ABSTRACT Numerous works and clinical research conducted in various institutions have cast fresh light on the notion of trauma and have contributed to the emergence of the concept of early relational trauma. Early relational trauma is a form of trauma rendered complex by the multiplicity of its sources and its modes of expression. Its main features are often attachment and acting-out disturbances. In families where such trauma occurs, links could sometimes be perverted and form a narcissistic configuration. This mode of functioning, organized around negativity, impacts the plurality of psychic processes and interferes with the treatment approaches of multidisciplinary teams. In order to promote a multifocal approach to care tailored to differences in situations, educational and socio-judicial practitioners. expression actingout acting out disturbances occurs configuration functioning negativity teams situations sociojudicial socio judicial practitioners

RESUMO Inúmeros trabalhos e pesquisas clínicas realizados em diversas instituições trouxeram à luz a noção de trauma e contribuíram para o surgimento do conceito de trauma relacional precoce. O trauma relacional precoce é uma forma de trauma complexo pela multiplicidade de suas fontes e seus modos de expressão. Suas principais características são frequentemente distúrbios de apego e atuação. Nas famílias onde ocorre tal trauma que às vezes pode ser pervertido em configurações narcísicas, esse modo de funcionamento organizado em torno da negatividade impacta a pluralidade do psíquico e interfere nas abordagens de tratamento das equipes multidisciplinares. Para promover uma abordagem multifocal de cuidados adaptados às diferenças de situações, profissionais de educação e sócio judiciais. expressão atuação narcísicas multidisciplinares situações judiciais

Resumo Níveis elevados de ambivalência estão associados a piores resultados e abandono terapêutico. Este estudo teve como objetivo a adaptação transcultural e avaliação das propriedades psicométricas do Questionário de Ambivalência em Psicoterapia (QAP). Após adaptação cultural do instrumento, foram avaliados 181 indivíduos em psicoterapia de diversas abordagens, em clínicas-escola e consultórios particulares. O QAP foi avaliado quanto à estrutura interna e relação com variáveis externas. Na análise fatorial confirmatória, o modelo com melhor ajuste foi composto por três dimensões: duas de primeira ordem - Desmoralização e Alternância - e uma de segunda ordem - Ambivalência. A consistência interna foi 0,86. Na relação com variáveis externas, o QAP se correlacionou moderadamente com medidas de desconforto psicológico (OQ-45- Outcome Questionnaire) (r = 0,65) e motivação para mudança (URICA - University of Rhode Island Change Assessment): contemplação (r = 0,36) e manutenção (r = 0,37). A versão brasileira do QAP demonstrou ser um instrumento com boas características psicométricas, de aplicação rápida e fácil.

Abstract High levels of ambivalence are associated with poor outcomes and therapeutic abandonment. The objective of this study was to conduct a cross-cultural adaptation and assessment of the psychometric properties of the Ambivalence in Psychotherapy Questionnaire (APQ). After cultural adaptation of the instrument, we assessed 181 individuals undergoing psychotherapy of different approaches in school clinics and private practices. The APQ was validated regarding internal structure and relationship with external variables. In the confirmatory factor analysis, the model with the best fit was composed of three dimensions: two first-order - Demoralization and Wavering - and one second-order - Ambivalence. The internal consistency was 0.86. In relation to external variables, the APQ correlated moderately with measures of psychological distress (OQ-45- Outcome Questionnaire) (r = 0.65) and motivation to change (URICA- University of Rhode Island Change Assessment): contemplation (r = 0.36) and maintenance (r = 0.37). The results indicated that the Brazilian version of the APQ is a suitable instrument, of quick and easy application.

Resumen Los altos niveles de ambivalencia se asocian con peores resultados y abandono terapéutico. Este estudio tuvo como objetivo la adaptación transcultural y la evaluación de las propiedades psicométricas del Cuestionario de Ambivalencia en Psicoterapia (QAP). Después de la adaptación cultural del instrumento, 181 individuos fueron evaluados en psicoterapia utilizando diferentes enfoques, en clínicas-escuelas y consultorios privados. El QAP fue evaluado por su estructura interna y su relación con variables externas. En el análisis factorial confirmatorio, el modelo con mejor ajuste estuvo compuesto por tres dimensiones: dos de primer orden - Desmoralización y Alternancia - y una de segundo orden - Ambivalencia. La consistencia interna fue de 0,86. En relación con las variables externas, el QAP se correlacionó moderadamente con las medidas de malestar psicológico (OQ-45- Outcome Questionnaire) (r = 0,65) y motivación para el cambio (URICA- University of Rhode Island Change Assessment): contemplación (r = 0,36) y mantenimiento (r = 0,37). La versión brasileña del QAP demostró ser un instrumento con buenas características psicométricas, de rápida y fácil aplicación.

Resumo Fundamentos A doença do coronavírus 2019 (Covid-19) pode levar à insuficiência respiratória grave e lesão cardíaca aguda, mas não está claro com que frequência ela pode causar disfunção cardíaca. Objetivos Nesta revisão sistemática, nosso objetivo foi resumir os principais achados ecocardiográficos em pacientes com Covid-19. Métodos Conduzimos uma busca sistemática nos bancos de dados PUBMED, EMBASE, LILACS e Cochrane, além de artigos não pulicados ( preprints ) no MedRxiv e Scielo desde o início até 21 de julho de 2021. Foram incluídos estudos que apresentaram dados ecocardiográficos de pacientes com Covid-19. Características demográficas, doença cardiovascular (DCV) prévia, e achados ecocardiográficos foram extraídos dos estudos. Realizamos uma metanálise de proporções para estimar os principais achados ecocardiográficos. O nível de significância foi p<0,05. Resultados Do total de 11 233 estudos, 38 preencheram os critérios de inclusão e foram incluídos na metanálise. A proporção estimada de disfunção sistólica do ventrículo esquerdo (VE) foi 25% (IC95%: 19, 31; I2 93%), strain longitudinal global anormal 34% (IC95% 23, 45; I2 90%), disfunção sistólica do ventrículo direito (VD) 17% (IC95% 13, 21; I2 90%), derrame pericárdico 17% (IC95%: 9, 26; I2 97%), e hipertensão pulmonar 23% (IC95%: 15, 33, I2 96%). Disfunção sistólica do VE foi diretamente associada com prevalência de ecocardiograma anormal prévio nos estudos (p<0,001). A proporção de pacientes em ventilação mecânica, indicando gravidade da doença, não explicou a heterogeneidade nas proporções de disfunção do VE (p=0,37). Conclusão Entre os pacientes internados com Covid-19, a disfunção ventricular esquerda foi descrita em um quarto dos pacientes, com menores proporções de disfunção do ventrículo direito, derrame pericárdico e hipertensão pulmonar. No entanto, houve uma proporção mais alta de disfunção do VE nos estudos que relataram presença de doença cardíaca prévia, sugerindo que a disfunção cardíaca era predominantemente pré-existente.

Abstract Background Coronavirus disease 2019 (Covid-19) can lead to severe respiratory distress and acute cardiac injury, but it is unclear how often it can cause cardiac dysfunction. Objective In this systematic review, we aimed to summarize the main echocardiographic findings in patients with Covid-19. Methods We systematically searched in PUBMED, EMBASE, LILACS and Cochrane databases, in addition MedRxiv and Scielo preprints from inception to July 21st, 2021. Studies reporting echocardiographic data in patients with Covid-19 were included. Demographic characteristics, previous cardiovascular disease (CVD), and echocardiographic findings were extracted. We performed a meta-analysis of proportions to estimate the main echocardiographic findings. The level of significance was p < 0.05. Results From 11,233 studies, 38 fulfilled inclusion criteria and were included in the meta-analysis. The estimated proportions of left ventricular (LV) systolic dysfunction were 25% (95%CI: 19, 31; I293%), abnormal global longitudinal strain 34% (95% CI 23, 45; I290%), righ ventricular (RV) systolic dysfunction 17% (95%CI 13, 21; I290%), pericardial effusion 17% (95%CI: 9, 26; I297%), and pulmonary hypertension 23% (95%CI: 15, 33, I2 96%). LV systolic dysfunction was directly associated with study-specific prevalence of previous abnormal echocardiogram (p<0.001). The proportion of patients in mechanical ventilation, indicating severity of disease, did not explain the heterogeneity in the proportions of LV dysfunction (p=0.37). Conclusion Among hospitalized patients with Covid-19, LV dysfunction has been reported in one quarter, with smaller proportions of right ventricular dysfunction, pericardial effusion and pulmonary hypertension. However, there was a higher proportion of LV dysfunction among studies reporting the presence of prior heart disease, which suggests that cardiac dysfunction was mostly pre-existing.

Abstract

Resumo A Terapia Cognitivo-Comportamental Online (TCC) é uma intervenção que se mostra promissora para reduzir o consumo de álcool na população. Porém, devido à escassez de estudos na área, o presente estudo tem como objetivo avaliar os efeitos do processo terapêutico da TCC online para uma amostra de alcoolistas residentes em um município brasileiro. Como método foram analisadas o total de trinta e seis gravações de sessões de psicoterapia online, aplicadas em seis participantes, do sexo masculino, com diagnóstico prévio de dependência de álcool. Estes participantes procuraram o tratamento para cessar ou reduzir o consumo da substância. As gravações foram analisadas segundo o método Innovative Moments Coding System (IMCS). O IMCS é um método que analisa as mudanças ocorridas durante o processo terapêutico. Os resultados mostraram que: (1) houve um aumento no número de Momentos Inovadores (MIs) do início ao fim das sessões em todos os casos analisados, e (2) houve uma correlação entre a diminuição das doses de consumo de álcool ao final das sessões e aumento dos MIs. O presente estudo aplicou pela primeira vez com sucesso o IMCS para a dependência de álcool online e provou ser um método adequado para avaliar o processo de terapia para esta amostra. No entanto, é necessária a realização de pesquisas adicionais para confirmar a eficácia do IMCS para a dependência de álcool.

Abstract Online Cognitive Behavioural Therapy (CBT) is a promising intervention for reducing alcohol consumption among the population. However, due to the lack of studies in the area, the present study aims to evaluate the effects of the therapeutic process of online CBT for alcohol addicts in a Brazilian sample. Thirty-six recordings of six male participants diagnosed with alcohol dependence, who sought treatment to cease or reduce the substance’s consumption, were analysed using the Innovative Moments Coding System (IMCS). The IMCS is a method that analyses changes occurred during the therapeutic process. The results suggested: (1) an increase in the number of Innovative Moments (IMs) from the beginning to the end of the sessions in all analysed cases, and (2) a correlation between a decrease in the doses of alcohol consumption at the end of the sessions and the increase of IMs. The present study successfully applies for the first time the IMCS in alcohol dependence and proved to be an adequate method to evaluate the online therapy process for this sample. However, it is necessary to conduct further research to confirm the IMCS’s effectiveness for alcohol dependence.

Abstract: The main objective of this research study was to quantify the genetic parameters of 16 fruit and seed traits of Benincasa hispida (Thunb.) Cogn from Montería (Colombia). Ten families of half siblings (FHM) were evaluated in a completely randomized design with five replications. The results showed differences only between FHM for seed width (SW). The estimates of genetic variability were higher in SW and seed thickness, where the genetic component represented 81.58% and 45.91% of the phenotypic variance. The greatest heritability in broad sense (h2 A = 81.58%) and strict sense (h2 E = 13.05%) occurred in SW. Expected genetic gain expressed as a percentage of the mean occurred in SW and seed volume, being 60% higher than that of the general mean. In conclusion, the genetic parameters obtained here indicate that selecting fruits with broad, thick, and voluminous seeds would allow obtaining vigorous seedlings for propagation.

Resumen: El objetivo de esta investigación fue cuantificar los parámetros genéticos de 16 características de frutos y semillas de Benincasa hispida (Thunb.) Cogn. en Montería (Colombia). Se evaluaron 10 familias de hermanos medios, en un diseño completamente aleatorizado con cinco repeticiones. Se detectaron diferencias sólo entre familias de hermanos medios para ancho de semilla. Las estimaciones de variabilidad genética fueron mayores en ancho y grosor de semillas, donde el componente genético representó el 81,58% y 45,91% de la varianza fenotípica total. Las mayores heredabilidades en sentido amplio (h2 A = 81,58%) y estricto (h2 E = 13,05%) se presentaron en ancho de semillas. La ganancia genética esperada expresada como porcentaje de la media, ocurrió en ancho y volumen de semilla, con progreso 60% superior a la media general. Se concluyen que los parámetros genéticos obtenidos indican que la selección de frutos con semillas anchas, gruesas y voluminosas, permitirán obtener plántulas vigorosas para propagación.

Abstract Background Spider venom is a rich cocktail of neuroactive compounds designed to prey capture and defense against predators that act on neuronal membrane proteins, in particular, acetylcholinesterases (AChE) that regulate synaptic transmission through acetylcholine (ACh) hydrolysis - an excitatory neurotransmitter - and beta-secretases (BACE) that primarily cleave amyloid precursor proteins (APP), which are, in turn, relevant in the structural integrity of neurons. The present study provides preliminary evidence on the therapeutic potential of Phlogiellus bundokalbo venom against neurodegenerative diseases. Methods Spider venom was extracted by electrostimulation and fractionated by reverse-phase high-performance liquid chromatography (RP-HPLC) and characterized by matrix-assisted laser desorption ionization-time flight mass spectrometry (MALDI-TOF-MS). Neuroactivity of the whole venom was observed by a neurobehavioral response from Terebrio molitor larvae in vivo and fractions were screened for their inhibitory activities against AChE and BACE in vitro. Results The whole venom from P. bundokalbo demonstrated neuroactivity by inducing excitatory movements from T. molitor for 15 min. Sixteen fractions collected produced diverse mass fragments from MALDI-TOF-MS ranging from 900-4500 Da. Eleven of sixteen fractions demonstrated AChE inhibitory activities with 14.34% (± 2.60e-4) to 62.05% (± 6.40e-5) compared with donepezil which has 86.34% (± 3.90e-5) inhibition (p > 0.05), while none of the fractions were observed to exhibit BACE inhibition. Furthermore, three potent fractions against AChE, F1, F3, and F16 displayed competitive and uncompetitive inhibitions compared to donepezil as the positive control. Conclusion The venom of P. bundokalbo contains compounds that demonstrate neuroactivity and anti-AChE activities in vitro, which could comprise possible therapeutic leads for the development of cholinergic compounds against neurological diseases.

Over the last twenty years, the Groebke-Blackburn-Bienaymé (GBB) reaction has been emerged as a powerful tool to access different nitrogen-based heterocycles as privileged scaffolds in medicinal chemistry. This multicomponent reaction is usually catalyzed by ordinary Brønsted or Lewis acid catalysts. Herein, we present a comparative study on the catalytic efficiencies of different rare earth triflates in GBB reactions under microwave heating, involving 2-aminopyridine or 2-aminothiazole, as aminoazole component, and different aldehydes and aliphatic isocyanides. The use of gadolinium(III) triflate as cheaper alternative catalyst for the most commonly used scandium(III) triflate was acknowledged for the first time, and a library of twenty three imidazo[1,2-a]pyridines and imidazo[2,1-b]thiazoles could be obtained in good to excellent yields.

Abstract Background and Objective Adequate assessment of symmetry is a critical aspect when evaluating results in breast surgery. Most methods of asymmetry assessment are based on subjective observations by the surgeon or patients, as well as on the objective measurement of distances between key points, such as the sternal notch and the nipple. The widespread use of an objective method would have obvious advantages. We aim to design and test an imaging analysis method that allows to objectively assess the degree of breast asymmetry. Methods An application has been developed to quantify the degree of disparity between two similar images, based on a computer algorithm. The algorithm was used to compare images of breasts, yielding a numerical result that we named global breast asymmetry index (GBAI). This value was calculated in a series of 50 patients pre- and postoperatively. The result was compared with other asymmetry assessment methods, both objective and subjective, including a survey of 100 health professionals and a panel of experts. Results The implementation of our algorithm to calculate the breast asymmetry index shows similar results to subjective assessment of asymmetry by health personnel, improving other objective methods and presenting itself as a useful alternative to traditional methods of symmetry assessment. Conclusions Measurement of optical flow is a valid and objective method of assessment of the degree of breast asymmetry.

Resumen Antecedentes y Objetivo La gradación de la simetría es un aspecto fundamental para evaluar un resultado en cirugía mamaria. Los métodos más extendidos de valoración de asimetría se basan en percepciones subjetivas del cirujano o de la paciente, así como en la comparación objetiva de distancias entre puntos de interés tales como la horquilla esternal y el pezón. Utilizar de forma generalizada un método objetivo comportaría ventajas evidentes. El presente trabajo pretende diseñar y contrastar un método de análisis de imagen que permita objetivar el grado de asimetría mamaria en una paciente. Material y método Basándonos en un algoritmo informático que evalúa el grado de desplazamiento entre dos imágenes similares, desarrollamos una aplicación capaz de cuantificar el grado de desplazamiento que presenta una mama con respecto a la otra, arrojando un resultado numérico que denominamos globa breast asymmetry index (GBAI). Calculamos este valor en una serie de 50 pacientes de forma pre y postoperatoria. Comparamos el resultado con otros métodos de evaluación de asimetría tanto objetivos como subjetivos, incluyendo una encuesta a 100 profesionales sanitarios y a un panel de expertos. Resultados La adaptación de nuestro algoritmo para calcular un índice objetivo de asimetría mamaria muestra un comportamiento similar a la valoración subjetiva de la asimetría por parte del personal sanitario, mejorando otros métodos objetivos y presentándose como una alternativa útil a los métodos tradicionales de comparación de distancias. Conclusiones El cálculo de desplazamiento óptico es un procedimiento válido y objetivo para cuantificar la asimetría mamaria.

ABSTRACT INTRODUCTION Chronic kidney disease has reached epidemic levels in several Central American countries since the early years of this century. In El Salvador, it is the second cause of death in men, the fifth in persons over 18 years old and the third cause of hospital deaths in the adult population. Its features, especially those of a subtype unassociated with traditional risk factors such as diabetes and high blood pressure, are only partially understood. OBJECTIVE Estimate the magnitude of chronic kidney disease in the adult population of El Salvador, considering both prevalence of the disease in its diverse forms as well as presence of potential risk factors nationally and in major subpopulations. METHODS A descriptive, cross-sectional analysis was conducted on data obtained from the Survey of Chronic Non-communicable Diseases in Adults in El Salvador, completed in 2015. The original data (interviews and measurements) were collected between October 2014 and March 2015 from 4817 adults employing a two-stage probabilistic cluster sample, with stratification of primary sampling units. Our analysis, using 20 of the 118 primary variables included in the original survey, focused on point estimation of prevalence rates and means, related to both traditional biological risk factors and nontraditional ones, such as insufficient hydration, strenuous working conditions and exposure to toxic agents. A separate analysis was performed to estimate prevalence of chronic kidney disease from nontraditional causes. Corresponding confidence intervals were calculated with proper weighting. RESULTS The general prevalence of chronic kidney disease in El Salvador was 12.8% (men 18.0%; women 8.7%). Of the chronically ill kidney patients, 13.1% were between 20 and 40 years of age. Among biological risk factors, the most frequent was high blood pressure (37.0%). Among nontraditional risk factors, high levels of sugary drink consumption (81.0%), insufficient hydration (65.9%) and high levels of exposure to agrochemicals in the work environment (12.6%) were also observed. Prevalence of chronic kidney disease from nontraditional causes was 3.9% (men 6.1%; women 2.2%). CONCLUSIONS Chronic kidney disease has reached epidemic proportions in El Salvador. The data confirm a health tragedy that, although especially striking older men, also takes a severe toll on young men and women. The results confirm findings of previous research in several Salvadoran agricultural communities. The relatively high level of population exposure to agrochemicals is important and alarming, especially in rural areas, meriting health-impact studies that include and go beyond possible impact on chronic kidney disease.

A sinovite vilonodular pigmentada, englobada no grupo dos tumores tenossinoviais de células gigantes, é uma doença rara, benigna e com incidência de 1.8 casos por milhão de habitantes/ano. Ocorre por proliferação da membrana sinovial das articulações, bursas e das bainhas tendinosas, com pigmentação por depósitos de hemossideria. Afecta sobretudo indivíduos entre os 30 e 40 anos. Geralmente é monoarticular, afectando o joelho em cerca de 80% dos casos e o ombro em apenas 2.4% dos casos. A sua clínica é inespecífica, o ao RX esta entidade geralmente passa despercebida. A Ressonância Magnética, não é específica para o seu diagnóstico, mas é útil para diferenciá-la de outras patologias e estratificar a extensão da doença. O diagnóstico definitivo é histológico. A sinovectomia é o tratamento indicado. É fundamental saber o subtipo da doença para a escolha o método cirúrgico: aberto ou artroscópico. Apresentamos um caso de um tumor tenossinovial de células gigantes do ombro, localizado, tratado com exérese artroscópia. O tratamento foi eficaz, sem recidiva até à data.

Pigmented villonodular synovitis, which belongs to the group of giant cell tenosynovial tumors, is a rare benign disease, with an incidence of 1.8 cases per million inhabitants per year. It occurs by proliferation of the synovial membrane of the joints, bursae and tendinous sheaths, with pigmentation by haemosideria deposits. It mainly affects individuals between the ages of 30 and 40. Affects the knee in about 80% of the cases and the shoulder in only 2.4% of the cases. Its clinical manifestations are nonspecific and on XRay this entity usually goes unnoticed. Magnetic Resonance Imaging is not specific for diagnosis but is useful for differentiating it from other pathologies and stratifying the extent of the disease. Definitive diagnosis is histological. Synovectomy is the indicated treatment. Knowing the subtype of the disease is crucial for choosing the surgical method: open or arthroscopic. We present a case of a localized giant cell tenosynovial tumor of the shoulder treated with excision by arthroscopy. The treatment was effective, with no recurrence to date.

Objective: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. Methods: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. Results: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). Conclusion: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.

Resumen Una nueva especie de Catasetum fue encontrada en el departamento de Casanare hacia el oriente de Colombia, en la bioregión de la Orinoquía. Se describe e ilustra la especie y se estipulan parámetros asociados a su fenología, distribución y estado de conservación. La nueva especie, Catasetum lucisuareziae, es comparable con otras especies que se encuentran en la misma región, como C. rectangulare y C. callosum, pero difiere de ellas principalmente por su labelo trilobulado y la presencia de dos callos subglobulares en la base.

Abstract A new species of Catasetum was found in eastern Colombia, Casanare Department, in the Orinoquía bioregion. The species is described and illustrated, and data associated with its phenology, distribution and conservation status are discussed. The new species, C. lucisuareziae, is related to other species found in the same region, like C. rectangulare and C. callosum, from which it mainly differs by the three-lobed labellum and the presence of two subglobular calli at the base.