Diagnostic challenges in paediatric foreign body aspiration: a case report / Desafío diagnóstico en la aspiración de cuerpo extraño en pediatría: reporte de un caso

Abstract Introduction Foreign body aspiration (FBA) is a potentially fatal paediatric emergency. Our objective was to highlight the importance of a multidisciplinary approach to difficult/doubtful diagnosis. Case report 34-month-old girl referred for urgent rigid bronchoscopy after suspected metallic blade ingestion (found chewing on it). She had a previous recurrent history of wheezing. The physical examination revealed face/lip wounds, traces of powder on her teeth but no breathing difficulty. The plain X-Ray revealed radiopaque images of the upper pulmonary field and gastric chamber. In the absence of FBA clinical signs but considering a previous history of bronchial hyperresponsiveness, a direct digital radiographic study was performed. There were no images compatible with foreign bodies: the results were interpreted as artefacts and no bronchoscopy was performed. Conclusions A careful pre-anaesthetic evaluation, a high level of suspicion and excellent multidisciplinary communication led to the recognition of false radiologic findings. A conservative approach was followed and invasive procedures in a remote location, with high anaesthetic risk for the paediatric population were avoided.

Resumen Introducción La aspiración de cuerpo extraño (ACE) es una emergencia pediátrica potencialmente fatal. La intención del presente artículo es resaltar la importancia de un abordaje multidisciplinario en caso de un diagnóstico difícil/dudoso. Reporte de caso Se trata de una paciente de 4 meses de edad remitida para broncoscopia rígida de urgencia, luego de la sospecha de ingestión de una hojilla metálica (se encontró a la bebé mordiéndola). La paciente tenía antecedentes de sibilancia. Al examen físico se encontraron heridas en la cara y los labios, rastros de polvo en los dientes, pero no había dificultad respiratoria. El examen de rayos-x mostraba imágenes radio opacas en el cuadrante superior derecho del pulmón y en la cámara gástrica. En virtud de la ausencia de signos clínicos de ACE en una paciente con antecedentes de hiperresponsividad bronquial, se realizó un estudio radiográfico digital. No hubo imágenes compatibles con cuerpos extraños: los resultados se interpretaron como artefactos y no se realizó la broncoscopia. Conclusiones Un cuidadoso examen pre-anestesia, el alto grado de sospecha y una excelente comunicación multidisciplinaria, permitieron el reconocimiento de hallazgos radiológicos falsos. Se siguió un abordaje conservador, evitando así procedimientos invasivos en lugares remotos con alto grado de riesgo para la población pediátrica.

Desemprego: discurso e silenciamento – um estudo com clientes de um serviço de aconselhamento psicológico / Unemployment: speech and silencing – a research with clients of a counseling service

O objetivo desta pesquisa foi discutir a relação entre o fenômeno do desemprego e o sofrimento psíquico na atualidade. A pesquisa teve caráter qualitativo e se baseou na análise de entrevistas semidirigidas. Foram entrevistados clientes do Serviço de Aconselhamento Psicológico (SAP) do Instituto de Psicologia da USP. A quantidade de pessoas interessadas em falar sobre a questão e a diversidade de suas origens sociais surpreenderam os pesquisadores. No processo de análise das entrevistas, observamos uma recorrente queixa de impossibilidade de se falar sobre a experiência pessoal do desemprego. Sobre essas queixas, analisamos dois aspectos em tensão: a heterogeneidade das significações da experiência do desemprego e a ideologia homogeneizante sobre a expressão do emprego/desemprego. Construímos três hipóteses para problematizar esses aspectos e para ampliar as possibilidades de exercício de uma psicologia que compreenda a singularidade da experiência psicossocial no âmbito da clínica e da psicologia social do trabalho.

The aim of this research was to discuss the relation between unemployment and psychic suffering nowadays. This research has qualitative approach and was based on semi-directive interviews. The interviewed people were clients from a Counseling Service (Psychology Institute, USP). The number of interested people to talk about unemployment and their several social backgrounds were both outstanding surprises. In the analyze process of interview, different expressed claims about of the social impossibility to talk about personal experience of unemployment were dethetabled. From these expressions, two aspects in tension were analyzed: the different meanings of unemployment experience, and the effects of a homogeneous ideology over the employment questions. This research shows three hypotheses to problematizing these aspects and to broadening the exercise of a psychology that leads to understand the specific psychosocial experience at fields of the clinic and of the social sychology of work.