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.

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.

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.

Lo studio valuta il ruolo delle difficoltà di vita post-migratorie (PMLD) in 101 immigrati visitati in medicina generale. Sono stati considerati anche i traumi premigratori e il disturbo post-traumatico da stress (PTSD). Circa un terzo dei pazienti somatizza. Le variabili sociodemografiche sono simili tra somatizzatori e non. I traumi premigratori, il PTSD e la probabilità di avere almeno una PMLD grave o molto grave sono aumentati nei somatizzatori. Nei somatizzatori sono più frequenti quattro tipi di PMLD: paura di non ricevere assistenza medica, difficoltà lavorative, discriminazione e scarsa assistenza sociale. I traumi e il PTSD influenzano l'effetto delle PMLD sulle somatizzazioni. I risultati suggeriscono che, in campioni specifici di immigrati visitati in medicina generale, gravi traumi premigratori aumentino la sensibilità alle PMLD e che il disagio dovuto alle PMLD amplifichi la tendenza a somatizzare.

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 undergraduate 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 (Rev Méd Chile 2004; 132: 809-16)

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

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 (Rev Méd Chile 2002; 130: 181-190)