This article examines the dynamic relationship between defences and individuation in the analytic process. The concept of defence was introduced by Sigmund Freud in his 1894 paper, “The Neuro‐Psychoses of Defence”, to describe the use of defences by some patients to resist the progress of the analytic process. Defence mechanisms are unconscious processes utilized to protect the ego and the Self against perceived threats. Obviously, the term “defence” is itself borrowed from military operations. As Jung proposes, the psyche has an instinctive urge towards wholeness and integration which he refers to as the process of individuation. Because the function of defence mechanisms is to avoid change, i.e., maintain homeostasis, defence mechanisms constitute an anti‐individuation force within the psychic system. In analysis, there is an ever present “stealth war” between individuation and anti‐individuation processes within the psyche. However, there is often little attention given to the influence of defences in much of the Jungian literature and in many Jungian training programmes. As a result, many Jungian therapists, candidates, and analysts are poorly equipped to recognize and engage in the “stealth war” occurring between defence mechanisms that stand in opposition to the progress of analysis and the ultimate aim of Jungian psychoanalysis, i.e., individuation. This article concludes with an appeal to maintain adequate focus on requisite fundamental analytic processes amidst an expanding interest in broad collective concerns.
Background: Dengue fever is a viral infection transmitted through the bite of an infected Aedes mosquito, prevalent in urban and semi-urban areas within tropical and subtropical regions. Methods: This cross-sectional study was conducted by utilizing secondary data sourced from the governmental dashboard from January 2020 to December 2024 which consolidates and displays pre-analyzed information on reported dengue cases and fatalities throughout Bangladesh. Results: During 2020, minimal dengue-related data was recorded due to the COVID-19 pandemic, with 3 deaths among 1,405 reported cases. The subsequent years showed a rise in cases, with 28,429 and 62,382 reported in 2021 and 2022 respectively. There was fivefold (321,179 cases) increase in dengue cases in 2023, and setting a new record. In 2024, a total of 101,214 dengue cases were documented. Deaths attributed to dengue were 105 in 2021 and increased to 281 in 2022 which was followed by 1,705 deaths in 2023, making it the deadliest year thus far. However, fatalities declined to 575 in 2024. Males accounted for 63.1% of patients with predominant female fatalities (over 51%). The age group most affected in both 2023 and 2024 was 21-25 years. The highest number of deaths occurred in the 36-40 age group in 2023 (165 fatalities) while 56 deaths were noted in the 25-30 age group in 2024. In 2024, the Dhaka North City Corporation reported the highest incidence of dengue cases (21,254), while the Dhaka South City Corporation recorded the most fatalities (239). Conclusion: The risk of dengue becoming a major public health issue in Bangladesh is alarming due to the country’s dense population and favorable conditions for mosquito proliferation. Bangladesh Armed Forces Med J Vol 58 No (1) June 2025, pp 48-54
Abstract Introduction It is industry standard for a patient to maintain a single mattress throughout admission, which may be problematic with burn injuries. Significant burn injuries are high exudate wounds which provide challenging care, including frequent dressing changes and environmental contamination. As part of an infection prevention process improvement (PI) including routine air mattress (AM) exchanges throughout admission, the purpose of this study was to examine microbial contamination of mattresses before and after utilization. Methods This single center, retrospective study was conducted in an ABA-verified burn center. Routine AM exchanges began in November 8, 2020, including logging serial numbers of incoming/outgoing AM and periodic environmental cultures. Pre- and post-occupation AM environmental cultures (EC) (outside and inside the top cover and baffles) were compared with patient culture data. All patients were admitted to the Burn Center. Results During the 91 weeks, a total of 635 AM were exchanged. A total of 34 AM were cultured with 20 (59%) being post- and 14 being the pre-occupation. For the pre-occupation AM cultures, all 14 outer and inner surfaces cultured sterile. Regarding post-occupation AM, 80% had a positive EC of the outside surface, while 58% had positive environmental culture from inside the sealed AM. The median time of AM utilization prior to culturing was 6 (6, 7) days. All microbes isolated from post-occupation AM matched culture data from each patient’s hospital course. There were a total of 42 microbes isolated from environmental swabs taken from the outside cover with the most common: S.epidermidis 38%, S.aureus 14%, and P.aeruginosa 12%. A total of 40 microbes were isolated from inside the sealed AM with the most common: S.epidermidis 25%, Acinetobacter spp. 13%, Enterobacter spp. 10%, and Pseudomonas spp. 10%. There were 5 different EC taken from inside the sealed AM resulting in fungal growth. The 34 EC were taken from AM of 9 patients during the 91 week period. The median age was 48 (22, 66) years with 42 (21.25, 44) %TBSA burned. The median weight was 92 (76, 98) kg with body mass index of 27.47 (23.72, 37.11) kg/m2. Two of the 9 patients were below 20 % TBSA burned (9 and 19.5%) while the remaining 7 patients had greater that 20% TBSA burns. There was an inverse signals between size of burn and amount of wound closure and contamination. Conclusions AM are not impervious to the heavy exudate of patients with large burn injuries. Over time, the mattress becomes contaminated with microorganisms specific to the patient. This study justifies the infection prevention practice of routine mattress exchanges during admission for patients with large, open burn wounds. We do not send patients back from the operatory theater or hydrotherapy with reused dressing. Given these findings mattresses should be no different. Applicability of Research to Practice First study to analyze infectious mitigation potential of routine AM exchanges in burn patients.
