ABSTRACT Mucormycosis is a rare, sometimes severe fungal infection that has emerged as a possible complication of COVID-19. We report a case of a non-diabetic, apparently immunocompetent patient diagnosed with rhino-orbital-cerebral mucormycosis shortly after COVID-19 treatment with dexamethasone. The patient received optimized systemic antifungal therapy and extensive surgical treatment. So far, four months after the last hospital discharge, the patient has been in good general condition. This case is a dramatic reminder that beneficial corticosteroid therapy in general inevitably carries a risk of opportunistic infection, and corticosteroid therapy for COVID-19 risks orbital-rhinocerebral mucormycosis that clinicians should watch for with vigilance.

ABSTRACT This paper is related to two institutional scientific research projects, which research on mental health care practices during the Covid-19 pandemic. The aim of this paper is to describe and analyze health and mental health practices focused on maintaining the assistance bonds and strengthening of care-producing networks in the context of pandemic, developed in the Metropolitan Area of Buenos Aires, Argentina. This exploratory and descriptive study uses qualitative techniques for data collection and analysis. Several core issues of characterization and analysis of experience are addressed based on the reconstruction of four brief experiences from our own professional practice. It is concluded that these practices recover the perspective of health and mental health care through the humanization of the bond and the inclusion of the affective dimension in mental health care practices. From very diverse institutional territories and through flexible and creative interventions, these practices have managed to maintain participatory processes, consolidate interdisciplinary approaches and strengthen community care networks in an exceptional and complex context.

RESUMEN El presente escrito se vincula a dos proyectos institucionales de investigación científica, en los que se ha propuesto indagar sobre prácticas de cuidado en salud mental durante la pandemia de Covid-19. El objetivo de este trabajo es describir y analizar prácticas de salud/salud mental centradas en el sostenimiento del vínculo en la atención y el fortalecimiento de redes productoras de cuidados en contexto de pandemia, desarrolladas en el Área Metropolitana de Buenos Aires, Argentina. Se trata de un estudio exploratorio y descriptivo que utiliza técnicas cualitativas para la recolección y análisis de datos. A partir de la reconstrucción de cuatro breves relatos vivenciales de nuestra propia práctica profesional, se abordan diversos núcleos temáticos de caracterización y análisis de la experiencia. Se concluye que estas prácticas recuperan la perspectiva de cuidados en salud/salud mental a través de la humanización del vínculo y la inclusión de la dimensión afectiva en la atención. Se trata de prácticas que, desde territo- rios institucionales muy diversos y por medio de dispositivos flexibles y creativos, han logrado sostener procesos participativos, afianzar abordajes interdisciplinarios y fortalecer las redes comunitarias de cuidados en un contexto de excepcionalidad y alta complejidad.

ABSTRACT This paper is related to two institutional scientific research projects, which research on mental health care practices during the Covid-19 pandemic. The aim of this paper is to describe and analyze health and mental health practices focused on maintaining the assistance bonds and strengthening of care-producing networks in the context of pandemic, developed in the Metropolitan Area of Buenos Aires, Argentina. This exploratory and descriptive study uses qualitative techniques for data collection and analysis. Several core issues of characterization and analysis of experience are addressed based on the reconstruction of four brief experiences from our own professional practice. It is concluded that these practices recover the perspective of health and mental health care through the humanization of the bond and the inclusion of the affective dimension in mental health care practices. From very diverse institutional territories and through flexible and creative interventions, these practices have managed to maintain participatory processes, consolidate interdisciplinary approaches and strengthen community care networks in an exceptional and complex context.

RESUMEN El presente escrito se vincula a dos proyectos institucionales de investigación científica, en los que se ha propuesto indagar sobre prácticas de cuidado en salud mental durante la pandemia de Covid-19. El objetivo de este trabajo es describir y analizar prácticas de salud/salud mental centradas en el sostenimiento del vínculo en la atención y el fortalecimiento de redes productoras de cuidados en contexto de pandemia, desarrolladas en el Área Metropolitana de Buenos Aires, Argentina. Se trata de un estudio exploratorio y descriptivo que utiliza técnicas cualitativas para la recolección y análisis de datos. A partir de la reconstrucción de cuatro breves relatos vivenciales de nuestra propia práctica profesional, se abordan diversos núcleos temáticos de caracterización y análisis de la experiencia. Se concluye que estas prácticas recuperan la perspectiva de cuidados en salud/salud mental a través de la humanización del vínculo y la inclusión de la dimensión afectiva en la atención. Se trata de prácticas que, desde territo- rios institucionales muy diversos y por medio de dispositivos flexibles y creativos, han logrado sostener procesos participativos, afianzar abordajes interdisciplinarios y fortalecer las redes comunitarias de cuidados en un contexto de excepcionalidad y alta complejidad.

Women have adopted various positions in childbirth over the centuries, changing either by personal preference, by indication from professionals attending the delivery or due to external factors such as use of medication or instrumented delivery. The position at birth may influence the duration of the expulsive period, pain intensity, neonatal outcome, perineal lesions or postpartum haemorrhage and has an effect on general well-being and female satisfaction. This review aims to analyze the benefits and risks associated with the positions most frequently chosen by women and specific advantages of different positions in each context of labor.

Abstract: This article analyzes the childhood diary that one of my interviewees, Mariana, wrote during her childhood in the Argentinian dictatorship after her father was abducted in 1977 and the family was exiled to Mexico. Mariana allows us into her universe and shares her feelings and emotions. Her words, in letters to her missing father, illustrate her everyday life and that of many other children experiencing similar situations of violence. My aim is to show that children are social actors, whose contribution is vital to constructing a history that includes them as active agents. I address the historical importance of listening to children’s voices, and the significance of their childhood writings.

Resumen: Este artículo está centrado en el análisis del diario de infancia que una de mis entrevistadas, Mariana, escribió durante su niñez en la dictatorial República Argentina a partir del secuestro de su padre, producido en 1977, situación que dio pie al exilio familiar en México. Mariana nos permite entrar en su universo, conocer sus sentimientos y emociones, y acercarnos -a través de sus palabras plasmadas en las cartas que le escribe a su padre desaparecido- a su vida cotidiana y a través de ella a la de muchos otros niños que vivieron situaciones de violencia similares. Mi propósito es enfatizar que los niños son actores sociales y su aporte es vital en la construcción de una historia que los incluya como agentes activos. Abordaré la importancia histórica de escuchar la voz de los niños y el significado de acceder a escritos elaborados por ellos mismos durante la infancia.

OBJECTIVES: to determine the immediate insertion rate of intrauterine devices (IUD) after induced abortions in 1 672 women seen in curettage service, as well as the negative causes to accept this contraceptive method. METHODS: a cross-sectional and descriptive study was conducted in Curettage services of Mariana Grajales Gynecology and Obstetrics University Hospital of Santa Clara province during January and June, 2008. RESULTS: a post-abortion IUD was used in 38,15% of the patients underwent pregnancy termination during study period whereas a 19,13% denies the use of post-abortion contraceptive method; main ages are related to group aged 20-35 coinciding with the women reproductive age, with a mean of 23,4 ± 2,3, as well as that in this period the t Misoprostol treatment was started in all adolescents, thus, the data are not constant each month; the main causes of IUD rejection are related to a lack of knowledge on effectiveness of this method, the lack of information, for fear to pain, and other symptoms associated with it and the rejection reference of IUDs. CONCLUSIONS: Post-abortion insertion must to be considered as a possibility for women whose contraceptive method be failed and must to underwent a abortion but that it is necessary the use of a long-term contraceptive method.

OBJETIVOS: determinar las tasas de inserción inmediata de dispositivos intrauterinos posabortos provocados en 1 672 mujeres que acuden al servicio de legrado, así como las causas de las negativas para aceptar este método anticonceptivo. MÉTODOS: se realizó un estudio descriptivo transversal en el Servicio de Legrados del Hospital Universitario Ginecoobstétrico «Mariana Grajales» de Santa Clara, en el período comprendido entre enero y junio de 2008. RESULTADOS: se aceptó utilizar un DIU posaborto en un 38,15 % del total de pacientes sometidas a interrupción de embarazo en el período de estudio, mientras un 19,13 % refiere que no va a utilizar ningún método anticonceptivo posaborto; las principales edades están en relación con el grupo de 20 a 35 años, coincidiendo con el grupo de edad reproductiva de la mujer, con una media de 23,4 + 2,3 además que en este período se comenzó a instaurar el tratamiento con misoprostrol en la totalidad de las adolescentes, por eso los datos no son constantes en cada mes; las principales causas de rechazo del DIU están en relación con el desconocimiento sobre la efectividad del método, la falta de información, el temor al dolor y otros síntomas asociados al mismo y la referencia de rechazo de los DIU. CONCLUSIONES: la inserción posaborto debe considerarse como una posibilidad para las mujeres cuyo método anticonceptivo haya fallado y deban someterse a un aborto pero que desean utilizar un método anticonceptivo a largo plazo.

OBJETIVO: comparar parto e seguimento de gravidez entre grávidas adolescentes e não-adolescentes que pariram num hospital terciário da região de Lisboa (Portugal). MÉTODOS: estudo retrospectivo com 10.656 partos. Foram avaliados: seguimento da gravidez, idade gestacional no parto, tipo de parto, necessidade de episiotomia e lacerações graves, índice de Apgar no quinto minuto e peso ao nascer. As grávidas foram divididas em dois grupos, acima e abaixo dos 20 anos. O grupo abaixo dos 20 anos foi depois subdividido entre grávidas com menos ou mais de 16 anos. Foi usado o teste do χ2 para análise estatística. RESULTADOS: as adolescentes tiveram pior seguimento: primeira consulta após as 12 semanas (46,4 versus 26,3%) e menos de quatro consultas (8,1 versus 3,1%), menos distocia (21,5 versus 35,1%), menos cesarianas (10,6 versus 20,7%) e menor necessidade de indução do trabalho de parto (16,5 versus 26,5%). Não houve diferença significativa para idade gestacional no parto e taxa de recém-nascidos de baixo peso. Entre adolescentes, as menores de 16 anos tiveram mais recém-nascidos de baixo peso (12 versus 7,4%) e mais partos entre 34 e 37 semanas (10,8 versus 4,2%). CONCLUSÕES: num hospital com serviço dedicado a grávidas adolescentes com apoio social e psicológico, apesar de pior seguimento pré-natal vigilância, o seu desempenho não foi pior. Uma atenção especial deve, no entanto, ser dada a grávidas abaixo dos 16 anos.

PURPOSE: to compare delivery and pregnancy follow-up among adolescent and non-adolescent pregnant women whose delivery occurred in a tertiary hospital from Região de Lisboa (Portugal). METHODS: retrospective study with 10,656 deliveries. Pregnancy follow-up, delivery type, need of episiotomy and severe lacerations, Apgar index at the fifth minute and the delivery weight have been evaluated. The pregnant women were divided into two groups, over and under 20 years old. The group with women under 20 was further subdivided in pregnant women under or over 16. The χ2 test has been used for statistical analysis. RESULTS: adolescents presented worse follow-up: first appointment after 12 weeks (46.4 versus 26.3%) and less than four appointments (8.1 versus 3.1%), less dystocia (21.5 versus 35.1%), less caesarian sections (10.6 versus 20.7%), and lower need for inducing labor (16.5 versus 26.5%). There was no significant difference concerning gestational age at delivery and ratio of low weight newborns. Among adolescents, the ones under 16 had more low weight newborns (12 versus 7.4%) and more deliveries between 34 and 37 weeks (10.8 versus 4.2%). CONCLUSIONS: in a hospital attending adolescents with social and psychological support, the fact of them having had a worse follow-up in the pre-natal phase, their performance has not been worse. Nevertheless, special attention might be given to pregnant women under 16.

El objetivo de este trabajo fue estudiar la prevalencia de anemia y de las deficiencias de hierro, ácido fólico y vitamina B12 en Betania del Topocho, población indígena de la etnia Piaroa, del Estado Amazonas, Venezuela, una zona con alta incidencia de malaria. Se estudiaron 184 sujetos de todas las edades que asistieron al Centro de salud para despistaje de malaria. Se realizó hematología completa por Coulter counter, la cuantificación de ferritina por ELISA con anticuerpos monoclonales, y la determinación de ácido fólico y vitamina B12 séricas por un ensayo inmunoradiométrico. La prevalencia de anemia fue de 89.6% y las deficiencias de hierro, ácido fólico y vitamina B12 afectaron 37.1, 70.3 y 12.4% de la población estudiada, respectivamente. La infección con Plasmodium fue detectada por diagnóstico molecular en el 53.2% de los casos, y 86% de ellos eran anémicos. La mayor incidencia de anemia fue encontrada en niños, con una prevalencia del 100% en lactantes de ambos sexos. La alta prevalencia de anemia y deficiencias de hierro y ácido fólico indican un problema de salud y de nutrición importante en esta comunidad que debe ser tratada de forma adecuada y urgente. Los casos de anemia debidos a deficiencia de hierro, podrían estar siendo subestimados, ya que la ferritina sérica es también una proteína de fase aguda que aumenta en caso de infección, aunque los datos de prevalencia fueron también analizados con un punto de corte de 30 μg/L para la concentración de ferritina.

The objective of this work was to determine the prevalence of anemia and deficiencies of iron, folic acid and vitamin B12 in Betania del Topocho, a Piaroa community from Estado Amazonas, Venezuela, a zone with a high incidence of malaria. The group studied included 184 subjects of all ages that assisted to the local health center for malaria diagnosis. Analysis performed included hematology by coulter counter, ferritin quantification by ELISA with monoclonal antibodies and folic acid and vitamin B12 determinations by an immunoradiometric assay. It was found that the prevalence of anemia was 89.6% and deficiencies of iron, folic acid and vitamin B12 affected 37.1, 70.3 and 12.4% of the population studied, respectively. Plasmodium infection was detected by molecular diagnosis in 53.2% of the cases, and 86% of them were anemic. The highest incidence of anemia was found in children, with a prevalence of 100% in infants of both sexes. The high prevalence of anemia, iron and folic acid deficiencies found, indicates an important health and nutrition problem that should be immediately and properly addressed. The number of cases of anemia due to iron deficiency could be underestimated, since ferritin concentration increased as a acute phase protein, although prevalence data was also analyzed with a cutoff point of 30 μg/L for ferritin concentration.