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El propósito de este estudio fue conocer el efecto de la tensión laboral en el bienestar del sueño y su relación con algunas características sociodemográficas como el género, el cargo laboral y la edad. La muestra del estudio fue de 119 participantes de diversas organizaciones en las zonas central y metropolitana de Puerto Rico (64% hombres, 36 % mujeres). La edad promedio de los participantes fue de 37 años y, de ellos, el 64% ostentaba un grado universitario. Se utilizaron dos instrumentos: uno como Indicador del Bienestar del Sueño y otro como Indicador de Demandas-Control-Apoyo. Se establecieron cuatro hipótesis de investigación y se confirmaron las cuatro, encontrando que el bienestar del sueño se afecta por la tensión laboral. Asimismo se corroboró la presencia de diferencias derivadas del género y el cargo laboral. También se encontró que la edad tiene una relación baja con el sueño. Se recomienda hacer más investigación sobre el tema

The purpose of this study was to know the effect of work stress on sleep well-being and its relationship with some sociodemographic characteristics such as gender, job position and age. The sample of the study was 119 participants from different organizations in the central and metropolitan areas of Puerto Rico (64% men, 36% women). The average age of the participants was 37 years and, of them, 64% held a university degree. Two instruments were used: one as a Sleep Wellbeing Indicator and the other as Demand Indicator-Control-Support. Four research hypotheses were established and the four were confirmed, finding that sleep wellbeing is affected by work stress. Likewise, the presence of differences derived from gender and job position was corroborated. It was also found that age has a low relation to sleep. It is recommended to do more research on the subject

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BACKGROUND: Portomesenteric vein thrombosis (PMVT) is a rare but severe complication after laparoscopic bariatric surgery, with potentially serious consequences. We aimed to describe the incidence, clinical features, management, outcome, and midterm follow-up in patients with PMVT after laparoscopic sleeve gastrectomy (LSG). METHODS: This retrospective and descriptive study included patients who underwent LSG between November 2009 and July 2015 and developed PMVT. The following data were analyzed: age, gender, body mass index (BMI), thrombosis risk factors, surgical technique, thromboembolic prophylaxis, primary surgery outcomes, clinical features, treatment, thrombophilia testing results, and follow-up findings, including imaging and endoscopic findings. RESULTS: A total of 1236 patients underwent LSG, and 5 (0.4 %) developed PMVT. The mean age was 34.4 years, and 3 patients were women. The mean BMI was 38.5 kg/m2. Two patients had received hormonal contraceptive treatment. Four patients had a history of smoking. All of the patients received anticoagulant treatment, and none required surgery. The mean hospitalization duration was 7.6 days. Two patients showed complete recanalization. One patient showed portal cavernomatosis on delayed images. Two patients had a positive thrombophilia test. No portal hypertension endoscopic findings were observed. CONCLUSIONS: PMVT is a rare complication, for which smoking was identified as a predominant risk factor. Early diagnosis and prompt anticoagulant therapy could lead to a dramatic decrease in the incidence of intestinal infarction, mortality, and extrahepatic portal hypertension in the near future. However, careful follow-up is necessary to evaluate the impact of PMVT on long-term patient outcomes.

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Thyroid storm is a rare and potentially fatal disease characterized by severe clinical manifestations of thyrotoxicosis. The most common cause of hyperthyroidism is Graves's disease (GD) and infections are the most important precipitating factor. A woman of 33 years with history of hyperthyroidism, hypertension and morbid obesity. She was treated with propylthiouracil for one year, and then suspended controls and treatment 2 years ago. Consult for 2 weeks characterized by dyspnea, cough and expectoration, plus an episode of generalized tonic-clonic seizure. In postictal state, persists with dyspnea and chest pain, which is brought to the emergency room. It is hypotensive, with fever and tachycardia, SatO2 60% on room air. It is intubated and connected to invasive mechanical ventilation. It evolves with monomorphic ventricular tachycardia, requiring cardioversion twice, recovering sinus rhythm. Imaging studies reported bilateral lung disease. CT scan brain and lumbar punture are normal. As is treated as septic shock lung focus. Among its tests: TSH 0.01 mIU/L, T4 T 23.9 ug/dL, T4L 4.77 ng/dL, T3 5.38 ng/ml, with Wartofsky Score: 90. It is managed as TS, treatment is initiated with methimazole, Propranolol, Hydrocortisone. Thyroid ultrasound shows: Goiter with cold nodules. In addition has positive TRAb. She recovers both of system cardiovascular and their respiratory infection. The patient is prepared with amiodarone and lugol for total thyroidectomy. Concordant biopsy with GD.

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Introducción: El sobrepeso y la obesidad son cada vez más prevalentes y colaboran a mayor riesgo cardiovascular. No existen estudios sobre estas patologías en la población atacameña, (tercer grupo más numeroso entre las etnias originarias en Chile). Objetivo: Evaluar niveles de sobrepeso y obesidad de la población de etnia atacameña y comparar el estado nutricional de atacameños ubicados en una región Rural (Alto el Loa), y una urbana (Calama). Metodología: Se analizaron exámenes de medicina preventiva del adulto (EMPA) de postas rurales de Alto El Loa, y del Centro Comunitario de Salud Familiar (CECOF) de Calama en los años 2007 y 2008. Se seleccionaron pacientes con ambos apellidos de origen ataca-meño, quienes además tuvieran padres y abuelos (maternos y paternos) con apellidos del mismo origen. Se midió peso, talla, IMC, circunferencia de cintura (CC), presión arterial (PA), glicemia y colesterol plasmáticos. Resultados: 43 sujetos de Alto el Loa (AL) y 98 sujetos de Calama cumplieron criterios de selección. En el grupo Alto El Loa el peso fue normal en 30 por ciento de los sujetos, hubo sobrepeso en 46,5 por ciento y obesidad en 23,5 por ciento. Los valores correspondientes para el grupo de Calama fueron 25 por ciento, 42,7 por ciento y 32,3 por ciento, respectivamente (N.S.). Al comparar ambos grupos, solo hubo diferencias significativas en colesterol plasmático (163 mg/dl AL vs 188 mg/dl Calama) y CC en hombres (110cm AL vs 99,3cm Calama) y mujeres (113cm AL vs 90,6cm Calama). Conclusión: Ambos grupos de atacameños presentaron más de un 70 por ciento de malnutrición por exceso. Solo hubo diferencias entre ambos grupos en CC y colesterol total. Destaca la CC mayor en Alto El Loa (zona de menor mestizaje), que sugieren un genotipo atacameño con tendencia a mayores niveles de grasa abdominal.

Background: Overweight and obesity are cardiovascular risk factors becoming more prevalent in later years. There are no studies related to this problem in the atacameña population, which is the third largest group among original inhabitants in Chile. Aim: to evaluate prevalence of overweight and obesity in "atacameños" of northern Chile and to compare these findings in a rural (Alto el Loa) and an urban locations (Calama). Methods: The data obtained from preventive medical examinations performed in primary care centers of Alto el Loan and Calama during 2007 and 2008 were used for the analysis. The subjects included had both paternal and maternal grand parents with "atacameños" surnames. Weigth, height, body mass index, waist circumference, blood pressure, blood glucose level and serum cholesterol were determined. Results: 43 subjects from Alto el Loa and 98 subjects from Calama were included. Weight was normal in 30 percent of subjects from Alto el Loa; overweight was present in 46.5 percent and obesity in 23.5 percent. Corresponding values for subjects from Calama were 25 percent, 42.7 percent and 32.3 percent (NS). The only significantly different variables were serum cholesterol (163 mg/dl in Alto el Loa vs 188 mg/dl in Calama) and waist circumference: (110cm in Alto el Loa vs 99,3 cm in Calama for males, and 113cm in Alto el Loa vs 90.6cm in Calama for women). Conclusion: malnutrition leading to overweight and obesity affected 70 percent of "atacameños". Lower serum cholesterol levels and increased waist circumference suggest the presence of factors leading to accumulation of abdominal fat in the rural population.

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BACKGROUND: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever. AIM: To report the clinical and laboratory features of eight patients with cat-scratch disease. MATERIAL AND METHODS: Review of the medical records of eight patients (aged 22 to 57 years, six males) with a serological diagnosis of cat-scratch disease (an IgG titer over 1:256, by immunofluorescence). RESULTS: Only five patients recalled having had contact with cats. Seven had fever and weight loss. Six had excessive sweating and five had chills. Seven had painfully enlarged lymph nodes mainly in submandibular and axillary regions. All had an increased C reactive protein and six had elevated erythrocyte sedimentation rate. Five had leukocytosis and four an elevated serum lactate dehydrogenase. The disease subsided in all, even in one patient that did not receive antimicrobials. CONCLUSIONS: Cat-scratch disease should be considered in the differential diagnosis of adult patients with lymph adenitis and fever.

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El objetivo de este artículo es revisar los efectos y rasgos tóxicos descritos en la literatura y establecer un manejo clínico adecuado y específico para la intoxicación con estos medicamentos.

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