Frecuencia del síndrome de Burnout en residentes de Medicina Interna del Hospital de Clínicas

RESUMEN Introducción: el concepto de Síndrome de Burnout ha sido definido como un síndrome de agotamiento emocional, despersonalización y reducción de la satisfacción personal que puede ocurrir entre personal de sanitario. Objetivo: determinar la frecuencia de síndrome de Burnout y factores de riesgo asociados en residentes de Medicina Interna. Material y método: diseño observacional, descriptivo, prospectivo, de corte transversal, que incluyó residentes de Medicina Interna del Hospital de Clínicas (San Lorenzo, Paraguay) en el año 2019. Se aplicó el cuestionario Maslach Burnout Inventory. El cuestionario se aplicó en Google Drive y se envió a los residentes por mensajería instantánea. Resultados: se incluyeron en el estudio 50 residentes, la edad media fue 28,5±3,7 años, 52% fueron mujeres, 78% son solteros. Cumplían los criterios para Burnout 90% de los residentes, de los cuales 51% fueron varones. El sexo masculino, estado civil soltero, trabajo fuera de la residencia y sueño <6 horas diarias se relacionaron con el desarrollo del Síndrome de Burnout (OR <1) pero sin significancia estadística. Conclusión: la frecuencia del síndrome de Burnout en los residentes de Medicina Interna del Hospital de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción es muy alta. El sexo más afectado fue el masculino y la mayoría en solteros. Se encontró asociación con algunos factores de riesgo, pero sin alcanzar significancia estadística.

ABSTRACT Introduction: The concept of burnout syndrome has been defined as a syndrome of emotional exhaustion, depersonalization and reduction of personal satisfaction that can occur among healthcare personnel. Objective: To determine the frequency of burnout syndrome and associated risk factors in residents of Internal Medicine. Material and method: Observational, descriptive, prospective, cross-sectional design, which included residents of Internal Medicine of the Hospital de Clínicas (San Lorenzo, Paraguay) in 2019. The Maslach Burnout Inventory questionnaire was applied. The questionnaire was applied on Google Drive and sent to residents by instant messaging. Results: Fifty residents were included in the study, the mean age was 28.5±3.7 years, 52% was women and 78% was single. Ninety percent of the residents met the criteria for burnout, and 51% of them were male. Male sex, unmarried marital status, work outside the residence and sleep <6 hours a day were related to the development of burnout syndrome (OR <1) but without statistical significance. Conclusion: The frequency of burnout syndrome in residents of Internal Medicine of the Hospital of the Faculty of Medical Sciences of the National University of Asunción is very high. The most affected sex was male and the majority was single. Association was found with some risk factors, but without statistical significance.

Eficácia e segurança da oxigenoterapia com cânula nasal de alto fluxo na insuficiência respiratória hipercápnica moderada aguda / Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure

RESUMO Objetivo: Avaliar a eficácia e a segurança da oxigenoterapia com uso de cânula nasal de alto fluxo no tratamento da insuficiência respiratória hipercápnica moderada em pacientes que não conseguem tolerar ou têm contraindicações para ventilação mecânica não invasiva. Métodos: Estudo prospectivo observacional de 13 meses envolvendo participantes admitidos a uma unidade de terapia intensiva com insuficiência respiratória hipercápnica ou durante o processo de seu desenvolvimento. Os parâmetros clínicos e de troca gasosa foram registrados em intervalos regulares durante as primeiras 24 horas. Os parâmetros finais foram saturação de oxigênio entre 88 e 92%, juntamente da redução do esforço respiratório (frequência respiratória) e da normalização do pH (≥ 7,35). Os participantes foram considerados não responsivos em caso de necessidade de utilização de suporte ventilatório. Resultados: Trinta participantes foram tratados utilizando oxigenoterapia com cânula nasal de alto fluxo. Esta foi uma população mista com exacerbação de doença pulmonar obstrutiva crônica, edema pulmonar cardiogênico agudo, e insuficiência respiratória aguda pós-operatória e pós-extubação. Observou-se melhora não significante na frequência respiratória (28,0 ± 0,9 versus 24,3 ± 1,5; p = 0,22), que foi aparente nas primeiras 4 horas do tratamento. Ocorreu melhora do pH, embora só se tenham obtido níveis normais após 24 horas de tratamento com cânula nasal de alto fluxo (7,28 ± 0,02 versus 7,37 ± 0,01; p = 0,02). A proporção de não responsivos foi de 13,3% (quatro participantes), dos quais um necessitou e aceitou ventilação mecânica não invasiva, e três necessitaram de intubação. A mortalidade na unidade de terapia intensiva foi de 3,3% (um participante), e um paciente morreu após a alta para a enfermaria (mortalidade hospitalar de 6,6%). Conclusão: O oxigenoterapia com cânula nasal de alto fluxo é eficaz para a insuficiência respiratória hipercápnica moderada e ajuda a normalizar os parâmetros clínicos e de troca gasosa, com taxa aceitável de não responsivos que necessitaram de suporte ventilatório.

ABSTRACT Objective: To assess the efficacy and safety of high-flow nasal cannula oxygen therapy in treating moderate hypercapnic respiratory failure in patients who cannot tolerate or have contraindications to noninvasive mechanical ventilation. Methods: A prospective observational 13-month study involving subjects admitted to an intensive care unit with or developing moderate hypercapnic respiratory failure. Clinical and gas exchange parameters were recorded at regular intervals during the first 24 hours. The endpoints were a oxygen saturation between 88 and 92% along with a reduction in breathing effort (respiratory rate) and pH normalization (≥ 7.35). Subjects were considered nonresponders if they required ventilatory support. Results: Thirty subjects were treated with high-flow nasal cannula oxygen therapy. They consisted of a mixed population with chronic obstructive pulmonary disease exacerbation, acute cardiogenic pulmonary edema, and postoperative and postextubation respiratory failure. A nonsignificant improvement was observed in respiratory rate (28.0 ± 0.9 versus 24.3 ± 1.5, p = 0.22), which was apparent in the first four hours of treatment. The pH improved, although normal levels were only reached after 24 hours on high-flow nasal cannula therapy (7.28 ± 0.02 versus 7.37 ± 0.01, p = 0.02). The rate of nonresponders was 13.3% (4 subjects), of whom one needed and accepted noninvasive mechanical ventilation and three required intubation. Intensive care unit mortality was 3.3% (1 subject), and a patient died after discharge to the ward (hospital mortality of 6.6%). Conclusion: High-flow nasal cannula oxygen therapy is effective for moderate hypercapnic respiratory failure as it helps normalize clinical and gas exchange levels with an acceptable rate of nonresponders who require ventilatory support.

The consumption of antioxidants protects against cognitive and physical disabilities in aged with obesity.

INTRODUCTION: antioxidants play an important role in the antioxidant defense system. Obesity and the aging process increase oxidative stress. The disruption of the oxidant-antioxidant balance towards oxidant condition could be related to cognitive and physical disabilities. OBJECTIVE: to evaluate the consumption of antioxidants, the oxidative stress status and their relationship with cognitive and functional alterations in aged with obesity. METHOD: a cross-sectional study was conducted with 94 subjects ≥ 60 years stratified by body mass index (BMI) (76.6% were women). The antioxidants intake as well as cognitive and functional status were evaluated by validated surveys. The oxidative stress markers were thiobarbituric acid reactive substances (TBARS) and lipid-hydroperoxides (LOOH). RESULTS: the antioxidants consumption of the participants was below the recommended daily intakes (RDI) independently of the BMI group. Especially, a lower consumption of vitamins E and D, selenium and ß-carotenes was observed. The concentration of TBARS was higher (p < 0.05) in the obese (1.2 µM) versus the normal weight group (0.7 µM). The concentration of LOOH in the normal weight group (17 µM) did not show statistical difference versus obese group (15 µM). The presence of obesity in aged showed an association with walking difficulties. Multivariable analysis adjusted for several variables showed that the intake of selenium, copper and magnesium is associated with lower risk of cognitive and physical disabilities. CONCLUSIONS: aged with obesity showed a higher concentration of peripheral TBARS, walking difficulties and lower intake of antioxidants. The consumption of copper, selenium, and magnesium seems to protect against cognitive and physical disabilities in aged with obesity.

Funciones ejecutivas y antecedentes familiares de alcoholismo en adolescentes / Executive Functions and Parental History of Alcoholism in Adolescents / Funções executivas e antecedentes familiares de alcoolismo em adolescentes

Objetivo. Comparar las funciones ejecutivas y los antecedentes de alcoholismo familiar en adolescentes con y sin historia personal de abuso de alcohol. Método. Se realizó un estudio descriptivo-comparativo en el que se evaluaron cuatro grupos de participantes: (a) 15 abusadores de alcohol con historia familiar de alcoholismo, (b) 15 abusadores de alcohol sin historia familiar de alcoholismo, (c) 15 sin consumo de alcohol con historia familiar de alcoholismo y (d) 15 sin consumo de alcohol sin historia familiar de alcoholismo. Para evaluar las funciones ejecutivas de los participantes se emplearon el índice de memoria de trabajo del WISC-IV, el test de fluidez verbal fonológica, el Wisconsin Card Sorting Test, el Stroop, la tarea go/no-go y la tarea del burro hambriento. Resultados. Se encontró menor rendimiento en las pruebas en los adolescentes con antecedentes personales y familiares de abuso de alcohol, con diferencias estadísticamente significativas (p < 0.005) en memoria de trabajo, fluidez verbal, flexibilidad cognoscitiva y toma de decisiones. Conclusión. Los resultados confirman que el compromiso en las funciones ejecutivas junto con los antecedentes familiares de alcoholismo son factores de vulnerabilidad al abuso de alcohol en adolescentes.

Objective. The aim of this study was to compare executive functions and parental history of alcoholism among adolescents with and without a history of alcohol abuse. Method. This study was descriptive with four groups of participants: (a) 15 abusers with a family history of alcoholism, (b) 15 abusers without a family history of alcoholism, (c) 15 alcohol free participants with a family history of alcoholism, and (d) 15 participants who do not use alcohol and have no family history of alcohol abuse. The instruments used to evaluate the executive functions of participants were the Working Memory of WISC-IV, the Phonological fluency test, the Wisconsin Card Sorting Test, the Stroop test, a go no-go task and the Hungry Donkey Task. Results. Results show lower scores in adolescents with a personal and family history of alcohol abuse, with statistically significant differences (p < 0.005) in working memory, verbal fluency, cognitive flexibility and decision-making. Conclusion. Executive functions and a family history of alcoholism are factors of vulnerability to alcohol abuse in adolescents.

Escopo. Compara as funções executivas e os antecedentes de alcoolismo familiar em adolescentes com e sem história pessoal de abuso de álcool. Metodologia. Para isto, foi feito um estudo descritivo-comparativo no qual foram avaliados quatro grupos de participantes: a) 15 abusadores de álcool com história familiar de alcoolismo, b) 15 abusadores de álcool sem história familiar de alcoolismo, c) 15 sem consumo de álcool com história familiar de alcoolismo e d) 15 sem consumo de álcool sem história familiar de alcoolismo, Foram empregados o Índice de Memória de Trabalho do WISC-IV, o teste de fluidez verbal fonológica, o Wisconsin Card Sorting Test, o Stroop, a tarefa go no-go e a tarefa do Burro Faminto para avaliar as funções executivas dos participantes. Resultados. Foi achado um menor rendimento nas provas nos adolescentes com antecedentes pessoais e familiares de abuso de álcool, com diferencias estatisticamente significativas (p < 0.005) em memória de trabalho, fluidez verbal, flexibilidade cognoscitiva e toma de decisões. Conclusão. É concluído que o comportamento nas funções executivas junto com os antecedentes familiares são fatores de vulnerabilidade para o abuso de álcool em adolescentes.

Histiocytic Sarcoma with p16-Overexpression Presenting as Uterine Cervical Mass.

A 67-year-old woman presented with post-menopausal bleeding. Physical examination and imaging revealed a cervical mass with extensive pelvic involvement and supraclavicular lymphadenopathy. Clinical diagnosis was stage IVB cervical carcinoma. Cervical biopsy revealed high-grade squamous intraepithelial lesion and epithelioid tumor cells in the stroma. Lymph node biopsy revealed metastasis by similar epithelioid tumor cells. The epithelioid tumor cells were positive for p16, CD68, and CD163 on immunohistochemical study. The diagnosis of histiocytic sarcoma (HS) was rendered. This case demonstrated a rare presentation of HS mimicking cervical carcinoma. Awareness of this rare entity with appropriate ancillary tests is essential for accurate diagnosis. In contrast to the previous postulation of p16-inactivation as the pathogenesis of HS, p16-overexpression might suggest a different pathway for tumorigenesis.

Revisión sistemática de modelos neurobiológicos y ejecutivos en alcoholismo / Systematic review on neurobiological and executive models in alcoholism

Resumen Alteraciones estructurales y funcionales en alcoholismo son identificadas de manera usual, pero sin claridad respecto a la diferenciación de si estas son secuelas o son previas al mismo. El objetivo de la investigación fue realizar una revisión de las publicaciones de los años 2010 a 2015 respecto a la neurobiología y el funcionamiento ejecutivo desde los enfoques de secuelas y de vulnerabilidad, en PubMed, Dialnet, Elsevier y Google Scholar, con los descriptores en inglés y español secuelas o vulnerabilidad neurobiológica al alcoholismo y secuelas o vulnerabilidad en funciones ejecutivas en el alcoholismo. Se encontraron 59 artículos de los cuales 37 corresponden al modelo de secuelas y 22 al modelo de vulnerabilidad. Se evidencia incremento en los estudios que resaltan los factores de predisposición neurobiológica y neuropsicológica para el inicio de consumo de alcohol.

Abstract Structural and functional alterations are usually identified, but without clarity regarding the definition of whether they are prior to it. The objective was to review the publications of 2010 to 2015 regarding neurobiology and executive functioning from the sequel and vulnerability models, publishing in PubMed, Dialnet, Elsevier and Google Scholar, with Spanish and English descriptor: sequel or neurobiological vulnerability to alcoholism and sequelae or vulnerability in executive functions on alcoholism. We found 59 articles of which 37 correspond to sequel model and 22 to vulnerability model. It evidenced an increase in studies about neurobiological and neuropsychological predisposition for onset of alcohol consumption.

Efectividad de un programa de prevención en salud mental mediante el diálogo socrático y el pensamiento crítico / Effectiveness of a prevention program in mental health by socratic dialogue and critical thinking

Objetivo: El propósito de este estudio fue analizar el impacto del programa de prevención mediante el diálogo socrático y el pensamiento crítico, en la depresión y la ansiedad. Materiales y métodos: Participaron 110 universitarios que accedían al primer año de la carrera; se utilizó un diseño experimental aleatorizado con grupo experimental y control. La variable independiente fue el diálogo socrático y el pensamiento crítico, y las variables dependientes fueron la sintomatología depresiva y/o ansiosa y los pensamientos negativos, positivos y ansiosos. Como instrumentos se utilizaron la Escala de depresión del Centro de Estudios epidemiológicos (CES-D), el Cuestionario revisado de 90 síntomas (SCL-90R), el Cuestionario de Pensamientos Automáticos Revisado (ATQ-TP), y el Cuestionario de Automanifestaciones Ansiosas (ASSQ). Resultados: Al comparar los resultados entre los dos grupos, se observó que el programa resultó efectivo en la reducción de los pensamientos negativos para el grupo experimental, aunque no se identificaron otros efectos. Conclusiones: El dialogo socrático y el pensamiento crítico - en el marco de un programa de prevención, reducen los pensamientos negativos en los universitarios de primer año.

Objective: The purpose of this study was to analyze the impact of the prevention program by Socratic dialogue and critical thinking, on depression and anxiety. Method: Participants were 110 students who entered their freshman year; an experimental design with experimental and control group was used. Independent variable was Socratic dialogue and critical thinking, and dependent variables were depression and/or anxiety symptoms, and negative, positives and anxious thoughts. Applied instruments consisted on Center for Epidemiologic Studies Depression Scale (CES-D), Symptom Check List - 90 Revised (SCL-90R), Automatic Thoughts Questionnaire - Revised (ATQ-RP), and Anxious Self-Statements Scale (ASSQ). Results: By comparisons between the two groups, it was observed the effectiveness of the program in negative thought reduction, although no other effects were identified. Conclusions: Socratic dialogue and critical thinking - like a prevention program - can change negative thoughts in students at freshman year.

Unprotected carotid artery stenting in symptomatic elderly patients: a single-center experience.

BACKGROUND AND PURPOSE: Surgery is known to have fewer adverse events in patients aged >75 years with carotid stenosis, but some are not candidates due to comorbidity. Stenting using protection devices is the most accepted endovascular technique. Our aim is to show the safety and efficacy of carotid stenting without any protection device in these patients. MATERIAL AND METHODS: All patients older than 75 years with carotid stenosis treated in our center between January 2002 and December 2012 were included in this prospective study. All were treated by carotid stenting without protection devices. Angiographic results, neurologic complications and Doppler ultrasound were collected during the procedure and within 30 days. RESULTS: 49 patients were included (mean age 78.2 years, range 75-86). The average degree of stenosis was 88.2%. During the procedure there were two cases of transient ischemic attack and one intraparenchymal hemorrhage. At 30 days there was a non-disabling stroke. The combined rate of disabling stroke plus myocardial infarction plus death was 6% at 30 days and the rate of any stroke was 4% during the procedure and 2% at 30 days. CONCLUSIONS: Endovascular treatment of carotid stenosis without protection devices in symptomatic patients aged >75 years is an alternative to endovascular treatment with protection devices. Complications and mortality rates are similar to studies that used protection devices in lower risk patients.

Oxidized alginate hydrogels as niche environments for corneal epithelial cells.

Chemical and biochemical modification of hydrogels is one strategy to create physiological constructs that maintain cell function. The aim of this study was to apply oxidised alginate hydrogels as a basis for development of a biomimetic niche for limbal epithelial stem cells that may be applied to treating corneal dysfunction. The stem phenotype of bovine limbal epithelial cells (LEC) and the viability of corneal epithelial cells (CEC) were examined in oxidised alginate gels containing collagen IV over a 3-day culture period. Oxidation increased cell viability (P ≤ 0.05) and this improved further with addition of collagen IV (P ≤ 0.01). Oxidised gels presented larger internal pores (diameter: 0.2-0.8 µm) than unmodified gels (pore diameter: 0.05-0.1 µm) and were significantly less stiff (P ≤ 0.001), indicating that an increase in pore size and a decrease in stiffness contributed to improved cell viability. The diffusion of collagen IV from oxidised alginate gels was similar to that of unmodified gels suggesting that oxidation may not affect the retention of extracellular matrix proteins in alginate gels. These data demonstrate that oxidised alginate gels containing corneal extracellular matrix proteins can influence corneal epithelial cell function in a manner that may impact beneficially on corneal wound healing therapy.

[Unsual clinical signs of primary hyperparathroidism]. / Manifestaciones clínicas inusuales del hiperparatiroidismo primario.

BACKGROUND: A growing number of patients with primary hyperparathyroidism (PHPT) are diagnosed in the absence of symptoms following routine biochemical screening. However, in some countries, overt manifestations and osteitis fibrosa cystica (OFC) still dominate the clinical profile of PHPT patients. METHODS: We retrospectively studied clinical and biochemical manifestations of 47 consecutive patients with primary hyperparathyroidism who were treated with parathyroidectomy from October 1993 to June 2005. RESULTS: Mean age was of 51.3 years. Our sample included 40 women (85%) and 7 men (15%). Seventy eight percent of cases had radiological features of OFC, namely subperiosteal bone resorption, cortical cysts and osteopenia. Pathological fracture occurred in nine patients (19.1%). Fifteen (32%) patients had clinically evident bony deformities or brown tumors mostly located in the mandible and maxilla. CONCLUSIONS: Our results indicate that symptomatic osteitis fibrosa cystica and severe decrease of bone mineral density were the primary manifestations of primary hyperparathyroidism. Most patients were referred to an oncology hospital for treatment due to a suspected malignant neoplasm. A comprehensive clinical evaluation with biochemical markers, imaging studies and histological results is needed to establish a possible diagnosis of primary hyperparathyroidism.

Deep brain stimulation for pediatric movement disorders.

Deep brain stimulation (DBS) has been used for the treatment of tremor and dystonia in adults since 1997. With more than 50,000 treated adults, it has become part of the standard care for pharmacoresistant tremor, Parkinson disease, and dystonias. Dystonias are a heterogeneous group of disorders with intrinsic (genetic) and extrinsic etiologic factors. In children and adults, DBS has been used for the treatment of both primary and secondary dystonias. Pediatric use has been more limited, with only a few experienced centers worldwide. Awake surgery can be safely performed with a dedicated multidisciplinary team approach to help ensure appropriate lead placement. It is incumbent upon us, as physicians, to advise patients and payers on the appropriate use of this technology. Neuromodulation of other disorders, including epilepsy, Tourette syndrome, obsessive-compulsive disorder, and depression, by DBS is under active investigation. Pediatric DBS is still in its early stages; experience will help us refine the indications and techniques for applying this complex technology to our most vulnerable patients, which should lead to our common goal of improving quality of life for our patients and their families. We review the role of DBS and our experience with establishing a dedicated pediatric DBS program.

Manifestaciones clínicas inusuales del hiperparatiroidismo primario / Unsual clinical signs of primary hyperparathroidism

Introducción: Un creciente número de pacientes con hiperparatiroidismo primario son diagnosticados en la ausencia de síntomas, gracias a la determinación rutinaria de calcio sérico. Sin embargo, en algunos países las manifestaciones típicas continúan dominando la presentación del hiperparatiroidismo primario. Métodos: Estudiamos retrospectivamente las manifestaciones clínicas y bioquímicas de 47 pacientes consecutivos con hiperparatiroidismo primario, tratados con paratiroidectomía entre octubre de 1993 y junio de 2005. Resultados: La edad media fue de 51.3 años. Se incluyeron 40 mujeres (85%) y siete varones (15%). El 63% de los pacientes fue referido por la sospecha de neoplasia maligna. En 78% de los casos se identificaron lesiones radiológicas compatibles con osteítis fibrosa quística, resorción subperóstica, lesiones líticas múltiples, osteopenia y osteoporosis. La presencia de fractura en terreno patológico se observó en 19.1%. Quince pacientes (32%) tenían tumores pardos, con localización más frecuentemente en la mandíbula y la maxila. Conclusiones: En esta serie, la osteítis fibrosa quística sintomática y la severa disminución de la densidad mineral ósea fueron las manifestaciones dominantes del hiperparatiroidismo primario. En su mayoría, los pacientes fueron referidos a una unidad oncológica para su tratamiento debido a la sospecha de alguna neoplasia maligna. Una adecuada evaluación clínica, bioquímica, radiológica e histológica es necesaria para establecer el posible diagnóstico de hiperparatiroidismo.

BACKGROUND: A growing number of patients with primary hyperparathyroidism (PHPT) are diagnosed in the absence of symptoms following routine biochemical screening. However, in some countries, overt manifestations and osteitis fibrosa cystica (OFC) still dominate the clinical profile of PHPT patients. METHODS: We retrospectively studied clinical and biochemical manifestations of 47 consecutive patients with primary hyperparathyroidism who were treated with parathyroidectomy from October 1993 to June 2005. RESULTS: Mean age was of 51.3 years. Our sample included 40 women (85%) and 7 men (15%). Seventy eight percent of cases had radiological features of OFC, namely subperiosteal bone resorption, cortical cysts and osteopenia. Pathological fracture occurred in nine patients (19.1%). Fifteen (32%) patients had clinically evident bony deformities or brown tumors mostly located in the mandible and maxilla. CONCLUSIONS: Our results indicate that symptomatic osteitis fibrosa cystica and severe decrease of bone mineral density were the primary manifestations of primary hyperparathyroidism. Most patients were referred to an oncology hospital for treatment due to a suspected malignant neoplasm. A comprehensive clinical evaluation with biochemical markers, imaging studies and histological results is needed to establish a possible diagnosis of primary hyperparathyroidism.

Evolution of maxillofacial brown tumors after parathyroidectomy in primary hyperparathyroidism.

BACKGROUND: Brown tumor occasionally affects the facial bones. Clinically, these lesions can be mistaken for a neoplasm. Opinions are divided on the course of management of the bony lesions once parathyroidectomy has been carried out. METHODS: We treated 22 patients with primary hyperparathyroidism and osteitis fibrosa cystica and observed their clinical and biochemical recovery. RESULTS: Fifteen patients (68.2%) had brown tumors in mandible, and 7 (31.8%) in maxilla. After parathyroidectomy, 21 patients had normal total serum calcium values. All brown tumors presented a spontaneous progressive regression; in 18 cases, regression was total, with a mean time period of 10 months. Two patients had partial regression after nearly 2 years. Another 2 patients were lost to follow-up. CONCLUSIONS: After successful parathyroid surgery, the bony lesions tended to regress spontaneously, either partially or completely. However, if the lesion is disfiguring or symptomatic, surgical excision may be indicated.

[Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation]. / Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario / Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation

Objetivo: Con el fin de analizar el diagnóstico diferencial de las lesiones óseas con células gigantes en los huesos faciales, presentamos un caso con hiperparatiroidismo primario no diagnosticado previamente, que presentó múltiples tumores pardos maxilofaciales como primera manifestación clínica de la enfermedad. Caso clínico: Mujer de 70 años de edad con tumor en el arco anterior de la mandíbula de un año de evolución. Una biopsia confirmó la presencia de una lesión con células gigantes. Radiológicamente se corroboró la presencia de otras dos lesiones líticas en la región maxilofacial. Durante la evaluación bioquímica previa a la cirugía se consideró la posibilidad de hiperparatiroidismo. Por tomografía computarizada se localizó tumor de paratiroides en una posición atípica. La resección quirúrgica confirmó adenoma de paratiroides. La paciente cursó con hipocalcemia sintomática, siendo manejada con suplementos de calcio y calcitriol. Al cuarto mes de la cirugía, persistía con cifras normales de calcio sérico y el tumor mandibular se había reducido parcialmente. Conclusiones: La detección de una lesión ósea con células gigantes en la región maxilofacial es un elemento diagnóstico primordial puesto que varias entidades, entre ellas el tumor pardo del hiperparatiroidismo, pueden tener una imagen histológica similar. Sólo una evaluación clínica, radiológica y bioquímica sistemática puede permitir un diagnóstico definitivo. La presencia de múltiples tumores pardos maxilofaciales simultáneos en el hiperparatiroidismo primario es poco común, y en raras ocasiones puede ser el primer signo de la enfermedad.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

Propiedades psicométricas del inventario de situaciones y comportamientos agresivos y del inventario de motivos para la agresión / Psychometric properties of the situation and aggressive behavior inventory and the motives for aggression inventory

Se examinaron las propiedades psicométricas del Inventario de Situaciones y Comportamientos Agresivos (ISCA) y del Inventario de Motivos para la Agresión (IMA) en 373 estudiantes de Psicología y Medicina de la ciudad de Tunja en Colombia. En el ISCA, los comportamientos más frecuentes fueron la agresión verbal y las actitudes o gestos de ira; las correlaciones más altas se encontraron entre agresión física, verbal y amenazas; las situaciones mas frecuentes fueron los problemas en los estudios, las relaciones familiares, interpersonales, y la economía familiar o personal, no observándose correlaciones elevadas entre las situaciones, o entre las situaciones con las conductas. Se obtuvieron un Alfa de Cronbach de 0.87 para el total del inventario; de 0.81 para la subescala de comportamientos y de 0.79 para la de situaciones. En el IMA, los motivos más frecuentes fueron la ira, el malestar emocional, el tener que defenderse y el defender los valores; se obtuvo un Alfa de Cronbach de 0.91. En ambos cuestionarios se obtuvo una sola dimensión (validez de constructo) y una buena validez discriminante, con la subescala de Psicopatía del Cuestionario de Análisis Clínico de Krug (1987), y convergente, con el Cuestionario de Agresión de Buss y Perry (1992). Los coeficientes de homogeneidad resultaron adecuados y los ítems del IMA, especialmente el placer que produce agredir, conseguir tener lo que se quiere, que algo haya producido malestar y el valorar a las personas agresivas, fueron predictores de las conductas del ISCA.

Psychometric properties of the Situation and Aggressive Behavior Inventoryand the Motives for Aggression Inventory were examined in a sample of 373 students of Medicine and Psychology in the city of Tunja in Colombia. In the Situation and Aggressive Behavior Inventory, most common aggressivebehaviors were verbal aggression and attitudes or rage gestures, withphysical aggression, verbal aggression and threatening showing the highestcorrelations; most common situation were study problems, family and interpersonalrelations, and familiar or personal economy, no high correlations were found among situations or situations with behaviors. In the Motives for Aggression Inventory, most common motives were rage, emotional discomfort, self-defense and defending values. A Cronbach´s Alpha of 0.91 was obtained. Both of the questionnaires showed a single dimension(construct validity) and satisfactory divergent validity, with the Psychopathysubscale of the Clinical Analysis Questionnaire by Krug (1987), andconvergent validity, with the Aggression Questionnaire by Buss and Perry (1992). Homogeneity coefficients were appropriated. Motives in the IMA,specially the pleasure of being aggressive, getting what you want, something makes you feel bad, and valuing aggressive persons, were predictors of the behaviors in the ISCA.

Percepción de salud en guardas de seguridad que trabajan en turnos irregulares / Health Perception in safety guards who work under irregular shifts

Se observó la influencia del tipo de turno de trabajo y el tiempo de permanencia en el mismo, así como de variables socioeconómicas (edad, estado civil e ingresos), en el estado de salud de 67 guardas de seguridad, que trabajaban en turnos de 8, 12 y combinado de 8 y 12 horas, en el departamento de Boyacá (Colombia). Se utilizó la versión para Colombia del Cuestionario de Calidad de Vida relacionado con la Salud Short Form 36 (SF-36) y una encuesta de datos socioeconómicos. En las dimensiones del SF-36, el conjunto de los participantes obtuvo una medida de 89,6 en Función Física, 91,4 en Rol Físico, 89,6 en Rol Emocional, 30,3 en Dolor Corporal, 75,2 en Vitalidad, 80,4 en Función Social, 72,5 en Salud Mental y 72,1 en Salud General. Se realizó un análisis de conglomerados con las variables socioeconómicas, el tipo de turno y el tiempo de permanencia en el mismo, obteniéndose dos grupos de 42 (grupo 1) y 25 (grupo 2) sujetos; el grupo 1 tenía en promedio menores ingresos que el grupo 2, el estado civil predominante fue el de soltero, había participantes de los turnos de 8 horas y combinado, y llevaban trabajando en el turno un promedio de 2,5 años; en el grupo había aproximadamente igual número de solteros que de casados/unión libre, estaba compuesto únicamente por participantes del turno de 12 horas; y llevaban trabajando en el turno un promedio de 1,8 años. Mediante la prueba U de Mann-Withney se observó que solamente la dimensión de Rol Físico presentaba diferencias entre los grupos.

Osteosarcoma telangiectásico de fémur en un varón joven / Telangiectatic osteosarcoma of femur in the young man

El osteosarcoma telangiectásico es una lesión maligna rara que constituye aproximadamente un 2,5 por ciento de todos los osteosarcomas primarios. Ha sido asociado con un curso más agresivo que el osteosarcoma convencional en series clínicas grandes. Por su comportamiento clínico, aspectos radiológicos e histopatológico es muy semejante a otros tumores benignos como el quiste óseo aneurismático. Presentamos el caso de un paciente masculino de 24 años de edad sano, con dolor crónico en su rodilla izquierda como único síntoma. Fue diagnosticado con esta rara forma de osteosarcoma y amputado. Recibió un régimen de 6 meses de quimioterapia, despúes del cual le fueron encontradas metástasis pulmonares y en la pared torácica. Es importante reconocer esta variante de osteosarcoma y diferenciarla de lesiones benignas porque solamente la resercción, como tratamiento, conlleva un pronóstico reservado, mientras que si se adiciona quimioterapia, la expectativa de vida mejora. Además de esto, es importante recordar esta entidad en el diagnóstico diferencial del miembro doloroso en gente joven y sana.