ABSTRACT
La enfermedad de Lemierre, descrita por primera vez en el año 1936 por el médico Francés André Lemierre, es una complicación inusual de una infección orofaríngea, que progresa con tromboflebitis séptica secundaria e infecciones embólicas frecuentes. Es producida por microorganismos anaerobios, siendo el Fusobacterium necrophorum el germen aislado con mayor frecuencia. Para su diagnóstico, además del estudio microbiológico, se emplean los estudios por imágenes como la ecografía Doppler y la tomografía computada (TC). La antibióticoterapia precoz y prolongada, a dosis altas, ha mejorado considerablemente el pronóstico; no obstante, en ocasiones, se hace necesario recurrir a la escisión quirúrgica de las venas yugulares. En la actualidad con la terapia antimicrobiana, casos como éste son cada vez más raros, incluso a veces olvidados, pero dada su gravedad deben sospecharse ante cuadros faríngeos de evolución tórpida
Subject(s)
Tomography, X-Ray Computed , Ultrasonography, Doppler , Lemierre SyndromeABSTRACT
ABSTRACT Coral reefs are one of the most vulnerable ecosystems to ocean warming and acidification, and it is important to determine the role of reef building species in this environment in order to obtain insight into their susceptibility to expected impacts of global changes. Aspects of the life history of a coral population, such as reproduction, growth and size-frequency can contribute to the production of models that are used to estimate impacts and potential recovery of the population, acting as a powerful tool for the conservation and management of those ecosystems. Here, we present the first evidence of Siderastrea stellata planulation, its early growth, population size-frequency distribution and growth rate of adult colonies in Rocas Atoll. Our results, together with the environmental protection policies and the absence of anthropogenic pressures, suggest that S. stellata population may have a good potential in the maintenance and recovery in the atoll. However, our results also indicate an impact on corals' recruitment, probably as a consequence of the positive temperature anomaly that occurred in 2010. Thus, despite the pristine status of Rocas Atoll, the preservation of its coral community seems to be threatened by current global changes, such as more frequent thermal stress events.
Subject(s)
Animals , Climate Change , Anthozoa/anatomy & histology , Anthozoa/growth & development , Coral Reefs , Time Factors , Atlantic Ocean , Brazil , Environmental Monitoring , Population Growth , Geographic MappingABSTRACT
Resumen La rehabilitación integral de las personas con trauma raquimedular requiere integrar lo físico, emocional y social, es necesario indagar como estos factores se interrelacionan y afectan su calidad de vida. El objetivo fue determinar la interrelación de los factores fisiológicos y psicológicos en la rehabilitación integral de las personas con trauma raquimedular a partir de la Teoría de los Síntomas Desagradables de Elizabeth Lenz. Estudio descriptivo transversal, con 51 personas. Las variables independientes fueron clasificación ASIA, nivel de la lesión y sexo; las variables dependientes los factores fisiológicos y psicológicos. Se aplico análisis univariado y la prueba t para identificar las diferencias estadísticamente significativas. La disrreflexia autonómica, las disfunciones vesicales e intestinales generan estados de depresión y expresión de ira especialmente en los hombres, es muy importante brindar soporte para el cuidado de estos factores durante la rehabilitación integral.
Abstract The comprehensive rehabilitation of people with spinal cord trauma takes into account the person as a whole being in the physical, emotional and social sense; therefore, it is necessary to investigate how these factors interact and affect their quality of life. The objective was determining the interrelation between the physiological and psychological factors on rehabilitation of people with spinal cord trauma from the theory of unpleasant symptoms Elizabeth Lenz. A transversal descriptive study, with 51 people. The independent variables were ASIA classification, the level of injury, and gender; the dependent variables were the physiological and psychological factors. A univariate analysis, the t- test was applied to identify statistically significant differences. The autonomic dysreflexia and both bladder as well as bowel dysfunction, are symptoms that generate states of depression and expression of anger, and are more evident in men. The support is required in the care of these factors during la integral rehabilitation.
Subject(s)
Psychological Phenomena , Spinal Cord , Spinal Cord Injuries , Autonomic Dysreflexia , Physiological Phenomena , Psychology , Quality of Life , Rehabilitation , Signs and Symptoms , Affect , Depression , MeningesABSTRACT
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
Subject(s)
Humans , Decision Making, Organizational , Health Care Rationing/methods , Health Resources , Health Services Accessibility , Ethics Committees/trends , Ethical ReviewABSTRACT
El principio de la confidencialidad ha sido siempre uno de los grandes valores éticos de la práctica médica. Si pudiéramos señalar el comienzo de esta obligación, necesariamente debemos recurrir a la tradición hipocrática, cuya mayor expresión la encontramos en el Juramento de Hipócrates. La regla general que se aplica es que un profesional de la medicina debe guardar estricta reserva de todo lo que se entere, tanto en el ejercicio de su profesión como fuera de ella. Por lo tanto, no sólo tiene tal obligación respecto de pacientes propios, sino que también de los ajenos. Este principio está íntimamente relacionado con la doctrina clásica del secreto médico, que obliga al médico, como un derecho objetivo del paciente, a no revelar los datos, hechos o cualquier otra información que conozca en el ejercicio profesional, salvo orden judicial o autorización libre y espontánea del paciente mayor de edad. De esta manera, la práctica médica se ve envuelta en una serie de resguardos éticos, con el sólo fin de asegurar que las acciones médicas busquen siempre el beneficio del paciente
Subject(s)
Humans , Confidentiality , Ethics, Medical , Physician-Patient RelationsABSTRACT
Background: Personnel working in neonatal intensive care units frequently face difficult ethical problems related to the initation, maintenance or withdrawal of life support therapies. Aim: To assess the importance of ethical issues in the clinical decision making of health care providers in neonatal intensive care units. Material and methods: A questionnaire based on five clinical vignettes that assessed judgments about quality of life, impact of parent's opinions and decision making in emergency situations and with different degrees, of certainty, was designed. Eleven neonatologists and 20 nurses and midwives specialized in neonatology anonymously answered this questionnaire. Results: There was a great inter individual variability in therapeutic approaches in cases with a bad vital and neurological prognosis. In cases of medical emergencies with uncentain diagnoses, bad vital prognosis but neurological indemnity, most professionals coincided in delivering all possible therapeutic options. Parent's opinions had a great impact in medical decisions, except when there was neurological indemnity. Conclusions: The specific responsibilities of the different agents in medical decision making must be delimited. Parents do not have absolute rights over their offspring and physicians must reject useless therapies
Subject(s)
Humans , Male , Female , Infant, Newborn , Intensive Care Units, Neonatal/standards , Decision Making , Infant, Newborn, Diseases/therapy , Ethics, Medical , Respiratory Distress Syndrome, Newborn/therapy , Attitude of Health Personnel , Intensive Care, Neonatal , Informed Consent/legislation & jurisprudence , Anencephaly/therapy , Congenital, Hereditary, and Neonatal Diseases and Abnormalities/therapy , Nervous System Diseases/therapy , Health Care Surveys , PrognosisABSTRACT
All research proposals involving humans, submitted within a two years period to the ethics commitee of the School of Medicine of the Catholic University, were retrospectively reviewed. "Ethical problem" was defined as any explicit disagreement with the ethical principles and guidelines for the protection of human subjects involved in biomedical research, according to the Helsinki declaration. In 20 of 44 reviewed projects, an ethical problem was identified. The most commont problems were the absence or inadequacy of the informed consent, the justification of the use of placebo and problems related to the methodological aspects of the research, particularly the lack of an adequate control group when the potential benefits of a new drug were evaluated. According to the Nuremberg code, the Helsinki declaration and the International Principle of Ethics in Biomedical Research, we analyse ethical problems and suggest judgement elements for them
Subject(s)
Humans , Ethics Committees/standards , Ethics, Medical , Research Design , Placebos , Clinical Trials as Topic , Cost-Benefit Analysis , Helsinki DeclarationABSTRACT
En este artículo se analizan los problemas éticos que plantea la participación de sujetos cognitivamente impedidos en proyectos de investigación biomédica. Se sugiere que, tanto de un punto de vista teórico como práctico, es importante reconocer que los sujetos cognitivamente impedidos no son necesariamente incompetentes para consentir en proyectos de investigación. Por esta razón se plantea que el caso de sujetos cognitivamente impedidos, en quienes se documente una preservación relativa de sus capacidades cognitivas, debería priviligiarse la obtención de un consentimiento informado contemporáneo a la investigación en la cual se les propone participar. En el caso particular de pacientes con Enfermedad de Alzheimer y otras demencias en etapas iniciales, debería priviligiarse la obtención de un "consentimiento antecedente" previo a que estos pacientes devengan incompetentes. Sólo cuando el paciente cognitivamente impedido es evidentemente incompetente se puede justificar su enrolamiento mediante un consentimiento subrogado. Sin embargo no parece conforme a la dignidad de la persona humana, ni a los principios éticos clásicos de la investigación biomédica, el hecho que el consentimiento subrogado se extienda a investigaciones con riesgos mayores que el "riesgo mínimo" y que no implican un beneficio terapéutico para los sujetos