Construcción y validación de la escala de predicción y valoración del riesgo de violencia (EPERV-55) en trastorno mental grave / Construction and validation of the violence risk prediction and assessment scale (EPERV-55) in severe mental disorder

OBJETIVO: diseñar y validar la Escala de Predicción y Evaluación de Riesgo de Violencia (EPERV-55) en personas con trastorno mental grave (TMG) hospitalizadas en unidades de media y larga estancia. MÉTODO: se elaboró un cuestionario EPERV-55, con 55 ítems, en función de la literatura revisada y del conocimiento del equipo investigador sobre diferentes herramientas de predicción y evaluación de violencia en TMG. Se integraron datos clínicos de predicción y de gestión del riesgo, incluyendo la taxonomía NANDA/NOC. Para la validez de constructo se obtuvieron datos de pacientes ingresados en Unidades de Salud Mental del Hospital Parc Sanitari Sant Joan de Déu (Barcelona). Se valoró la consistencia interna de la escala con el coeficiente alfa de Cronbach. La validez convergente se evaluó mediante el coeficiente de correlación de Rho de Spearman comparando la EPERV-55 con la Escala de Riesgo de Violencia de Plutchik. Para medir la sensibilidad y especificidad se utilizó el test U de Mann-Whitney. Los análisis se realizaron con los programas estadísticos R 2.13 y SPSS 19. RESULTADOS: participaron 177 sujetos. A escala presentó un alpha de Cronbach de 0,92. La fiabilidad test-retest fue buena en 23 ítems de la escala y moderado en 32 ítems. La validez convergente fue significativa con las escalas EPERV-55-RV (correl. Spearman: -0,348 y -0,458 respectivamente; p < 0,001). En la sensibilidad y especificidad se objetivaron diferencias significativas en violencia general (p < 0,004) y violencia heteroagresiva (p < 0,005). El índice de la curva de Roc fue significativa en violencia heteroagresiva, hacia objetos y general. CONCLUSIONES: la escala EPERV-55 es un instrumento válido para evaluar y predecir el riesgo de violencia en personas con TMG hospitalizadas en unidades de media y larga estancia

OBJECTIVE: to design and validate the Violence Risk Prediction and Assessment Scale (EPERV-55) in persons with severe mental disorder (SMD) hospitalized in medium and long-stay units. METHOD: an EPERV-55 questionnaire was prepared, including 55 items, based on the literature reviewed and the knowledge by the research team about different tools for violence prediction and evaluation in SMD. Clinical data on risk prediction and management were incorporated, including the NANDA/NOC taxonomy. For construction validity, data were collected from patients hospitalized in Mental Health Units of the Hospital Parc Sanitari Sant Joan de Déu (Barcelona). The internal consistency of the scale was assessed with Cronbach's Alpha Coefficient. Convergent validity was evaluated through Spearman's Rho Correlation Coefficient, comparing EPERV-55 vs. the Violence Risk Scale by Plutchik. Mann-Whitney's U Test was used in order to measure sensitivity and specificity; analyses were conducted with the R 2.13 and SPSS 19 statistic programs. RESULTS: the study included 177 subjects. The model presented 0.92 in Cronbach's alpha. Test-retest accuracy was good in 23 items of the scale, and moderate in 32 items. Convergent validity was significant with the EPERV-55-RV scales (Spearman's Correlation: -0.348 and -0.458 respectively; p < 0.001). Regarding sensitivity and specificity, significant differences were observed in Overall Violence (p < 0.004) and Hetero-aggressive Violence (p < 0.005). The Roc Curve index was significant in Hetero-aggressive Violence, against objects, and general. CONCLUSIONS: the EPERV-55 scale is a valid tool to evaluate and predict the risk of violence in persons with SMD hospitalized in medium and long-stay units

Post-glacial population expansion of the Monterey Spanish mackerel Scomberomorus concolor in the Gulf of California.

The level of genetic homogeneity and demographic history of the Monterey Spanish mackerel Scomberomorus concolor was assessed by analyses using sequences of the mitochondrial (mt)DNA-control region of samples from the two oceanographic regions of the Gulf of California in order to define the stock structure for this exploited vulnerable species. The data were consistent with a single homogeneous population and revealed the hallmark of fluctuations in population size; these fluctuations appear to have occurred during glacial events of the middle to late Pleistocene, which may in turn be related to the colonization and expansion of S. concolor populations in the gulf.

Generation of oxyradicals (O2. and H2O2), mitochondrial activity and induction of apoptosis of PBMC of Cyprinus carpio carpio treated in vivo with halomethanes and with recombinant HSP60 kDa and with LPS of Klebsiella pneumoniae.

Halomethanes (HM) can be immunotoxic in mammals; however, in the fish immune system HM effects are unknown. In the current study, we evaluated the mitochondrial activity (MA) by MTT, induction of apoptosis by SubG0 technique and quantified serum ROS concentration (O2. and H2O2) and ROS production in PBMC of Cyprinus carpio carpio treated i.p. with CH2Cl2, CHCl3 and BrCHCl2 (0.004-40.0 mg/kg) for 96 h. Positive controls were recombinant heat shock protein of 60 kDa (rHSP60 kDa) of Klebsiella pneumoniae and its LPS. In addition, for in vitro PBMC cultures, two culture media and two sources of sera were tested. Both positive controls increased the MA more than 4-fold as well as the production of O2. (26-fold) and H2O2 (5-fold) compared to their controls. HM induced different effects on MA, ROS production and an induction of apoptosis, depending on the chlorination patterns and the dose; however, a systemic damage prevails. To fish treated with CH2Cl2, the apoptosis was related with serum ROS concentration and with MA. In contrast, in fish dosed with CHCl3 relationships were not found, deducing a systemic damage. However, in fish treated with BrCHCl2, serum O2. concentration and in vitro ROS generation performed by PBMC were involved in the induction of apoptosis of these cells but not with MA suggesting also immunotoxic effects. The current study demonstrated that HMs are immunomodulators increasing an acute inflammatory response and that rHSP60kDA of K. pneumoniae and its LPS are appropriate antigens to assess the immune response of C. c. carpio.

The relationship between the bioactivation and detoxification of diazinon and chlorpyrifos, and the inhibition of acetylcholinesterase activity in Chirostoma jordani from three lakes with low to high organophosphate pesticides contamination.

In fish, a number of studies have linked acetylcholinesterase (AChE) inhibition with exposure to organophosphate pesticides (OPs); however, evidence suggests the need to study aspects related to the bioactivation and detoxification of OPs, since their neurotoxicity is dependent on these processes. Thus, the study aim was to examine the relations between chlorpyrifos (CPF) and diazinon (DZN) bioactivation by hepatic CYP450 izoenzymes (CYP 2B6, CYP 2C19, CYP 3A4) and detoxification by aryl esterases and oxonases with brain and muscle AChE activity in Chirostoma jordani from three lakes with low to high OPs contamination in water and sediments. We found two patterns of bioactivation in vitro: (i) in fish from a lake with high CPF pollution, the main isoenzymes involved in this process were CYP 2C19>CYP 2B6>CYP 3A4, and (ii) in fish captured in a lake with a high concentration of DZN, the isoenzymes were CYP 3A4>CYP 2C19>CYP 2B6. Bioactivation is shown in this study to be fundamental in brain and muscle AChE inhibition in vivo. The rate of bioactivation of CPF was lower than for DZN. CPF bioactivation was accompanied by reduced detoxification and higher neurotoxicity, which was inversely dependent on the environmental contamination of CPF. Detoxification was also inversely correlated with environmental contamination by CPF, and was higher with diazoxon than chlorpyrifos-oxon. Oxonases were the most relevant enzymes involved in detoxification. The current findings suggest a series of strategies between the bioactivation and detoxification of OPs that allowed the survival of C. jordani despite of OPs pollution levels.

MMP1, MMP9, and COX2 expressions in promonocytes are induced by breast cancer cells and correlate with collagen degradation, transformation-like morphological changes in MCF-10A acini, and tumor aggressiveness.

Tumor-associated immune cells often lack immune effector activities, and instead they present protumoral functions. To understand how tumors promote this immunological switch, invasive and noninvasive breast cancer cell (BRC) lines were cocultured with a promonocytic cell line in a Matrigel-based 3D system. We hypothesized that if communication exists between tumor and immune cells, coculturing would result in augmented expression of genes associated with tumor malignancy. Upregulation of proteases MMP1 and MMP9 and inflammatory COX2 genes was found likely in response to soluble factors. Interestingly, changes were more apparent in promonocytes and correlated with the aggressiveness of the BRC line. Increased gene expression was confirmed by collagen degradation assays and immunocytochemistry of prostaglandin 2, a product of COX2 activity. Untransformed MCF-10A cells were then used as a sensor of soluble factors with transformation-like capabilities, finding that acini formed in the presence of supernatants of the highly aggressive BRC/promonocyte cocultures often exhibited total loss of the normal architecture. These data support that tumor cells can modify immune cell gene expression and tumor aggressiveness may importantly reside in this capacity. Modeling interactions in the tumor stroma will allow the identification of genes useful as cancer prognostic markers and therapy targets.

Halomethane-induced cytotoxicity and cell proliferation in human lung MRC-5 fibroblasts and NL20-TA epithelial cells.

Halomethanes (HMs) can be formed during the chlorination process to obtain drinking water. In liver cells, HMs had been shown to be mutagenic and carcinogenic; however, their bioactivation by CYP 2E1 and GSTT1 is required. Although inhalation is the most common pathway of exposure, reports on the toxic effects induced by HMs in human lung are contradictory. The aim of this study was therefore to evaluate in vitro cytotoxicity and cell proliferation induced by CH(2)Cl(2), CHCl(3) and BrCHCl(2) in human lung NL20-TA epithelial cells and MRC-5 fibroblasts, and their relationship with CYP 2E1 and GSTT1 activity. High concentrations of these HMs induced cytotoxicity, particularly in cells treated with BrCHCl(2). Low concentrations of BrCHCl(2) stimulated hyperproliferation of fibroblasts, the most probable consequence of which is regenerative proliferation related to collagen induction. Fibroblasts exposed to BrCHCl(2) exhibited low levels of CYP 2E1 activity suggesting that released bromine is able to alter this activity by affecting the active site or auto regulating the activity itself. GSTT1 was up to ten times more active than CYP 2E1 in both cell lines, indicating that potential lung damage is due to formation of pro-carcinogens such as formaldehyde.

Implications of cytochrome 450 isoenzymes, aryl-esterase and oxonase activity in the inhibition of the acetylcholinesterase of Chirostoma jordani treated with phosphorothionate pesticides.

Organophosphate pesticides must be metabolized by cytochrome-P450 isoenzymes such CYP 2C19 as CYP 3A4 to induce neurotoxicity, but damage apparently depends on the activity of aryl esterases of the oxonase type that are involved in detoxication of these compounds. However, information on this subject is not available in fish. Chirostoma jordani has sustained significant population reductions, probably due to changes in land-use as well as pesticide impact; nevertheless, no specific studies demonstrating this are available. This study shows for the first time that the activity of cytochrome-P450 isoenzymes (CYP 2B6, CYP 2C19, CYP 3A4) in C. jordani is involved in diazinon and chlorpyrifos bioactivation. However, higher toxicity of chlorpyrifos cannot be explained solely because its bioactivation. Differences in toxicity between both pesticides are due to the activity of aryl esterases and oxonases that are responsible for oxon detoxication. Both hepatic enzymes metabolize diazoxon more efficiently than chlorpyrifos oxon. At lethal concentrations, detoxication is particularly important since mortality was lower with diazinon (LC50=1.5 µg/L) than with chlorpyrifos (LC50=0.17 µg/L). At sublethal levels, maximum acetylcholinesterase inhibition took place at 4h in both brain and muscle and was of lower magnitude in diazinon-treated fish. This is due to the higher affinity of both aryl esterases for diazoxon, which allows higher detoxication rates and therefore greater recovery of acetylcholinesterase activity.

Evidence of bioactivation of halomethanes and its relation to oxidative stress response in Chirostoma riojai, an endangered fish from a polluted lake in Mexico.

Halomethanes (HMs) are produced autochthonously in water bodies through the action of ultraviolet light in the presence of HM precursors, such as dissolved organic carbon and halogens. In mammals, toxic effects induced by HMs are diverse and include oxidative stress, which is also induced by divalent and polyvalent metals; however, in fish little information is available on HM metabolism and its possible consequences at the population level. In the present study, high CYP 2E1 and GST theta-like activities were found in viscera of the Toluca silverside Chirostoma riojai from Lake Zumpango (LZ; central Mexico). Formaldehyde, one of the HM metabolites, was correlated with CYP 2E1 activity and also induced lipid peroxidation in viscera. Hepatic CYP 2E1 activity was correlated with GST theta-like activity, suggesting the coupling of both pathways of HM bioactivation and its consequent oxidative damage. Sediment metals, among others, were also responsible for oxidative stress, particularly iron, lead, arsenic and manganese. However, under normal environmental conditions, the antioxidant enzymes of this species sustain catalysis adapted to oxidative stress. Findings suggest that this fish species apparently has mechanisms of adaptation and recovery that enable it to confront toxic agents of natural origin, such as metals and other substances formed through natural processes, e.g., HMs. This has allowed C. riojai to colonize LZ despite the high sensitivity of this species to xenobiotics of anthropogenic origin.

[Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management]. / Diarrea crónica refractaria y malabsorción secundaria a hipogammaglobulinemia común variable, infestación crónica por giardia lamblia y gastrectomía total por adenocarcinoma gástrico: un manejo nutricional complejo.

Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

Estudio longitudinal del impacto del tratamiento con infusores de insulina en variables psicológicas, la calidad de vida y el control glucémico de pacientes con diabetes mellitus tipo 1 / Longitudinal study of the impact of the treatment with insulin infusion in psychological, quality of life, and glycemic control of patient with type 1 diabetes mellitus

Introducción: Desde el estudio DCCT, han sido muchas las investigacionesque han intentado evaluar las distintas propuestas de terapia intensiva. Pocosestudios a largo plazo incluyen variables psicosociales. Objetivos: Evaluarvariables psicológicas y metabólicas en pacientes con diabetes tipo 1 tras 2años de tratamiento con infusión subcutánea continua de insulina (ISCI). Materialesy métodos: Veintidós pacientes con diabetes tipo 1 en tratamientocon múltiples dosis de insulina recibieron tratamiento con ISCI. Se realizó unaevaluación a los 6, 12 y 24 meses, utilizando diversos instrumentos como elBDI, el DQOL, la MHLC, el STAI y el cuestionario de miedo a las hipoglucemias.Se admitió un control glucémico adecuado con una HbA1c <7,5%. Elanálisis estadístico se realizó mediante pruebas no paramétricas y el coeficientede correlación de Pearson. Resultados: Los pacientes partían de una puntuaciónmedia en depresión de 9,55 ± 9,12 (media ± DT). En calidad devida, los datos iniciales fueron 92,95 ± 16,15, mientras que el nivel de HbA1cfue de 8,45 ± 1,59%. Al cabo de los 2 años de tratamiento, se aprecian mejorassignificativas en las puntuaciones obtenidas en depresión (p= 0,018),calidad de vida (p= 0,005) y control glucémico (p= 0,003). La ansiedad rasgoy el locus de control externo correlacionaron significativamente, encontrándoseuna fuerte relación entre el miedo a las hipoglucemias y las variablespsicológicas estudiadas. Los pacientes con mal control glucémico basal mejoraronal cabo de los 2 años de tratamiento. Conclusiones: Después de 2años con ISCI, los pacientes con diabetes tipo 1 mejoran significativamente sucalidad de vida, su control glucémico y su sintomatología depresiva(AU)

Introduction: Since the DCCT study, many studies have tried to assess differentintensive therapies. However, few long-term studies have included psychosocialvariables. Objectives: To evaluate psychological and metabolic variablesin patients with type 1 diabetes after 2 years of therapy with continuoussubcutaneous insulin infusion (CSII). Materials and methods: Twenty-twotype 1 diabetic patients treated with multiple daily injections were treated withCSII. An evaluation at 6, 12 and 24 months was performed, using several instrumentsas BDI, DQOL, MHLC and a questionnaire to evaluate fear of hypoglycaemia.Acceptable metabolic control was admitted with HbA1c <7.5%.Statistical analysis was realized using non parametric tests and Pearson’s correlationcoefficient. Results: Initially, patients had a mean score for depressionof 9.55 ± 9.12 (mean ± SD). In quality of life, initial values were 92.95 ±16.15, while the level of HbA1c was 8.45 ± 1.59%. After 2 years of treatmentwe found significant improvement in depression (p= 0.018) and quality of life(p= 0.005) scores and glycemic control (p= 0.003). Trait anxiety and externallocus of control showed a significant correlation, with a strong correlation betweenfear of hypoglycemia and the analyzed psychosocial variables. Patientswith bad basal glycemic control improved after 2 years of treatment. Conclusions:After two years with CSII, type 1 diabetic patients improve significantlytheir quality of life, glycemic control and depressive symptoms(AU)

Reacciones psicológicas de la mujer ante el diagnóstico de cáncer de mama / No disponible

En este trabajo pretendemos estudiar las reaccionesde la mujer tras recibir el diagnóstico de cáncer demama. Para ello, hemos tomado a aquellas pacientesmastetomizadas que nos consultaron por problemas psicológicosen relación a esta enfermedad y que siguieronun proceso de psicoterapia reglada. En este contexto tanparticular, donde se expresaron libre y espontáneamente,fue posible obtener numerosos enunciados referidosa las vicisitudes por las que pasaron.Se desveló que sus reacciones eran de carácter emocional(no sentimental) y que el contenido de éstasdependía del momento del diagnóstico en que se hallabany de la elaboración que hicieron, pasando por: preocupación,sorpresa, extrañamiento, miedo y hasta desbordamiento.Estas manifestaciones corrían paralelas ala necesidad de que la paciente tomara diversas decisionesen relación al tratamiento, para las cuáles evidentementeno se hallaba capacitada.Finalmente, descubrimos pacientes que mostraronespeciales dificultades en este proceso de asimilacióndebido a las características de su personalidad y, en estesentido, aislamos algunos rasgos especialmente problemáticos:omnipotencia, control, temor al cambio, inflexibilidad, etc(AU)

Our purpose is to study the reactions of women afterreceiving a diagnosis of breast cancer. We took a sampleof mastectomized women who consulted for psychologicalproblems related to the disease and followeda regular process of psychotherapy. In this context offree and spontaneous expression, numerous statementsabout the events that passed by was obtained.We found that the reactions were emotional in nature(not sentimental) and that the content of these dependedon the time of diagnosis going through several stages:concern, surprise, alienation, fear. these events dependedon the decisions to be taken in relation to treatmentfor which they were not capable.Finally we discovered some patients who had greatdifficulty in the process of assimilation due to personalitycharacteristics what allowed us to isolate the problematicfeatures: omnipotence, control, fear of change,inflexibility etc(AU)

Antibodies against recombinant heat shock proteins of 60 kDa from enterobacteria in the sera and synovial fluid of HLA-B27 positive ankylosing spondylitis patients.

OBJECTIVE: To study the association of HLA-B27 with IgG antibodies to different enterobacterial HSP60s in patients with ankylosing spondylitis (AS). METHODS: IgG antibodies to 60 kDa enterobacterial HSPs were determined by ELISA in paired samples of sera and synovial fluid from 21 HLA-B27+ ankylosing spondylitis (AS) patients; and in sera from 32 HLA-B27+ AS patients, 35 HLA-B27+ healthy relatives of AS patients, and 60 HLA-B27- healthy individuals with no family members with AS. RESULTS: HLA-B27+ patients and healthy individuals showed significantly higher IgG antibody levels to recombinant enterobacterial HSP60s than HLA-B27- healthy controls. The levels of anti-HSP60Sf and anti-HSP60Ec antibodies correlated with disease activity and anti-HSP60Ec antibodies with male gender. No association between enterobacterial HSP60 antibody levels and disease duration was observed. All groups had lower levels of IgG antibodies to rHSP60 from Streptococcus pyogenes (rHSP60 Spy). In paired samples of sera and synovial fluid from B27+ patients, IgG antibodies to enterobacterial HSP60s were detected, but in significantly higher levels in sera than in synovial fluid. The anti-rHSPSpy IgG response in these samples was lower and similar in the three groups. CONCLUSIONS: A correlation was found between HLA-B27 and the response to recombinat enterobacterial HSP60s. This response could be associated with disease activitir and gender in some proteins and the presence eof IgG antibodies to these proteins in synovial fluid could be associated with the inflammatory process and initiation of AS.

Phase I enzyme induction in Girardinichthys viviparus, an endangered goodeid fish, exposed to water from native localities enriched with polychlorinated biphenyls.

The present study examines the induction of mixed-function oxidase (MFO) enzymes, including CYP content CYP1A (EROD) activity and alcohol dehydrogenase activity (ADH), in an endemic Mexican fish species, the black-fin goodeid Girardinichthys viviparus, exposed to the water of two localities, Lake Texcoco (LTX) and Lake Zumpango, and to the same matrices enriched in polychlorinated biphenyls (PCBs) to simulate the potential toxic effects of sublethal increases in these xenobiotics. Fishes of both sexes born in the laboratory were exposed for 1, 2, 4, 8, and 16 days. Water from the two types of localities of the black-fin goodeid contains MFO inducers. Of the two, the most contaminated is LTX water, which also contains PCBs. EROD activity was higher in all treatments with female compared with male fish. This suggests greater metabolic compromise in female fish as a response to damage caused by these xenobiotics. In this species, CYP induction displayed two patterns that were not always concurrent with higher CYP1A activity. In the enriched matrix system, biotransformation processes were notably altered. Increased ADH may indicate that this enzyme is involved in the biotransformation of PCBs and their metabolites, particularly in male fish, and provides at least a part of reductive power required by the MFO enzymes; however, specific studies are needed to clarify this point.

¿En qué consiste el "esquema L"? (Parte I) / What the "schema L" consists of? (Part I)

A lo largo de la obra de Lacan es común encontrar diferentes diagramas que pueden entenderse como intentos de formalizar ciertos aspectos de la teoría psicoanalítica; estos últimos deben quedar claros, al menos desde el punto de vista teórico, para poder actuar correctamente en el trabajo analítico. En esta ocasión, vamos a centrarnos en unos de ellos: el “esquema L”, cuya presentación se produce en unos de sus seminarios orales, dedicado a la posición del “yo” en la teoría de Freud y que captó la atención de facultativos y epecialistas de aquella época. En él su autor trabajaba, de un modo ciertamente original, el funcionamiento de las relaciones intersubjetivas en sus conexiones con el lenguaje. En la primera parte del trabajo, vamos a estudiar los componentes del “esquema L” y las dos relaciones fundamentales que se establecen entre ellos y que forman los ejes “imaginario” y “simbólico”. Lacan los considera en oposición, pues se interfieren mutuamente, de modo tal que el mensaje inconsciente queda interrumpido o cortocircuitado constatemente por la relación imaginaria, formada por el “yo” y su semejante, el “otro”

Along Lacan´s work it´s usual to find several diagrams that can be understood as an attempt to conceptualised some aspects of the psychoanalytic theory. The latter one must be clear, at least from de theoretical point of view, to be able to a properly psychoanalytic work. At this time, we are going to centred on one of them: schema L, whose presentation take place at one on Lacan´s seminar about the ego position in Freud´s theory and which catch the eye of specialist of that time. It´s also an original way of expound the performance of the inter-subjective relations in its connetion with the language. In the first part of this work we study the components of the “schema L” and two of the main relations among themselves that form the two axis: “imaginary” and “symbolic”. Lacan consider these to be in opposition since they interfere with each other so that the unconscious message is broken by the imaginary relation between the ego and its equal “the other”

El concepto del "yo" en el corpus freudolacaniano y sus consecuencias en la práctica clínica y psicoterapéutica / No disponible

Este trabajo se encuentra consagrado a dilucidar el papel del “yo” en las intervenciones tanto clínicas como psicoteraoéuticas con los pacientes. Partimos de la deformación que realizaron ciertas directrices teóricas que asentaron en suelo norteamericano, entre las que se encuentran los representantes de la Ego Psychology. Esta última se ha dedicado a entender al “yo” como elemento independiente del aparato psíquico, caracterizado por us autonomía funcional, sobre el que el psicoanalista tiene que apoyarse en la cura. Para tal fin, este promueve la identificación con su propia persona, consiguiendo finalmente la feliz adaptación del paciente a la sociedad. Tal propuesta es denunciada por Jacques Lacan, quien sostiene que un auténtico tratamiento analítico tiene que traspasar las fronteras del ego, haciendo emerger el deseo del paciente, lo cual coincide con la subversión planteada por Freud. Actuar conforme a los postulados del fundador del psicoanálisis conlleva el descubrimiento de la originalidad del sujeto, más allá de los ideales de adaptación norteamericanos

We try to dilucidate what role the ego play in either clinical or psychotherapeutic work with psychiatrics patients. We criticize here some theoretical guideline from North America as Ego Psychology. This last conceptualise the Ego as an element with functional autonomy of the psyche, on which the psychoanalyst support along the cure. All this finally leads the patient to identify on self with the therapist what is supposed to procure his social adapatation. Jacques Lacan disagree with this proposal since he maintains that tre true psychoanalytical treatment have to goes through the ego, coming out the subjects desire. This follows the really subversion laid by Freud. This procedure from psychoanalysis founder comes close to the originality of the subject beyond the North Americans´ ideals of adaptation

Estrogenic effects of polychlorinated biphenyls and relation to cytochrome P4501A activity in the endangered goodeid fish Ameca splendens.

The present study examines the relationships between cytochrome P4501A (CYP1A) activity and vitellogenin (VTG) induction in Ameca splendens elicited by a polychlorinated biphenyl (PCB) mixture. Ethoxyresorufin-O-deethylase (EROD) activity, mRNA levels of VTG, and VTG induction were evaluated in male and female fish exposed for 1, 2, 4, 8, and 16 d to a commercial PCB mixture. Polychlorinated biphenyls induced higher EROD in both sexes and this induction was higher in females than in males. Maximum EROD and VTG induction occurred on day 1 in females, while in males these maxima occurred on days 8 and 16. A correlation between EROD and VTG induction was found only in males (p<0.001), and VTG induction was also higher in males than in females (p<0.01). Exposure to PCBs elicited increases in VTG expression and induction over time in males, while in females these decreased at the end of the exposure period. Deficiencies in the feedback mechanisms of male A. splendens exposed in the wild to xenoestrogens such as PCBs have probably contributed to alter the sex ratio of wild populations of this species.

¿Cómo cuantificar la variabilidad glucémica? / How to evaluate glycemic variability?

La insulinoterapia intensiva se asocia con fluctuaciones glucémicas que pueden tener un efecto negativo en las complicaciones agudas y crónicas y en la calidad de vida de los pacientes con diabetes, por lo que su controles un objetivo terapéutico de primer nivel. La atención diabetológica de calidad supone actualmente la incorporación al seguimiento diabetológico de medidas de variabilidad glucémica como los valores promedio (hemoglobina glicosilada [HbA1c], glucemias medias, número de hipo- o hiperglucemias), las variaciones glucémicas (desviación estándar [DE] y coeficientes de variación de glucemias, valor M, MAGE [mean amplitudeof the largest glycaemic], media de las diferencias diarias [MDD] e índice de labilidad [IL]), y el riesgo de valores extremos bajos, elevados o ambos. Para cuantificar las hipoglucemias, disponemos de procedimientos para su valoración, así como del HYPO score y otros scores específicos para las «no percibidas». Todos estos índices introducen criterios objetivablesque permiten establecer categorías de pacientes en la toma de decisiones ante las nuevas y complejas propuestas terapéuticas diabetológicas (infusores de insulina, trasplantes de tejido pancreático, etc.), asícomo valorar el impacto metabólico de éstas

Intensive insulin therapy is associated with glycemic fluctuations,which may have negative effects on acute and chronic complicationsand quality of life of patients with diabetes, being the possibility ofcontrolling them a first level therapeutic objective. A good diabetescare implies the incorporation of measures of the glycemic instabilitysuch as average measures (HbA1C, glycemic average, number ofhypo or hyperglycemic events), measures of glycemic variations(standard deviation, glycemic coefficient of variation, M-value, MAGE,MODD and lability index) and measures of risk for extreme valueseither low or high values, or both. To determine the number of hypoglycaemicevents, it is simply possible to quantify them, using ahypo score or specific scores for hypoglycaemia unawareness episodes.These indexes will permit the use of objective criteria andcategorization of patients before complex therapeutic decisions suchas insulin infusion systems, pancreas transplantation, etc. were made,as well as to evaluate the metabolic impact of them

Estudio psicológico del personaje de Cyrano de Bergerac de Edmond Rostand / Psychological study of the character from Cyrano de Bergerac by Edmond Rostand

El trabajo que presentamos seguidamente trata dediscernir las características psicológicas de un personajede una obra literaria: Cyrano de Bergerac, que pertenecea la novela homónima, escrita en el s. XIX por EdmondRostand. Nuestro proceder sigue una serie de pasos biendefinidos: 1º) comienza haciendo una descripción delprotagonista, 2º) se establecen las conexiones internas,subjetivas, de los diferentes aspectos psicológicos halladosy 3º) se intenta filiar en una “estructura clínica”concreta a dicho personaje.La conclusión apunta a que nos encontramos ante unsujeto que, detrás de su brillante puesta en escena y suvalentía, alberga un gran miedo al acercamiento íntimoa la persona que ama. Para resolver el conflicto, va aemplear a un apuesto patán a quién va a dotar de suenorme ingenio formando, entre ambos, al hombre“perfecto”, el único capaz de despertar del deseo de laprotagonista. En el temor e inhibición de Cyrano descubrimosvarios componentes de gran interés: el miedo alrechazo debido a su “defecto” (la gran nariz), la búsquedade lo grandioso que le hace despreciar lo cotidiano ysu deseo de sentirse libre, junto a la incapacidad parasometerse a cualquier tipo de compromiso. La trama alcompleto se caracteriza por mostrar al lector una brillantepresentación de imágenes engañosas, en las quese ven envueltos los tres implicados y demuestra elpoder tan asombroso que poseen las imágenes para elser humano, aspecto en el que Lacan incidió acertadamente.Tal vez esto explique el éxito tan apabullanteque tuvo la obra cuando se estrenó en 1897

In the present work we try to identify psychologicalcharacteristics of a literature character. We’ve chosenCyrano de Bergerac, wrotten in the 19th century byEdmond Rostand. Our method of study takes definitesteps: 1) to describe the character 2) to make connectionsamong several subjective phychological characteristics.3) to include the character into some of the clinicalstructure.We consider Cyrano a man who shows great couragebut resting behind a fear of intimate relationship as aresult of the feeling of ugliness but also because of hisideal of perfection, and his incapacity of commitment.This make him use a handsome friend to get both togetherthe perfect image that his love Roxana desire. Sothree characters are involved in a play of false images.This all explain the powerful value of image accordingto J. Lacan theory

Cuerpo, corporalidad y esquema corporal en la mujer mastectomizada (I) / Body, corporality and body schema in mastectomized women (I)

En este artículo nuestra pretensión ha consistido en mostrar una investigación sobre las reacciones afectivas de las mujeres intervenidas de mastectomía, tras el diagnóstico de cáncer de mama. En la primera parte, presentamos diferentes aspectos psicológicos que creemos imprescindibles para, posteriormente, dedicarnos a mostrar los resultados. Nuestro punto de partida tiene que ver con que las reacciones postmastectomía no pueden entenderse si no analizamos previamente las experiencias referidas al cuerpo, un fenómeno que ya trató la psiquiatría clásica y que se muestra bastante complejo a la observación, pero que es necesario de analizar. De ahí que hayamos tenido que trabajar con las vivencias referidas al “cuerpo”, la “corporalidad” y el “esquema corporal” (EC), dividiendo este último en: “imagen corporal” de la que ya habló Schilder en 1923, y el “cuerpo simbólico”, algo que Lacan nos ha legado. Para terminar, añadimos un nuevo componente: el “esquema corporal sexuado” (ECS), en el que se muestran qué partes son valoradas positivamente y qué otras lo son negativamente dentro del EC. Esto nos induce a plantear una especie de mapa del ECS (m-ECS), donde se recogen partes representadas y no-representadas, provocando estas últimas un “agujero”

In this work we report our research on emotional response in mastectomized women following cancer breast diagnosis. First we consider the main psychological aspects involving the matter, to afterwards reach to their consequences, in the second part of this work. The starting point to be able to understand aftermastectomy emotional response lead us to study about the experience with respect to the body, a complex theme already studied by traditional psychiatry. It is necessary a distinction among different experiences from “corporality”, “body” and “body schema” and between “corporal image” by Schilder, and “symbolic body” according to Lacan theory. We last add a new component: “Sexualized body schema” that includes those parts of the body schema which are either positively or negatively valued. This lead us to pose a sort of sexualized body schema map where different body parts are either represented or notrepresented, resting therefore a “hole”