"Amor perdido": la elaboración del duelo en la neurosis histérica

En el presente trabajo se analiza un caso de neurosis histérica desde la teoría psicoanalítica, así mismo se enlaza con el tema del duelo en el noviazgo, por ruptura amorosa, esta condición hace resurgir el sufrimiento que se vivió en la infancia y que tienen que ver con pérdidas y abandonos de la figura paterna. La paciente acudió a terapia por espacio de casi dos años, al principio asistiendo dos veces por semana, para posteriormente acudir una vez y suspenderla por un tiempo indeterminado. La dificultad para aceptar la pérdida de la relación en el noviazgo hizo buscar el tratamiento, por parte de la paciente, sin embargo, aunado a esta situación se presentaba una conflictiva familiar severa, en forma caótica, lo cual repercutía en su estado de ánimo. El análisis de figura del padre formo parte importante del proceso. El abandono repetido del padre durante la infancia marco la vida de la paciente, de tal manera que se le describía como un padre que abandonaba, chantajeaba y era conflictivo, sufría de alcoholismo y huía para no enfrentar sus problemas, de este modo significaba una perdida. La relación en el noviazgo, fue conflictiva, marcada por la desconfianza, los celos y las separaciones. La paciente lo relaciona con la situación sufrida en la infancia. Una parte muy importante de este trabajo es la presentación del caso clínico, a través de sus de diferentes categorías se muestran momentos seleccionados del análisis, así como las intervenciones realizadas, con una orientación psicoanalítica que es la base para la explicación del trabajo analítico realizado con la paciente y sus respectivos avances.

Sensitization to indoor aeroallergens in children who attended the Allergy Service of the “Dr. José Eleuterio González” University Hospital of Monterrey, Mexico

Background: Indoor aeroallergens are the main cause of sensitization in children and represent a risk factor for the development of allergic diseases. Objective: Identify the major indoor aeroallergens most often sensitized to pediatric patients treated at the Allergy Service at the “Dr. José Eleuterio González” University Hospital of Monterrey Methods: We performed an observational and descriptive study where we reviewed reports of positive skin tests to the following common indoor aeroallergens: Dermatophagoides farinae (D. farinae), Dermatophagoides pteronyssinus (D. pteronyssinus), Canis familiaris (C. familiaris), Felis domesticus (F. domesticus), Blattella germanica (B. germanica) and Periplaneta americana (P. americana), found in patients under 16 years with symptoms of allergy, during the period of 2011-2012. Results: We performed 439 skin tests to aeroallergens in pediatric patients. Of these, 57.6% were male and 42.4% were female. Mean age was 6.3 years. The age groups were under 3 years: 17.8%, 3-5 years: 35%, 6-12 years: 36%, and 13-16 years: 11.2%. The main diagnoses were: allergic rhinitis (71.8%), asthma (16.6%), and atopic dermatitis (4.3%). In 57.9% of the cases, they had at least one positive skin test to any aeroallergen. The rate of sensitization to speciic aeroallergens was: D. Pteronyssinus 49.0%, D. farinae 44.6%, B. germanica 13.9%, P. Americana 10.9%, F. domesticus 10.7%, and C. familiaris 5.9%. Conclusion: Indoor aeroallergen sensitization can occur early in life, although it was more frequent in the preschooler and elementary school group. Dust house mites were the most commom cause of allergic sensitization.

Comparison of the eficacy and safety of 4 mg of ondansetron vs. 4 mg of nalbuphine for the treatment of neuraxial morphineinduced pruritus

Objective: To compare the eficacy and safety of 4 mg of ondansetron vs. 4 mg of nalbuphine for the treatment of neuraxial morphine-induced pruritus, in patients at the “Dr. José Eleuterio González” University Hospital from September 2012 to August 2013. Material and methods: A controlled, prospective, randomized study of 28 patients (14 per group) receiving neuraxial morphine analgesia was conducted, which was registered and approved by the ethics Committee of the Institution and patients agreed to participate in the study under informed consent. The results were segmented and contrasted (according to drug) by hypothesis testing; the association was determined by X2 with a 95% conidence interval (CI). Results: Pruritus was effectively resolved in both groups and no signiicant difference was found in the rest of the variables. An increase in the visual analogue scale (eVA) was observed at 6 and 12 hours for the ondansetron group, which was statistically signiicant (p≤0.05), however both groups had an eVA of less than 3. Conclusions: When comparing the eficacy and safety of ondansetron 4 mg vs. nalbuphine 4 mg for the treatment of neuraxial morphine induced pruritus, the only signiicant difference found was the mean eVA at 6 and 12 hours, favoring the ondansetron group. However, both groups scored less than 3 on the eVA. Therefore, we consider that both treatments are effective and safe in the treatment of pruritus caused by neuraxial morphine.