fruit and roots; they were processed and identified in the Universidad de Los Llanos' plant pathology laboratory. Pathogen/disease symptom incidence was evaluated in the field. Four fungal pathogens were found and identified: Colletotrichum gloesporoides (Penz.) Penz (anthracnose), 40% incidence, Peronospora sparsa Berk (downy mildew), 20% incidence, Oidium sp. (powdery mildew), 12.5% incidence, and Botrytis cinerea Perms (gray mold disease), 7.5% incidence.

Resumo Realizou-se um diagnóstico fitopatológico num cultivo de amora preta no Vilarejo de Pascote, município de Gutiérrez, Cundi­namarca, Colômbia. As amostras vegetais foram colhidas das folhas, caule, flor, fruto e raiz; que foram processados e identificados no laboratório de patologia vegetal da Universidad de los Llanos. A incidência de cada sintoma foi avaliada no campo. Foram encontrados quatro patógenos fúngicos: Colletrotrichum. gloesporoides (Penz.) Penz. com uma inci­dência de 40,00%; Peronospora sparsa Berk com uma incidência de 20,00%; Oidium sp, com uma incidência de 12,50%; e Botrytis cinérea Perms., com uma incidência de 7,50%.

Juegos de apuestas en estudiantes universitarios: diferencias en impulsividad rasgo, distorsiones cognitivas y severidad en función del tipo de apuestas / Gambling behavior in college students: differences in trait-like impulsivity, cognitive distortions and severity as a function of gambling preference

Resumen El juego patológico se caracteriza por un patrón persistente y excesivo de juego, con interferencias en la vida personal, social, familiar y laboral. Objetivo: Examinar en estudiantes universitarios diferencias en impulsividad rasgo, distorsiones cognitivas y severidad en el involucramiento con los juegos de apuestas en función de los juegos de apuestas de preferencia (estratégicos y no estratégicos); y variaciones en impulsividad en función de los diferentes niveles de severidad en el involucramiento con los juegos de apuestas (sin riesgo, bajo riesgo, alto riesgo). Método: Participaron 295 estudiantes que completaron instrumentos para medir: 1-ocurrencia y preferencia de juegos de apuestas (cuestionario ad-hoc), 2-severidad en el involucramiento con los juegos de apuestas (versión en español del South Oaks Gambling Screen, 3-impulsividad rasgo (versión en español de UPPS-P Impulsive Behavior Scale), 4-distorsiones cognitivas (versión en español del Gamblers' Beliefs Questionnaire). Resultados: Se encontraron diferencias estadísticamente significativas en impulsividad, distorsiones cognitivas y severidad en el involucramiento con los juegos de apuestas en función de la preferencia por determinados tipos de apuestas, y en impulsividad en función del nivel de severidad en el involucramiento con los juegos de apuestas. Conclusión: Los hallazgos describen características psicológicas asociadas a una mayor vulnerabilidad a exhibir modalidades problemáticas de involucramiento con los juegos de apuestas; y sugieren que quienes exhiben preferencias por juegos de apuestas categorizados como estratégicos, o por apuestas estratégicas y no estratégicas combinadas, son quienes parecen estar en mayor riesgo de presentar problemas con el juego de apuestas.

Abstract Pathological gambling is characterized by a persistent and excessive pattern of gambling, with interference in personal, social, family and work life. Objective: To examine, in college students, differences in impulsivity trait, cognitive distortions and severity in gambling involvement as a function gambling preference (strategic and non-strategic); and variations in impulsivity as a function of levels of severity in gambling involvement (no risk, low risk, risk). Method: 295 students completed a survey to measure: 1-occurrence and preference of gambling (ad-hoc questionnaire), 2-severity of gambling involvement (Spanish version of the South Oaks Gambling Screen), 3- impulsivity trait (Spanish version of the UPPS-P Impulsivity Behavior Scale), 4-cognitive distortions (Spanish version of the Gamblers' Beliefs Questionnaire). Results: Analysis of Variance revealed significant differences in impulsivity, cognitive distortions and gambling severity as a function of gambling preference; and significant differences in trait-like impulsivity as a function of gambling severity. Conclusion: These findings describe psychological characteristics associated with increased vulnerability to exhibit gambling problems. The findings also suggest that individuals with a preference for strategic gambling or strategic and no strategic gambling, seem to be at heightened risk for problematic gambling.

Validez de contenido del cuestionario de juego patológico SOGS en el ámbito forense colombiano / The Validity of the SOGS Pathological Gambling Survey's Content in the Colombian Forensic Field / Validade de conteúdo do questionário de jogo patológico SOGS no campo forense colombiano

Resumen Tradicionalmente se ha distinguido el juego como pasatiempo (play) del juego con apuestas (gambling). El juego con apuestas ha facilitado la aparición de conductas problemáticas como el juego patológico, conocido como ludopatía. En Colombia la Ley 1554 de 2012 en el artículo 7° parágrafo I, menciona la importancia de definir guías y protocolos de atención y evaluación de la ludopatía. No obstante, en el contexto colombiano son escasos los estudios que evalúen y atiendan esta problemática. El presente estudio, tuvo como objetivo establecer la validez de contenido del instrumento South Oaks Gambling Screen (SOGS) ampliamente utilizado en el ámbito de la psicología forense. La metodología consistió, en primer lugar, en una etapa de adaptación y ajustes al instrumento, y posteriormente, una etapa de juicio de expertos mediante el método Delphi. Entre los principales resultados del estudio se encuentran: la adaptación de los criterios diagnósticos del cuestionario del DSM-III-R al DSM-5, la adaptación al lenguaje colombiano que permite establecer una mayor comprensión del cuestionario y la incorporación de aspectos relacionados con el juego y las apuestas en línea. El producto de este estudio constituye un instrumento viable para su utilización en el ámbito jurídico y forense, mediante el criterio probatorio del artículo 226 del Código General del Proceso.

Abstract Traditionally, "play" has been distinguished as a hobby within "gambling". Gambling has facilitated the appearance of problematic conducts, such as pathological gambling, also known as compulsive gambling. In Colombia, Law 1554/2020, in article 7, paragraph 1, mentions the importance of defining attention and assessment guides and protocols for compulsive gambling. However, there are few studies in the Colombian context that assess and attend to this issue. This study's objective was to establish the validity of the South Oaks Gambling Screen (SOGS) instrument's content, which is widely used in the field of forensic psychology. The methodology first consisted of a stage adapting to and adjusting the instruments and then a stage of expert judgment through the Delphi method. The study's main results includes: adapting the survey's diagnostic criteria from DSM-III-R to DSM-5, adapting it to Colombian Spanish, which ensures better understanding of the survey and incorporating aspects related to online gambling and betting. This study's product comprises an instrument that may be used in legal and forensic fields through the standard of proof in article 226 of the General Procedural Code.

Resumo Tradicionalmente, tem sido distinguido o jogo como um passatempo (play) do jogo com apostas (gambling). O jogo com apostas facilitou o aparecimento de comportamentos problemáticos, como o jogo patológico, conhecido como jogo compulsivo. Na Colômbia, a Lei 1554 de 2012 em seu artigo 7, parágrafo I, menciona a importância de definir diretrizes e protocolos para o atendimento e avaliação do jogo patológico. Porém, no contexto colombiano, existem poucos estudos que avaliem e abordem esse problema. O presente estudo teve como objetivo estabelecer a validade de conteúdo do instrumento South Oaks Gambling Screen (SOGS) amplamente utilizado na área da psicologia forense. A metodologia consistiu, em primeiro lugar, em uma etapa de adaptação e ajustes do instrumento e, posteriormente, em uma etapa de julgamento de especialistas através método Delphi. Entre os principais resultados do estudo estão: a adaptação dos critérios de diagnóstico do questionário DSM-III-R ao DSM-5, a adaptação à língua colombiana que permite uma maior compreensão do questionário e a incorporação de aspectos relacionados com o jogo e as apostas online. O produto deste estudo constitui um instrumento viável para sua utilização no campo jurídico e forense, através do critério probatório do artigo 226 do Código Geral do Processo.

Supervivencia de pacientes con cáncer de pulmón sometidos a cirugía de resección con linfoadenectomía por muestreo / Survival of patients with lung cancer undergoing resection surgery with lymphadenectomy by sampling

RESUMEN Fundamentación: En la provincia Sancti Spíritus no se reportan estudios sobre la supervivencia de pacientes con cáncer de pulmón sometidos a cirugía de resección con linfoadenectomía por muestreo. Objetivo: Evaluar la supervivencia de los pacientes con cáncer de pulmón sometidos a cirugía de resección pulmonar y linfadenectomía por muestreo. Metodología: Se realizó una investigación retrospectiva en el Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus, desde el 1 de enero del 1996 al 31 de diciembre del 2007. Fueron incluidos 48 pacientes a los que se les realizó cirugía de resección pulmonar con linfadenectomía por muestreo. Como variable principal fue considerada la supervivencia global a los 5 y 10 años. Otras variables fueron: edad, sexo, clasificación histológica y estadio patológico del tumor primario. Resultados: Predominaron los pacientes del sexo masculino, los mayores de 50 años y con estadio patológico IB. La estirpe histológica predominante fue el carcinoma epidermoide. La mediana de supervivencia fue superior para los estadios tempranos. La mayor supervivencia a los 5 años correspondió a los estadios IA y IIA. A los 10 años no hubo diferencias en la supervivencia de los pacientes. Conclusiones: La mayor supervivencia a los 5 años de los pacientes sometidos a cirugía de resección pulmonar y linfadenectomía por muestreo correspondió a los que se encontraban en estadios con menor extensión de la enfermedad. Entre los 5 y 10 años después de la cirugía hubo una estabilización en la sobrevida de todos los pacientes, indistintamente del estadio patológico inicial.

ABSTRACT Background: In Sancti Spiritus province there are no reports on the survival of patients with lung cancer undergoing resection surgery with lymphadenectomy by sampling. Objective: To evaluate the survival of patients with lung cancer undergoing lung resection surgery and lymphadenectomy by sampling. Methodology: A retrospective investigation was conducted at Camilo Cienfuegos General Provincial Hospital of Sancti Spíritus, from January 1, 1996 to December 31, 2007. They were included 48 patients who underwent lung resection surgery with lymphadenectomy by sampling. The main variable was considered overall survival at 5 and 10 years. Other variables were: age, sex, histological classification and pathological stage of the primary tumor. Results: Male patients, those older than 50 years and with pathological stage IB predominated. The predominant histological line was squamous cell carcinoma. The median survival was higher for the early stages. The greatest survival at 5 years corresponded to stages IA and IIA. At 10 years there were no differences in patient survival. Conclusions: The greatest survival at 5 years of patients undergoing lung resection surgery and lymphadenectomy by sampling corresponded to those who were in stages with less extension of the disease. Between 5 and 10 years after surgery there was stabilization in the survival of all patients, regardless of the initial pathological stage.

A morphological classification for vocal fold leukoplakia / Classificação morfológica das leucoplasias de prega vocal

Abstract Introduction: There is still no general method for discriminating between benign and malignant leukoplakia and identifying vocal fold leukoplakia. Objective: To evaluate the reliability of a morphological classification and the correlation between morphological types and pathological grades of vocal fold leukoplakia. Methods: A total of 375 patients with vocal fold leukoplakia between 2009 and 2015 were retrospectively reviewed. Two observers divided the vocal fold leukoplakia into flat and smooth, elevated and smooth, and rough type on the basis of morphological appearance. The inter-observer reliability was evaluated and the results of classification from both observers were compared with final pathological grades. Clinical characteristics between low risk and high risk group were also analyzed. Results: The percentage inter-observer agreement of the morphological classification was 78.7% (κ = 0.615, p < 0.001). In the results from both observers, the morphological types were significantly correlated with the pathological grades (p1 < 0.001, p2 < 0.001, Kruskal-Wallis test; r1 = 0.646, p1 < 0.001, r2 = 0.539, p2 < 0.001, Spearman Correlation Analysis). Multivariate analysis showed patient's age (p = 0.018), the size of lesion (p < 0.001), and morphological type (p < 0.001) were significantly different between low risk group and high risk group. Combined receiver operating characteristic curve analysis of significant parameters revealed an area under the receiver operating characteristic curve of 0.863 (95% CI 0.823-0.903, p < 0.001). Conclusions: The proposed morphological classification of vocal fold leukoplakia was consistent between observers and morphological types correlated with pathological grades. Patient's age, the size of lesion, and morphological type might enable risk stratification and provide treatment guidelines for vocal fold leukoplakia.

Resumo Introdução: Ainda não há um método universal estabelecido para diferenciar entre a leucoplasia benigna e maligna ou identificar as leucoplasias das pregas vocais. Objetivo: Avaliar a confiabilidade de uma classificação morfológica e a correlação entre os tipos morfológicos e os graus histopatológicos das leucoplasias de pregas vocais. Método: Os registros de 375 pacientes com leucoplasia da prega vocal assistidos entre 2009 e 2015 foram revisados retrospectivamente. Dois observadores dividiram a leucoplasia da prega vocal entre tipo plano e liso, elevado e liso, e rugoso, com base na aparência morfológica. A confiabilidade interobservador foi avaliada e os resultados de classificação de ambos os observadores foram comparados com os graus histopatológicos finais. As características clínicas entre os grupos de baixo risco e alto risco também foram analisadas. Resultados: A porcentagem da concordância interobservador da classificação morfológica foi de 78,7% (κ = 0,615, p < 0,001). Nos resultados de ambos os observadores, os tipos morfológicos correlacionaram-se significativamente com os graus histopatológicos (p1 < 0,001, p2 < 0,001, teste de Kruskal-Wallis; r1 = 0,646, p1 < 0,001, r2 = 0,539, p2 < 0,001, análise de correlação de Spearman). A análise multivariada mostrou que a idade do paciente (p = 0,018), o tamanho da lesão (p < 0,001) e o tipo morfológico (p < 0,001) foram significativamente diferentes entre o grupo de baixo risco e o de alto risco. A análise da curva ROC (Receiver Operating Characteristic) combinada de parâmetros significativos revelou uma área sob a curva de 0,863 (IC 95%: 0,823 ± 0,903, p < 0,001). Conclusões: A classificação morfológica proposta para leucoplasia de prega vocal foi consistente entre observadores e os tipos morfológicos correlacionaram-se com os graus histopatológicos. A idade do paciente, o tamanho da lesão e o tipo morfológico podem permitir a estratificação de risco e fornecem diretrizes de tratamento para a leucoplasia da prega vocal.

Tumour sidedness and clinicopathological features of resected colon cancer in rural population of Northern Pakistan: single institutional analysis / Lateralidade tumoral e características clínico-patológicas do câncer de cólon ressecado na população rural do norte do Paquistão: análise em uma única instituição

ABSTRACT Objectives: Different clinicopathological and molecular features have been demonstrated between right and left sided colon cancers. We aimed to characterize colon cancer and sidedness among a North-Pakistani rural population diagnosed with colon cancer in our institution. Methods: Seventy patients were included in the study that received adjuvant chemotherapy at Bannu Institute of Nuclear Medicine Oncology and Radiotherapy) Bannu, Pakistan from January 2014 to December 2017. Chi-square test was used for significance of categorical variables. p-Values less than 0.05 were considered significant. Results: Mean age at diagnosis for right side colon cancer patients was 43.94 years and for left side colon cancer, it was 49.83 with no significant difference. Male patients were presented more with right (77% vs. 54%, p = 0.044) and females with predominantly left sided tumours i.e. (46% vs. 23%, p = 0.044). Right sided cancer tended to be more poorly differentiated (20% vs. 0%, p = 0.020). Mucinous adenocarcinoma was seen mostly in right sided colon cancer (37% vs. 3%, p ≤ 0.001). There were more locally advanced presentation of right side colon cancer with more node positive (83% vs. 60%, p = 0.025) and lymphovascular invasion (51% vs. 37%, p = 0.016). Sigmoid colon was the most common tumour subsite involved. Conclusion: Our study is the first report of colon cancer in a rural population in North-Pakistan. An earlier onset of tumours (44-50 years) was observed in comparison with global data.

RESUMO Objetivo: Características clínico-patológicas e moleculares distintas foram observadas em tumores de cólon no lado direito ou esquerdo. O presente estudo teve como objetivo caracterizar o câncer de cólon e sua lateralidade em uma população rural norte-paquistanesa diagnosticada com câncer de cólon nesta instituição. Métodos: O estudo incluiu 70 pacientes que foram submetidos a quimioterapia adjuvante no Instituto Bannu de Medicina Nuclear Radioterapia Oncológica (BINOR), Bannu, Paquistão, entre janeiro de 2014 e dezembro de 2017. O teste qui-quadrado foi utilizado para mensurar a significância das variáveis categóricas. Valores de p menores que 0,05 foram considerados significativos. Resultados: A média de idade ao diagnóstico entre pacientes com câncer de cólon no lado direito foi de 43,94 anos e entre aqueles com câncer de cólon no lado esquerdo, 49,83, sem diferença significativa. Os pacientes do sexo masculino apresentaram mais tumores no lado direito (77% vs. 54%, p = 0,044) e as pacientes do sexo feminino apresentaram mais tumores no lado esquerdo (46% vs. 23%, p = 0,044). Tumores mal diferenciados foram mais comumente observados no lado direito (20% vs. 0%, p = 0,020). Adenocarcinoma mucinoso foi observado principalmente em casos de tumores no lado direito (37% vs. 3%, p ≤ 0,001). A apresentação local estava mais avançada em tumores de cólon no lado direito, com mais linfonodos positivos (83% vs. 60%, p = 0,025) e invasão linfovascular (51% vs. 37%, p = 0,016). O cólon sigmoide foi o sublocal mais comum. Conclusão: O presente estudo é o primeiro relato de câncer de cólon em uma população rural no norte do Paquistão. Em comparação com dados globais, observou-se um surgimento mais precoce dos tumores (44-50 anos).

Fractura patológica de cadera en edad pediátrica. Revisión de la angiomatosis quística ósea / Pathological hip fracture of pediatric age. Revision of the cystic angiomatosis of the bone

Resumen: Introducción: La angiomatosis quística ósea es una enfermedad con solamente 200 casos descritos basados en la proliferación no maligna angiomatosa en tejido óseo y vísceras. Se observa más en la pelvis, los huesos largos y la cintura escapular. La evolución clínica varía de formas autolimitantes a osteólisis agresiva masiva (Gorham-Stout). Su diagnóstico es por exclusión, con datos clínico-radiológicos (imágenes líticas) y resultados histopatológicos no específicos. Caso clínico: Nuestro estudio se basa en el caso clínico de un paciente de 14 años diagnosticado con angiomatosis quística ósea, con afección ósea diseminada, que vino a nuestro centro por el dolor y la impotencia funcional en la cadera derecha, diagnosticando una fractura pertrocantérea. Se le hizo una osteosíntesis con tornillo deslizante de la placa VERSA de cuatro agujeros. Se utilizó un injerto alogénico de hueso esponjoso de la cabeza femoral. La evolución fue satisfactoria con ambulación a plena carga por mes sin requerir medicación analgésica y control de rayos X a los ocho meses, los cuales mostraron signos de completa integración del injerto. La escala analgésica del dolor (EVA) mostró una puntuación de 2/10 por mes. Discusión: Hay controversia con respecto al tratamiento de estas fracturas por la osteosíntesis con el injerto del hueso. Nos enfrentamos a un caso sin criterios clínicos serios, pero con múltiples focos de osteólisis. Se decidió no intervenir profilácticamente la cadera contralateral, ya que es asintomática y hay diferentes patrones de evolución descritos en la literatura y los riesgos en la cirugía

Abstract: Introduction: Bone cystic angiomatosis is a disease with only 200 cases described, based on angiomatous nonmalignant proliferation, in bone tissue and viscera. It focuses on pelvis, long bones and scapular waist. Clinical evolution ranges from self-limiting forms to massive aggressive osteolysis (Gorham-Stout).Its diagnosis is of exclusion, with nonspecific clinical, radiological (lytic images) and histopathological findings. Clinical case: Our study is based on the clinical case of a 14-year-old man diagnosed with bone cystic angiomatosis, with disseminated bone involvement, who came to our center for pain and functional impotence in the right hip, diagnosing a pertrochanteric fracture. It was operated by open reduction and osteosynthesis with four-hole VERSA sliding plate screw. An allogeneic graft of cancellous bone was used from femoral head. The evolution was satisfactory, with ambulation at full load per month without requiring analgesic medication and control X-ray at eight months that showed signs of complete integration of the graft. The analgesic pain scale (visual analogue scale) showed a score of 2/10 per month. Discussion: There is controversy regarding the treatment of these fractures by osteosynthesis with bone graft. We are facing a case without serious clinical criteria, but with multiple foci of osteolysis. It was decided not to intervene prophylactically the contraleteral hip, since it is asymptomatic and there are different patterns of evolution described in the literature and risks in surgery.

Amadeus: A Psicologia da Inveja e sua função no processo criativo: um estudo da Psicologia Simbólica / The psychology of envy and its role in the creative process: a study of symbolic psychology / La psicología de la envidia y su función en el proceso creativo: un estudio de la psicología simbólica

O autor analisa a peça de teatro "Amadeus" e estuda a função da inveja na relação de Mozart e Salieri. Caracteriza a inveja como uma função estruturante normal da maior importância no desenvolvimento da consciência. Chama atenção para a dificuldade de se compreender este fato devido às nossas concepções psicológicas se acharem ainda dominadas pela obra repressora-puritana da Inquisição. Afirma que na apresentação da peça a patologia mental de Mozart é ainda maior que a de Salieri. Relaciona a inveja patológica de Mozart com um complexo paterno negativo e a de Salieri com a prostituição de sua Anima. Explica a deterioração progressiva das personalidades de Mozart e Salieri: ao não assumirem sua inveja normal, esta se tornou cada vez mais sombria e patológica, ultrapassando o dinamismo neurótico e atingindo o psicótico. Descreve a função estruturante normal do ciúme para melhor discriminar a inveja e exemplificar o ciúme patológico com a peça Otelo, de Shakespeare. Finalmente, diferencia a função estruturante normal do ciúme e da inveja nos ciclos arquetípicos matriarcal, patriarcal, de alteridade e cósmico. ■

The author describes envy as a normal structuring function in the development of personality. Envy constellates symbols for development and helps to discriminate the Ego from the Other (the I from not I) in the construction of identity. When envy is not given proper attention it becomes part of the Shadow, which may lead to neurotic and even psychotic behavior. An example is given in the relationship between Mozart and Salieri such as it was represented in Peter Shaffer's play "Amadeus". Envy constellated the symbol of Mozart in the development of Salieri's personality as an expression of his betrayed creativity. Since early youth, social ambition had led Salieri to create for fame instead of for his own Self. The betrayal of the Anima formed a powerful symbol of prostituted creativity in his pathological Shadow, which was constellated through envy when he met Mozart. Unable to attend his envy creatively by confronting his Shadow, Salieri acted out his envy destructively by destroying Mozart, his own Anima and himself. Envy constellated the negative father complex in Mozart's personality when he met Salieri. The prodigious child soon surpassed his father. Lack of appropriate protection, affection and loving guidance developed a negative father complex in Mozart's personality. This prevented social adaptation due to a compulsive aggression toward authority figures expressed through defensive irony, ridicule and overall irreverent behavior. Marriage and fatherhood activated the father role and strongly intensified these defenses. As an Italian musician successfully serving the Viennese monarchy, Salieri stood for an extraordinary example of social adaptation and success. Envy constellated the negative father complex through the symbol of social unadaptation present in Mozart's Shadow. By defensively humiliating Salieri through his creativity, Mozart greatly intensified Salieri's defenses against his own genuine creativity. Plotting against Mozart's efforts to support his family through music lessons and court services, Salieri significantly strengthened Mozart's defenses against social adaptation. Such complementary defensive behavior prevented envy from further creative development and established a neurotic symbiotic relationship. The creative forces of both personalities were so powerful, however, that neurotic defenses were insufficient to express their pathological Shadows. Psychopathic aggression and psychotic megalomaniac dynamism took over Salieri's personality, while paranoid, persecutory delusion had and irreversible effect on Mozart's career. The author further clarifies the role of envy in normal and pathological development by comparing it with jealousy as expressed in Shakespeare's Othello. Envy is predominantly active, Jang and revolutionary. It stimulates growth through greed. Jealousy is predominantly passive, Yin and reactionary. lt stimulates the maintenance of the status quo through the threat of loss. Envy functions predominantly through the power drive and favors Ego development by limiting omnipotence through self-humiliation and competitive performance. Jealousy functions predominantly through the erotic drive by rejecting the Ego's narcissistic self-assurance through doubt. Both are archetypal structuring functions indispensable for the symbolic development of Consciousness from its very beginning. While envy discriminates the Ego from the Other through delimitation of the Ego's power, jealousy discriminates the Ego from the intimate Other by introducing a threatening, affectionate foreign Other. The author questions the classical psychoanalytical consideration of jealousy as a later development of envy due to the triangular structure of jealousy as compared to the binary structure of envy. The author argues that jealousy can act through an intimate Other, which is so closely fused with the I that, psychodynamically speaking, jealousy can function in the primary binary relationship as much as envy. The difference, then, lies not in the triangular structure of jealousy but on the threat, which the Other holds for the I in jealousy, which is a complementary psychological function of the threat which the I holds for the Other in envy. The paper ends with a brief description of the different structuring functions of envy and jealousy in each of the four archetypal cycles of symbolic personality development (matriarchal-patriarchal, otherness and cosmic). ■

El autor analiza la pieza de teatro "Amadeus" y estudia la función de la envidia en la relación de Mozart y Salieri. Caracteriza la envidia como una función estructurante normal de la mayor importancia en el desarrollo de la conciencia. Llama atención a la dificultad de comprender este hecho debido a que nuestras concepciones psicológicas se hallan todavía dominadas por la obra represora-puritana de la Inquisición. Afirma que en la presentación de la pieza la patología mental de Mozart es aún mayor que la de Salieri. Relaciona la envidia patológica de Mozart con un complejo paterno negativo y la de Salieri con la prostitución de su Anima. Explica el deterioro progresivo de las personalidades de Mozart y Salieri: al no asumir su envidia normal, ésta se volvió cada vez más sombría y patológica, superando el dinamismo neurótico y alcanzando lo psicótico. Describe la función estructurante normal de los celos para mejor discriminar la envidia y ejemplificar los celos patológicos con la pieza Otelo de Shakespeare. Finalmente, diferencia la función estructurante normal de los celos y la envidia en los ciclos arquetípicos matriarcal, patriarcal, de alteridad y cósmico. ■