Uso de ibuprofeno en el tratamiento de pacientes pediátricos con poliuria y disnatremia. Reporte de una serie de casos / Ibuprofen use for the treatment of pediatric patients with polyuria and dysnatremia. A case series report

Los niños con lesiones selares y/o supraselares pueden presentar diabetes insípida central con posterior secreción inadecuada de hormona antidiurética. Nosotros observamos, en algunos casos, aumento de la incidencia de poliuria, natriuresis e hiponatremia, tríada diagnóstica del síndrome cerebral perdedor de sal. Aquí comunicamos la evolución de 7 pacientes con antecedentes de daño agudo del sistema nervioso central y diabetes insípida central seguida por síndrome cerebral perdedor de sal. Como tratamiento aportamos secuencialmente fluidos salinos parenterales, cloruro de sodio oral, desmopresina, mineralocorticoides e incluso tiazidas. Ante la persistencia de poliuria con hiponatremia, agregamos ibuprofeno. Como resultado de este esquema terapéutico secuencial, este grupo redujo significativamente los valores de diuresis diaria de 10 ml/kg/h a 2 ml/kg/h en un tiempo promedio de 5 días, normalizando también las natremias (de 161 mEq/L a 143 mEq/L) en un tiempo promedio de 9 días. En ningún caso observamos efectos adversos asociados al tratamiento.

Children with sellar and/or suprasellar lesions may develop central diabetes insipidus with subsequent inappropriate antidiuretic hormone secretion. An increased incidence of polyuria, natriuresis, and hyponatremia has been reported in some cases, which make up the diagnostic triad of cerebral salt wasting syndrome. Here we report the clinical course of 7 patients with a history of acute central nervous system injury and central diabetes insipidus followed by cerebral salt wasting syndrome. Treatment included the sequential use of parenteral saline solution, oral sodium chloride, desmopressin, mineralocorticoids, and even thiazides. Due to persistent polyuria and hyponatremia, ibuprofen was added. As a result of this sequential therapeutic regimen, daily urine output reduced significantly from 10 mL/ kg/h to 2 mL/kg/h over an average period of 5 days, together with a normalization of natremia (from 161 mEq/L to 143 mEq/L) over an average period of 9 days. No treatment-related adverse effects were observed in any case.

O desequilíbrio esforço-recompensa está associado à hipertensão arterial entre servidores públicos brasileiros? Resultados do ELSA-Brasil / Is the effort-reward imbalance associated with hypertension among Brazilian civil servants? Results from the ELSA-Brasil study

Resumo Objetivos: analisar a associação entre o estresse no trabalho, segundo o modelo de desequilíbrio esforço-recompensa (DER), e a hipertensão arterial (HA), assim como investigar o papel modificador de efeito do excesso de comprometimento (EC) e do sexo. Métodos: análise seccional de dados de trabalhadores(as) ativos que participaram da segunda onda de coleta de dados (2012-2014) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). O estresse no trabalho foi mensurado pela versão brasileira da escala de DER, composta por três dimensões: esforço, recompensa e EC. A HA foi definida como níveis de pressão arterial sistólica/diastólica ≥ 140/90 mmHg ou uso de medicamento anti-hipertensivo. Empregou-se regressão logística, bruta e ajustada por potenciais fatores de confusão. As interações multiplicativas foram investigadas. Resultados: participaram 9.465 servidores, 51,9% do sexo feminino. A prevalência de HA foi de 34,9%. No modelo ajustado, associações limítrofes foram identificadas entre o DER (razão>1) e maior EC com maiores chances de HA (OR: 1,11; IC95%: 1,00; 1,24; e OR: 1,13; IC95%: 1,01; 1,26, respectivamente). A análise de interação indicou que sexo e EC não são modificadores de efeito. Conclusão: DER e EC associaram-se a maiores chances de HA, após ajuste. Sexo e EC não foram modificadores de efeito.

Abstract Objectives: to evaluate the association between job stress, according to the effort-reward imbalance (ERI) model, and hypertension (HTN), as well as to investigate the effect modifier role of overcommitment (OC) and sex. Methods: cross-sectional analysis of data from active workers who participated in the second data collection wave (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Job stress was measured by the ERI scale - Brazilian version, comprising three dimensions: effort, reward, and OC. HTN was defined as systolic or diastolic blood pressure levels ≥ 140/90 mmHg or antihypertensive medication use. Associations were estimated by logistic regression, crude and adjusted for potential confounding factors. Multiplicative interactions were investigated. Results: a total of 9,465 civil servants participated in the study, 51.9% females. HTN prevalence was 34.9%. The adjusted model identified borderline associations between ERI (ratio > 1) and higher OC with higher odds of HTN (OR = 1.11, 95%CI = 1.00; 1.24; and OR = 1.13; 95%CI = 1.01; 1.26, respectively). Interaction analysis indicated no differences in associations according to sex and OC. Conclusion: results show that ERI and OC are associated with higher odds of HTN after adjustment. Sex and OC were not effect modifiers.

Rabdomiólisis asociada con hipocalemia en el embarazo y aspectos perinatales. Reporte de un caso clínico / Rhabdomyolysis associated with hypokalemia in pregnancy and perinatal aspects. A case report

Resumen ANTECEDENTES: La rabdomiólisis es un síndrome causado por una lesión en las fibras musculares que produce la liberación de componentes intracelulares (mioglobina, creatinfosfocinasa, aldolasa y lactato deshidrogenasa; electrolitos) hacia el espacio extracelular y la circulación sanguínea, lo que resulta en complicaciones graves (alteraciones cardiovasculares, edema cerebral y muerte). Existen pocos casos reportados de rabdomiólisis durante el embarazo, los informes descritos en la bibliografía se enfocan en infecciones y alteraciones hidroelectrolíticas. CASO CLÍNICO: Paciente de 28 años, primigesta, que inició con alteraciones musculares luego de un cuadro infeccioso, en la semana 18 del embarazo, por lo que se le practicaron estudios para encontrar la causa del desequilibrio hidroelectrolítico (determinación de hipocalemia), con elevación súbita de creatinfosfocinasa. El urocultivo resultó positivo a Escherichia coli. El tratamiento consistió en reposición hidroelectrolítica, con administración de potasio ajustado a los requerimientos de la paciente, antibiótico y aporte nutricional, con alta hospitalaria a los dos días. Continuó en control prenatal y en la semana 32.2 tuvo preeclampsia, por lo que se decidió efectuar cesárea, de la que se obtuvo un recién nacido masculino, de 2395 g, Apgar 9/9, con evolución satisfactoria de la madre y su hijo. CONCLUSIONES: El embarazo es un estado fisiológico que implica mayor susceptibilidad de infecciones o complicaciones asociadas con desequilibrio hidroelectrolítico. Es importante considerar la rabdomiólisis durante el embarazo; el diagnóstico se establece mediante examen clínico y estudios de laboratorio.

Abstract BACKGROUND: Rhabdomyolysis is a syndrome, caused by injury to the muscle fiber, which produces the release of intracellular components such as myoglobin, creatine kinase, aldolase and lactate dehydrogenase, electrolytes, into the extracellular space and blood circulation, which can cause serious complications. such as cardiovascular disorders, cerebral edema and death. There are few reported cases of rhabdomyolysis in pregnancy, the reports described in the literature have been associated with infections and hydroelectrolytic changes. The clinical case is presented due to the importance of the repercussion to the maternal-fetal binomial, since it can result in a serious outcome. CLINICAL CASE: The case of a primiparous pregnant patient is presented, who debuted with clinical symptoms accompanied by muscular alterations after an infection, in week 18 of gestation, for which a study protocol was requested with the finding of hydroelectrolyte imbalance, of the hypokalemia type, with sudden elevation of creatine phosphokinase. A positive urine culture for Escherichia coli was found. Management with hydroelectrolyte replacement was indicated, with potassium replacement adjusted to requirements, antibiotic, and nutritional contribution, with hospital discharge after 2 days. Prenatal control was continued and at week 32.2 she presented preeclampsia, which is why a cesarean section was decided, a male weighing 2395 g, Apgar 9/9, with satisfactory evolution of the binomial was obtained. CONCLUSIONS: Pregnancy is more susceptible to infections or complications associated with hydroelectrolyte imbalances, rhabdomyolysis can occur in pregnancy, and it is important not to rule it out, its diagnosis can be made clinically and through laboratory tests.

Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica / Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

Crisis suprarrenal: prevención, corticoterapia y elección del fármaco, revisión de la evidencia actual y recomendaciones / Adrenal crisis: prevention, corticotherapy and choice of the drug, review of current evidence and recommendations

INTRODUCCIÓN. La crisis suprarrenal se refiere a la insuficiencia suprarrenal aguda; la cual es un trastorno en el que la corteza adrenal no produce suficientes hormonas esteroides (en especial cortisol) para satisfacer las demandas del cuerpo, de acuerdo al mecanismo fisiopatológico se la puede clasificar como primaria, secundaria y terciaria, siendo más común en pacientes con insuficiencia suprarrenal primaria. Es una emergencia potencialmente mortal que requiere tratamiento inmediato. OBJETIVO. Establecer una estrategia de prevención y tratamiento de la crisis suprarrenal, así como la farmacoterapia ideal y sus alternativas válidas. MATERIAL Y MÉTODOS. Se realizó una revisión bibliográfica en varias revistas virtuales de alto carácter científico como Cochrane Library, Cochrane Systematic Reviews Database, MEDLINE a través de PubMed y ClinicalTrial.gov. Se seleccionaron revisiones sistemáticas con o sin metaanálisis, ensayos clínicos y recomendaciones de expertos relacionados con prevención y tratamiento de crisis suprarrenal en general. RESULTADOS. Se obtuvieron 1819 resultados, de los cuales se seleccionaron 20 artículos con mayor validez y replicabilidad en el medio para establecer un protocolo unificado de actuación. CONCLUSIÓN. El objetivo de la terapia es el tratamiento de la hipotensión y reversión de las anomalías electrolíticas y de la deficiencia de cortisol. Se deben infundir por vía intravenosa grandes volúmenes (1 a 3 litros) de solución salina al 0,9% o dextrosa al 5% en solución salina al 0,9% y la administración de hidrocortisona (bolo de 100 mg), seguido de 50 mg cada 6 horas (o 200 mg / 24 horas como infusión continua durante las primeras 24 horas). Si no se dispone de hidrocortisona, las alternativas incluyen prednisolona, prednisona y dexametasona.

INTRODUCTION. Adrenal crisis refers to acute adrenal insufficiency; which is a disorder in which the adrenal cortex does not produce enough steroid hormones (especially cortisol) to meet the body's demands, according to the pathophysiological mechanism it can be classified as primary, secondary and tertiary, being more common in patients with primary adrenal insufficiency. It is a life-threatening emergency that requires immediate treatment. OBJECTIVE. To establish a strategy for the prevention and treatment of adrenal crisis, as well as the ideal pharmacotherapy and its valid alternatives. MATERIAL AND METHODS. A literature review was performed in several highly scientific virtual journals such as Cochrane Library, Cochrane Systematic Reviews Database, MEDLINE through PubMed and ClinicalTrial.gov. Systematic reviews with or without meta-analysis, clinical trials and expert recommendations related to prevention and treatment of adrenal crisis in general were selected. RESULTS. A total of 1819 results were obtained, from which 20 articles with greater validity and replicability in the setting were selected to establish a unified protocol for action. CONCLUSIONS. The aim of therapy is the treatment of hypotension and reversal of electrolyte abnormalities and cortisol deficiency. Large volumes (1 to 3 liters) of 0.9% saline or 5% dextrose in 0.9% saline and administration of hydrocortisone (100 mg bolus), followed by 50 mg every 6 hours (or 200 mg / 24 hours as a continuous infusion for the first 24 hours) should be infused intravenously. If hydrocortisone is not available, alternatives include prednisolone, prednisone, and dexamethasone.

The perception of family members regarding patient's vertigo and imbalance.

INTRODUCTION AND OBJECTIVES: Family members play a major role in the assessment and final result of the treatments of patients. The goal of the present study was to evaluate how much the perception of patients' family members could be trusted regarding the vertigo and imbalance which they experienced. MATERIALS AND METHODS: A cross-sectional study was conducted on 110 patients and their family members who were referred to the Central Vestibular Clinic in Mashhad from April 2018 to September 2019. Family members were categorized as spouses, children, and other relatives of patients. Patients and their family members separately completed the Dizziness Handicap Inventory (DHI) by the paper and pencil method. DHI has a high reliability, validity, and internal consistency. RESULTS: Mean DHI scores of patients and their family members were 45.35±20.24 and 42.01±22.83, respectively. The correlation between DHI scores of patients and family members, except children, were significant (p<.05). CONCLUSION: A relatively weak to moderate relationship between the perception of patients and their family members, except children, was found. They were more aware of the physical aspects of vertigo and imbalance than the emotional ones.

Percepción de los familiares del vértigo y el desequilibrio del paciente / The perception of family members regarding patient's vertigo and imbalance

Introduction and objectives: Family members play a major role in the assessment and final result of the treatments of patients. The goal of the present study was to evaluate how much the perception of patients’ family members could be trusted regarding the vertigo and imbalance which they experienced. Materials and methods: A cross-sectional study was conducted on 110 patients and their family members who were referred to the Central Vestibular Clinic in Mashhad from April 2018 to September 2019. Family members were categorized as spouses, children, and other relatives of patients. Patients and their family members separately completed the Dizziness Handicap Inventory (DHI) by the paper and pencil method. DHI has a high reliability, validity, and internal consistency. Results: Mean DHI scores of patients and their family members were 45.35±20.24 and 42.01±22.83, respectively. The correlation between DHI scores of patients and family members, except children, were significant (p<.05). Conclusion: A relatively weak to moderate relationship between the perception of patients and their family members, except children, was found. They were more aware of the physical aspects of vertigo and imbalance than the emotional ones. (AU)

Introducción y objetivos: Los familiares juegan un papel principal en la evaluación y resultado final de los tratamientos de los pacientes. El objetivo del presente estudio fue evaluar cuánta percepción de los familiares del paciente merece confianza en cuanto al vértigo y el desequilibrio que experimentan los pacientes. Materiales y métodos: Se realizó un estudio transversal en 110 pacientes y sus familiares, que fueron derivados a la Clínica Vestibular Central de Mashhad de abril de 2018 a septiembre de 2019. Los familiares fueron categorizados como esposos, hijos, y otros familiares de los pacientes. Los pacientes y sus familiares completaron separadamente el Dizziness Handicap Inventory con lápiz y papel. Dicho inventario tiene una gran fiabilidad, validez y consistencia interna. Resultados: Las puntuaciones medias del Dizziness Handicap Inventory de los pacientes y sus familiares fueron de 45,35±20,24 y 42,01±22,83, respectivamente. La correlación entre las puntuaciones de Dizziness Handicap Inventory de los pacientes y sus familiares, exceptuando los hijos, fue significativa (p<0,05). Conclusión: Se encontró una relación de relativamente débil a moderada entre la percepción de los pacientes y sus familiares, exceptuando los hijos. Ellos fueron más observadores de los aspectos físicos del vértigo y el desequilibrio, en comparación con los aspectos emocionales. (AU)

Modelo esfuerzo-recompensa, salud y enfermedad en personal sanitario: una revisión sistemática / Effort-Reward Model and health and disease in healthcare workers: A systematic reviews

Scientific literature has shown relation between the perception of a high Effort-Reward Imbalance (ERI) and poor health or disease in healthcare workers. The aim of the study was to carry out a systematic review of how psychosocial risks in the work environment, conceptualized from the effort-reward imbalance model, influence different dimensions of health or illness in health care professionals. Articles that were published between 2010 and 2019 were reviewed by consulting Web of Knowledge, PsycINFO and Scopus databases. 27 scientific articles were included. High ERI and over-commitment are associated with poor health or disease in different dimensions.The main limitations of this review are a possible publication bias and the impossibility of establishing causal relationships between environmental psychosocial risks and health or illness. It is necessary to address the psychosocial risks of the health care work environment and to implement improvement programs to achieve a good balance between efforts and rewards.

La bibliografía científica ha evidenciado asociaciones entre la percepción de un alto desequilibrio esfuerzo-recompensa (Effort-Reward Imbalance, ERI) y mala salud o enfermedad en sanitarios. En este trabajo se realizó una revisión sistemática de estudios que analizaron cómo influyen los riesgos psicosociales del entorno laboral, conceptualizados desde el modelo del desequilibrio esfuerzo-recompensa, en diferentes dimensiones de salud o enfermedad en personal sanitario. Para ello, se revisaron artículos publicados entre 2010 y 2019 consultando las bases de datos Web of Knowledge, PsycINFO y Scopus. Se incluyeron 27 artículos científicos. Un alto ERI y un exceso de compromiso (sobrecompromiso) se asocian con mala salud o enfermedad en personal sanitario. Las principales limitaciones de esta revisión son un posible sesgo de publicación y la imposibilidad de establecer relaciones de causalidad entre los riesgos psicosociales del entorno y la salud o enfermedad. Es necesario evaluar los riesgos psicosociales del entorno laboral de los sanitarios y desarrollar y aplicar programas de intervención para que haya un ajuste adecuado entre esfuerzos y recompensas.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

The link between authentic leadership, organizational dehumanization and stress at work / La relación entre el liderazgo auténtico, la deshumanización organizacional y el estrés en el trabajo

Organizational dehumanization has detrimental consequences for workers' well-being. Previous research has focused on organizational factors that trigger workers' dehumanization or stress at work. However, less is known about the factors that can protect workers against the detrimental effects of dehumanization. In the present research, we performed a correlational study (N = 930) and a direct replication of it (N = 913) to analyze 1) the mediation role of organizational dehumanization in the relationship between authentic leadership and stress at work, and 2) the possible moderation of organizational identification and the frequency of leader-follower interactions. The results indicated that higher authentic leadership predicted lower organizational dehumanization and stress at work. Moreover, organizational dehumanization mediates the relationship between authentic leadership and stress at work (AU)

La deshumanización organizacional tiene efectos muy perjudiciales para el bienestar profesional. Estudios previos se han centrado en identificar factores organizacionales que desencadenan la deshumanización de los trabajadores o el estrés en el contexto laboral. Sin embargo, se conoce muy poco sobre los factores que pueden proteger a los trabajadores de los efectos negativos de la deshumanización. En esta investigación llevamos a cabo un estudio correlacional (N = 930) y una replicación directa (N = 913) para analizar 1) el papel mediador de la deshumanización organizacional en la relación entre liderazgo organizacional y estrés en el trabajo y 2) la posible moderación de la identificación con la organización y la frecuencia de la interacción líder-seguidores. Los resultados mostraron que un mayor nivel de liderazgo auténtico predecía un menor nivel de deshumanización organizacional y de estrés en el trabajo. Además, la deshumanización organizacional media en la relación entre liderazgo auténtico y estrés en el trabajo (AU)

The perception of family members regarding patient's vertigo and imbalance.

INTRODUCTION AND OBJECTIVES: Family members play a major role in the assessment and final result of the treatments of patients. The goal of the present study was to evaluate how much the perception of patients' family members could be trusted regarding the vertigo and imbalance which they experienced. MATERIALS AND METHODS: A cross-sectional study was conducted on 110 patients and their family members who were referred to the Central Vestibular Clinic in Mashhad from April 2018 to September 2019. Family members were categorized as spouses, children, and other relatives of patients. Patients and their family members separately completed the Dizziness Handicap Inventory (DHI) by the paper and pencil method. DHI has a high reliability, validity, and internal consistency. RESULTS: Mean DHI scores of patients and their family members were 45.35±20.24 and 42.01±22.83, respectively. The correlation between DHI scores of patients and family members, except children, were significant (p<.05). CONCLUSION: A relatively weak to moderate relationship between the perception of patients and their family members, except children, was found. They were more aware of the physical aspects of vertigo and imbalance than the emotional ones.

«El convento de las monjas torcidas». Síndrome de Pisa y camptocormia inducido por antipsicóticos / “The bent nuns convent”. Antipsycotic-induced Pisa Syndrome and Camptocormia

La camptocormia y el sídrome de Pisa (pleurothotonus) se caracteriza por una postura anormal en el tronco, con una flexión de la columna toracolumbar de entre 15-45° durante la bipedestación y la marcha que se corrige completamente con el decúbito supino. Se asocia a la enfermedad de Parkinson y a otras enfermedades neurodegenerativas, siendo su fisiopatología incierta. Se presentan 3 casos de camptocormia secundaria a antipsicóticos atípicos (AU)

Camptocormia is an involuntary flexion between 15-45° of the thoracolumbar spine when standing, walking or sitting, which disappears completely in the supine position. Is associated to Parkinson's disease and other neurodegenerative conditions, being its physiopatology unknown. We report three cases of atypical anti-psychotic induced camptocormia (AU)

Alterações hidroeletrolíticas em pessoas com cirrose / Hydroelectrolytic alterations in cirrhotic patients

O objetivo deste estudo foi evidenciar e discutir as principais alterações hidroeletrolíticas em pessoas com cirrose. Trata-se de uma revisão integrativa, de natureza qualitativa. Os artigos foram selecionados por meio da plataforma Medical Literature Analysis and Retrievel System Online. Os principais achados identificados a partir dos artigos selecionados foram a ocorrência de hiponatremia, o mau prognóstico diante da presença de distúrbios hidroeletrolíticos em relação à sobrevida em pessoas com cirrose e a importância da albumina. Indivíduos com cirrose são suscetíveis ao desenvolvimento de distúrbios hidroeletrolíticos devido às mudanças fisiopatológicas da doença e às condições clínicas apresentadas. A hiponatremia e a hipocalemia são os mais recorrentes, destacando, porém, a necessidade de atenção aos demais distúrbios. (AU)

The objective of this study was to show and discuss the main hydroelectrolytic alterations in cirrhotic patients. This is an integrative review, a qualitative study, in which articles were selected at the Medical literature Analysis and Retrieval System Online. The main findings identified in the articles selected were the occurrence of hyponatremia, the poor prognostic, due to the presence of hydroelectrolytic disorders, regarding cirrhotic individuals survival and the importance of albumin. Individuals with cirrhosis are susceptible to the development of hydroelectrolytic disorders due to the pathophysiological alterations of the disease and because of the clinical status presented. Hyponatremia and hypokalemia are the most recurrent, but attention shall be given to the other disorders too. (AU)

"The bent nuns convent". Antipsycotic-induced Pisa Syndrome and Camptocormia. / «El convento de las monjas torcidas¼. Síndrome de Pisa y camptocormia inducido por antipsicóticos.

Camptocormia is an involuntary flexion between 15-45° of the thoracolumbar spine when standing, walking or sitting, which disappears completely in the supine position. Is associated to Parkinson's disease and other neurodegenerative conditions, being its physiopatology unknown. We report three cases of atypical anti-psychotic induced camptocormia.

Identification of patterns related to linkage groups or disequilibrium by factor analysis / Identificação de padrões relacionados a grupos de ligação ou de desequilíbrio por análise de fatores

ABSTRACT: Empirical patterns of linkage disequilibrium (LD) can be used to increase the statistical power of genetic mapping. This study was carried out with the objective of verifying the efficacy of factor analysis (AF) applied to data sets of molecular markers of the SNP type, in order to identify linkage groups and haplotypes blocks. The SNPs data set used was derived from a simulation process of an F2 population, containing 2000 marks with information of 500 individuals. The estimation of the factorial loadings of FA was made in two ways, considering the matrix of distances between the markers (A) and considering the correlation matrix (R). The number of factors (k) to be used was established based on the graph scree-plot and based on the proportion of the total variance explained. Results indicated that matrices A and R lead to similar results. Based on the scree-plot we considered k equal to 10 and the factors interpreted as being representative of the bonding groups. The second criterion led to a number of factors equal to 50, and the factors interpreted as being representative of the haplotypes blocks. This showed the potential of the technique, making it possible to obtain results applicable to any type of population, helping or corroborating the interpretation of genomic studies. The study demonstrated that AF was able to identify patterns of association between markers, identifying subgroups of markers that reflect factor binding groups and also linkage disequilibrium groups.

RESUMO: Padrões empíricos de desequilíbrio de ligação (LD) podem ser utilizados para aumentar o poder estatístico do mapeamento genético. Este trabalho foi realizado com o objetivo de verificar a eficácia da análise de fatores (AF) aplicada a conjuntos de dados de marcadores moleculares do tipo SNP, visando identificar grupos de ligação e blocos de haplótipos. O conjunto de dados SNPs utilizado foi oriundo de um processo de simulação de uma população F2, contendo 2000 marcas com informações de 500 indivíduos. A estimação das cargas fatoriais (loadings) da AF foi feita de duas formas, considerando a matriz de distâncias entre os marcadores (A) e considerando a matriz de correlação (R). O número de fatores (k) a ser utilizado foi estabelecido com base no gráfico scree-plot e com base na proporção da variância total explicada. Os resultados indicam que as matrizes A e R conduzem a resultados similares. Com base no scree-plot considerou-se k igual a 10 e os fatores interpretados como sendo representativos dos grupos de ligação. O segundo critério conduziu a um número de fatores igual a 50, e os fatores interpretados como sendo representativos dos blocos de haplótipos. Isto mostra o potencial da técnica que permite obter resultados aplicáveis ​​a qualquer tipo de população, corroborando a interpretação de estudos genômicos. O trabalho demonstrou que a AF foi capaz de identificar padrões de associação entre marcadores, identificando subgrupos de marcadores que refletem grupos de ligação fatorial e também grupos de desequilíbrio de ligação.

Desequilibrio electrolítico por medicamentos y sustancias tóxicas / Electrolyte imbalance related to drugs and toxic substances

Las alteraciones del equilibrio hidroelectrolítico pueden ser primarias o secundarias al proceso mismo de una enfermedad, a la terapia farmacológica, o en algunos casos a la exposición intencional o no a sustancias tóxicas. El diagnóstico de los trastornos electrolíticos se establece por medio del análisis de laboratorio clínico, pero su interpretación debe ser correlacionada con el contexto clínico del paciente. Los medicamentos pueden interferir con la absorción de los electrolitos, alterar las respuestas hormonales que afectan la homeostasis, o bien impactar de forma directa la función del órgano responsable de mantener el balance electrolítico [1-2]. Entender los mecanismos fisiopatológicos de estas potenciales anormalidades, permite al clínico anticipar, vigilar y corregir de forma temprana, evitando alteraciones graves en el paciente

Acid-base imbalance: a review with proposed unified diagnostic algorithm / Desequilibrio ácido-base: una revisión con el algoritmo de diagnóstico unificado propuesto

Abstract Introduction: Alterations in the acid-base balance are studied in all medical specialties. Although most cases derive from a preexisting pathology, they can also manifest themselves in a primary context. The proper identification of the acid-base disorder allows the pathological process to be characterized. The correct interpretation of the blood gasometry as a technique for monitoring the ventilatory status, oxygenation and acid-base balance of a patient requires the integration of various physicochemical approaches in order to specify a diagnosis, quantify a therapeutic response, and monitor the severity or the progression of a pathological process. Methodology: A literature review was conducted in the PubMed, Scopus and Science Direct databases. The articles were selected according to the title and the abstract and sorted by topics relevant by pathophysiology, divergences, clinical approach, diagnosis, and management. Results: A guide the clinical correlation of the critical patient with the blood gasometry parameters to characterize the acid-base disorder through the proposition of a diagnostic algorithm. Conclusion: The incorporation of the three theories in a diagnostic algorithm facilitates a greater understanding of the pathophysiological mechanisms and allows us to identify a more precise therapeutic objective to correct the underlying disorder in the different clinical contexts of the patient.

Resumen Introducción: las alteraciones del equilibrio ácido-base se estudian en todas las especialidades médicas. Aunque la mayoría de los casos derivan de una patología preexistente, también pueden manifestarse en un contexto primario, por lo que la identificación adecuada del trastorno ácido-base permite caracterizar su proceso patológico. La correcta interpretación de la gasometría sanguínea como técnica para monitorizar el estado ventilatorio, la oxigenación y el equilibrio ácido-base de un paciente requiere la integración de varios enfoques fisicoquímicos para precisar un diagnóstico, cuantificar una respuesta terapéutica y monitorizar la gravedad o la progresión de un proceso patológico. Materiales y métodos: se realizó una revisión de la literatura en las bases de datos PubMed, Scopus y ScienceDirect. Los artículos fueron seleccionados según el título y el resumen, y ordenados por tópicos relevantes por fisiopatología, divergencias, abordaje clínico, diagnóstico y manejo. Resultados: en la literatura consultada se evidenció que el uso de un enfoque lógico y sistemático es necesario para interpretar adecuadamente los parámetros de la gasometría sanguínea e identificar oportunamente el trastorno ácido-base. Conclusión: la incorporación de las tres teorías en un algoritmo diagnóstico facilita una mayor comprensión de los mecanismos fisiopatológicos y permite identificar un objetivo terapéutico más preciso para corregir el trastorno de base en los diferentes contextos clínicos del paciente.

A resposta do setor de saneamento no Brasil à COVID-19 / La respuesta del sector de saneamiento en Brasil a la COVID-19 / The Brazilian sanitation sectors response to COVID-19

Resumo A essencialidade da água à vida talvez tenha ficado ainda mais evidente com a pandemia da COVID-19. Aos prestadores dos serviços de saneamento foi atribuída a responsabilidade de garantir à população a manutenção do abastecimento de água potável, fornecendo meios para que ela pudesse preservar os hábitos de higiene e controlar a propagação do vírus. No entanto, como se poderia garantir que a prestação do serviço não fosse afetada, seja pelo acometimento dos funcionários, seja pela reduzida capacidade de pagamento dos usuários? Este foi o desafio enfrentado pelos prestadores. Diversas foram as medidas adotadas pela Administração Pública para responder no curto prazo a esse desafio, tais como: restrição ao atendimento presencial nas unidades, isenção tarifária aos usuários da tarifa social e suspensão do corte por inadimplência. Contudo todas estas medidas podem desequilibrar as contas dos prestadores de serviço, deixando-os em uma situação de instabilidade que, a princípio, deverá ser sustentada até o fim da pandemia, quando os processos de reequilíbrio econômico-financeiro serão conduzidos pelos reguladores. Estes são e continuarão sendo os principais atores na minimização dos impactos que incidiram sobre os prestadores e na mediação das negociações futuras. Este artigo traz recomendações aos reguladores sobre como tratar os desequilíbrios causados pela pandemia nos futuros processos. Caberá aos reguladores emitir diretrizes claras com relação ao procedimento a ser adotado pelos prestadores, para que possam pleitear o reequilíbrio de suas contas. Deve-se cogitar neste momento a flexibilização das metas contratuais.

Resumen Talvez, la esencialidad del agua para la vida se ha hecho aún más evidente con la pandemia de COVID-19. Los proveedores de servicios de saneamiento tuvieron la responsabilidad de mantener el suministro de agua potable para proporcionarle a la población los medios para mantener sus hábitos de higiene y controlar la propagación del virus. Pero, ¿cómo podría garantizarse que la prestación del servicio no se vería afectada, sea por la disminución de empleados o la capacidad de pago reducida de los usuarios? Este fue el desafío planteado a los proveedores. La Administración Pública tomó varias medidas para responder rápidamente a este desafío. Las iniciativas más adoptadas fueron la restricción del servicio presencial, la exención de tarifas para los usuarios vulnerables socioeconómicamente y la suspensión del corte por incumplimiento. El hecho es que todas las medidas pueden desequilibrar las cuentas de los proveedores de servicios, dejándolos en una situación de inestabilidad que, en principio, debería mantenerse hasta el final de la pandemia, cuando los reguladores llevarán a cabo los procesos de reequilibrio económico y financiero. Los reguladores son y serán los principales actores para minimizar los impactos en los proveedores y mediar en las negociaciones futuras. Este artículo proporciona recomendaciones a los reguladores sobre cómo abordar los desequilibrios causados por la pandemia en procesos futuros. Competirá a los reguladores emitir pautas claras con respecto al procedimiento que adoptarán los proveedores para que puedan reclamar el reequilibrio de sus cuentas. En este momento, se debe considerar la flexibilización de los objetivos contractuales.

Abstract The COVID-19 pandemic has evidenced the essentiality of water more prominently. Service providers were responsible for maintaining drinking water supply to the population to maintain good hygiene habits and control the spread of the virus. However, the challenge for providers was guaranteeing the service would not be affected, either by employees falling ill or by users unable to pay for the service provision. Public administration adopted several measures to respond in the short term to this challenge. The actions most frequently observed were the restriction of in-person services, payment exemption for vulnerable users, and suspension of procedures against non-payment. The measures may have unbalanced the accounts of the service providers, leaving them in a situation of instability that, in principle, should be sustained until the end of the pandemic, when the regulators will conduct the process to re-establishing the financial balance. The regulators are and will be the main actors in minimizing the impacts on providers and in mediating future negotiations. This article provides recommendations to regulators on how to address the imbalances caused by the pandemic in future processes. Regulators will have to issue clear guidelines regarding the procedures that providers will adopt to rebalance their accounts. Consideration should be given at this time to making contractual targets more flexible.