Résumé
ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.
Résumé
Objective To compare the effectiveness and safety of ultra-early (< 24 h)and delayed (≥ 24 h ) endovascular embolization of ruptured intracranial aneurysms with systematic review. Methods PubMed,Embase,the Cochrane Library,VIP,Wanfang Data,and China National Knowledge Internet (CNKI)were retrieved according to inclusion,exclusion criteria and retrieval strategies,and the clinical literature of ultra-early and delayed endovascular embolization for the treatment of ruptured intracranial aneurysms were obtained. The Review Manager 5. 3 software was used to conduct Meta-analysis for good prognosis rate,postoperative mortality,and postoperative rebleeding rate. Results A total of 10 articles were included,9 of them were retrospective control studies and 1 was prospective control study. A total of 2 021 patients were enrolled,including 970 patients treated with ultra-early treatment;1 051 patients treated with delayed treatment. There was significant difference in the good prognosis rate (OR,2. 67,95% CI 2. 07 -3. 44,P < 0. 01)and the postoperative rebleeding rate (OR,0. 23,95% CI 0. 11 -0. 47)between the ultra - early embolization group and the delayed embolization group (all P < 0. 01). There were no significant difference in the mortality between the two groups (OR,0. 76,95% CI 0. 51 -1. 13,P = 0. 17). The subgroup analysis showed that there were significant differences in the good prognosis rate in the ultra-early group compared with the early group (< 3 d,OR,1. 98,95% CI 1. 33 -2. 95)and the middle and late group (≥3 d,OR,4. 66,95% CI 2. 21 -9. 81,all P < 0. 01). Conclusion Compared with the delayed group, ultra-early embolization of ruptured intracranial aneurysms may improve the good prognosis rate,reduce the rebleeding rate,and not increase the mortality after procedure at the same time. However,more high quality and large sample randomized controlled trials are needed to confirm them.
Résumé
Neste trabalho apresentamos os resultados de um atendimento realizado a partir da queixa de dificuldade na amamentação de um bebê de dois meses. Este se fundamentou em um modelo de intervenção com base psicanalítica, que chamamos de intervenção psicanalítica pais-bebê. Parte-se do pressuposto de que a amamentação seja um possível canal de comunicação de angústias inconscientes e conflitos latentes na dinâmica familiar, simbolicamente servindo de acesso a esses conflitos, ao mesmo tempo em que se espera que a partir de sua nomeação se encontrem novos caminhos afetivos que possibilitem que ela transcorra como um canal de encontro mútuo da mãe com seu bebê. Em determinados casos a efetiva permanência da amamentação como fonte de alimento nutricional demonstra ser também beneficiada.
Through this work, the authors wish to present the results of a psychoanalytical work performed in the case of a breast-feeding complaint for a 2 months old baby. This work relies on the authors parent-infant psychoanalytical model. Such a model assumes that breast-feeding is a communication channel for unconscious anxiety and underlying conflicts existing in the familys behavior. Also, this model assumes that their nomination can help the parents in finding new affective ways, allowing a re-encounter between mother and baby. In some cases, the extended breast-feeding process that results also benefits from this approach.
En este artículo las autoras muestran los resultados de un trabajo psicoanalítico realizado en un caso de dificultad de amamantamiento de un bebé de 2 meses. Este trabajo es fundamentado en el modelo psicoanalítico padresbebé de las autoras. Este modelo presupone que el amamantamiento es un canal de comunicación de angustias inconscientes y conflictos subyacentes de la dinámica familiar. También, este modelo presupone que la designación de los mismos pueda ayudar a los padres a encontrar nuevos caminos afectivos que permitan un re-encuentro entre la madre y el bebé. En algunos casos, la extensión del periodo de amamantamiento es otro de los beneficios inducidos por este trabajo.