Spanish validation of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and factors associated with physician burnout.

OBJECTIVES: The aim of this study was to investigate the psychometric properties of the Spanish version of the Stigma of Occupational Stress Scale for Doctors (SOSS-D) and the factors associated with Physician Burnout in Paraguay. METHODS: Participants included 747 Paraguayan healthcare workers, aged 24-77 years old, of both sexes. SOSS-D was translated into Spanish and validated through an exploratory and confirmatory factor analysis. Participants were also scored with the Oldenburg Burnout Inventory (OLBI), the CAGE questionnaire, and the stigma subscale of the Perceived Barriers to Psychological Treatment (PBPT) measure. RESULTS: Three factors had a raw eigenvalue greater than 1, and explained 61.7% of total variance. The confirmatory analysis confirmed that the scale is three-dimensional. The model adjustment was good, according to all fit indices. OLBI results indicate clinically significant disengagement in 85.9% and clinically significant exhaustion in 91.6% of participants. Of the 747 participants, 57.6% reported alcoholic beverage consumption and among those, 19.3% had problematic alcohol consumption according to the CAGE questionnaire. The correlation between SOSS-D and the stigma subscale of the PBPT was statistically significant (r = 0.245, p < 0.001). CONCLUSIONS: The Spanish version of the SOSS-D was found to have good psychometric properties and adequately reproduces the three-dimensional model of the original English version.

Relationship between family history of alcohol problems and different clusters of depressive symptoms.

OBJECTIVES: Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms. METHODS: Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations. RESULTS: There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters. CONCLUSION: FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.

Psychometric properties of the Spanish version of the Fear of COVID-19 scale in Paraguayan population.

OBJECTIVE: The aim of this study is to test the psychometric properties of the Spanish validation of the Fear of COVID-19 Scale (FCV-19S) in a Paraguayan population. METHODS: Participants were recruited through an Internet-based survey. All participants whose scores in the Hospital Anxiety and Depression Scale (HADS) and The Fear Questionnaire (FQ) were greater than zero were included. 1245 subjects responded voluntarily: 1077 subjects, scoring >0, were considered. RESULTS: To establish construct validity of the FCV-19S, an exploratory factor analysis was performed using the KMO test, which was adequate, and the Bartlett sphericity test, which was significant (p <.0001). The CFI, NFI, GFI, TLI and RMSEA indices were used to evaluate the model and showed good adjustment. Cronbach's α showed valid internal consistency (α = 0.86). This validation was supported by significant correlation (p <.001) with the HADS scale for anxiety and depression and with the FQ scale for specific phobia. CONCLUSIONS: The Spanish version of the FCV-19S is a 7-item scale with two dimensions, psychological symptoms and physiological symptoms, which demonstrated robust psychometric properties in a Paraguayan population.

Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery.

OBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesions that were managed via an EEA, as well as the specific anatomy of each case. METHODS: All patients were treated in a single center by a multidisciplinary surgical team between 2015 and 2019. Before surgery, a dedicated anatomical analysis of the brainstem safe entry zone was performed, and proper surgical planning was carried out. Neurophysiological monitoring was used in all cases. Anatomical dissections were performed in three human cadaveric heads using 0° and 30° endoscopes, and specific 3D reconstructions were executed using Amira 3D software. RESULTS: All lesions were located at the level of the ventral brainstem. Specifically, one mesencephalic cavernoma, two pontine ca- vernomas, one pontine gliomas, and one medullary diffuse midline glioma were reported. Cerebrospinal fluid leak was the major complication that occurred in one case (medullary diffuse midline glioma). From an anatomical standpoint, three main safe entry zones were used, namely the anterior mesencephalic zone (AMZ), the peritrigeminal zone (PTZ, used in two cases), and the olivar zone (OZ). Reviewing the literature, 17 cases of various brainstem lesions treated using an EEA were found. CONCLUSIONS: To our knowledge, this was the first preliminary clinical series of intrinsic brainstem lesions treated via an EEA presented in the literature. The EEA can be considered a valid surgical alternative to traditional transcranial approaches to treat selected intra-axial brainstem lesions located at the level of the ventral brainstem. To achieve good results, surgery must involve comprehensive anatomical knowledge, meticulous preoperative surgical planning, and intraoperative neurophysiological moni- toring.

Association of QRS Complex Fragmentation with QT Interval Prolongation in Patients with Ischemic Heart Disease.

BACKGROUND: The fragmented QRS complex (FQRS) was found to be associated to malignant ventricular arrhythmias and sudden death in patients with hypertrophic cardiomyopathy and other entities. There is scant data available correlating the presence of FQRS with QT interval prolongation in patients with ischemic heart disease (IHD). METHODS: A descriptive, retrospective, cross-sectional study was performed in 123 patients with IHD to analyze and correlate the presence of FQRS with QT interval prolongation in the conventional 12-leads electrocardiogram in patients with documented chronic IHD. RESULTS: There were 62% male patients. The mean age was 63.8±12.6 years. Thirty six (44%) patients had fragmented QRS (64% men and 36% women). The duration of QT and QTc, the mean values were 413±59ms, and 463±67ms, respectively. Of the 36 patients with FQRS, 23 patients have prolongation of the QTc interval, and 13 patients did not present it. Of the 45 patients without FQRS, 21 of them have prolongation of the QTc interval, and 24 patients did not have it. These data resulted in a sensitivity of 52% with a moderate SnNout, a specificity of 65% with moderate SpPin, a positive predictive accuracy of 64%, a negative predictive accuracy of 53%. These data resulted in a prevalence of 54%. CONCLUSION: the presence of FQRS in the ECG has a moderate sensitivity and specificity, as well as, moderate negative and positive predictive value of the existence of QT interval prolongation in patients with ischemic heart disease.

Attitude of Medical Students in Paraguay Towards Homosexuality.

INTRODUCTION: The attitude of medical students towards homosexuality may affect the quality of care for homosexual patients. This study aimed to describe the attitude of medical students at the National University of Asuncion, Paraguay towards homosexuality. METHODS: This observational, cross-sectional study was conducted in June 2016 in consecutive medical students from the National University of Asunción (Santa Rosa del Aguaray branch), Paraguay. The 10-item attitude towards homosexuality scale (EAH-10) was used to assess participants' acceptance/ rejection of homosexuals as individuals, homosexuality as a sexual orientation, and public manifestations of homosexuality. RESULTS: A total of 48 female and 29 male participants (mean age, 21 ± 2 years) were included. Most were Catholic (71.4%), followed by non-Catholic Christian (10.4%), agnostic (9.1%), atheist (2.6%), and other (6.5%). 71.4% reported having at least one homosexual friend. The mean EAH-10 score was 27.23 ± 9.379. 42.9% of participants were indifferent or undecided in their attitude towards homosexuality and 28.6% were discriminatory. Having homosexual friends was associated with a lower EAH-10 score (t = -3.447 [75], p = 0.001). CONCLUSION: Education about health issues of homosexuals is needed for medical students in Paraguay.

Estrés, ansiedad y depresión en estudiantes secundarios de la ciudad de Santa Rosa del Aguaray, Departamento de San Pedro, 2016 / Stress, anxiety and depression in high school students of the city of Santa Rosa del Aguaray, Department of San Pedro, 2016

Introducción: En este estudio interesa investigar los niveles de estrés, ansiedad y depresión que tiene una población de estudiantes secundarios. Creemos importante estudiar esta temática, en particular porque al tratarse de preuniversitarios debe darse especial énfasis a la detección e intervención precoz sobre situaciones que podrían afectar su desarrollo personal, académico, familiar y social. Materiales y métodos: Estudio observacional, descriptivo, con corte transversal y muestreo no probabilístico a criterio, realizado en estudiantes de educación media del Colegio Nacional "Santa Rosa", del Departamento de San Pedro. Para medir estrés, ansiedad y depresión, se utilizó el DASS-21, que consta de 21 ítems. Resultados: Se evidenció la existencia de al menos cierto nivel del estrés en el 43,5% de los estudiantes entrevistados, siendo de nivel extremo en 8,7% de los participantes. Se reportó algún grado de ansiedad en por lo menos el 71,7%, y algún grado de depresión en al menos 52,2% de los participantes. Discusión: Si bien los niveles de estrés encontrados en la presente investigación son menores a los reportados en la bibliografía, los valores de ansiedad y depresión superan los reportados por otros estudios en población similar. La investigación sobre los niveles de estrés, ansiedad y depresión en estudiantes preuniversitarios es un tema actual e innovador, que busca encontrar soluciones efectivas para hacer frente a estas condiciones que repercuten negativamente en la vida de los estudiantes.

Introduction: In this study it is interesting to investigate the levels of stress, anxiety and depression in a population of high school students. We believe that it is important to study this issue, particularly as they are pre-university students. Special emphasis should be placed on early detection and intervention on situations that could affect personal, academic, family and social development of high school students. Materials and methods: Observational, descriptive and cross-sectional study, with non-probabilistic and at criterion sampling, of students of the "Santa Rosa" National School, Department of San Pedro, enrolled in secondary education. To measure stress, anxiety and depression, we used the DASS-21, which consists of 21 items. Results: There was evidence of at least a certain level of stress in 43,5% of the students interviewed. Extreme level of stress was found in 8,7% of the participants. Some degree of anxiety was reported in at least 71,7% of the population, and some degree of depression in at least 52,2% of the participants. Discussion: Although the levels of stress found in the present study are lower than those reported in the literature, the values of anxiety and depression exceed those reported by other studies in a similar population. Research on the levels of stress, anxiety and depression in pre-university students is a current and innovative topic, which seeks to find effective solutions to address these conditions that have a negative impact on the lives of students.

Uso de cannabis y desarrollo de esquizofrenia: ¿cuáles son los vínculos? / Cannabis use and schizophrenia development: which are the links?

El cannabis es la droga más utilizada por personas con esquizofrenia. Sin embargo, la relación entre el consumo de cannabis y el desarrollo de esquizofrenia aún no ha sido completamente aclarada. Esta comunicación corta pretende destacar algunos vínculos estudiados entre el consumo de cannabis y el desarrollo de esquizofrenia. Los autores resumen algunos de los principales hallazgos de varias investigaciones realizadas sobre este tema, incluyendo estudios sobre la sustancia blanca del cerebro, el circuito de recompensa cerebral, la fisiopatología del hipocampo, el volumen cerebral, la edad de inicio de la psicosis, las características del uso de cannabis y los rasgos de personalidad, la genética, la neuroquímica, así como la respuesta al estrés. Los autores concuerdan con la noción de que hay dos hipótesis más convincentes sobre el vínculo entre el cannabis y la esquizofrenia: 1. Cannabis como causa contribuyente y, 2. Vulnerabilidad compartida. Los autores hacen hincapié en que el consumo de cannabis no provoca por sí mismo un trastorno psicótico; sin embargo, tanto el uso temprano como el uso intensivo del mismo son más probables en individuos con una vulnerabilidad a la psicosis. El uso del cannabis es posiblemente el factor de riesgo medioambiental más modificable de la esquizofrenia, por lo que es necesaria una advertencia de salud pública de que el consumo de cannabis puede aumentar el riesgo de trastornos psicóticos.

Cannabis is the drug most often used by persons with schizophrenia. However, the relationship between cannabis use and schizophrenia development has not yet been fully clarified. This short communication aims to highlight some studied links between cannabis use and schizophrenia development. The authors summarize some of the main findings of several investigations done on this topic, including studies on brain white matter, brain reward circuit, hippocampal pathophysiology, brain volume, age of psychosis onset, and characteristics of cannabis use, personality traits, genetics, neurochemistry, and stress response. The authors agree with the notion that there are two most convincing hypotheses regarding the link between cannabis and schizophrenia: 1. Cannabis as a contributing cause and, 2. Shared vulnerability. The authors stress that cannabis use does not in itself cause a psychotic disorder; however, both early use and heavy use of it are more likely in individuals with a vulnerability to psychosis. The use of cannabis is arguably the most modifiable environmental risk factor for schizophrenia, so it is necessary to ensure a public health warning that cannabis use can increase the risk of psychotic disorders.

Aptitudes vocacionales y procesos de aprendizaje en estudiantes secundarios del Colegio Nacional "Santa Rosa", Departamento de San Pedro, Paraguay, 2016 / Vocational skills and learning processes in high school students of the "Santa Rosa" National School, San Pedro Department, Paraguay, 2016

Introducción: Los procesos de aprendizaje son técnicas de estudio utilizadas por los estudiantes con el objeto de lograr la excelencia académica. Las aptitudes vocacionales engloban aquellos ejes referentes a distintas profesiones en las que los estudiantes pueden desempeñarse. Materiales y métodos: Estudio observacional, descriptivo, de corte transverso, con muestreo no probabilístico a criterio realizado en estudiantes del Colegio Nacional "Santa Rosa", del Departamento de San Pedro, matriculados en la educación media. Resultados: 58,7% fueron mujeres. Edad media fue de 17±1 años. Las aptitudes vocacionales con más respuestas positivas fueron aquellas del eje de servicio social, seguido por el eje científico. En cuanto a los procesos de aprendizaje, se encontró que los estudiantes se sienten bastante conformes con su técnica y lugar de estudio. Los problemas principales en su proceso de aprendizaje se encontraron en su estado físico y su plan de trabajo. Discusión: Se deben estudiar las aptitudes vocacionales que tienen los estudiantes de secundaria para ayudarlos y guiarlos en el proceso de selección de una futura carrera, así como para detectar precozmente problemas de aprendizaje, evitando así el bajo rendimiento académico y el abandono de la carrera.

Introduction: Learning processes are study techniques used by students in order to achieve academic excellence. Vocational skills encompass those axes related to different professions in which students can perform. Materials and methods: Observational, descriptive and cross-sectional study, with non-probabilistic and at criterion sampling, of students of the "Santa Rosa" National School, Department of San Pedro, enrolled in secondary education. Results: 58.7% were women. Mean age was 17±1 years. The vocational skills with the most positive responses were those of the social service axis, followed by the scientific axis. In terms of learning processes, students were found to be quite comfortable with their technique and place of study. The main problems in their learning process were found in their physical state and in their work plan. Discussion: The vocational skills of high school students have to be evaluated to help and guide them in the process of selecting a future career, as well as to detect early learning problems, in order to avoid poor academic performance and dropping out of the career.

Autoestima en estudiantes de medicina de la universidad nacional de Asunción, Paraguay / Self-esteem in medical students of the national university of Asunción, Paraguay

Introducción: Autoestima puede ser definida como el desarrollo de la convicción de que uno es competente para vivir y merece la felicidad, es por tanto capaz de enfrentar la vida con confianza, benevolencia y optimismo lo cual ayuda a alcanzar las metas. Materiales y método: Fue un estudio observacional descriptivo con corte transverso con muestreo no probabilístico de casos consecutivos que se realizó de mayo a junio del 2016 a estudiantes de medicina de la Universidad Nacional de Asunción. Se incluyó a todos los estudiantes que aceptaron participar voluntariamente. Resultados: Se incluyó a 75 sujetos. 60% fue del sexo femenino con edades comprendidas entre 18 y 28 años y una media de 22±2 años. El 48% presenta autoestima elevada, el 18,7% autoestima baja y el 33,3% autoestima baja. Discusión: La prevalencia de autoestima baja en nuestro estudio fue mayor a la encontrada en una población similar donde el 24,5% mostraba puntajes acordes a baja autoestima en contraste con el 33,3% de nuestro estudio. Estos resultados pueden ser explicados por las altas prevalencias de ansiedad, depresión, estresores psicosociales y estrés académico propios de esta población.

Introduction: Self-esteem can be defined as the development of the conviction that one is competent to live and deserves happiness, it is therefore able to face life with confidence, benevolence and optimism which helps to achieve the goals. Methods: It was a descriptive study with transverse cutting non-probability sampling of consecutive cases was conducted from May to June 2016 to medical students at the National University of Asuncion. All students who agreed to participate were included voluntarily. Results: We included 75 subjects. 60% were female with aged between 18 and 28 years and a mean of 22 ± 2 years. 48% have high self-esteem, 18.7% low self-esteem and 33.3% low self-esteem. Discussion: The prevalence of low self-esteem in our study was higher than that found in a similar population where 24.5% had low self-esteem scores chords in contrast to 33.3% of our study. These results can be explained by the high prevalence of anxiety, depression, psychosocial stressors and academic stress of this population.

Características clínicas de la epidemia de Dengue en el Servicio de urgencias del Hospital de clínicas / Clinical features of the Dengue epidemic in the emergency Department of the Hospital de clínicas

Introducción: El Dengue es una enfermedad infecciosa, sistémica y dinámica. Es una sola enfermedad, con diferentes presentaciones clínicas y evolución impredecible. Se hizo endémica en Paraguay desde el año 2002; el objetivo de este trabajo es determinar las características clínicas y epidemiológicas de la epidemia de diciembre de 2012 a febrero de 2013. Materiales y Métodos: Diseño descriptivo, retrospectivo, transversal. Fueron incluidos pacientes que desarrollaron criterios de casos probables de Dengue que consultaron al Servicio de Urgencias del Hospital de Clínicas. 1037 pacientes cumplían los criterios de inclusión. Resultados: La frecuencia de casos de Dengue fue del 14%. La edad promedio fue de 37,7 ± 16,3. El 56% era del sexo femenino. El 87% de los pacientes provenían del departamento Central. El mes de mayor número de casos con 48% fue febrero. El 83% de los pacientes fue tratado de forma ambulatoria. El promedio de días de internación fue de 2,39 ± 1,65. Sólo el 20% de los pacientes presentó algún tipo de comorbilidad. La fiebre estuvo presente en el 99,3% de los pacientes. El 20% de los pacientes tenía signos de alarma al momento de la consulta. La presión de pulso promedio fue 40,4 ± 12,1 La frecuencia cardiaca media fue de 93,8 ± 17,3. Promedio de hematocrito fue 42,2 ± 5,07. Promedio de plaquetas fue 111.500 ± 79972,1. Promedio de leucocitos 4561 ± 3717. Se registró un óbito. Conclusión: Este trabajo muestra las diferentes aristas de una de las epidemias más importantes desarrollada a nivel país. Palabras clave: dengue, características clínicas, hospital de clínicas

Background: Dengue is an infectious disease, systemic and dynamic. It presents several clinical manifestations and unpredictable outcome. It is endemic in Paraguay since year 2002; the aim of this research is to determine clinical and epidemiologic characters of the epidemic from December 2012 to February 2013. Methods: It was designed an cross sectional study, observational and retrospective. They were included patients that developed criteria of dengue cases that consulted in Emergencies Service of Clinics Hospital. Results: Frequency of Cases dengue were 14%. Age mean was 37, 7 ± 16,3. 56% were women. 87% of the patients came from Central Department. February was the month with mostly cases with 48%. 83% patients did not require internment. The average days of hospitalization were 2.39 ± 1.65. 20% of patient had some comorbidity. Fever was detected in 99,3% of patients. 20% had signs alarms at the moment of the consult. The average pulse pressure was 40,4 ± 12,1. The average cardiac frecuency was 93,8 ± 17,3. The average hematocrit was 42,2 ± 5,07. The average of platelets was 111.500 ± 79.972,1. The Average of leukocytes was 4561 ± 3717. One death was recorded. Conclusion: This paper shows the different aspects of one of the most important epidemics developed in our country. Keywords: dengue, clinical, hospital clinics.