Entre territórios pandêmicos: cartografia de um Consultório na Rua durante a pandemia de covid-19 / Exploring pandemic territories: cartography of a street clinic during the covid-19 pandemic / Entre territorios pandémicos: cartografía de un Consultorio en la Calle durante la pandemia de covid-19

O objetivo do presente artigo foi realizar uma cartografia de um Consultório na Rua, durante o período da pandemia de covid-19. A cartografia foi produzida por uma vivência no consultório de um município de grande porte no sul do Brasil, de agosto de 2021 a janeiro de 2022. Foi perceptível que a locomoção e o funcionamento do serviço reconhecem outros territórios das Pessoas em Situação de Rua, muitas vezes não percebidos por outros pontos do Sistema Único de Saúde. Foram encontradas tanto as barreiras já estabelecidas historicamente quanto as emergentes da pandemia. Foi vivenciado que a esta população não utiliza o território do modo que a cidade racionalizada planeja, sendo, portanto, singular. O reconhecimento do serviço, aliado à compreensão de como as Pessoas em Situação de Rua vivem no território urbano, em cada realidade, mostrou-se essencial para a produção de cuidado.

The objective of this article was to conduct a cartographic study of a street clinic during the covid-19 pandemic. The cartography was based on an experiential approach in a street clinic located in a major city in southern Brazil, between August 2021 and January 2022. It became evident that the flows and operation of the service acknowledged the alternative territories inhabited by the homeless population, often overlooked by other parts of Brazil's Unified Health System. Both historically established barriers and those emerging from the pandemic were encountered. It was observed that the homeless population does not conform to rationalized urban plans, displaying unique patterns of engagement with the urban territory. Recognizing the significance of the service, coupled with a comprehensive understanding of the unique living conditions of homeless individuals, proved indispensable for the provision of effective care.

El objetivo de este artículo fue realizar una cartografía de un Consultorio en la Calle durante el período de la pandemia del covid-19. La cartografía fue producida por una experiencia en un Consultorio en la Calle en una gran ciudad del sur de Brasil, de agosto de 2021 a enero de 2022. Se pudo observar que la locomoción y operación del servicio reconocen otros territorios habitados por personas en situación de calle, a menudo no percibidos por otros puntos del Sistema Único de Salud. Se encontraron barreras, tanto históricamente establecidas como emergentes debido a la pandemia. Se constató que la población en situación de calle no utiliza el territorio de la forma planificada por la ciudad racionalizada. El reconocimiento del servicio, junto con la comprensión de cómo viven las personas en situación de calle en el territorio urbano en cada realidad, se mostró fundamental para la producción del cuidado.

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

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.

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.

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.

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.

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

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.

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)

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

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

Uma leitura metapsicológica sobre a compulsão à repetição e suas potencialidades terapêuticas / Las potencialidades terapéuticas inscritas en la compulsion a la repetición y algunas justificaciones metapsicologicas / A metapsychological analisis about the compulsion towards repetition and its therapeutic potentialities

RESUMO Fenômenos associados à compulsão à repetição apresentam-se na clínica psicanalítica como reveladores de uma dor da qual o paciente nada sabe dizer, mas que se impõe como um destino implacável. Partilhando da opinião de alguns psicanalistas sobre as potencialidades terapêuticas inscritas na compulsão à repetição e cientes das dificuldades que envolvem a sua justificação teórica, este artigo busca aclarar a trama conceitual da metapsicologia que pode vir a embasar tal compreensão. Desse modo, partindo de uma pesquisa conceitual, objetivamos explicitar os fenômenos metapsicológicos que estão inscritos na repetição, propiciando uma releitura de aspectos importantes da obra freudiana. Assim, o artigo desenvolve a ideia de que as energias disruptivas presentes na compulsão à repetição, ao serem submetidas ao trabalho de ligação realizado pelo 'Eu', um processo secundário por excelência, articulado às noções de fusão e desfusão pulsionais, presentes em textos da etapa madura das reflexões de Freud, permite lançar alguma luz sobre processos obscuros subjacentes aos fenômenos em tela.

RESUMEN Fenómenos asociados a la compulsión a la repetición se presentan en la clínica psicoanalítica como reveladores de un dolor del cual el paciente nada sabe decir, pero que se impone como un destino implacable. Compartiendo la opinión de algunos psicoanalistas en las potencialidades terapéuticas inscritas en la repetición y conscientes de las dificultades que envuelven su justificación teórica, este artículo busca explicitar la trama conceptual metapsicológica que puede venir a embasar su comprensión. Así, empiezando desde una búsqueda conceptual, tenemos como objetivo demuenstrar a los fenómenos metapsicológicos que se encuentran inscritos en la repetición, proporcionando una reinterpretación de importantes aspectos de la obra de Freud. Por lo tanto, este articulo desarrolla la idea de energías disruptivas encuentradas en la compulsión hacia la repetición cuando se las envían al trabajo de ligación realizado por el 'Yo', un procedimiento secundario por excelencia, enlazados a la comprensión de fusión y desfusion pulsionales, que están presentes en textos de la etapa madura de las relfexiones de Freud, permitiendo tirar alguna luz sobre procesos oscuros subyacentes a los fenómenos en discusión.

ABSTRACT Phenomena associated with repetition compulsion appear in the psychoanalytic clinic revealing a pain the patient knows nothing about, but which imposes as a relentless fate. Sharing the opinion of some psychoanalysts about therapeutic potentialities inscribed in the compulsion repetition and aware of the difficulties involved in their theoretical justification, this article sought to explain the conceptual framework necessary to understand the process underlying such phenomena. Thus, starting from a conceptual research, we aimed to explain the metapsychological phenomena inscribed in repetition, providing a new understanding of important aspects of the Freudian work. Therefore, the article develops the idea that disruptive energies present in repetition compulsion when subjected to connection carried out by the 'Self', a secondary process par excellence, articulated to the notions of drive fusion and defusion, available in texts from the mature stage of Freud's reflections, allows to shed light on obscure processes underlying the phenomena in question.

Atelier photo comme dispositif d'analyse de l'activité de collecte des déchets / Photo workshop as a device for analyzing garbage collection activity / Oficina de fotos como dipositivo para análise da atividade de coleta de lixo

Résumé L'article présente une expérience d'analyse des activités du travailleur de la collecte des déchets dans une ville, basée sur le dispositif de l'Atelier photo et ayant comme référence théorique la Clinique de l'Activité. L'objectif de l'étude est d'analyser l'activité des travailleurs exerçant le métier d'éboueurs dans une ville de l'État de Rio de Janeiro. L'Atelier photo a été choisi comme dispositif de recherche et d'intervention afin d'utiliser les images comme déclencheurs de la coanalyse du travail, faisant émerger une réalité collective, présente dans toutes les activités de travail. L'objectif de ce dispositif est de déclencher, à partir de la production d'images, des questions et des réflexions sur l'activité de travail. En ce sens, à travers les résultats recueillis lors de cette recherche et intervention, il est devenu évident que l'Atelier photo peut être un dispositif possible dans le développement du pouvoir d'agir des travailleurs, permettant ainsi des échanges collectifs, le genre professionnel étant un instrument décisif du pouvoir d'agir des personnes impliquées.

Abstract The article presents an experience of analysis of the activities of the garbage collection worker in a city, based on the device of the Photo Workshop and having as a theoretical reference the Clinic of the Activity. The focus of the study is on the analysis of the activity of workers who work as garbage collectors in a city in the state of Rio de Janeiro. The Photo Workshop was chosen as a research and intervention device in order to use the images as triggers for the co-analysis of the work, giving rise to a collective reality, present in all work activities. The purpose of this device is to trigger, from the production of images, questions and reflections about the work activity. In this sense, through the results collected from this research and intervention, it became evident that the Photo Workshop can be a possible device in the development of the workers' power to act, thus enabling collective exchanges, with the professional genre being a decisive instrument of the workers' power to act. involved.

Resumo O artigo apresenta uma experiência de análise das atividades do trabalhador de coleta de lixo em uma cidade, com base no dispositivo de Oficina de fotos e tendo como referência teórica a Clínica da Atividade. O foco do estudo está na análise da atividade dos trabalhadores que exercem o ofício de coletores de lixo, em uma cidade do Estado do Rio de Janeiro. A Oficina de fotos foi escolhida como dispositivo de pesquisa e intervenção a fim de utilizar as imagens como disparadores da co-análise do trabalho, fazendo emergir uma realidade coletiva, presente em todas as atividades de trabalho. O objetivo desse dispositivo é disparar, a partir da produção de imagens, questionamentos e reflexões acerca da atividade de trabalho. Nesse sentido, através dos resultados coletados desta pesquisa e intervenção, ficou evidenciado que a Oficina de Fotos pode ser um dispositivo possível no desenvolvimento do poder de agir dos trabalhadores, possibilitando assim intercâmbios coletivos, sendo o gênero profissional um instrumento decisivo do poder de agir dos envolvidos.

Is There a Cure in Psychoanalysis? A Clinic for the Untreatable / Existe Cura em Psicanálise? Uma Clínica para o Intratável

ABSTRACT This work aims to explore the dynamics of the cure in psychoanalysis, passing through a literary perspective. We begin by locating the idea of cure in psychoanalysis as the cure of the intractable, by thinking the logic of the cure through an aesthetic dimension. Next, we advance the idea of a literary subject, with the myth as a guiding element of a literary body that sustains its own existence. We adopt Kafka's idea of minor literature to understand the fragmented subject inserted in the culture. We then propose the neologism 'vereedades', playing on the proximity of the words 'truth' and 'path' in Portuguese ('verdade' and 'veredas') to explore curative dynamics, in which the subject explores his/her own style.

RESUMO Este trabalho visa explorar a dinâmica da cura em psicanálise, passando por uma perspectiva literária. Iniciamos localizando a ideia de cura em psicanálise como a cura do intratável, pensando a lógica da cura via uma dimensão estética. Na sequência, seguimos com a noção de sujeito literário, com o mito como um norte de um corpo literário que sustenta a própria existência do sujeito. Adotamos a ideia de uma literatura menor de Kaka para compreender o sujeito fragmentado em sua inserção na cultura. Então propomos o neologismo 'veredades', brincando com a proximidade das palavras 'verdade' e 'veredas' para explorar a dinâmica da cura, em que o sujeito explora seu próprio estilo.

Intensificação laboral e gênero profissional de professoras da educação infantil / Intensification of labor and professional gender of female teachers of early childhood education

As reformas neoliberais levaram à intensificação do trabalho, dada a exigência de maiores e melhores resultados em contextos laborais cujas condições eram insuficientes para realizá-lo. Este artigo visa compreender, a partir do referencial teórico da Clínica da Atividade, a relação entre intensificação do trabalho docente e gênero profissional. Trata-se de um estudo de caso derivado de uma intervenção com seis professoras da Educação Infantil que utilizou o método de instrução ao sósia. Os registros de áudio produzidos ao longo das instruções ao sósia foram transcritos e submetidos à análise construtivo-interpretativa. O número de alunos por sala, fator inerente à organização do trabalho, mostrou-se promotor dessa intensificação, uma vez que exigia mais dos profissionais, sem a contrapartida necessária das condições de trabalho. Nesse cenário, ocorreu a construção coletiva do que era chamado de "domínio de sala", norma de proceder não oficializada relativa às habilidades necessárias à atuação docente para lidar com a intensificação laboral. Desenvolveu-se, assim, uma cultura profissional que orientou a ação das docentes, de modo a viabilizar a atividade e preservar o poder de agir

Neoliberal reforms have led to the intensification of work, given the demand for greater and better results in labor contexts whose conditions were insufficient to realize it. This article aims to understand based on the theoretical framework of the Clinic of Activity the relationship between intensification of the teaching work and professional genre. This is a case study derived from an intervention with six children's education teachers that used the method of instruction to the look-alike. The audio recordings produced during the instruction to the look-alike were transcribed and submitted to constructive-interpretative analysis. The number of students per classroom, a factor inherent to the work organization, proved to be a promoter of this intensification, since it demanded more from professionals, without the necessary counterpart of working conditions. In this scenario there was a collective construction of what was called "classroom mastery," an unofficial rule of thumb related to the necessary skills for teaching to deal with work intensification. Thus, a professional culture was developed that guided the teachers' action to make the activity viable and preserve the power to act