Error y práctica médica: responsabilidad del médico / Medical error and malpractice: medical responsibility

Se realiza un análisis ético-epistémico para delimitar en los errores de la práctica médica aquellos que se deben a una mala-praxis médica e implican responsabilidad ética del médico. Se propone que buena práctica médica es aquella realizada con prudencia, pericia, diligencia, recta intención y recta conciencia. Se define cada uno de estos términos, así como Lex Artis e intención médica. Se examinan las fuentes de errores pre-médicas, las limitaciones de los exámenes e instrumentos como son la especificidad, sensibilidad, límite de resolución, graduaciones de escala, etc. La necesidad de interpretar los resultados según su variación dada por el instrumento y por la ubicación del valor dado en la población a la que pertenece el paciente. La necesidad de interpretar un resultado de un paciente dentro de su contexto genómico ambiental. Se delimitan los errores administrativos, informáticos, logísticos, del paciente y finalmente se define mala-praxis médica aquella en que el médico incurre en impericia, negligencia, imprudencia o con mala intención o mala conciencia.

An epistemic-ethical analysis is performed to distinguish between medical errors with or without responsibility. A good medical praxis is performed with prudence, expertise, diligence, good-intention and integrity. Each one of these terms is defined as well as Lex Artis and medical intention. Sources of pre-medical errors are examined, such as the limitation of examinations and instruments, specificity, sensitivity, resolution limit, scale gradation, etc. The need for interpretation of laboratory results within their instrumental limits, their position within the population variability and genome-environmental condition of the patient is emphasized. Also errors may come from administration, information systems and from the patient. Medical mal-practice is defined as that made without prudence and expertise, with negligence, maliciousness or bad-conscience.

En referencia al plagio intelectual. Documento de la Comisión de Ética de la Facultad de Medicina de la Universidad de Chile / Plagiarism

Plagiarism is defined as the intellectual fraud in which an individual attempts to unduly appropriate, for his/her own benefit, the knowledge, ideas or discoveries of someone else. It is not uncommon in academic settings where research is conducted and a creative work is carried out. Due to the dismal consequences of plagiarism, cautionary measures and sanctions are required to avoid it. This paper is intended to warn and promote a discussion about plagiarism. The Faculty of Medicine of the University of Chile and its ethics committee believe that a fight against these type of actions will contribute to prevent their detrimental effects on the moral and intellectual patrimony of our society.

Etica científica y embriones congelados / Scientific ethics and frozen embryos

Background: Scientific Ethics is the theory and praxis of decisions. Philosophical Ethics is presented as the theory and praxis of the good. As the good differs among cultures, Philosophical Ethics is dependent on the endo-cultural good conception. The decision (included that one of adhesion or not to a world vision) depends on neuro-psychic specific factors: i) cognitive factors that include mostly the knowledge of the alternatives and their consequences and the ideological or religious conception of good in relation to the alternatives; ii) affective factors that make alternatives pleasant, unpleasant or neutral, attractive, repulsive or neutral; iii) emotional factors that associate to alternatives anger, peace or neutrality, sadness, happiness or neutrality; iv) value factors that assign importance, triviality or neutrality to alternatives, or assign them significance, irrelevancy or neutrality. There are unspecific factors such as the psychic energy, desire or others. Mixed factors such as attitude, motivation, intention and others. Scientific Ethics deals with the mind as a materio-energetic process which is different from the soul, eggs and embryos of any species are full individuals of that species, because, they have initiated a copy of their genome that specify, give autonomy and define them as individuals. For Scientific Ethics to leave frozen embryos like that for ever, to defrost and get rid of them or to use their cells for science are synonymous of killing them. To defrost them to use their cells as stem cells for somatic cell therapy or to implant them into uteri to continue their development is to maintain alive their cells, but only the implantation allows their maintenance as individuals, thus, being the only compatible with the Christian ethics. The compatibility of these alternatives with other ethics is discussed

Comienzo ontogénico del individuo humano desde su genoma / Ontogenetic origin of the human individual from his genome

Diverse propositions about the ontogenetic origin of a live organism, specially human beings, are examined. Unambiguous and objective propositions about this origin are that a live organism is an ontogenetically programmed and integrated organisation, that the origin condition has the greater influence on other processes, that in pluricellular organisms, no organ or tissue can be considered critical to establish origins and that the origin must be established by endogenous elements. Several hypotheses about the origin of life are discarded. The integration between oocyte cytoplasm and the genetic material that it receives, that culminates in the first genome replication, is proposed as the process that gives origin to the individual. This process occurs in all living organisms

Dimorfismo sexual en el núcleo mediano del rafe humano: estudio preliminar con el método de Golgi Cox / Sexual dimorphism in human medial raphe nucleus: a preliminar study using the Golgi Cox method

Brains from a female and a male newborn who died from an asphictic syndrome were examined to study the cytoarchitecture of the median raphe nucleus using the Golgi-Cox and morphometric methods. This nucleus is part of the serotonergic system. The morphometric analysis showed in the female newborn a significant increase of neurons. Also she had a higher proportion of ovoid and multipolar cells and a lower proportion of fusiform cells than the newborn male. Our findings suggest that this neuronal distribution may be the anatomical substrate for a serotonergic specific system in each sex

Ritmos anuales escolar: vacaciones-estudio y de menarquia / Annual menarche and scholar rhythms

Background: It has been hypothesized that the yearly menarche rhythm could be caused by the seasonal variation of photoperiod and temperature or by the annual distribution of the scholar vacation and study periods. Aim: To test the hypothesis that the distribution of study vacation periods is a condition that modifies the annual menarche rhythm. Subjects and methods: Two thousand ninety four school girls from Chile, 2.356 girls from Madras, India, 3.454 girls from Medellin, Colombia and 2.627 girls from Debrecen, Hungary, were studied. They were asked about the month of their menarche. Vacation months were considered those with more than 6 days of leave from school. Results: The seasonal hypothesis was refuted because there were contradictions with the expected antithetical behavior in both hemispheres, there was a significant heterogeneity of the yearly menarche among girls from the same region, the expected cline of the menarche frequency variance from equator to poles was not observed, finding an antithetical cline instead and there was a significant heterogeneity among months of the same season. On the other hand, months with vacation periods coincided significantly with peaks of menarche, while study months had lower proportion of menarche (total binomial probability <10-6). Girls whose month of menarche was the same as their month of birth, did not agree completely with the vacation-study hypothesis as the rest of the sample. Conclusions: Vacation periods influenced menarche rhythm. However, these periods coincide with most cultural events and this strong association needs further study to be considered causal. It is not possible to assume school stress as the main explanatory variable. Ontogenetic factors such as birth imprinting also can influence the menarche rhythm, as shown in girls whose month of menarche coincided with their month of birth

Etica científica del origen humano / Scientific ethics of human origin

The analysis of the early human life from the view point of a scientific ethics is presented. Life is a historical materioenergetic process of specific organization. This phylo-ontogenetic process is a continuos process without interruption. Biology has demonstrated that human eggs or embryos are ful human individuals, even though not all human conception is a human being. The contradictions involved in taking ethical decisions after knowing the percentage of conceptions obtained by in vitro or in fallopian tube fertilization that reach the birth are shown. The advantages of scientific ethics in the analysis of the origin of the different positions are indicated. These advantages come from the dissection of the different cognitive, affective-emotional and value atribution frames involved in the alternative decisions

Evaluación de la estatura como indicador nutricional poblacional / Assessment of height as nutritional population index

Material and Methods: Height, weight, sexual maturation biacromial and bi-iliac diameters of low and from French, English and North American children in the same age range. Results: Chilean girls had an earlier sexual maturation, had bigger biacromial and bi-iliac diameters and had a higher weight for height than European girls. Weight for height of these girls was over the values propesed by the Chilean Ministry of Health, that are based in NCHS/WHO tables. Chilean girls with recent European ancestry were taller than girls without this ancestry. Chilean boys were smaller and had lower weights than their foreign counterparts. Bi-iliac diameters were similar to those of French boys and sexual maturation was similar to Englis boys. Conclusions: These results indicate that genetics and not undernutrition is inolved in the shorter height of Chilean girls, when compared with their European or North American counterparts

Alotipos Gm y Km en una muestra de población urbana chilena / Gm and Km allotypes in a chilean urban population sample

The sample included 460 controls of a case control study of typhoid fever. The G1m-G2m-G3m most frequent haplotypes were: za,..;g or 1,17;(-);21=0.4493;fn;b or 3;23;5,13=0.2522;f-,..;b or 3;(-);5,13=0.1389; zax;..;g or 1,2,17;(-);21=0.0685;za;..;b or 1,17;(-);5,13=0.0454;za;n;g or 1,17;23;21=0.0207;f;..;g or 3;(-);21=0.0129. The frequencies of Km alleles were 0.2391 and 0.7609 for Km1 and km3 respectively. These frequencies are within those found in Amerindian and Caucasian populations as expected from the origin of the Chilean population. Gm haplotypes did not differ from Hardy-Weinberg equilibrium, while a significant lack of homozygous Km1/km1 was found in Km

Confiabilidad de la sensibilidad y especificidad del 100 porciento / Trust in sensibility-specificity of 100 percent

A new strategy and 4 methods are presented to calculate the limits of the confident interval for an estimate of a proportion equalto 1.0 or 0.0. A current formula which includes 1/(2n) for continuity correction leads to a confident interval which does not include the parameter estimate. Thus, it is proposed: 1) The exclusion of the factor 1/(2n) in that formula leads to correct most of its inconsistences. The new strategy assumes that the upper limit of a confident interval when the estimates is 100 percent is also 100 percent. The lower limit is calculated by assuming that there is a proportion in the population, from where the sample was taken, such as the probability of getting 100 percent in the sample is equal to the probability of falling into type 1 error of current statistics (0.05, 0.01, etc.). Three methods are proposed with this strategy. 2) A combinatorial solution based in the knowledge of the number of individuals at whom the test can be applied. 3) A solution based on the binomial distribution. 4) A solution based on the Poisson distribution

Código de ética de la Sociedad de Biología de Chile / Ethic code of the Chilean Biological Society

The Chilean Biological Society has approved an ethics code for researchers, elaborated by its Ethic Committee. The text with 16 articles, undertakes the main ethical problems, that reserchers must solve, such as institutional, professional or societal ethics. scientific fraud, breaches in collaboraticve work, relationship between researchers, participation in juries and committees, ethical breaches in scientific publications, scientific responsability and punishment. This code declares its respect and valorization of all life forms and adheres to international biomedical ethical codes. It declares that all knowledge, created or obtained by researchers is mankind's heritage

Ritmo anual de la menarquia en Medellín, Colombia / Anual rythm of menarche in Medellín, Colombia

Hypotheses on seasonal, phylogenetic and ontogenic factors or imprinting that may produce menarcheal rhythm were tested in a sample of school girls from Medellín, Colombia. The questionnaire included a net of important religious or national feasts and periods of vacation or study to prevent memory biases. Europeanb, Asian and Chilean samples showed peaks of menarche in december and january, but a few samples showed a second in june, july and august. The winter short photoperiod and low temperature were assumed to be the cause of the winter peak in most european samples. However, this seasonal hypothesis was refuted when a chilean sample also showed a peak in december, january and february (summer). In the present study performed in a sample from a tropical country we found 2 peaks of menarche, one in july and the other in november, december and january; thus, the seasonal hypothesis can be hardly supported. Moreover, this sample showed a high coincidence between the month of menarche and the month of birth, and a different pattern of menarche when menarches are distributed according to their coincidence with the gestational development. Both facts affirm the ontogenetic hypothesis, because they were also found in several samples. Since this population is different from those already studied and its monthly distribution of menarches and births is also different from those ones, the hypothetical phylogenetic factors find additional support. The possible influence of school stress and other environmental factors in the menarcheal rhythm are discussed