Frecuencia del síndrome de desgaste profesional en un grupo de especialistas en Cirugía Plástica y estudiantes del posgrado en Colombia / Frequency of burnout syndrome in a group of specialists in Plastic Surgery and postgraduate students in Colombia

Introducción y objetivo: El síndrome burnout o síndrome de desgaste profesional, fue descrito por Freudenberger, psiquiatra psicoanalista norteamericano en 1974, y empleado públicamente por primera vez por Cristina Maslach en 1976 para referirse a una situación cada vez más frecuente entre trabajadores de los servicios humanos, que por la naturaleza de su trabajo, debían mantener un contacto directo y continuo con la gente, desgastándose profesionalmente tras meses o años de dedicación. En los 80, Maslach creó un instrumento para su valoración, el Maslach Burnout Inventory (MBI), con 3 versiones, una de los cuales tiene como objetivo las personas que trabajan en el sector de servicios de la salud, que valora 3 dimensiones: agotamiento emocional, despersonalización y realización personal en el trabajo, que sigue vigente y es considerado el instrumento más utilizado y acertado para el diagnóstico de la enfermedad.El objetivo de nuestro estudio es determinar la frecuencia y factores asociados del síndrome de desgaste profesional en médicos especialistas y estudiantes de posgrado en Cirugía Plástica, Estética y Reconstructiva en Colombia.Material y método.Estudio de corte transversal durante el XX Curso Internacional de Cirugía Plástica Estética de la Sociedad Colombiana de Cirugía Plástica, Estética y Reconstructiva (SCCP) de septiembre 2018 en Barranquilla. Solicitamos consentimiento informado y utilizamos el cuestionario Maslach Burnout Inventory y un cuestionario sociodemográfico para evaluar los factores asociados con el síndrome. Definimos el burnout o síndrome de desgaste profesional como la asociación de alto agotamiento emocional, despersonalización y bajo rendimiento profesional. Realizamos el análisis multivariado después del ajuste del modelo logístico binario con la identificación de los factores de riesgo y el calculo de (OR). De los 623 médicos registrados en el curso, 132 participaron en el estudio. (AU)

Background and objective: The burnout was originally described by Freudenberger, an American psychoanalyst psychiatrist in 1974, and this term was used for the first time by Cristina Maslach in 1976 to refer to an increasingly frequent situation among workers of human services, who by the nature of their work, had to maintain direct and continuous contact with people, wasting out professionally after months or years of dedication. In the 1980s, Maslach created an instrument for its assessment, the Maslach Burnout Inventory (MBI), with 3 versions, one aimed at people who work in the human services sector (Human Services Survey). It values 3 dimensions: emotional exhaustion, depersonalization and personal accomplishment at work, is still in use and is considered the most accurate instrument for diagnosing the disease.The objective of this study was to determine the frequency and associated factors of burnout syndrome in a group of plastic surgeons and postgraduate students in Aesthetic and Reconstructive Plastic Surgery in Colombia.Methods.Cross-sectional study carried out during the XX International Course of Aesthetic Plastic Surgery of the Colombian Society of Aesthetic and Reconstructive Plastic Surgery (SCCP) carried out in September 2018 in Barranquilla. Informed consent was requested and the Maslach Burnout Inventory questionnaire and a sociodemographic questionnaire were used to evaluate the factors associated with the syndrome. Burnout syndrome was defined as the association of high emotional exhaustion, depersonalization and low personal accomplishment. The multivariate analysis was performed after fitting the binary logistic model with the identification of risk factors and the calculation of the (OR). Of the 623 physicians registered in the course, 132 participated in the study. (AU)

Enfermedad de Paget mamaria: revisión de la literatura / Paget's disease of the breast: review of the literature

Resumen La enfermedad de Paget mamaria es una neoplasia infrecuente de la mama, muchas veces de difícil diagnóstico y mal pronóstico. El objetivo es revisar los aspectos fundamentales clínicos, diagnósticos, así como los avances más recientes en su tratamiento. Se realizó una búsqueda bibliográfica a través de PUBMED, GOOGLE SCHOLAR y UPTODATE, de los últimos 20 años. Fueron seleccionados e incluidos en la revisión 38 artículos. La enfermedad de Paget mamaria es una neoplasia maligna infrecuente del complejo areola pezón de características inflamatorias al examen físico, asociado en un 85% de los casos a un cáncer de mama subyacente, en el 50% de los casos no identificable al examen físico, de difícil diagnóstico, cuya sospecha clínica se confirma con imágenes, biopsia e inmunohistoquímica. El tratamiento es mastectomía versus cirugía conservadora y radioterapia. Un mal enfoque clínico, retrasa el diagnóstico y empeora la sobrevida. MÉD.UIS.2021;34(1): 45-53.

Abstract Paget's disease of the breast is an uncommon neoplasm of the breast, many times difficult to diagnose and of poor prognosis. The objective is to review the fundamental clinical and diagnostic aspects, as well as the most recent advances in its treatment. A bibliographic search of the last 20 years was carried out through PUBMED, GOOGLE SCHOLAR and UPTODATE. 38 articles were selected and included in the review. Mammary paget disease is a rare malignant neoplasm of the nipple areola complex with inflammatory features on physical examination, associated in 85% of cases with underlying breast cancer, in 50% of cases not recognizable on physical exam, difficult to diagnose, whose clinical suspicion is confirmed by imaging, biopsy and immunohistochemistry. Treatment is mastectomy versus conservative surgery and radiotherapy. A poor clinical approach delays the diagnosis and worsens survival rate. MÉD.UIS.2021;34(1): 45-53.

Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad / Bilateral trigger finger, surgical and conservative treatment in a 4 year old patient / Polegar em gatilho bilateral, tratamento cirúrgico e conservador em paciente de quatro anos de idade

Introducción. El dedo en gatillo es una anomalía infrecuente en niños que afecta principalmente al dedo pulgar, de etiología desconocida. El manejo puede ser conservador o quirúrgico. Reporte de caso. Paciente pediátrica escolar de 4 años y 7 meses de edad es remitida al servicio de cirugía plástica por deformidad en flexión fija del pulgar derecho, de 4 meses de evolución asociada a nódulo palpable. Se interviene quirúrgicamente de forma efectiva, sin complicaciones, secuelas ni recurrencia. Discusión. La paciente fue manejada quirúrgicamente de forma efectiva Se hizo un seguimiento durante 3 años con una evolución satisfactoria, teniendo una recuperación total de la función del pulgar, sin secuelas y adecuada adaptabilidad al medio. Conclusión. Este artículo tiene como objetivo presentar un caso clínico que busca llamar la atención sobre las indicaciones del tratamiento conservador versus quirúrgico que existen en la literatura, corresponde a una paciente pediátrica de nuestro medio con dedo pulgar en gatillo bilateral, su manejo y los resultados postoperatorios. El dedo pulgar en gatillo pediátrico tiene una baja prevalencia en el mundo. No hay estudios de incidencia ni prevalencia en nuestro medio. La edad de presentación es variable, los signos y síntomas no son iguales a los del adulto, el compromiso puede ser bilateral, su diagnóstico es clínico y el tratamiento quirúrgico, dependiendo del grado de compromiso, puede ser el más efectivo. Cómo citar: Bretón Gómez GA, Vargas Rueda JJ, Ardila Forero PA, López Villegas A. Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad. MedUNAB. 2020;23(1):131-136. doi:10.29375/01237047.3616

Introduction. Trigger finger is a rare anomaly in children; it is of unknown etiology and mainly affects the thumb. Management may be conservative or surgical. Case report. Pediatric patient of 4 years and 7 months of age is referred to plastic surgery service for fixed flexion deformity of the right thumb, after 4 months of evolution associated with a palpable nodule. It is successfully intervened surgically, without complications, sequels or recurrence. Discussion. The patient was effectively treated via surgery. Follow-up was carried out for three years with satisfactory evolution, showing full recovery of the function of the thumb, with no after-effects and with adequate adaptability to the environment. Conclusion. The objective of this article is to present a clinical case that aims to draw attention to the indications for conservative versus surgical treatment existing in the literature, corresponding to a pediatric patient from our milieu with a bilateral trigger finger, its treatment and postoperative results. Pediatric trigger finger has low prevalence in the world. There are no incidence or prevalence studies in the cases that were reviewed. The age at which it arises is variable; the signs and symptoms are not the same as those of adults; involvement may be bilateral; diagnosis is clinical and surgery may be the most effective treatment, depending on the degree of involvement. Cómo citar: Bretón Gómez GA, Vargas Rueda JJ, Ardila Forero PA, López Villegas A. Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad. MedUNAB. 2020;23(1):131-136. doi:10.29375/01237047.3616

Introdução. O dedo em gatilho é uma anomalia incomum em crianças, que afeta principalmente o polegar, de etiologia desconhecida. O tratamento pode ser conservador ou cirúrgico. Relato de caso. Paciente pediátrica de quatro anos e sete meses de idade é encaminhada ao serviço de cirurgia plástica para deformidade em flexão fixa do polegar direito, com quatro meses de evolução associada a nódulo palpável. Foi tratada cirurgicamente de forma eficaz, sem complicações, sequelas ou recorrência. Discussão. A paciente foi tratada cirurgicamente de forma eficaz. Foi feito um acompanhamento por três anos com uma evolução satisfatória, com recuperação total da função do polegar, sem sequelas e adaptabilidade adequada ao ambiente. Conclusão. Este artigo tem como objetivo apresentar um caso clínico que busca chamar a atenção para as indicações do tratamento conservador versus cirúrgico, existentes na literatura, que corresponde a uma paciente pediátrica em nosso meio com um polegar de gatilho bilateral, seu manejo e resultados pós-operatórios. O polegar em gatilho pediátrico tem uma baixa prevalência no mundo. Não há estudos de incidência ou prevalência nos casos consultados. A idade de apresentação é variável, os sinais e sintomas não são iguais aos do adulto, o comprometimento pode ser bilateral, o diagnóstico é clínico e o tratamento cirúrgico, dependendo do grau de comprometimento, pode ser o mais eficaz. Cómo citar: Bretón Gómez GA, Vargas Rueda JJ, Ardila Forero PA, López Villegas A. Dedo pulgar en gatillo bilateral, tratamiento quirúrgico y conservador en paciente de 4 años de edad. MedUNAB. 2020;23(1):131-136. doi:10.29375/01237047.3616

Reduction of opioid-withdrawal symptoms with quetiapine.

OBJECTIVE: To determine the utility of quetiapine in a population undergoing ambulatory detoxification from opioids. METHOD: Medications utilized in our outpatient clinic for opioid withdrawal were evaluated for quality-assurance purposes. The treatment regimen generally included clonidine, hydroxyzine, trazodone, diphenoxylate/atropine, and sometimes chlordiazepoxide. Patients were also initially given eight 25-mg tablets of quetiapine and instructed to take 1 or 2 tablets every 4 hours as needed for symptoms of withdrawal or craving (with a maximum daily dose of 200 mg). Data were based on patient evaluations from June 2003 to June 2004. RESULTS: 41% of all patients (N = 213) successfully completed the detoxification phase of the program (i.e., completed at least 5 days of abstinence). A medication questionnaire was instituted for quality-assurance purposes after some apparent initial success with quetiapine. A retrospective analysis of these data revealed that, of the 107 patients evaluated for medication response, 79 reported that quetiapine helped reduce craving for opioids, 52 reported that quetiapine helped reduce their anxiety, 24 reported a reduction in somatic pain, 22 reported that quetiapine helped alleviate insomnia, and 14 reported an improved appetite. Four individuals did not feel quetiapine had any benefit, and another 7 were unable to tolerate quetiapine because of side effects. The quetiapine dose used ranged from 25 to 600 mg/day (mean +/- SD dose = 206 +/- 122 mg/day). CONCLUSIONS: Quetiapine use during opioid cessation was found to help abate symptoms of opioid withdrawal in our patient population and was generally well tolerated.