Síndrome de DRESS: eritema cutáneo, fiebre y hepatitis asociado a lamotrigina: reporte de dos casos y revisión de la literatura / DRESS syndrome: skin rash, fever and acute hepatitis associated to lamotrigine: report of two cases and review of the literature

DRESS syndrome is an infrequent adverse drug reaction but in some cases may be life-threatening. It is characterized by cutaneous rash, systemic symptoms and eosinophilia. It is usually caused by aromatic anticonvulsants, sulfonamides and some antiviral drugs, among others. In this article we present two cases of drug induced hypersensitivity syndrome with rash, systemic symptoms (DRESS) associated to lamotrigine therapy with hepatic involvement and a review of the literature. The first case is a 78 year-old woman, presenting with myalgia, fever, abdominal pain and skin rash on her face and extremities. Labora¬tory tests revealed alteration of hepatic profile with hepatocellular pattern. After ruling out other causes, she recognized recent use of lamotrigine. The drug was withdrawn and she had a favourable evolution. The second case is a 30 year-old woman being treated for depression who presented with rash, adenopathies, fever and alteration of hepatic profile twenty four days after starting lamotrigine. Infectious causes were ruled out and she had a good response to corticosteroid treatment.

El síndrome de DRESS es una reacción adversa a medicamentos, poco frecuente pero potencialmente letal. Se caracteriza por eritema cutáneo, síntomas sistémicos y eosinofilia. Suele ser producido por los anticonvulsivantes aromáticos, sulfonamidas y algunos fármacos antivirales, entre otros. En este artículo presentamos dos casos de DRESS secundario a lamotrigina con compromiso hepático y revisión de la literatura. El primero de ellos, una mujer de 78 años, consulta por mialgias, fiebre, dolor abdominal y eritema maculopapular en cara y extremidades. Los exámenes de laboratorio revelaron alteración de pruebas de función hepática con patrón hepatocelular. Luego de descartar otras causas, la paciente reconoció uso reciente de lamotrigina. Se suspendió la droga y evolucionó favorablemente. El segundo caso es una mujer de 30 años en tratamiento por trastorno depresivo quien, veinticuatro días post-inicio de lamotrigina, comienza con eritema, adenopatías, fiebre y alteración de pruebas de función hepática, excluyéndose etiologías infecciosas; se inicia tratamiento corticoesteroidal con buena respuesta.

[Management of occupational stress among patients with cardiac diseases]. / Gestione dello stress occupazionale in pazienti cardiopatici.

The object of our study was the evaluation of psycophysic condition, stress perception and coping in a sample of subject in cardiac rehabilitation. Our study recruited 48 worker patients (44 male, M = 50.5 +/- 8.8; 4 female, M = 50.8 +/- 8.7). They were submitted to: 1) cardiac evaluation and rehabilitation in DH regimen; 2) psychological assessment; 3) work's characteristic evaluation. The evaluation were made at the moment of recruitment and six month later 42 subjects went back to work after 81.8 +/- 49 days; 2 subjects had a worsening of their clinic conditions not consistent with an occupational resumption; 4 subjects didn't go back to work. In the 42 worker subjects we have find a significant decrease of anxiety (p < 0.019) and depression levels (p < 0.004); a significant improvement of Quality of Life perception in its physical (p < 0.000) and psychic aspects (p < 0.021) and an improvement about the ability to reorganize the work to better ménage stress (p < 0.012).

Autoevaluación sobre formación en medicina paliativa en una cohorte de residentes / Self assessment about proficiency on palliative care in a cohort of residents

Background: Little is known about the status and level of medical education on palliative care, symptom control and aspects of end of life care provided by medical school programs in Chile. Aim: To determine if a cohort of residents had palliative care and end of life care education during pre graduate and post graduate training. Residents were also asked to self assess their proficiency in these areas. Material and Methods: In 2002, we contacted 200 of a total of 327 residents of the postgraduate programs of the Pontificia Universidad Catolica de Chile. They were asked to anonymously answer a preformed questionnaire addressing different aspects related to palliative care, symptom control and end of life issues. Results: Less than 25 percent of residents received some degree of palliative care education during their studies, and approximately half of them considered that the level of proficiency reached was less than 25 percent. This contrasted with a good self assessment in the management of pain and gastrointestinal symptoms. For the treatment of the anorexia-cachexia syndrome and delirium, approximately 50 percent of the cohort had a mean self assessment score of 3 in a scale of 1 to 7. More than 80 percent of residents considered that palliative medicine education is important for their medical career. Conclusions: Chilean medical schools must improve palliative care and end of life training as part of their mandatory curriculum in both the pre and post graduate levels.

[A project for the occupational reintegration of impaired subjects]. / Un progetto per il reinserimento occupazionale di soggetti svantaggiati.

In this paper we have explained the criteria for an integrated socio-medical intervention (Local Health Care Institution, Cooperation, Scientific Institute of Care and Research) within the frame of a Communitary Initiative titled "Local network for return to work of persons with social disadvantage". The goal of the Initiative is to "create and experiment new facilities to support intervention strategies for return-to-work, and to start a virtuous circle matching the demands of both the disadvantaged persons and the local labour market". In the paper we describe the functional evaluations, performed in the Medical Center of Pavia by specialists in the field of Rehabilitation, Psychology and Ergonomy, and the following return-to-work phase, performed by operators of the Cooperation.

[Work and alcohol: considerations on a caseload of patients undergoing treatment]. / Lavoro e alcol: considerazioni su una casistica di pazienti in trattamento.

An enquiry into alcohol dependent subjects admitted to the clinical wards of the first section of Occupational Medicine belonging to Medicina Preventiva Occupazionale e di Comunità of University of Pavia for an alcohol disaddiction treatment has been performed through a phone interview. 289 patients have been contacted and time elapsed from admission to interview was one to three years. The questions focused alcohol abstinence, occupational position before and after admission, any improvement in the work sphere (relationship with the collegues), any feeling of empowerment of the work abilities and any increase in the responsibilities load. From our results we can conclude that alcohol disaddiction carried on during admission has positively contributed to the reinstatement of alcoholics patients.

Mortalidad por cáncer vesicular en Chile y su relación con las tasas de colecistectomía: análisis de la última década / Gallbladder carcinoma mortality rates and it relation with cholecystectomy rates

Extrahepatic biliary trract cancer (aminly gallbladder cancer) mortality rates have increased from 7.84 x 100.000 to 9.6 x 100.000 in Chile durignthe last decade. The most significant risk factor for gallbladder cancer is gallstone disease. However, no apparent changes in the prevalence of gallstone disease has ocurred during this period. In contrast, cholecystectomy rates have consistently decreased during the decade. The aim of this study was to correlate extrahepatic biliary tract cancer mortality and cholecystectomy rates of previous years during the last decade in our Country. The best correlation coefficient between both variables was obtained when mortality was correlated with cholecystectomy rates two years prior to the mortality rate (r= -0.92). This finding is consistent with the hypothesis that changes in the number of cholecystectomies performed in a specific geographic area would reciprocally change gallblader cancer mortality rate. It was estimated that increasing cholecystectomies by 12.500 per year would decrease at mortality rate from this cancer by approximately 1.0 x 100.000 two years in Chile