Efectividad del tratamiento farmacológico de la agresividad en pacientes con trastorno límite de la personalidad. Revisión sistemática

Introducción: el Trastorno Límite de la Personalidad afecta del 2% al 6% de los adultos en Estados Unidos. Es una condición de alta relevancia dentro de las patologías psiquiátricas debido a características como impulsividad, inestabilidad en las relaciones interpersonales, disregulación en el estado de ánimo y comportamiento agresivo. Esto determina un impacto negativo en la funcionalidad del individuo siendo la agresividad contra sí mismo o contra otras personas uno de sus componentes claves. Métodos: Revisión sistemática de la literatura de artículos de bases de datos y búsqueda manual de revistas relacionadas que aportaran la mejor evidencia con el fin de encontrar estudios que evaluaran, con instrumentos objetivos, los tratamientos farmacológicos disponibles para el manejo de la agresividad en el TLP .Se evaluó calidad metodológica y los estudios se organizaron en tablas de evidencia. Resultados: La búsqueda arrojo 1081 artículos de los cuales se seleccionaron 52 como potenciales y cinco fueron incluidos en esta revisión. Se clasificaron como nivel de evidencia Ib. El topiramato, el aripiprazol, el divalproato y la fluoxetina mostraron mejores resultados que el placebo especialmente en agresividad e impulsividad. El topiramato fue asociado con pérdida de peso. Los medicamentos fueron seguros y bien tolerados. Discusión: Los medicamentos evaluados mostraron ser mejores que placebo. La diversidad en las escalas utilizadas genera complejidad en la interpretación de resultados. Conclusión: La evidencia sugiere que el tratamiento farmacológico es efectivo en síntomas como agresividad e impulsividad comparado con placebo. Deben considerarse estudios que evalúen combinaciones de fármacos y psicoterapia.

El desempeño de Unamsil en el programa DDR durante el proceso de paz en Sierra Leona. Estudio de caso: los niños soldados. 1998-2005

El interés de este Estudio de Caso es investigar la manera en que la Misión de Paz de la ONU en Sierra Leona (UNAMSIL) redireccionó el programa Desarme, Desmovilización y Reintegración (DDR) hacia los niños soldados durante el post-conflicto en el país. Se analiza cómo a través de la coordinación de diferentes Agencias y Organizaciones Internacionales con UNAMSIL, el Gobierno y la Sociedad Civil hace posible que se refuerce el rol de los Interim Care Centers (ICCs) en donde se enfrentaron las necesidades esenciales de los menores excombatientes para lograr un mejor proceso de su desmovilización y reintegración. Se explica de igual forma, las diferentes herramientas que sirven para llevar a cabo la resolución del conflicto y la reconstrucción de la paz, enfocándose en el peacekeeping, peacemaking y peacebuilding, como mecanismos que ayudaron a crear un espacio seguro para los niños exsoldados. Por último, se exponen los alcances y límites de los ICCs con respecto a la reintegración de los menores excombatientes

Análisis de la ayuda oficial al desarrollo. estudio de caso: programa conjunto de UNICEF y UNFPA sobre la mutilación genital femenina en Kenia (2008-2012)

El interés de este estudio de caso es analizar el Programa Conjunto de UNFPA y UNICEF sobre MGF/E en Kenia bajo la luz de los postulados poscolonialistas. Partiendo de la idea de que la MGF es una manifestación de las desigualdades de género, se argumenta que el PC reproduce la imagen de la mujer keniana como una víctima del poder masculino. A partir de esta imagen se deslegitima el orden cultural de los grupos que siguen esta tradición, afectando las lógicas de unidad y cohesión de la sociedad. El análisis de este tipo de dinámicas permite comprender mejor los procesos de intervención de las organizaciones internacionales sobre las estructuras sociales de actores frágiles del sistema internacional.

Ecologia demogràfica de la perca americana (Micropterus salmoides) a l'Estany de Banyoles

L'Estany de Banyoles, sistema peculiar tant des del punt de vista de la seva formació geològica com de les seves característiques limnològiques, conté actualment una comunitat de peixos profundament modificada respecte de la comunitat original. La perca americana (Micropterus salmoides), introduïda a finals dels anys seixanta del segle XX, és avui una de les espècies dominants en aquesta comunitat, i ocupa sobretot l'hàbitat litoral de l'Estany. Es tracta d'una espècie molt ben estudiada a Nord Amèrica des de diverses disciplines de la biologia i des de fa diverses dècades, cosa que ha comportat que actualment es disposi d'un gran volum d'informació sobre ella. Amb tot, fora del seu continent d'origen ha rebut poca atenció, malgrat l'amplia expansió que ha experimentat arreu del món. En aquesta tesi doctoral s'han abordat, amb un enfocament descriptiu, aspectes fins ara desconeguts per a l'espècie a l'Estany de Banyoles, a la península ibèrica i fins i tot a Europa. Concretament, se n'ha analitzat la condició, el creixement i la demografia, així com les seves variacions temporals. Amb aquesta finalitat, s'ha dissenyat un mostreig composat de deu campanyes de pesca intensives més alguns petits mostrejos addicionals intercalats, mostreig que s'ha allargat des del juliol del 1997 i fins el novembre del 1999. La captura dels exemplars s'ha realitzat mitjançant una tècnica de pesca elèctrica amb una embarcació posada a punt expressament per a aquest estudi, la qual s'ha mostrat considerablement eficient malgrat les dificultats que ofereix el medi. S'ha realitzat un mostreig de marcatge-recaptura basat en la mutilació d'aletes i, en alguns casos, en el marcatge amb pintura acrílica. Només en la darrera campanya (novembre del 1999) s'ha sacrificat una part important de les captures a fi de retirar-ne els otòlits per a la determinació de l'edat. Pel que fa a l'anàlisi de les dades, s'ha aplicat un ampli ventall de mètodes i models per a cada un dels aspectes estudiats, a fi de contrastar-ne els resultats i validar-ne la seva fiabilitat. En el cas de la condició, s'han aplicat mètodes d'anàlisi de la covariància (ANCOVA) i altres mètodes anàlegs, així com, paral·lelament, regressions i anàlisis derivades a partir de la relació longitud-pes. En l'estudi del creixement, s'han realitzat ajustaments de diversos models mitjançant regressions sobre dades de mida a l'edat i sobre dades d'increments de mida observats per interval de temps. També s'han aplicat anàlisis de freqüències de longitud, i, finalment, s'han aplicat mètodes de retrocàlcul a partir dels increments anuals del radi observats en els otòlits. Finalment, en el cas de l'estudi de la demografia, s'han aplicat models de marcatge-recaptura per a l'estimació de la grandària poblacional i de la supervivència, i, a més, s'han ajustat diversos models continus de supervivència sobre aquestes estimacions prèvies. També s'han estimat les capturabilitats associades a la nova tècnica de captura. Per una altra banda, s'ha implementat i realitzat un mostreig sobre la població de pescadors esportius de l'Estany encarat a determinar, bàsicament, la pressió de pesca a què es veu sotmesa l'espècie. Els resultats mostren sobretot una alta estabilitat interanual en tots els aspectes estudiats, que s'explica per l'estabilitat ambiental que, al seu torn, és característica d'aquest ecosistema lacustre. Això reverteix en una longevitat màxima observada que iguala la màxima descrita a la literatura per a l'espècie. Alhora, també s'han descrit fortes oscil·lacions estacionals tant en la condició, com en el creixement, com també en la supervivència, les quals, però, presenten certes diferències en la seva temporalitat, cosa que indica una certa diferenciació en els factors que les regulen.

Demetrio Aguilera-Malta: Los que se van: inicios y retornos (Dossier: Cuatro narradores del 30, relecturas en su centenario)

La autora revisa los relatos de Aguilera-Malta incluidos en Los que se van. Ellos anticipan los contenidos y rasgos de su narrativa posterior, constituyendo un verdadero «octamerón de las pasiones» humanas. Sentimientos existenciales complejos animan a los personajes: una amistad llevada a sus límites, el autoengaño en relación al objeto amoroso, la autoexpiación de una vieja culpa, un «Don Juan» de las islas, que súbitamente, al encontrar el amor por primera vez, castiga al mal que lo posee mediante la autocastración y la muerte (el mal como algo intrínseco y extrínseco, a la vez). Una estructura compleja, intensidad en la forma, economía de recursos, claro sentido de fabulación: todos estos elementos, presentes en su narrativa posterior, se evidenciaban ya, con precoz maestría, en los cuentos incluidos en Los que se van.

Women's work choices in Kenya: the role of social institutions and household gender attitudes

This study considers the factors that influence women’s work behavior in Kenya. In particular, it examines whether gender attitudes and certain types of social institutions influence the probability of employment or type of employment for women. Using data from the Demographic and Health Survey of 2008–9, we find that religion and ethnicity are significant determinants of women’s employment in Kenya. While personal experience of female genital mutilation is insignificant, spousal age and education differences, as well as marital status (which reflect attitudes both in women’s natal and marital families), are significant determinants of women’s employment choices.

Kvinnlig Könsstympning : Litteraturstudie om praktisk handläggning och komplikationsrisker vid förlossning

Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated

Sexual blinging of women : Alice Walker's african character tashi and issue of female genital cutting

This thesis provides a reading of the different forms of representation that can be attributed to the character Tashi, the protagonist of the novel Possessing the Secret of Joy (1992), written by the African American writer Alice Walker. Before this work Tashi had already appeared in two previous novels by Walker, first, in The Color Purple (1982) and then, as a mention, in The Temple of My Familiar (1989). With Tashi, the author introduces the issue of female circumcision, a ritual Tashi submits herself to at the beginning of her adult life. The focus of observation lies in the ways in which the author’s anger is transformed into a means of creative representation. Walker uses her novel Possessing the Secret of Joy openly as a political instrument so that the expression “female mutilation” (term used by the author) receives ample attention from the media and critics in general. The aim of this investigation is to evaluate to what extent Walker’s social engagement contributes to the development of her work and to what extent it undermines it. For the analysis of the different issues related to “female genital cutting”, the term I use in this thesis, the works of feminist critics and writers such as Ellen Gruenbaum, Lightfoot-Klein, Nancy Hartsock, Linda Nicholson, Efrat Tseëlon and the Egyptian writer and doctor Nawal El Saadawi will be consulted. I hope that this thesis can contribute as an observation about Alice Walker’s use of her social engagement in the creation of her fictional world.

Biology of Grapsus grapsus (LINNAEUS, 1758) (Brachyura, Grapsidae) in the Saint Peter and Saint Paul Archipelago, Equatorial Atlantic Ocean

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Relative abundance and population biology of the non-indigenous crab Charybdis hellerii (Crustacea: Brachyura: Portunidae) in a southwestern Atlantic estuary-bay complex

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Pitiose cutânea equina de localização atípica tratada topicamente com solução de anfotericina B e DMSO

Background: Cutaneous lesions by Pythium insidiosum infection are commonly observed in horses, especially in those living at flooded environments. Equine pythiosis is characterized by the development of tumoral masses that are frequently located at distal limbs, ventral abdomen, thorax, breast and face. The lesions are usually granulomatous, serosanguineous and ulcerated, most often destroyed by self-mutilation due to the intense pruritus. The proposed treatment includes surgical excision followed by antifungal drugs administration, which can be done systemically or topically. Amphotericin B and dimethyl sulfoxide (DMSO) in association has been successfully used for cutaneous pythiosis topical treatment due to the DMSO property to carry any substance through plasmatic membranes.Case: The present report concerns a 12-year-old mixed breed gelding presenting with self-mutilation of a tumoral mass located at the left flank. The owners reported that the horse had initially presented a small wound that had evolved to a 20-cm in diameter mass in 4 weeks. Tissue samples were collected, processed and stained by the Gomori's methenamine silver (GMS) method. The histopathological analysis revealed Pythium insidiosum hyphae in a granulomatous tissue, especially located at peripheral region, where kunkers were present. Surgical excision of the mass followed by cauterization was indicated as initial treatment, and due to financial reasons, the owners elected only the topical antifungal therapy to control the fungus infection after surgery. Flunixin meglumine was also administrated for five days aiming the control of pain and inflammation. The wound was cleaned with povidone-iodine solution and rinsed with a solution containing, 50 mg, of amphotericin B in 10 mL of sterile water and 10 mL of DMSO. This procedure was carried Out twice a day. The wound healed fast due to an excellent centripetal epithelialization. and the horse was discharged after 64 days showing only 5% of the initial wound area. The owner reported by telephone the complete healing and hair growth 10 days after discharge.Discussion: Despite the atypical location of the tumoral lesion described at the present report, the history and clinical manifestations, especially the intense pruritus, showed similarity with other characteristic reports of equine cutaneous pythiosis. The diagnosis was confirmed by the histopathological examination showing hyphae structures, as described to be evidences of the presence of Pythium insidiosum in the tissue. The surgical procedure was the first step to provide remission of clinical signs, and one day after surgery the pruritus desapeared. After excision of the granulomatous tissue and cauterization, daily topical administration of amphotericin B associated with DMSO was effective in destroying the infectious agent, as observed by the excellent epithelization. A pink granulation tissue grew up providing an ideal surface for epithelial migration and the healing process progressed quickly. Centripetal epithelialization reduced the wound area until 3% of the initial area in 64 days of treatment, when the remaining wound was found almost completely healed and covered with hair. At the present report, the horse presenting pythiosis was only topically treated. The recommended therapy using amphotericin B and DMSO solution was effective, economically viable and low risk, considering that the systemic antifungal therapy usually suggested is expensive and extremely nephrotoxic. The atypical location of the lesion on the left flank shows that any anatomical region can be affected by the fungus, since the conditions for its development were present.

Neurocisticercose e síndrome de lennox-gastaut: relato de caso

Relata-se o caso de uma menina que, aos 2 anos de idade, apresentou a forma epiléptica, hidrocefálica e encefalítica da neurocisticercose, diagnosticada por exame do líquido cefalorraqueano e tomografia computadorizada de crânio, evolução com crises polimórficas, episódios de descompensação da hipertensão intracraniana por obstrução do sistema de derivação ventriculoperitoneal, retardo no desenvolvimento neuropsicomotor e cegueira até que, aos 10 anos de idade, foi diagnosticada síndrome de Lennox-Gastaut. Atualmente, a paciente tem 16 anos, apresenta sequelas neurológicas e crises parciais complexas com automatismos, parcialmente controladas com o uso de clobazan e oxcarbazepina. A primeira associação de neurocisticercose e síndrome de Lennox-Gastaut foi descrita em 1973, por Frochtengarten & Scarante, em uma menina com quadro clínico semelhante ao do caso relatado.

Loss of vision secondary to obsessive-compulsive disorder: a case report

Objective: To report a rare case of self-inflicted eye injury secondary to obsessive-compulsive disorder (OCD).Method: Case report.Results: A 41 year-old patient had significant bilateral visual loss and blunt trauma through touching his ocular cavities due to recurrent doubts regarding their shape and urges to check the format of bones and cartilages. Differential diagnosis with tic disorders is discussed, and the patient's treatment approach is described.Conclusion: Although rare, severe clinical complications can occur in OCD. (C) 2009 Elsevier B.V. All rights reserved.

The use of bone scintigraphy to detect active Hansen's disease in mutilated patients

Mutilation of extremities was very frequent in patients affected by leprosy in the past; although it is now much less common, it is still seen, mainly in patients with long-term disease. In general, mutilation of the nose and ears is caused by the bacillus and mutilation of the hands and feet a consequence of chronic trauma. Leprosy must be chronically treated and any decision to interrupt therapy is based on laboratory tests and biopsy. Scintigraphy is a non-invasive procedure which could be of great value in to determining disease activity. We studied eight patients (five males and three females, aged 64-73 years) who presented with mutilation of the nose (2), ear (1), feet (3) or foot and hand (2), Conventional three-phase bone scintigraphy (750 MBq) and X-ray examinations of the affected areas were performed in all patients. Bone scintigraphy was abnormal in four patients (the presence of bacilli was confirmed by biopsy in two of them), and normal in the other four. In all patients except for the one with ear mutilation, radiography only showed the absence of bone. We conclude that bone scintigraphy is very useful to determine disease activity in cases of mutilation caused by leprosy. It seems to be superior to conventional radiography and may enable bone biopsies to be avoided.

Perda dentária em uma população rural e as metas estabelecidas pela Organização Mundial de Saúde

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)