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O objetivo deste artigo é propor uma reflexão a respeito do manejo clínico, no qual a analista, mesmo percebendo a negação da paciente a se vincular, se coloca mais presente, face a face, deixando-se perceber como presença viva. Isto possibilitou, lentamente, a construção de um vínculo entre a dupla, mesmo diante de desorganizações da economia psicossomática da paciente, que surgem após a vivência de situações de vida extremamente difíceis. Será apresentado seu caso clínico no qual vários sintomas estão presentes: diverticulite no sigmoide e reto, cistite recorrente e dois episódios de Acidente Isquêmico Transitório (AIT). O contato mais aprofundado com a sua história, nos remeteu a núcleos regredidos, associados a uma angústia relacionada à questão do reconhecimento. Foi usado o referencial teórico da Psicanálise Vincular e da Psicossomática Psicanalítica, a fim de explicitar que através do vínculo estabelecido, da relação transferencial, do acolhimento e do manejo específico dessa clínica, pôde-se criar um espaço onde foi possível à paciente explicitar em palavras os pensamentos e sentimentos insuportáveis que, até então, expressava em seu corpo e ter, assim, a condição psíquica de, aos poucos, retomar a sua própria vida.

The objective of this article is to propose a reflection about the clinical management, in which the analyst, even realizing the patient's denial to be bound, is more present, face to face, letting herself be perceived as a living presence. This allowed, slowly, the construction of a bond between the duo, even in the face of disorganizations of the psychosomatic economy of the patient, which emerge after the experience of extremely difficult life situations. It will be presented its clinicai case in which several symptoms are present: Diverticulitis in the sigmoid and rectum, recurrent cystitis and two episodes of Transient Ischemic Accident (TIA). The deeper contact with his history, referred us to regressed nuclei, associated with an anguish related to the issue of recognition The theoretical framework of Binding Psychoanalysis and Psychoanalytic Psychosomatics was used, in order to explain that through the established bond, the transference relationship, the welcoming and the specific management of this clinic, it was possible to create a space where the patient could be Explain in words the unbearable thoughts and feelings that, until then, expressed in his body and thus have the psychic condition of gradually resuming his own life.

El objetivo de este artículo es proponer una reflexión sobre el manejo clínico, en el que el analista, incluso al darse cuenta de la negación del paciente para estar vinculado, está más presente, cara a cara, dejándose percibir como una presencia viva. Esto permitió, lentamente, la construcción de un vínculo entre el dúo, incluso ante las desorganizaciones de la economia psicosomática del paciente, que surgen después de la experiencia de situaciones de vida extremadamente dificiles. Se presentará su caso clínico en el que se presentan varios sintomas: Diverticulitis en el sigmoide y el recto, cistitis recurrente y dos episodios de Accidente Isquémico Transitorio (AIT). El contacto más profundo con su historia nos remitió a núcleos regresivos, asociados con una angustia relacionada con la cuestión del reconocimiento. Se utilizó el marco teórico de Psicoanálisis Vincular y Psicosomática Psicoanalítica., con el fin de explicar que, a través del vínculo establecido, la relación transferente, la acogida y la gestión específica de esta clínica, fue posible crear un espacio donde el paciente pudiera ser Explique con palabras los pensamientos y sentimientos insoportables que, hasta entonces, expresaron en su cuerpo y así tienen la condición psíquica de reanudar gradualmente su propia vida.

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BACKGROUND: Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. METHODS: A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. RESULTS: The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. CONCLUSIONS: Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

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BACKGROUND: Patients who undergo Roux-en-Y gastric bypass (RYGB) have significant weight loss, and abdominoplasty is an effective corrective surgery for removing excess skin. This study aimed to evaluate the impact of the weight of removed tissue on the development of postoperative complications in patients undergoing abdominoplasty without lipoaspiration after gastric bypass at the Federal District North Wing Regional Hospital, Brasília, Brazil. METHODS: Data were analyzed from a prospective registry of patients who underwent abdominoplasty without lipoaspiration after gastric bypass from January 2011 to December 2018. The variables examined included body mass index (BMI) before RYGB and before plastic surgery, weight loss, weight of the excised abdominal flap, comorbidities, and medical complications. Analysis of the role of the weight of the removed tissue after abdominoplasty was performed to assess outcome measures. RESULTS: One hundred sixty-three patients were included. The mean age of the patients was 42 years. Their BMI at the time of abdominoplasty was 27.49 kg/m2, and the average weight loss before abdominoplasty was 47.13 kg. The preweight loss BMI was 45.27 kg/m2, and the ∆BMI was 17.78 kg/m2. The overall complication rate was 29.4%. An amount of removed tissue from the abdomen ≥ 2000 g significantly increased the rates of postoperative complications (46.7% vs. 19.4%; p = 0.002; OR = 3.13). CONCLUSIONS: Removal of ≥ 2000 g of tissue from the abdomen led to significantly more complications in patients who underwent abdominoplasty after gastric bypass. In addition, this group of patients was significantly associated with the presence of higher anthropometric variable values (BMI, weight loss, max BMI, and ∆BMI) and not associated with the presence of comorbidities.

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O presente texto é uma síntese das experiências profissionais vivenciadas junto a um grupo operativo constituído por cuidadores do Programa Maior Cuidado, da Prefeitura Municipal de Belo Horizonte. Apresenta as análises das condições de trabalho enfrentadas por estes profissionais e sua participação na gênese e desenvolvimento de fenômenos psicopatológicos. Esta empreitada permitiu a sistematização de alguns fatores envolvidos na psicodinâmica do adoecimento do trabalhador-cuidador, as possibilidades de superação e as limitações inerentes ao processo. Fundamentou-se em algumas noções de Grupo Operativo de Pichon-Rivière e nas pesquisas em Psicodinâmica do trabalho desenvolvidas por Christophe Dejours...

The present study analyzes the professional experiences of an operative group composed of caregivers of the Greater Care Program of the City of Belo Horizonte. It presents analyses of the working conditions encountered by these professionals and their participation in the genesis and development of psychopathological phenomena. This contract allowed the systematization of some factors involved in the psychodynamics of illness of the worker or caregiver, the opportunities for overcoming this, and the limitations inherent in the process. It was based on notions of the Operative Group of Pichon–Riviere and research in the psychodynamics of work developed by Christophe Dejours...

El presente texto es una síntesis de las experiencias profesionales vividas junto a un grupo operativo constituido por los cuidadores del Programa Cuidado Mayor de la Prefectura Municipal de Belo Horizonte. El texto presenta el análisis de las condiciones de trabajo enfrentadas por estos profesionales y su participación en la génesis y desenvolvimiento de fenómenos psicopatológicos. Esta vivencia permitió una sistematización de algunos factores envueltos en la psicodinámica del padecimiento del trabajador-cuidador, las posibilidades de superación y las limitaciones inherentes al proceso. Asimismo, este trabajo se encuentra ancorado en algunas concepciones del Grupo Operativo de Pichón-Rivière y en las pesquisas del trabajo desarrolladas por Christophe Dejours con psicodinámica...

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O presente texto é uma síntese das experiências profissionais vivenciadas junto a um grupo operativo constituído por cuidadores do Programa Maior Cuidado, da Prefeitura Municipal de Belo Horizonte. Apresenta as análises das condições de trabalho enfrentadas por estes profissionais e sua participação na gênese e desenvolvimento de fenômenos psicopatológicos. Esta empreitada permitiu a sistematização de alguns fatores envolvidos na psicodinâmica do adoecimento do trabalhador-cuidador, as possibilidades de superação e as limitações inerentes ao processo. Fundamentou-se em algumas noções de Grupo Operativo de Pichon-Rivière e nas pesquisas em Psicodinâmica do trabalho desenvolvidas por Christophe Dejours.(AU)

The present study analyzes the professional experiences of an operative group composed of caregivers of the Greater Care Program of the City of Belo Horizonte. It presents analyses of the working conditions encountered by these professionals and their participation in the genesis and development of psychopathological phenomena. This contract allowed the systematization of some factors involved in the psychodynamics of illness of the worker or caregiver, the opportunities for overcoming this, and the limitations inherent in the process. It was based on notions of the Operative Group of Pichon–Riviere and research in the psychodynamics of work developed by Christophe Dejours.(AU)

El presente texto es una síntesis de las experiencias profesionales vividas junto a un grupo operativo constituido por los cuidadores del Programa Cuidado Mayor de la Prefectura Municipal de Belo Horizonte. El texto presenta el análisis de las condiciones de trabajo enfrentadas por estos profesionales y su participación en la génesis y desenvolvimiento de fenómenos psicopatológicos. Esta vivencia permitió una sistematización de algunos factores envueltos en la psicodinámica del padecimiento del trabajador-cuidador, las posibilidades de superación y las limitaciones inherentes al proceso. Asimismo, este trabajo se encuentra ancorado en algunas concepciones del Grupo Operativo de Pichón-Rivière y en las pesquisas del trabajo desarrolladas por Christophe Dejours con psicodinámica.(AU)

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El presente estudio investiga la utilidad de determinar puntos de corte ajustados según la edad gestacional y el peso al nacer de neonatos (2-100 días) en la cuantificación de 17-hidroxiprogesterona en muestras de sangre seca en papel de filtro. Se analizaron los resultados de 6.266 determinaciones realizadas en el marco del Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas. Los datos se dividieron en cuatro grupos; Grupo 1: recién nacido pretérmino con bajo peso; Grupo 2: recién nacido pretérmino con peso normal; Grupo 3: recién nacido a término con bajo peso y Grupo 4: recién nacido a término con peso normal. Se establecieron puntos de corte diferentes a partir del cálculo del percentilo 99 de la distribución de frecuencias. Basado en este análisis se realizó la comparación de la tasa de resultados falsos positivos que se obtuvieron según el punto de corte establecido por el fabricante y los obtenidos en el estudio. Los nuevos puntos de corte obtenidos fueron: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L y 82,38 nmol/L para los grupos 1, 2, 3 y 4 respectivamente. Se evidenció una tasa total de falsos positivos del 1% con los nuevos puntos de corte, significativamente menor a la tasa del 6,2% obtenida al utilizar el punto de corte del fabricante. Esto puso en evidencia que el uso de puntos de corte adecuadamente establecidos para la población en estudio reduce significativamente las complicaciones derivadas de las repeticiones de análisis y eventualmente la tasa de recitaciones, lo cual es una importante contribución a la Salud Pública.

The present work studies the usefulness of determining adjusted cut-offs for the quantification of 17-hydroxyprogesterone in dried blood samples on filter paper, taking into account the gestational age and weight of the neonates. The results of 6266 determinations made within the framework of the National Program of Strengthening Early Detection of Congenital Disease were analysed. Data were divided into groups, Group 1: early established from the calculation of the 99 percentiles of the frequency distribution. New cutoff points were: 217.72 nmol/L, 102.14 nmol/L, 61.62 nmol/L and 82.38 nmol/L for groups 1, 2, 3 and 4 respectively. It showed a total rate of 1% false positives with the new cut-off points, which was significantly lower than the rate of 6.2% obtained using the manufacturer's cutoff. This revealed that the use of properly established cut-offs for the study of population reduces significantly the complications derived fromn analysis repetitions and eventually the recitation rate, which is an important contribution to Public Health.

O presente estudo investiga a utilidade de determinar pontos de corte estabelecidos conforme a idade gestacional e o peso ao nascer de neonatos (2-100 dias) na quantificação da 17-hidroxiprogesterona em amostras de sangue seco em papel filtro. Foram analisados os resultados de 6.266 determinações feitas no âmbito do Programa Nacional de Fortalecimento da Detecção Precoce de Doenças Congênitas. Os dados foram divididos em quatro grupos; Grupo 1: recém-nascido pré-termo com baixo peso, Grupo 2: recém-nascido pré-termo com peso normal, Grupo 3: recém-nascido a termo com baixo peso e Grupo 4: recém-nascido a termo com peso normal e foram estabelecidos pontos de corte diferentes a partir do cálculo do percentil 99 da distribuição de frequências. Com base nesta análise foi realizada a comparação da taxa de resultados falsos positivos obtidos conforme o ponto de corte estabelecido pelo fabricante e os obtidos no estudo. Os novos pontos de corte obtidos foram: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L e 82,38 nmol/L para os grupos 1, 2, 3 e 4, respectivamente. Tornou-se evidente uma taxa total de 1% de falsos positivos, com os novos pontos de corte significativamente menor do que a taxa de 6,2% obtida utilizando o ponto de corte do fabricante. Isto revelou que o uso de pontos de corte de forma adequada estabelecidos para a população em estudo reduz significativamente as complicações decorrentes das repetições de análises e eventualmente a taxa de repetição de novos encontros, o que é uma importante contribuição para a saúde pública.

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El presente estudio investiga la utilidad de determinar puntos de corte ajustados según la edad gestacional y el peso al nacer de neonatos (2-100 días) en la cuantificación de 17-hidroxiprogesterona en muestras de sangre seca en papel de filtro. Se analizaron los resultados de 6.266 determinaciones realizadas en el marco del Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas. Los datos se dividieron en cuatro grupos; Grupo 1: recién nacido pretérmino con bajo peso; Grupo 2: recién nacido pretérmino con peso normal; Grupo 3: recién nacido a término con bajo peso y Grupo 4: recién nacido a término con peso normal. Se establecieron puntos de corte diferentes a partir del cálculo del percentilo 99 de la distribución de frecuencias. Basado en este análisis se realizó la comparación de la tasa de resultados falsos positivos que se obtuvieron según el punto de corte establecido por el fabricante y los obtenidos en el estudio. Los nuevos puntos de corte obtenidos fueron: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L y 82,38 nmol/L para los grupos 1, 2, 3 y 4 respectivamente. Se evidenció una tasa total de falsos positivos del 1% con los nuevos puntos de corte, significativamente menor a la tasa del 6,2% obtenida al utilizar el punto de corte del fabricante. Esto puso en evidencia que el uso de puntos de corte adecuadamente establecidos para la población en estudio reduce significativamente las complicaciones derivadas de las repeticiones de análisis y eventualmente la tasa de recitaciones, lo cual es una importante contribución a la Salud Pública.(AU)

The present work studies the usefulness of determining adjusted cut-offs for the quantification of 17-hydroxyprogesterone in dried blood samples on filter paper, taking into account the gestational age and weight of the neonates. The results of 6266 determinations made within the framework of the National Program of Strengthening Early Detection of Congenital Disease were analysed. Data were divided into groups, Group 1: early established from the calculation of the 99 percentiles of the frequency distribution. New cutoff points were: 217.72 nmol/L, 102.14 nmol/L, 61.62 nmol/L and 82.38 nmol/L for groups 1, 2, 3 and 4 respectively. It showed a total rate of 1% false positives with the new cut-off points, which was significantly lower than the rate of 6.2% obtained using the manufacturers cutoff. This revealed that the use of properly established cut-offs for the study of population reduces significantly the complications derived fromn analysis repetitions and eventually the recitation rate, which is an important contribution to Public Health.(AU)

O presente estudo investiga a utilidade de determinar pontos de corte estabelecidos conforme a idade gestacional e o peso ao nascer de neonatos (2-100 dias) na quantificaþÒo da 17-hidroxiprogesterona em amostras de sangue seco em papel filtro. Foram analisados os resultados de 6.266 determinaþ§es feitas no Ômbito do Programa Nacional de Fortalecimento da DetecþÒo Precoce de Doenþas CongÛnitas. Os dados foram divididos em quatro grupos; Grupo 1: recém-nascido pré-termo com baixo peso, Grupo 2: recém-nascido pré-termo com peso normal, Grupo 3: recém-nascido a termo com baixo peso e Grupo 4: recém-nascido a termo com peso normal e foram estabelecidos pontos de corte diferentes a partir do cálculo do percentil 99 da distribuiþÒo de frequÛncias. Com base nesta análise foi realizada a comparaþÒo da taxa de resultados falsos positivos obtidos conforme o ponto de corte estabelecido pelo fabricante e os obtidos no estudo. Os novos pontos de corte obtidos foram: 217,72 nmol/L, 102,14 nmol/L, 61,62 nmol/L e 82,38 nmol/L para os grupos 1, 2, 3 e 4, respectivamente. Tornou-se evidente uma taxa total de 1% de falsos positivos, com os novos pontos de corte significativamente menor do que a taxa de 6,2% obtida utilizando o ponto de corte do fabricante. Isto revelou que o uso de pontos de corte de forma adequada estabelecidos para a populaþÒo em estudo reduz significativamente as complicaþ§es decorrentes das repetiþ§es de análises e eventualmente a taxa de repetiþÒo de novos encontros, o que é uma importante contribuiþÒo para a saúde pública.(AU)

RESUMEN

BACKGROUND: Antiretroviral treatments (ART) form the basis of adequate clinical control in human immunodeficiency virus-infected patients, and adherence plays a primary role in the grade and duration of the antiviral response. The objectives of this study are: (1) to determine the impact of the implementation of a pharmaceutical care program on improvement of ART adherence and on the immunovirological response of the patients; and (2) to detect possible correlations between different adherence evaluation measurements. METHODS: A 60-month long retrospective study was conducted. Adherence measures used were: therapeutic drug monitoring, a simplified medication adherence questionnaire, and antiretroviral dispensation records (DR). The number of interviews and interventions related to adherence made for each patient in yearly periods was related to the changes in the adherence variable (measured with DR) in these same yearly periods. The dates when the laboratory tests were drawn were grouped according to proximity with the study assessment periods (February-May, 2005-2010). RESULTS: A total of 528 patients were included in the study. A significant relationship was observed between the simplified medication adherence questionnaire and DR over the 60-month study period (P < 0.01). Improvement was observed in the mean adherence level (P < 0.001), and there was a considerable decrease in the percentage of patients with CD4+ lymphocytes less than 200 cells/mm(3) (P < 0.001). A relationship was found between the number of patients with optimum adherence levels and the time that plasma viral load remained undetected. The number of interviews and interventions performed in each patient in the first 12 months from the onset of the pharmaceutical care program (month 6), was related to a significant increase in adherence during this same time period. CONCLUSION: The results suggest that the establishment and permanence of a pharmaceutical care program may increase ART adherence, increase permanence time of the patient with undetectable plasma viral loads, and improve patients' lymphocyte count.

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La diversidad y el aumento de instituciones de educación terciaria, junto con el incremento de oferta de carreras, posibilita el acceso a la educación superior a segmentos de la población hasta ahora excluidos, esto se traduce en un nuevo perfil de estudiante que se inserta en la educación terciaria. Asimismo, la reforma en salud, los cambios demográficos, epidemiológicos, sociales, culturales, económicos, el avance sostenido de enfermería como profesión y disciplina, exigen un replanteamiento en la formación y proponer un perfil de egreso acorde a las realidades y a las proyecciones enunciadas. Conscientes de esta situación se diseñó un currículo basado en competencias, centrado en el estudiante, que posibilite movilidad estudiantil. Para realizar el diseño precedentemente indicado se estableció un convenio de colaboración entre las cuatro instituciones de la red, se contrató a expertos que orientaron el diseño curricular, acorde a las tendencias en la disciplina de enfermería y educación. Se visitaron diferentes países para recabar experiencia; se analizaron documentos, se realizaron talleres con participación de diversos estamentos, donde se consideraron las competencias que se requieren en el ámbito laboral y concordar el perfil de egreso. Como productos se elaboró un marco contextual, con una amplia mirada, donde se relacionan los principales conceptos que iluminan la propuesta curricular, se definió un perfil y las competencias de egreso, se elaboró el plan de estudio asignando créditos a las asignaturas acorde al sistema de crédito transferible propuesto por los vicerrectores de las universidades adscritas al Consejo de Rectores de Chile.

The diversity and the increase of tertiary education institutions, as well as increasing career offer, allows access to higher education to segments of the population hitherto excluded, resulting in a new student profile that is inserted into tertiary education. Furthermore, health reform, demographic, epidemiological, social, cultural, economic changes, and sustained progress of nursing as a profession and discipline, requires a rethinking in the formation and propose a profile of graduates according to the reality and the contained projections. Aware of this situation a competency-based curriculum, student-centered, which enables student mobility was designed. To make the design previously indicated, a collaboration agreement among the four institutions in the network, was established. Experts that guided the curriculum, according to trends in the discipline of nursing, and education, were hired. Different countries were visited to gather experience, documents were analyzed, as well as workshops with the participation of various branches, which considered the skills required at workplace and match the graduate profile as well. As products, a contextual framework was developed, with a broad glance, where the main concepts that illuminate the curriculum proposal relate themselves; a profile and graduate competencies were defined and the curriculum assigning credits to subjects according to the transferable credit system proposed by the vice chancellors of the universities attached to the Council of Rectors of Chile, was prepared.

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The aim of this study was to show the benefits of combining therapeutic drug monitoring (TDM) and pharmacogenetic analyses to optimize efavirenz (EFV) therapy. Patients were selected to minimize nongenetic differences between patients: 32 HIV adherent patients without drug interactions treated with an EFV nonindividualized dose over at least 1 year and included in a TDM program were genotyped according to minimum steady-state concentrations (C ss min). The EFV plasma concentrations (n = 158) were quantified by high-performance liquid chromatography-ultraviolet, and genetic polymorphisms were analyzed using the PHARMAchip. Central nervous system side effects were assessed systematically. Genetic polymorphisms were detected in 79.2% of patients with EFV Css min outside the therapeutic range (1-4 mg/L), showing the high diagnostic efficacy of combining TDM with pharmacogenetic testing. CYP2B6 (516 G>T) polymorphisms were associated with a significant decrease in EFV plasma clearance in 80% of the poor metabolizer patients (G/T, T/T). All homozygous patients had C ss min greater than 4 mg/L, 75% of them showing central nervous system side effects. For such patients, pharmacogenetic testing with TDM could be advantageous because the polymorphism is a determinant of these circumstances and TDM would allow reductions in dose to be specified without assuming an equal dose for any given genotype. In fact, poor metabolizer patients required less than a 600 mg standard starting dose, implying that if CYP2B6 screening were available, EFV therapy could be started at 400 mg and later TDM-individualized. The results of this study clarify the genotype versus phenotype debate for optimizing drug therapy. Pharmacogenetic testing together with TDM links genotype to phenotypic differences in drug concentrations and adverse events, providing additional support for dosage adjustment and a more efficient use of both approaches. As genotype screens become cheaper, and in combination with TDM, adjusting dosages in the light of genetic polymorphisms will become a reality.

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O texto apresenta o erro como sinal de conhecimento do aprendiz no processo de aprendizagem, tentando abrir possibilidades de intervenção na área psicopedagógica(AU)