Síndrome de Rapunzel: atadura sicológica y simulación orgánica / Rapunzel syndrome: psychological bondage and organic simulation

Introducción. El síndrome de Rapunzel es una entidad infrecuente, que se presenta como un tricobezoar a causa de una aglomeración de cabello acumulado dentro del tracto gastrointestinal, por lo que simula otras patologías quirúrgicas. Caso clínico. Paciente femenina de 10 años de edad, con tricotilomanía y tricofagia, dolor abdominal y síntomas inespecíficos de obstrucción intestinal de ocho meses de evolución. Al examen físico se encontró abdomen con distensión y masa palpable en epigastrio y mesogastrio. La ecografía permitió hacer el diagnóstico de tricobezoar gástrico extendido hasta el intestino delgado, por lo que se llevó a cirugía para gastrotomía y se extrajo el tricobezoar, con evolución satisfactoria de la paciente. El abordaje integral permitió conocer la atadura sicológica por posible maltrato infantil. Resultado. La paciente tuvo una evolución satisfactoria y se dio egreso al quinto día de hospitalización. Actualmente se encuentra en seguimiento por sicología, siquiatría infantil y pediatría. Discusión. El caso clínico denota la importancia en reconocer situaciones de presentación infrecuente en pediatría, que puedan estar asociadas a alteraciones sicológicas o presunción de maltrato infantil y que se presenten como una condición orgánica recurrente que simule otras patologías abdominales frecuentes en la infancia. El retraso diagnóstico puede conducir a un desenlace no deseado con complicaciones. Conclusión. Se hace mandatorio el manejo integral del paciente pediátrico y aumentar la sensibilidad para reconocer situaciones de presunción de maltrato infantil, sobre todo en pacientes con una condición orgánica quirúrgica recurrente.

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions.

Validación de la Escala de Prácticas Espirituales con víctimas de violencia política en Chile / Validation of the Spiritual Practices Scale with victims of political violence in Chile

Resumen En este artículo se presenta la validación de una versión abreviada de la Escala de Prácticas Espirituales de Parsian y Dunning (2009). Para ello, se utilizó una muestra de personas adultas (n = 251, M = 60.85, DT = 13.40) víctimas de violencia política en Chile durante la dictadura cívico militar (1973-1990). Para valorar la estructura de la escala se realizó un Análisis Factorial Confirmatorio (AFC), se calculó el índice de fiabilidad (α = .85) y se valoró la validez convergente con una serie de correlaciones bivariadas entre variables. De acuerdo a lo esperado, el AFC informa un adecuado ajuste a la estructura unifactorial y los resultados dan cuenta de la relación significativa entre las prácticas espirituales y el crecimiento postraumático y entre las prácticas espirituales y la religiosidad. La relación entre estas dos últimas es media-baja (r = .29), lo cual permite concluir que, aunque relacionadas, son constructos diferentes. A partir del análisis de los datos, no se puede concluir que exista relación entre las prácticas espirituales con la edad y el nivel de ingresos. En conclusión, la versión abreviada de la Escala de Prácticas Espirituales presenta adecuados niveles de fiabilidad y validez, por lo que resulta recomendable para ser utilizada en la medición de prácticas espirituales, especialmente en aquellas poblaciones que no se adscriben a una fe teísta.

Abstract Spirituality, or what motivates the search for the sacred from particular and free positions, allows us to provide a framework from which to interpret the experience of loss and suffering, contributing in different ways to the resignification and re-authorship of people after the trauma. It is related to resilience, with that ability to overcome adverse events. It favors the mitigation of the negative effects of the traumatic event and fosters healthy and successful psychological development -despite the suffering caused by an external situation- by promoting the construction and redefinition of people's life purpose -one of the central components of human well-being-, being especially relevant in those who have been victims of trauma. Thus, spirituality can contribute to the reconfiguration of the narrative about the survived experience from practices that promote spiritual emotion such as the actions of meditating or praying, the latter considered as one of the mechanisms of self-revelation that is fundamental within the post traumatic growth process. Spirituality and religion maintain a complex interrelation that at times makes difficult the distinction between them. However, this distinction is especially sensitive and necessary when it comes to accounting for spirituality in people who do not profess a theistic faith. This is the case of a significant part of people with left-wing ideologies -who suffered some type of violence during the military dictatorships implanted from the second half of the 20th century in Latin America. Particularly in Chile, the civic-military dictatorship (1973-1990) was especially cruel with people of left-wing ideologies, many of them not ascribed to a belief of a theistic order. In this context, it is relevant to account for spiritual practices -differentiating them from religious beliefs- in relation to post-traumatic growth in people victims of political violence. For this objective we have proposed in this article the validation of the short version of the Parsian and Dunning (2009) Spiritual Practice Scale. For this purpose, we utilized a sample of adult people victims of political violence in Chile during the military dictatorship between 1973 and 1990 (n = 251, M = 60.85, DT = 13.40). To assess the structure of the scale, we estimated a confirmatory factor analysis (CFA). The reliability index was calculated (α = .85) and the convergent validity was assessed with a series of bivariate correlations between variables. As expected, the CFA reports an adequate adjustment to the unifactorial structure and the results show the significant relationship between spiritual practices and post-traumatic growth (r = .45), and between spiritual practices with religiosity (r = .29). Being the relationship between spiritual practices and religiosity medium-low, it allows us to conclude that although they are related, they are different constructs. From the analysis of the data, it cannot be concluded that there is a relationship between spiritual practices with age and income level. In conclusion, the short version of the Spiritual Practices Scale presents adequate levels of reliability and validity, so it is recommended to be used in the measurement of spiritual practices, especially in those populations that do not adhere to a theistic faith.

Indicadores de salud y bienestar social en población inmigrante y chilena: un estudio comparativo / Health and social well-being in immigrants and Chileans: a comparative study

Resumen En el presente estudio se comparan los niveles medios de salud y bienestar social de adultos nacidos en Chile (n = 155) e inmigrantes de nacionalidad colombiana (n = 166), peruana (n = 154) y venezolana (n = 180). Los resultados están en línea con la "hipótesis selectiva de la inmigración", pues se encontraron mayores niveles de salud (M inmigrantes = 40.35; Mchilenos = 38.93; t[203.579] = 2.745,p < .01) y bienestar social en inmigrantes (M = 88.62) que en chilenos (M = 85.42; t(190.778) = -3.197, p < .01). En general, en este trabajo se muestra el efecto negativo que tiene la percepción de discriminación sobre la salud, y el efecto positivo de las variables socioculturales de identidad endogrupal, enriquecimiento cultural y cercanía intergrupal sobre el bienestar social en personas inmigrantes.

Abstract This study compares the average health and social welfare levels of adults born in Chile (n = 155) and immigrants of Colombian (n = 166), Peruvian (n = 154), and Venezuelan (n = 180) nationality. The results are in line with the "selective hypothesis of immigration," since higher levels of health (Minmigrants = 40.35; Mchilenos = 38.93; t [203,579] = 2,745, p < .01) and social welfare were found in immigrants (M = 88.62) than in Chileans (M = 85.42; t (190,778) = -3,197, p < .01). In general, this work shows the negative effect that the perception of discrimination has on health, and the positive effect of the socio-cultural variables of endo-group identity, cultural enrichment, and inter-group closeness on the social welfare of immigrants.

Salud mental en población transgénero y género no conforme en Chile

Background: Transgender population is at a higher risk of suffering mental health problems than cisgender population (people whose sex and gender identity are in agreement) and other sexual minorities (gays, lesbians, and bisexuals), partly due to the greater stress that they suffer or for being victims of sexual prejudice. Aim: To describe positive and negative mental health indicators in a sample of transgender people living in Chile. Material and Methods: An intentional sample of 377 transgender individuals older than 18 years, living in the country's northern, center and southern zones were studied. Sociodemographic and well-being features, negative emotional symptoms, suicidal behavior, and substance consumption were assessed. Results: A precarious mental health was confirmed among participants. A high frequency of depression, ideation and suicide attempts, and high levels of depression, anxiety, and stress symptoms were identified. Also, a high frequency of substance abuse was found. These mental health indicators varied according to the sex assigned at birth and gender self-identification. Conclusions: Transgender people experience precariousness and vulnerability in their mental health.

Development of a dispersive liquid-liquid microextraction coupled with magnetic dispersive microsolid phase extraction for determination of triazines in wastewater samples.

The combination of two microextraction techniques (dispersive liquid-liquid microextraction [DLLME] and magnetic dispersive microsolid phase extraction [MDMSPE]) was developed and reported for atrazine and simazine preconcentration from wastewater samples. The proposal methodology involved the use of magnetite supports functionalized with different alkyl or phenyl groups. The magnetic adsorbents were synthesized by the solvothermal method assisted by microwave, characterized, and used in the sample preconcentration of atrazine and simazine. The method validation included parameters such as the wastewater matrix effect, repeatability, and recovery. The analyte separation and quantification were performed by high-performance liquid chromatography with ultraviolet detection (HPLC-DAD). Parameters, such as the polarity and mass of magnetic solids and pH, were evaluated to provide better extraction performance. The highest recoveries (> 95%) were obtained with 50 mg of the phenyl group support (CS2) at pH 5, using 5 mL of the sample and carbon tetrachloride and methanol, as extraction and dispersive solvents, respectively. The lowest limits of detection (LOD) achieved were 13.16 and 13.86 ng L-1, and the limits of quantification (LOQ) were 43.89 and 46.19 ng L-1 for simazine and atrazine, respectively, with repeatability (expressed as %RSD) below 5% in all cases. The developed method is simple, easy, and low cost for the analysis of two herbicides potentially dangerous for environmental and human health. Graphical abstract.

Efectos de un programa recreativo-pedagógico en las capacidades coordinativas en escolares / Effects of a recreational-pedagogical program on coordinating capacities in school children

RESUMEN Los bajos niveles de coordinación diagnosticados en los niños pueden afectar su desarrollo motriz posterior y su rendimiento académico, por lo tanto, se justifica formular y evaluar programas de intervención, que mejoren sus capacidades coordinativas. El objetivo de este estudio fue determinar el efecto de un programa recreativo pedagógico sobre las capacidades coordinativas, de 64 estudiantes, tanto de género masculino como femenino, con edades entre los 6 y 7 años, en una Institución educativa colombiana. En la investigación efectuada, se utilizó una metodología de corte cuantitativo, con un diseño cuasi experimental-descriptivo; la información, se recolectó mediante el test de Capón, usado antes y después de aplicar el programa recreativo-pedagógico diseñado. El procesamiento de los datos, se efectuó con el software libre R. Los resultados permitieron establecer que, en promedio, las diferencias entre las puntuaciones acumuladas entre el pre-test y el pos-test en el grupo experimental, sí son significativas y atribuibles al mencionado programa. En conclusión, tal programa sí produce efectos positivos en las capacidades coordinativas de los participantes en el estudio.

ABSTRACT The low levels of coordination diagnosed in children can affect their subsequent motor development and their academic performance; therefore, it is justified to formulate and evaluate intervention programs that improve their coordinative capacities. The objective of this study was to determine the effect of a pedagogical recreational program on the coordinative abilities of 64 male and female students aged between 6 and 7 years in a Colombian educational institution. In the research carried out, a quantitative cut-off methodology with a quasi-experimental-descriptive design was used; the information was collected by means of the Capón test, used before and after applying the designed recreational-pedagogical program. The processing of the data was done with free software R. The results allowed to establish that, on average, the differences between the scores accumulated between the pre-test and the post-test in the experimental group are significant and attributable to the aforementioned program. In conclusion, such a program does have positive effects on the coordinative abilities of the study participants.

Medidas de salud mental y bienestar subjetivo en una muestra de hombres gays y mujeres lesbianas en Chile / Health and wellbeing of sexual minorities

Background: Most of the information in Chile about health and wellbeing of sexual minorities refers to risk behaviors. Aim: To assess health and wellbeing in a sample of Chilean homosexual men and women. Material and Methods: Spanish versions of the Satisfaction With Life Scale and Outcome Questionnaire-45 (OQ-45) were answered by 191 homosexual women and 256 homosexual men aged 18 to 67 years, from four Chilean cities. Results: Lesbian women have better levels of satisfaction with life and adjustment in personal relationships than homosexual men. Eight percent of respondents had suicidal thoughts in some moment of their life. Conclusions: The information gathered in this work could help in the development of mental health policies for sexual minorities.

Relation between HIV status, risky sexual behavior, and mental health in an MSM sample from three Chilean cities / Relación entre el estado de seropositividad al VIH, el comportamiento sexual arriesgado y la salud mental en una muestra de HSH de tres ciudades chilenas

ABSTRACT Objective To explore the association among HIV status; negative psychological symptoms (anxiety, depression, and hostility); and risky sexual behaviors (multiple sexual partners and unprotected sexual intercourse) in a Chilean sample of men who have sex with men (MSM). Methods This study had a cross-sectional design and a sample of 325 MSM whose ages ranged from 18 to 64 years (mean: 30.8; standard deviation: 9.8). Association tests (chi-squared) and group mean comparisons (Student’s t-tests and F-tests) were performed. Results No statistically significant differences were found for condom use or for the number of sexual partners between HIV-positive men and those who are not infected. In both groups, about 50% reported sexual encounters without condom use in the past six months. There were statistically significant differences in symptoms associated with depression between the two groups. Conclusions These results reveal the need to strengthen messages about the importance of condom use, as the only way to prevent HIV, and as a means of preventing HIV infection and reinfection, in national prevention and self-care programs for sexually active subjects. More studies are needed in Latin America to advance HIV prevention efforts for the MSM population. The data generated by this study can be used to inform the development of HIV prevention programming strategies and interventions targeting the MSM population in Latin America.

RESUMEN Objetivo Explorar la relación entre el estado con respecto a la infección por el VIH, los síntomas psicológicos negativos (ansiedad, depresión y hostilidad) y el comportamiento sexual arriesgado (varios compañeros sexuales y relaciones sexuales sin protección) en una muestra de hombres que tienen relaciones sexuales con otros hombres (HSH) de Chile. Métodos Este estudio tuvo un diseño transversal y una muestra de 325 HSH de 18 a 64 años (media: 30,8; desviación estándar: 9,8). Se efectuaron pruebas de asociación (ji al cuadrado) y comparaciones entre las medias grupales (prueba de la t de Student y prueba F). Resultados No se observaron diferencias estadísticamente significativas respecto del uso de preservativos o del número de compañeros sexuales entre los hombres seropositivos al VIH y los no infectados. En los dos grupos, más del 50 % refirió que había tenido algún encuentro sexual sin protección en los seis meses anteriores. Se observaron diferencias estadísticamente significativas entre los dos grupos en cuanto a los síntomas asociados a la depresión. Conclusiones Estos resultados muestran la necesidad de fortalecer los mensajes acerca de la importancia del uso de preservativos como la única manera de prevenir el VIH y como un medio de prevenir la infección y la reinfección por este virus, en los programas nacionales de prevención y autocuidado destinados a las personas sexualmente activas. Es necesario efectuar más estudios en América Latina para impulsar las medidas de prevención de la infección por el VIH orientadas a la población de HSH. Los datos generados por este estudio pueden servir para formular estrategias programáticas de prevención e intervenciones dirigidas a esta población en América Latina.

[Role of the sympathetic nervous system in vasovagal syncope and rationale for beta-blockers and norepinephrine transporter inhibitors]. / Papel del sistema nervioso simpático en el síncope vasovagal y justificación del uso de betabloqueadores e inhibidores del transportador de noradrenalina.

Vasovagal or neurocardiogenic syncope is a common clinical situation and, as with other entities associated with orthostatic intolerance, the underlying condition is a dysfunction of the autonomic nervous system. This article reviews various aspects of vasovagal syncope, including its relationship with orthostatic intolerance and the role of the autonomic nervous system in it. A brief history of the problem is given, as well as a description of how the names and associated concepts have evolved. The response of the sympathetic system to orthostatic stress, the physiology of the baroreflex system and the neurohumoral changes that occur with standing are analyzed. Evidence is presented of the involvement of the autonomic nervous system, including studies of heart rate variability, microneurography, cardiac innervation, and molecular genetic studies. Finally, we describe different studies on the use of beta-blockers and norepinephrine transporter inhibitors (sibutramine, reboxetine) and the rationality of their use to prevent this type of syncope.

El síncope vasovagal o neurocardiogénico es una situación clínica común, y así como en otras entidades asociadas con la intolerancia ortostática, la condición de base es una disfunción del sistema nervioso autónomo. En este artículo se revisan diversos aspectos sobre el síncope vasovagal, incluyendo su relación con la intolerancia ortostática y el papel que juega el sistema nervioso autónomo. Se da una breve reseña histórica del problema, así como una descripción de la forma en que han evolucionado los términos y conceptos asociados al mismo. Se hace un análisis sobre la respuesta del sistema nervioso simpático al estrés ortostático, la fisiología del sistema barorreflejo y los cambios neurohumorales que ocurren. Se muestra evidencia sobre el papel del sistema nervioso autónomo, incluyendo estudios sobre variabilidad de la frecuencia cardiaca, microneurografía, inervación cardiaca y estudios genéticos moleculares. Finalmente, se describen diferentes estudios sobre el uso de betabloqueadores e inhibidores del transportador de noradrenalina (sibutramina, reboxetina) y la justificación de su uso en la prevención de este tipo de síncope.

Cardiac Autonomic Response to Active Standing in Adults With Vasovagal Syncope.

PURPOSE: Little is known about the autonomic response to active standing in vasovagal syncope, and most works have focused on children or adolescents. The aim of this work was to study the changes in cardiac autonomic modulation in adult patients with vasovagal syncope through heart rate variability analysis with linear and short-term complexity (alpha-1) indexes during supine position and active standing, in patients with positive or negative head-up tilt test (HUTT). METHODS: Twenty-five patients with vasovagal syncope were included. Heart rate variability linear and short-term complexity (alpha-1) indexes were recorded during an active standing test (15 minutes in each position) and compared among patients grouped by HUTT outcome and between positions. RESULTS: During supine position, positive HUTT (+HUTT) patients had longer mean RR (1016 [850-1051] milliseconds), higher pNN50 (17.7 [9.2-26.2]), lower sympathovagal balance (1.3 [0.5-1.7]), and alpha-1 (0.9 [0.8-1.0]) than negative HUTT (-HUTT) patients (871 [776-969] milliseconds, 8.8 [2.1-14.5], 2.9 [1.3-3.9], and 1.2 [1.0-1.1], respectively). During active standing, heart rate and alpha-1 increased in both groups; in +HUTT patients, pNN50 decreased, whereas sympathovagal balance increased. The magnitude of change between positions of sympathovagal balance and alpha-1 was 6.1 and 4.8 times larger in +HUTT than -HUTT patients, respectively. CONCLUSIONS: The underlying cardiac autonomic mechanism in vasovagal syncope may involve different autonomic patterns in subjects with a history of recurrent syncope and +HUTT or -HUTT.

Next generation sequencing for molecular confirmation of hereditary sudden cardiac death syndromes / Confirmación diagnóstica molecular mediante secuenciación masiva de nueva generación ("next generation sequencing") en síndromes hereditarios de muerte súbita cardíaca

Hereditary sudden cardiac death syndromes comprise a wide range of diseases resulting from alteration in cardiac ion channels. Genes involved in these syndromes represent diverse mutations that cause the altered encoding of the diverse proteins constituting these channels, thus affecting directly the currents of the corresponding ions. In the present article we will briefly review how to arrive to a clinical diagnosis and we will present the results of molecular genetic studies made in Mexican subjects attending the SCD Syndromes Clinic of the National Institute of Cardiology of Mexico City.

Los síndromes hereditarios de muerte súbita cardíaca comprenden una amplia gama de enfermedades resultantes de la alteración en los canales iónicos cardíacos. Los genes implicados en estos síndromes presentan mutaciones que causan alteraciones de las diversas proteínas que constituyen estos canales y que, por lo tanto, afectan directamente a las diferentes corrientes iónicas. En el presente artículo se revisa brevemente la forma de llegar a un diagnóstico clínico de dichos síndromes y se presentan los resultados de los estudios genéticos moleculares realizados en sujetos mexicanos que asisten a la Clínica de Síndromes Hereditarios de Muerte Súbita del Instituto Nacional de Cardiología Ignacio Chávez.

Síndrome de Andersen-Tawil: una revisión del diagnóstico genético y clínico con énfasis en sus manifestaciones cardíacas / Andersen-Tawil syndrome: A review of its clinical and genetic diagnosis with emphasis on cardiac manifestations

El síndrome de Andersen-Tawil resulta de la alteración de canales de potasio, se hereda de forma autosómica dominante y se cataloga como el tipo 7 de los síndromes de QT largo congénitos. El gen afectado es el KCNJ2, el cual codifica la proteína Kir2.1 que forma el canal de potasio rectificador interno («inward rectifier¼). Este canal interviene en la estabilización del potencial de membrana en reposo y controla la duración del potencial de acción en el sistema musculoesquelético y cardíaco. En miocitos ventriculares, es un componente responsable de la rectificación de la corriente de potasio en la fase 3 del potencial de acción. Debido a que Kir2.1 está presente en el sistema musculoesquelético, corazón y cerebro, las alteraciones de esta proteína dan origen a las principales características del síndrome: parálisis flácida, arritmias ventriculares y alteraciones leves a moderadas en el desarrollo del esqueleto, especialmente en manos y pies. En la presente revisión se aborda esta enfermedad desde el punto de vista del diagnóstico clínico y molecular con énfasis en sus manifestaciones cardíacas.

The Andersen-Tawil syndrome is a cardiac ion channel disease that is inherited in an autosomal dominant way and is classified as type 7 of the congenital long QT syndromes. Affected gene is KCNJ2, which forms the inward rectifier potassium channel designated Kir2.1. This protein is involved in stabilizing the resting membrane potential and controls the duration of the action potential in skeletal muscle and heart. It also participates in the terminal repolarization phase of the action potential in ventricular myocytes and is a major component responsible for the correction in the potassium current during phase 3 of the action potential repolarization. Kir 2.1 channel has a predominant role in skeletal muscle, heart and brain. Alterations in this channel produce flaccid paralysis, arrhythmias, impaired skeletal development primarily in extremities and facial area. In this review we address the disease from the point of view of clinical and molecular diagnosis with emphasis on cardiac manifestations.

Prevalence of fibromyalgia in vasovagal syncope.

BACKGROUND: Vasovagal syncope is an acute manifestation of autonomic nervous system dysfunction. This type of syncope is often associated with other dysautonomic expressions such as migraine, gastroparesis, or postural tachycardia syndrome. Autonomic nervous system dysfunction has been proposed as a key element in the pathogenesis of fibromyalgia. OBJECTIVES: The objectives of this study were to estimate the frequency of fibromyalgia in a sample of patients with vasovagal syncope and also to correlate the presence of syncope and fibromyalgia with different dysautonomic manifestations. METHODS: We studied 50 consecutive patients with vasovagal syncope seen at the Syncope Unit of the National Cardiology Institute of Mexico between June 2009 and June 2012. All individuals filled out the Composite Autonomic Symptoms and Signs questionnaire and the Fibromyalgia Impact Questionnaire. All cases underwent a head-up tilt test. A rheumatologist examined all participants to assess the presence of fibromyalgia. RESULTS: The median age of the studied population was 21 years. Sixty-eight percent of participants were women. Eight cases (16%) had concomitant fibromyalgia. Significantly, all fibromyalgia cases were female. This subgroup of fibromyalgia subjects had more secretomotor complaints (mainly dry eyes and dry mouth) and more bowel constipation than the remainder of the group. Also in this subgroup of fibromyalgia subjects, several significant associations were found between age, blood pressure, number of syncopal episodes, constipation, insomnia, pupillomotor impairment, and disability. In contrast, no correlations were found in the subgroup of fainters without fibromyalgia. CONCLUSIONS: Fibromyalgia was relatively frequent in these women with vasovagal syncope and could be associated with dysautonomic symptoms. Therefore, it seems important to search for dysautonomic comorbidities in patients with vasovagal syncope and/or fibromyalgia, to provide a patient-centered holistic approach, instead of the often currently used therapeutic partition.

La Psicología Política como momento de la Psicología Social en Chile: desplazamientos conceptuales y temáticos / A Psicologia Política como momento da Psicologia Social no Chile: deslocamentos conceituais e temáticos / Political Psychology as a moment of Social Psychology in Chile: conceptual and thematic shifts

El artículo propone entender a la psicología política como un momento de la psicología social, que se articula de manera diferente con las dimensiones de "la política y lo político" a partir de los cambios históricos de la sociedad y teóricos de la disciplina. Esta perspectiva permite observar cómo buena parte de la investigación psicosocial no ha sido incluida en las definiciones tradicionales de psicología política aun cuando pueda ser referida a fenómenos políticos o sociales. En base a este enfoque, se ofrece una panorámica de los tópicos de investigación psicosocial desarrollados actualmente en Chile y una identificación de los desplazamientos temáticos que se producen al interior de cada uno de los núcleos temáticos expuestos...

O artigo propõe entender a psicologia política como um momento da psicologia social, que se articula de maneira diferente com as dimensões da "política e o político" a partir das mudanças históricas da sociedade e dos teóricos da disciplina. Esta perspectiva permite observar como boa parte da pesquisa psicossocial não tem sido incluída nas definições tradicionais da psicologia política, mesmo quando se refere a fenômenos políticos ou sociais. Com base neste enfoque, os autores oferecem um panorama dos tópicos da pesquisa psicossocial desenvolvidos atualmente no Chile, bem como uma identificação dos deslocamentos temáticos produzidos no interior de cada um dos núcleos temáticos expostos...

This article seeks to understand political psychology as a moment of social psychology which is articulated differently along the dimensions of "policy and politics" and the historical changes of society and theoretical changes in the discipline. This perspective allows us to observe to what extent psychosocial research has not been included in the traditional definition of political psychology, even though it may be referred to political or social phenomena. Based on this approach the article provides an overview of currently psychosocial research topics in Chile as well as the identification of thematic shifts occurred within each reviewed thematic core...

Long-term efficacy of low doses of quinidine on malignant arrhythmias in Brugada syndrome with an implantable cardioverter-defibrillator: a case series and literature review.

BACKGROUND: To prevent the recurrence of ventricular arrhythmias (VA) in Brugada syndrome (BrS), only quinidine has been consistently reported to have a beneficial effect. Recommended doses are ≥ 1 g/d. The efficacy of lower doses of quinidine has been suggested on the basis of a few isolated experiences. OBJECTIVES: To describe the efficacy and safety of doses ≤ 600 mg/d of quinidine after cardioverter-defibrillator implantation in BrS at 2 referral centers and to compare those results with a comprehensive review of the literature. METHODS: In a retrospective analysis of medical records from the 2 centers, 6 men with BrS who received ≤ 600 mg/d of quinidine sulfate or hydroquinidine after cardioverter-defibrillator implantation were identified. Quinidine was initiated after arrhythmic syncope or appropriate shocks, including arrhythmic storm in 4. A literature search was performed to find previous cases with symptomatic BrS reported as having received ≤ 600 mg/d of quinidine. RESULTS: Quinidine prevented recurrence of VA in all patients from our series without side effects during a median follow-up of 4 years (from 2 to 8 years). In the literature review, 14 additional adults were found. With the exception of 3, quinidine effectively suppressed arrhythmic events in all of them. Four subjects who discontinued the medication experienced VA recurrence, successfully treated by restarting quinidine. CONCLUSIONS: Low doses of quinidine were well tolerated and effective to prevent the recurrence of VA, including arrhythmic storm, in subjects with BrS with an implantable cardioverter-defibrillator. Effectiveness of quinidine or hydroquinidine in doses ≤ 600 mg/d is 85%.