[Paniculitis as manifestation of prolonged febrile syndrome: Case report]. / Paniculitis como manifestación de síndrome febril prolongado en pediatría: Caso clínico.

Fever of unknown origin (FUO) is defined as fever over 7 to 10 days without a diagnosis despite a complete initial study. The most frequent causes are infections, autoimmune and tumors. Even though most cases are self-limited there is a minority that has an underlying etiology with an ominous forecast, encouraging a systematized study. OBJECTIVE: To report a rare case of a boy who presented fever of unknown origin associated to panniculitis and was diagnosed of subcutaneous panniculitis-like-T cell lymphoma and to emphasis the importance of a sequential study of FUO, in order to reach a diagnosis in patients who need a timely intervention. CLINICAL CASE: A ten year old boy, previously healthy, presented subcutaneous nodular lesions of 2 month of evolution, located in abdominal region and extremities, given few symptoms, associated with prolonged fever. He was hospitalized for proper study, in first instance infectious and immune causes were discarded and through lesions biopsy the diagnose of subcutaneous panniculitis-like-T cell lymphoma was reached. CONCLUSION: When FUO is diagnosed, most prevalent causes must be discarded. Then, differential diagnosis, such as immune and neoplasic etiologies, have to be considered. If FUO is associated to elemental nodular lesions, biopsy must be indicated early, in order to find potential malignant cases, avoiding therapeutic delay.

Paniculitis como manifestación de síndrome febril prolongado en pediatría: Caso clínico / Paniculitis as manifestation of prolonged febrile syndrome: Case report

El síndrome febril prolongado (SFP) se define en pediatría como la presencia de un episodio febril de al menos 7-10 días de evolución sin diagnóstico etiológico pese a un estudio inicial completo. La etiología más frecuente es la infecciosa, seguida por causas inmunoreumatológicas y neoplásicas. En la mayoría de los casos la evolución suele ser benigna y autolimitada, sin embargo una minoría presenta una causa subyacente con pronóstico sombrío, determinando necesidad de un estudio sistematizado. Objetivo: Presentar caso clínico de un escolar con SFP asociado a paniculitis y enfatizar importancia de estudio secuencial de SFP para pesquisar pacientes que requieren intervención oportuna. Caso clínico: Escolar de sexo masculino, 10 años de edad, previamente sano, quien consultó por cuadro de 2 meses de evolución, caracterizado por aparición de lesiones nodulares en abdomen y extremidades, poco sintomáticas, asociado a fiebre prolongada. Se hospitalizó para estudio, descartando causa infecciosa y reumatológica. Se confirmó diagnóstico de linfoma paniculítico de células T mediante biopsia y análisis histológico e inmunohistoquímico de las lesiones. Conclusiones: Al diagnosticar SFP se debe descartar causas más prevalentes (infecciosa) y luego plantear como diagnóstico diferencial etiología reumatológica y neoplásica. Si SFP se asocia a lesiones elementales nodulares, plantear precozmente la biopsia de modo de pesquisar potencial causa maligna y evitar retraso terapéutico.

Fever of unknown origin (FUO) is defined as fever over 7 to 10 days without a diagnosis despite a complete initial study. The most frequent causes are infections, autoimmune and tumors. Even though most cases are self-limited there is a minority that has an underlying etiology with an ominous forecast, encouraging a systematized study. Objective: To report a rare case of a boy who presented fever of unknown origin associated to panniculitis and was diagnosed of subcutaneous panniculitis-like-T cell lymphoma and to emphasis the importance of a sequential study of FUO, in order to reach a diagnosis in patients who need a timely intervention. Clinical case: A ten year old boy, previously healthy, presented subcutaneous nodular lesions of 2 month of evolution, located in abdominal region and extremities, given few symptoms, associated with prolonged fever. He was hospitalized for proper study, in first instance infectious and immune causes were discarded and through lesions biopsy the diagnose of subcutaneous panniculitis-like-T cell lymphoma was reached. Conclusion: When FUO is diagnosed, most prevalent causes must be discarded. Then, differential diagnosis, such as immune and neoplasic etiologies, have to be considered. If FUO is associated to elemental nodular lesions, biopsy must be indicated early, in order to find potential malignant cases, avoiding therapeutic delay.

The role of post-migration living difficulties on somatization among first-generation immigrants visited in a primary care service.

The role of post-migration living difficulties (PMLD) on somatization was studied in 101 first generation immigrants visited in primary care. Premigratory traumas and post-traumatic stress disorder (PTSD) were also assessed. About one third of patients somatized. Sociodemographic variables were similar in somatizers and non-somatizers. Premigratory traumas, PTSD and the likelihood to report at least one serious or very serious PMLD were higher in somatizers. Four kinds of PMLD were more frequent in somatizers: worries about unavailability of health assistance, working problems, discrimination and poor social help. Traumas and PTSD influenced the effect of PMLD on somatization. Findings suggest that in specific samples of primary care immigrants severe premigratory traumas increase the sensitivity to PMLD and in turn distress due to PMLD amplifies the tendency to somatize.

[Immigration, trauma, living difficulties and psychopathology: a preliminary study in a primary care setting]. / Immigrazione, traumi, difficoltà vitali e psicopatologia: uno studio preliminare in un setting di medicina generale.

AIM: Investigate the prevalence of Post-Traumatic Stress Disorder (PTSD), anxiety, depression and somatizations in a sample of immigrants visited in a transcultural primary care service. The relationship among psychopathological symptoms, pre-migratory events and post-migration living difficulties is also considered. METHODS: We studied 101 outpatients, attending the "Caritas" Primary Care Unit for immigrants in Rome. All participants fulfilled a socio-demographic questionnaire, a checklist of traumatic events (Harvard Trauma Questionnaire, HTQ), a checklist of post-migration living difficulties (Post-Migration Living Difficulties, PMLD) and the following questionnaires: the HTQ for the assessment of post-traumatic symptoms, the Hopkins Symptom Checklist (HSCL-25) for anxiety and depression, the Bredford Somatic Inventory (BSI) for somatization. RESULTS: 40 patients (39.60%) had an anxiety disorder, 47 (46.13%) a depressive disorder, 16 (15.84%) a PTSD and 39 (38,6%) a somatization syndrome. All these syndromes were significantly correlated. The number of traumatic events and of post-migration difficulties significantly increased the scores on the psychopathological scales. DISCUSSION: The prevalence of psychopathological syndromes in our primary care transcultural unit was high. This not only in refugees, but also in immigrants for other reasons. Moreover, the levels of psychopathological distress were significantly influenced by the number of pre-migratory traumas and of living difficulties in the host country.

The relationship between somatization and posttraumatic symptoms among immigrants receiving primary care services.

Traumatic experiences and somatization are related in studies on complex trauma, though this relation is rarely studied in immigrants. The relationship between somatization and self-reported traumatic experiences and posttraumatic symptoms in patients attending a primary care service for immigrants was studied. The sample consisted of 101 patients attending a primary healthcare service dedicated to immigrants. Participants completed two self-assessment questionnaires specifically designed for use in transcultural research: the Bradford Somatic Inventory and the Harvard Trauma Questionnaire. Both were translated and back-translated into eight languages. Somatization was significantly related to traumatic events and posttraumatic symptoms. In primary care centers for immigrants, physicians should give particular attention to somatization as a possible sign of unreported posttraumatic symptoms.

[The influence of phychological features and learning styles on the academic performance of medical students]. / Influyen las características psicológicas y los estilos de aprendizaje en el rendimiento académico de los estudiantes de medicina? Un estudio retrospectivo.

BACKGROUND: The degree of difficulty we experience while learning different concepts and skills depends, among other things, on our psychological features and learning style. This may be particularly true for medical students, whose formation involves the acquisition of multiple cognitive, affective and psychomotor skills. AIM: To assess whether the psychological features and learning styles of medical students are associated with their academic performance. SUBJECTS AND METHODS: The psychological preferences and learning styles of 66 students of the 2001-graduating cohort were determined with the Myers Briggs Type Inventory (MBTI) and the Kolb Learning Style Inventory (LSI), respectively. The academic performance was assessed by the Calificación Médica Nacional (CMN), Chile and by the marks obtained during the Basic (1st to 3rd), Preclinical (4th and 5th) and Clinical (6th and 7th) years of undergraduate training. RESULTS: The psychological features, together with the sex of students were found to be associated with the performance in the Preclinical and Clinical years, and to the CMN. In men, the interest and ability to communicate with people and the concern for harmony, and in women the tendency to function in a systematic and orderly way are the features associated to high academic performance. No associations were found between learning styles and academic performance. CONCLUSIONS: The finding that the psychological preferences of medical students are relevent to their academic performance opens a new perspective to analyze the medical education and to design programs aimed at improving learning.

[Psychological features and cognitive styles of students entering medicine and other careers at the Pontificia Universidad Católica de Chile]. / Características psicológicas y estilos cognitivos de estudiantes de medicina y de otras carreras de la Pontificia Universidad Católica de Chile.

BACKGROUND: The similarity between the psychological features of medical school freshmen of different cohorts suggests that Medicine attracts students with specific psychological types. However, it is also possible that medical students are similar to the students admitted to any other career with high admission requirements. AIM: To determine if medical school freshmen are different from those of Engineering, Architecture, Psychology and Journalism. SUBJECTS AND METHODS: The Spanish version of the Myers Briggs Psychological Type Indicator (MBTI) was applied to two cohorts of Medical School freshmen (90 students of the 2000 cohort and 91 students of the 2001 cohort) and to a sample of 669 freshmen from the careers of Engineering, Psychology, Architecture and Journalism. RESULTS: Students entering Medical School are similar to the students admitted to Engineering and different from those that entered Architecture, Psychology and Journalism in the Pontificia Universidad Católica de Chile in 2000 and 2001. Medicine attracts a larger proportion of concrete and practical students that have an objective and systematic approach to study and to life in general. Unlike Medicine, Psychology and Architecture attract more students that have a cognitive style characterized by an intuitive perception, and that face life with an open and flexible attitude. CONCLUSIONS: This study reveals that the psychological features of undergradutate students are associated to their career choice. These psychological variables, therefore, may be relevant to the students' vocational preferences and possibly to their future specialty choice.

[Psychological types and learning styles of students entering medical school at the Pontificia Universidad Católica de Chile]. / Tipos psicológicos y estilos de aprendizaje de los estudiantes que ingresan a medicina en la Pontificia Universidad Católica de Chile.

BACKGROUND: Psychological type and learning style influence the way students perceive and process information. However, research in medical education in Chile still does not put enough emphasis in the study of these variables. AIM: To characterize the psychological types and learning styles of the students admitted to a Medical School. SUBJECTS AND METHODS: The Myers Briggs Type Indicator (MBTI) and the Kolb's Learning Styles Inventory (IEA) were administered to the 270 students admitted from 2000 to 2002 to the medical school of the Pontificia Universidad Católica de Chile. RESULTS: Fifty five percent of our students are concentrated in 4 of the 16 psychological types described. These students are characterized by the ability to base their decisions upon logical and objective reasoning (Thinking [T]) and to face life in a structured and decided way (Judging [J]). Only 10% of the students have preferences opposite to T and J. These students base their decisions on the preservation of harmony and teamwork (Feeling [F]) and have a flexible attitude towards life (Perceiving [P]). The remaining 35% have types with pairs of preferences TP and FJ. With regard to learning styles, more than two thirds of our students are Assimilators or Convergers. These learners tend to assimilate large amounts of information and abstract the main concepts, rather than to pay attention to concrete details. In general, our students are more reflective than active; they evaluate thoroughly all alternatives before making a decision. CONCLUSIONS: The psychological types and learning styles of medical students cluster around specific patterns whose features may either favor or hamper a specific learning. Knowledge of the differences in psychological types and learning styles of students may provide teachers with a new and valuable tool for improving learning and contributing to the academic success of students.

[Health care resource allocation in Chile. Ethical considerations in decision making]. / Asignación de recursos en salud en Chile. Consideraciones éticas en la toma de decisión.

BACKGROUND: The inclusion of ethical aspects in the world health care reform is currently being discussed. AIM: To analyze the ethical component of health care decision making in Chile. MATERIAL AND METHODS: A qualitative analysis of interviews with 4 health service directors, 4 public hospital directors and 1 sub director. Inquiries to 16 public hospital ethics committees, about importance of ethical components in decision making, role of ethics committees in financial issues and the feasibility of incorporation explicit ethical considerations in decision making. RESULTS: There is an absence of explicit ethical criteria in decision making. There is little participation of directors in these issues and lack of information. Although ethical aspects are considered relevant, they are not taken into account. Ethics committees are mostly dedicated to evaluate research protocols. The community is not mentioned as a relevant actor in decision making about resource allocation. CONCLUSIONS: Health service directors and all health care personnel should be trained in bioethics. These aspects should be incorporated to their daily work.