Bioethics in medical care rationing during the coronavirus disease-19 pandemic

ABSTRACT Background: Coronavirus (CoV) disease (COVID)-19 poses difficult situations in which the ethical course of action is not clear, or choices are made between equally unacceptable responses. Methods: A web search was performed using the terms “bioethics; COVID-19; ethics; severe acute respiratory syndrome CoV-2; emergent care; pandemic; and public health emergencies.” Results: Protection from COVID-19 has resulted in the cancellation of necessary medical interventions, lengthened suffering, and potential non-COVID-19 deaths. Prolonged lockdown reduced well-being, triggering or aggravating mental illnesses and violence, and escalated medical risks. Collateral damage includes restrictions on visitations to hospitals, alienation from the deceased relative, or lack of warm caring of patients. Finally, in a public health crisis, public health interest overrides individual rights if it results in severe harm to the community. Conclusion: Balancing ethical dilemmas are one more challenge in the COVID-19 pandemic. (REV INVEST CLIN. 2021;73(1):1-5)

Frontiers in internal medicine

Clinical research in Internal Medicine has provided may scientific advances during the past few years. However, the newly generated information overrides the time available to read all of the medial literature regarding advances in Internal Medicine. The goal of this review is to summarize some of the most relevant improvements in clinical practice published over the last few years. From Cardiology to Pulmonary, the authors of this review expose in a succinct way what they and many of their peers consider to be the most trascendental information gathered from thousands of publications. The authors of this review article have attempted to avoid sensationalism by incluiding facts instead of just simply optimistic preliminary findings that can mislead clinicians' decision making. The review is focused on information obtained through well-designed, prospective clinical trials and cohorts where the effectiveness of medical interventions and diagnostic procedures were tested

Diabetic ketoacidosis in adults: clinical and laboratory features

In this retrospective study, we report the clinical and biochemical features of diabetic ketoacidosis (DKA) in adult patients who were managed at the Instituto Nacional de la Nutricion during a 6.5 year period. There were 98 episodes in 46 patients: 22 females (48 per cent) and 24 males (52 per cent). Six patients (13 per cent) had four or more episodes of DKA were the initial manifestation of diabetes. We compared our results with those from other reported series, finding no differences among them. The mean anion gap in our series was 30.4. Main complications identified were hypokalemia in five cases, hypoglycemia in four cases hypernatremia in four cases, and acute pulmonary edema, ventricular fibrillation, neurological deficit and coma in one case each. There were three death (6.5 per cent) in the whole group. To our knowledge, this is the largest series on adult patients with DKA reported in our country in the last decade. The obtained results may help evaluate prospectively the impact of different diagnostic and therapeutic strategies in the management of DKA

Transferencia de insulinas en 198 pacientes de seis países latinoamericanos / Transference of insulins in 198 patients of six Latinoamerican countries

Es un estudio multicéntrico, comparativo, ciego, aleatorio y prospectivo que evaluó la eficacia y seguridad de la transferencia de insulinas de origen animal a insulina humana biosintética en 198 pacientes de seis países latinoamericanos. Todos los pacientes recibían insulinas de origen animal al menos dos meses antes de su inclusión al estudio. Este tuvo una duración de seis semanas, con evaluaciones al inicio, y a las dos y seis semanas. La eficacia se determinó por cambios inicial-final en la glucemia de ayunas y hemoglobina glucosilada, y la seguridad por la aparición de efectos adversos. De los 198 pacientes, 94 se asignaron al grupo de insulina bovina y 104 al de humana. Al ingreso, ambos grupos fueron similares en sus características. El único cambio al final del estudio fue una disminución en la glucemia en ayunas en el grupo de insulina humana (bovina 212 ñ 95.3 vs 193 ñ 78.8 mg/dL, p= 0.18; humana 198 ñ 86.8 vs 169 ñ 71.7, p= 0.025). El resto de los parámetros no tuvieron modificaciones estadísticamente significativas, aunque la tendencia fue hacia la mejoría en las cifras de hemoglobina glucosilada en ambos grupos. Se presentaron episodios de hipoglucemia leve con mayor frecuencia en el grupo de insulina humana, y hubo un episodio de hipoglucemia grave sin síntomas premonitorios con insulina humana. Concluimos que la transferencia de insulina de origen animal a insulina humana biosintética, en pacientes diabéticos insulinorrequirientes latinoamericanos, es eficaz y razonablemente segura (con ajuste de las dosis de insulina al hacer el cambio)