Detecção de áreas vulneráveis ​​ao escorpionismo e sua associação com fatores ambientais em São Paulo, Brasil / Detection of areas vulnerable to scorpionism and its association with environmental factors in São Paulo, Brazil

Accidents caused by scorpions are considered a neglected condition and represent a major health problem in most tropical countries, especially for children and elderly people. In Brazil, scorpionism is recurrent in the southeast region, mainly in the state of Sao ˜ Paulo, due to the progressive increase in scorpions found in urban habitats. Thus, our study aimed to provide better insights into the geographic and epidemiological characteristics of scorpion envenomation in Sao ˜ Paulo state and identify the environmental factors that are associated with these accidents. This is an ecological and retrospective study with secondary data on scorpion accidents in the state of Sao ˜ Paulo from 2008 to 2018 obtained from the Notifiable Disease Information System. The SatScan software was used to identify the higher- and lower-risk spatiotemporal clusters. A total of 145,464 scorpion sting cases were recorded in the state of Sao Paulo, between 2008 and 2018; there was a four-fold increase in the incidence rate. Accidents occurred more frequently in the spring season, wherein higher-risk clusters were in the north and northwest regions of the state. High temperatures, low precipitation, and poor natural vegetation are associated with higher risk areas. Our study mapped vulnerable areas for scorpion accidents that can aid in the design ofefficient public health policies, which should be intensified during the spring season.

Relación entre edad, cepillado dental y experiencia de caries en niños / Relação entre idade, escovação dentária e experiência de cárie dentária em crianças / Relationship between age, toothbrushing and caries experience in children

El cepillado dental es el método tradicional reconocido para eliminar la biopelícula. Objetivo: Evaluar la relación entre edad y cepillado dental, así como la asociación entre hábitos de cepillado dental y presencia de caries en un grupo de escolares de Montevideo, Uruguay. Material y métodos: Se realizó un estudio observacional, transversal, analítico, en 127 escolares de 4 a 11 años de edad, en Montevideo, Uruguay. Se realizó una encuesta a los padres en relación a los hábitos de cepillado dental de sus hijos y se estudiaron las variables tiempo de cepillado, Índice de Higiene Oral simplificado y se registró el índice para caries dental ICDAS. Resultados: La edad media de los participantes fue 7,93 años (DS ± 1,95). El tiempo promedio de cepillado fue de 47 segundos (DS ± 27 segundos). Los tiempos de cepillado que reportaron los padres difirieron significativamente de los observados en los niños. Al aumentar la edad, el tiempo de cepillado también aumentaba. Se ajustó un modelo de regresión múltiple para analizar la relación entre la disminución en la magnitud del IHOS debido al cepillado y las variables edad, género, tiempo de cepillado y ayuda en el cepillado. Se verificó asociación entre las variables ayuda y/o supervisión en el cepillado y presencia o no de caries dental. Conclusiones: Se encontró una relación significativa entre cepillado dental, edad y tiempo de cepillado en la población estudiada. A mayor edad, mayor tiempo de cepillado y mejor resultado en el índice de higiene oral. Los niños que recibían supervisión o ayuda de los padres fueron los que presentaron menos lesiones de caries.

A escovação dentária é o método tradicional reconhecido para a remoção do biofilme. Objetivo: Avaliar a relação entre idade e escovação dentária, bem como a associação entre hábitos de escovação dentária e a presença de cáries em um grupo de escolares em Montevidéu, Uruguai. Material e métodos: Um estudo observacional, transversal, analítico foi realizado em 127 escolares de 4 a 11 anos, em Montevidéu, Uruguai. Foi realizada um levantamento dos pais sobre os hábitos de escovação dentária de seus filhos e as variáveis foram estudadas para o tempo de escovação, índice simplificado de higiene bucal e o índice de cárie dentária do ICDAS. Resultados: A idade média dos participantes foi de 7,93 anos (DS s 1,95). O tempo médio de escovação foi de 47 segundos (DS x 27 segundos). Os tempos de escovação relatados pelos pais diferiram significativamente daqueles observados nas crianças. À medida que a idade aumentava, o tempo de escovação também aumentava. Um modelo de regressão múltipla foi ajustado para analisar a relação entre a diminuição da magnitude do IHOS devido à escovação e as variáveis de idade, sexo, tempo de escovação e auxílio de escovação. Houve associação entre as variáveis ajuda e/ou supervisão na escovação e presença ou não de cárie dentária Conclusões: Verificou-se uma relação significativa entre escovação dentária, idade e tempo de escovação na população estudada. Quanto mais velho, maior o tempo de escovação e melhor resultado no índice de higiene bucal. As crianças que receberam a supervisão ou a ajuda dos pais eram essas com menos os ferimentos da cavidade

Dental brushing is the recognized traditional method for removing the biofilm. Objective: To evaluate the relationship between age and toothbrushing, as well as the association between toothbrushing and caries lesions in schoolchildren in Montevideo, Uruguay. Material and methods: An observational, cross sectional and analytic study was carried on 127 schoolchildren aged 4 to 11 years old, in Montevideo, Uruguay. The parents were asked about the oral health habits of their children through a questionnaire, and the variables toothbrushing time, Simplified Oral Hygiene Index and ICDAS index were registered. Results: Mean age of the children was 7,93 years (SD ± 1,95). Mean time of toothbrushing was 47 seconds (DS ± 27 seconds). The toothbrushing times reported by the parents differed significantly from those observed in the children. As age increased, brushing time also increased. A multiple regression model was adjusted to analyze the relationship between the decrease in the magnitude of IHOS due to toothbrushing and the variables age, toothbrushing time and brushing aid. There was an association between the variables help and / or supervision in brushing and presence or not of dental caries. Conclusions: A significant relationship was found between toothbrushing, age, gender and brushing time in this group of children. When the age was higher, they spent more time brushing their teeth and they had better results in oral hygiene index. Children who had parents help or supervision had lower caries lesions

Development and validation of analytical methods by HPLC for quality control of avermectins and milbemycins in bulk samples

This work aims to develop analytical methods using high-performance liquid chromatography with a diode array detector (HPLC-DAD) for analysis and quantification of avermectins (AVMs) and milbemycins (MBMs) in bulk samples. First, the methods were optimized and some parameters such as temperature, flow rate, injection volume and mobile phase with different proportions of solvents were evaluated. The best chromatographic conditions were obtained using the Phenomenex® C18 (150 × 4.60 mm, 5 µm) column at a temperature of 20 °C, flow rate of 1.2 mL min-1, injection volume of 20 µL, and detection at 250 nm. Acetonitrile: ultrapure water (87: 13, v/v) was used as mobile phase for moxidectin and eprinomectin, and acetonitrile: methanol: ultrapure water (53: 35: 12, v/v/v) for abamectin and ivermectin. Under these conditions satisfactory results were obtained, with appropriate limits of detection and quantification, acceptable linearity, precision, accuracy, and robustness. These methods satisfy the need for analytical methods for the multi-determination of MBMs and the B1a and B1b forms of AVMs by HPLC-DAD, which can be considered simple, effective, innovative and should aid in the development of the fiel

Urgencias médicas durante la práctica estomatológica / Medical emergencies during dental practice

Introducción: Las urgencias médicas pueden ocurrir durante la práctica estomatológica. Objetivo: Abordar elementos actuales sobre la epidemiología, prevención, cuadro clínico y tratamiento de las urgencias médicas más frecuentes durante la atención estomatológica. Material y Métodos: Se realizó una revisión bibliográfica en septiembre de 2021. Se evaluaron revistas de impacto de Web of Science (19 revistas). Se consultaron bases de datos de MEDLINE, Google Académico, PubMed y SciELO con los descriptores: "medical emergency", "odontology treatment", "epidemiology". Se incluyeron artículos en idioma español e inglés, mayoritariamente de los últimos 5 años. Los que mejor cumplieron los criterios de revisión fueron 31 artículos y fueron incluidos como referencias en este artículo. Desarrollo: Las urgencias más frecuentes son las lipotimias y los síncopes vaso vágales. El diagnóstico basado en los antecedentes patológicos y hallazgos clínicos permite tomar conductas adecuadas. La terapéutica actual aboga por la protocolización de la atención y el uso justificado, sustentado por el conocimiento, de un botiquín de medicamentos de urgencia. Conclusiones: Las urgencias médicas pueden ocurrir durante la práctica estomatológica y poner en riesgo la vida de los pacientes. Su incidencia es variable, el riesgo para la vida no es frecuente y la sobrevida es elevada. Confeccionar una adecuada historia clínica y preparar al personal evitará complicaciones posteriores(AU)

Introduction: Medical emergencies can occur during dental practice. Objective: To address current issues in the epidemiology, prevention, clinical picture and treatment of the most frequent medical emergencies during dental treatment. Material and Methods: A literature review was conducted in September 2021. Web of science impact journals (19 journals) were evaluated. Medline, PubMed, Google Scholar, and SciELO databases were consulted using the following descriptors: "medical emergency", "odontology treatment", and "epidemiology". Articles in Spanish and English were included, preferably those published within the last 5 years. A total of 31 articles were obtained and included as references in this article. Development: Lipothymia and vasovagal syncope are the most frequent emergencies. The diagnosis based on pathological antecedents and clinical findings allows us to take appropriate behaviors. The current therapy advocates for the protocolization of care and justified use, supported by knowledge about a first-aid kit. Conclusions: Medical emergencies can occur during dental practice, putting patients´ lives at risk. The incidence is changeable and the survival rate is high. The development of an adequate clinical history and training of the staff will prevent further complications(AU)

Biopsia de próstata, acceso transperineal bajo anestesia local / Prostate Biopsy, Transperineal Access under Local Anesthesia

Objetivo La biopsia de próstata es una ayuda esencial en el diagnóstico de cáncer, siendo el método más utilizado la biopsia transrectal guiada por ultrasonido (TRUS), con una tasa diagnóstica entre el 37% y el 45%, aunque no exenta de complicaciones como infecciones, dolor o sangrado. El enfoque alternativo y seguro a las biopsias TRUS se encuentra en la biopsia transperineal (BTP), realizada comúnmente bajo anestesia regional o general. El objetivo de este estudio fue determinar la efectividad de la BTP bajo anestesia local y guía ultrasonográfica transrectal, con el impacto sobre la sensibilidad del estudio y la tasa de readmisión hospitalaria por infección. Métodos Estudio de cohorte retrospectiva en el que se evaluaron 83 pacientes sometidos a BTP con anestesia local y guía ultrasonográfica transrectal de enero de 2017 a agosto de 2018 en una ciudad intermedia de Colombia. La muestea incluyó todos los hombres mayores de 18 años con datos de historia clínica disponibles para su análisis, así como los reportes histopatológicos de las biopsias. Se excluyeron casos de rebiopsia o con datos insuficientes. El análisis de datos nominales se realizó mediante la prueba de chi cuadrado, y el de los datos numéricos, con las prubas t de Student o de Mann-Whitney. Resultados Un total de 83 pacientes, con media de edad de 65 ± 7.9 años fueron sometidos al análisis del estudio histopatológico. Se excluyeron nueve pacientes que no tenían información disponible en el registro clínico sistematizado, ni en historia clínica de formato físico. Se encontró una proporción de positividad y diagnóstico de cáncer de prostata en el 39.7% (33) de los pacientes, distribuidos así: grado de grupo 1 (69.7%; 23); grado de grupo 2 )15.2%; 5); grados de grupos 3 y 4 (3% cada uno de ellos; 2); y grado de grupo 5 (9%; 3). En total, 60% (50) fueron negativos para malignidad y, de estos el 54% (27) tuvo hiperplasia. El antibiótico profiláctico indicado en el 96.7% (80) de los casos fue una cefalosporina de primera generación, administrada en el 15% (12) por vía parenteral preoperatoria. En esta serie de casos, no se documentaron ingresos hospitalarios asociados a infección después del procedimiento. Conclusiones La biopsia de próstata por vía transperineal es una técnica con rendimiento diagnostico similar al del abordaje transrectal: es segura, rápida, de fácil acceso, con bajo costo y, sobre todo, con un riesgo insignificante de infección y sepsis. Sus beneficios son altamente representativos en un sistema de salud como el de nuestro país, y la BTP facilita el acceso de la población vulnerable del área rural y de ciudades intermedias, en las que no se dispone de un urólogo experto.

Objective Prostate biopsy is an essencial aid in cancer diagnosis, and the the most widely-used method is known as transrectal ultrasound-guided (TRUS) biopsy, with a diagnostic rate ranging from 37% to 45%; however, it is not free of complications such as infections, pain, or bleeding. The alternative and safe approach lies in the transpineal biopsy (TPB), commonly performed under regional or general anesthesia. The objetive of the present study was to determine the effectiveness of TPBunder local anesthesia and transrectal ultrasound guidance, with the impact of the sensitiviy of the study and the rate of hospital readmission due to infection. Methods Retrospective cohort study in which 83 patients underwent TPB with local anesthesia and transrectal ultrasound guidance from january 2017 and august 2018 in an intermediate city in Colombia. The sample included all male subjects older than 18 years of age with medical history data available for analysis, as well as the histopathological reports of the biopsies. Cases of rebiopsy or with insufficient data were excluded. The analysis of the nominal data was performed using the chi-squared test, and that of the numerical data, with the Student t or the Mann-Whitney test. Results A total of 83 patientswith an average age was of 65 ± + 7.9 years, had their histopathological studies analyzed. We excluded nine patients who did not have information available in the systematized clinical registry nor in the medical history in physical format. Positivity and a diagnosis of prostate cancer was found in 39.7% (33) of the patients, who were distributed like this: grade group 1 (69.7%; 23); grade group 2 (15.2%; 5); grade groups 3 and 4 (each with 3%; 2); and grade group 5 (9%; 3). In total, 60% (50) were negative for malignancy, and, of these, 54% (27) had glandulostromal hyperplasia. The indicated prophylactic antibiotic in 96.7% (80) of the cases was a first generation cephalosporin and, in 15% (12) of the cases it was administered through a preoperative parenteral route. Hospital admissions after the procedure associated with infection were not documented in the present series of cases. Conclusions Transperineal prostate biopsy is a technique with diagnostic performance similar to that of the transrectal approach: it is safe, fast, easy to access, has a low cost and, above all, presents a minimum risk of infection and sepsis. Its benefits are highly representative in a health system like that of our country, and TPB facilitates the access of the vulnerable population of the rural area and of intermediate cities in which there is no availability of an expert urologist.

Índice de vulnerabilidad CAPE: Compasión, Acción Asertiva, Pragmatismo y Evidencia - Versión para América Latina y el Caribe (CAPE VI - LAC) "Globalización, conflicto, cambio climático, desastres naturales: poner la salud mental en la política exterior" / CAPE Vulnerability Index: Compassion, Assertive Action, Pragmatism and Evidence - Version for Latin America and the Caribbean (CAPE VI - LAC) "Globalisation, conflict, climate change, natural disasters: putting mental health into foreign policy"

Introducción: El índice de vulnerabilidad CAPE es un índice global de política exterior que identifica a los países a los que se dará prioridad para recibir ayuda exterior. Ofrece un enfoque evidenciado, estructurado y razonado para utilizar la ayuda en acuerdos bilaterales con la salud mental como base. La presente versión está diseñada específicamente para la región de América Latina y el Caribe (ALC), que comprende 33 países. Objetivos: Identificar los países a ser priorizados para la ayuda externa, a través de la versión ALC del Índice de Vulnerabilidad CAPE (CAPE VI-LAC). Materiales y métodos: Al igual que con la versión global del Índice de Vulnerabilidad CAPE, consideramos varios índices o medidas a nivel de país que indican el estado de salud o que puede influir en la salud. Para el análisis, calificamos a los 20 peores países. Utilizamos 26 indicadores validados y disponibles internacionalmente para explorar y realizar el análisis. Resultados: Las cifras y el mapa muestran los 32 países que figuraron entre los 20 peores en al menos un indicador y también los 12 peores dentro de la CAPE VI-LAC en su conjunto. De los 33 países de ALC, sólo San Cristóbal y Nieves no figuraba en ninguno de los 20 países peores en ningún momento. Conclusión: Lo que podemos concluir con un alto grado de certeza es que los 12 países con peores puntuaciones son posiblemente estados frágiles; países donde los gobiernos no tienen el control o la autoridad completos, a menudo son represivos y corruptos, participan en graves abusos de los derechos humanos y se caracterizan por la inestabilidad política de diversas formas, la desventaja por los cambios climáticos extremos, la pobreza extrema, la desigualdad social y étnica divisiones, incapaces de proporcionar servicios básicos y sufren focos de insurgencia en forma de terrorismo, que a menudo son violentos y brutales. Los gobiernos, los donantes de ayuda, las organizaciones regionales y los profesionales y las asociaciones de salud mental deben trabajar juntos para abordar estas situaciones.

Introduction: The CAPE Vulnerability Index is a global foreign policy index that identifies the countries to be prioritise for foreign aid. It offers an evidenced, structured and reasoned approach to using aid in bi-lateral agreements with mental health as a foundation. The present version is specifically design for Latin America and Caribbean (LAC) region, which comprises of 33 countries. Objectives: To identify the countries to be prioritized for foreign aid, through the LAC version of the CAPE Vulnerability Index (CAPE VI-LAC). Materials and methods: Like with the CAPE Vulnerability Index global version we consider various indices or measures at country level that indicate health status or what may influence health. For the analysis we score the worst 20 countries. We used 26 internationally available and validated indicators to explore and perform the analysis. Results: The figures and map show the 32 countries that featured in the worst 20 in at least one indicator and also the worst 12 within the CAPE VI-LAC as a whole. Of the 33 LAC countries only St Kitts and Nevis did not feature in any of the worst 20 countries at any time. Conclusion: What we can conclude with a great degree of certainty that the worst 12 scoring countries are possibly fragile states; countries where the Governments do not have complete control or authority, are often repressive and corrupt, participate in serious human rights abuses and are characterised by political instability of various forms, disadvantage by the extremes of climate changes, extreme poverty, inequality, social and ethnic divisions, unable to provide basic services and suffer from pockets of insurgency in the form of terrorism, which are often violent and brutal. Governments, aid donors, regional organizations, and mental health professionals and associations should work together in order to address these situations.

Factores asociados al reconocimiento de trastornos y problemas mentales en adolescentes en la Encuesta Nacional de Salud Mental, Colombia / Associated factors for recognition of mental problems and disorders in adolescents in the Colombian National Mental Health Survey

RESUMEN Introducción: Los problemas y los trastornos mentales son prevalentes en la población adolescente. Se calcula que alrededor de un 10% de los adolescentes sufren trastornos mentales que requieren atención y, en general, no se reconocen como tales. El objetivo es determinar potenciales factores asociados con que se reconozcan o no los trastornos y problemas mentales en la población colombiana. Métodos: De la Encuesta Nacional de Salud Mental (ENSM) del 2015 realizada en Colombia, se recogió a los adolescentes de 12-17 arios que respondieron a si algún profesional los había diagnosticado un problema o trastorno de salud mental y se los comparó con los que puntuaron positivo en trastornos mentales medidos por el CIDI 3.0 o en problemas mentales detectados por el SRQ-20. Resultados: Se obtuvo una muestra de 1.754 adolescentes, de los que el 7,3% (n = 129) tenían trastornos y el 22,6% (n = 396) tenían problemas. Del total con trastornos y problemas, reconocen que los tienen el 13,9% (n = 18) de las personas con trastornos y el 8,3% (n = 33) de aquellos con problemas. Se realizaron análisis bivariables con posibles variables relacionadas y, con los resultados, se construyó un modelo multivariable de regresión que evidenció factores asociados con el reconocimiento de trastornos o problemas, como disfunción familiar (OR = 2,5; IC del 95%, 1,3-4,5) y acudir a familiar en caso de problemas económicos (OR = 2,7; IC del 95%, 1,0-7,2). Conclusiones: El reconocimiento es de gran relevancia para que los adolescentes inicien el acceso a la asistencia. Los resultados proveen variables asociadas que permiten planear intervenciones que promuevan la detección de trastornos y problemas en esta población.

ABSTRACT Introduction: Mental problems and disorders are prevalent in the adolescent population. It is estimated that around 10% of adolescents have mental disorders that require attention and are generally not recognised as such. The aim was to determine potential factors associated with whether or not mental disorders and problems are recognised in the Colombian population. Methods: Adolescents aged 12 to 17 who said they had been diagnosed with a mental health problem or disorder by a healthcare professional were identified from the National Mental Health Survey conducted in Colombia in 2015. This group was compared with those who scored positive for mental disorders measured by CIDI 3.0 or mental problems detected by SRQ-20. Results: A sample of 1,754 adolescents was obtained, of whom 7.3% (n = 129) had disorders and 22.6% (n = 396) had problems. Of the total with disorders and problems, 13.9% (n = 18) of people with disorders and 8.3% (n = 33) with problems knew they had them. Bivariate analyses were performed with the possible related variables, and with the results we constructed a multivariate regression model that identified factors associated with the recognition of disorders or problems, such as family dysfunction (OR = 2.5; 95% CI, 1.3-4.5) or counting on family when having financial problems (OR = 2.7; 95% CI, 1.0-7.2). Conclusions: Recognition is of great importance for initiating access to care by adolescents. The results provide associated variables which can aid planning of interventions to improve the detection of disorders and problems in this population.

Una masa renal poco común en una adolescente ­ presentación de caso y revisión de la literatura / An Unusual Renal Mass in Adolescent ­ Case Report and Literature Review

Introducción Las neoplasias renales en la población pediátrica y adolescente son raras, entre el 6% y el 7% de las masas en pediatría. En adolescentes plantea un desafío clínico importante. Presentan variables manifestaciones sistémicas inespecíficas o cuadros asintomáticos. En la literatura se han identificado el Carcinoma de Células Renales y el Tumor de Wilms como las masas renales más prevalentes en menores de 20 años, el Adenoma Metanéfrico es una entidad muy poco común en esa población. Presentación de caso Adolescente, con dolor en flanco izquierdo y hematuria macroscópica monosintomática, estudios imagenológicos evidencian lesión de aspecto neoplásico renal izquierda, que al complementarse con estudios de inmunohistoquímica resulta en Adenoma Metanéfrico. Se realiza revisión de literatura publicada en las últimas tres décadas al respecto. La paciente es llevada a nefrectomía radical izquierda, y posteriormente el estudio anatomopatológico sugiere Adenoma Metanéfrico, con marcadores de inmunohistoquímica que corroboran el hallazgo. Conclusiones Los tumores renales en adolescentes son raros. Se requiere de alta sospecha clínica, un examen físico meticuloso y el apoyo en imágenes diagnósticas. Generalmente, el estudio histopatológico determina el diagnóstico definitivo, no obstante, cuando persiste la confusión, se recurre a la inmunohistoquímica. El Carcinoma de Células Renales es el más prevalente de los tumores renales en adolescentes, pero existen entidades indistinguibles al estudio imagenológico que plantean un desafío clínico; es el objetivo brindar una herramienta de apoyo en el abordaje del Adenoma metanéfrico e instar al desarrollo de conocimiento sobre una entidad patológica en ese grupo etario que ha sido poco documentado que indudablemente redundará en mejores prácticas e impacto científico, social y económico.

Introduction Renal neoplasms in pediatrics and adolescents patients are rare entities, 6­7% masses in pediatrics. In teenagers, set a noteworthy clinical challenge. Can manifest as variable signs or be asymptomatic. In scientific papers, Renal Cell Carcinoma and Wilms' tumor have been identified as the most prevalent tumors in aged lesser than 20 years; Metanephric Adenoma is an unusual pathologic entity into this population. Case Report A female youngster case, with left flank pain and monosymptomatic macroscopic hematuria, imaging studies show up a neoplastic appearance lesion at left kidney, demonstrated as Metanephric Adenoma afterwards by immunohistochemistry analysis. Literature review is performed by searching in the last three decades. Patient was taken to left radical nephrectomy, later the pathological analysis suggests Metanephric Adenoma, and with immunohistochemistry markers is supported this finding. Conclusions Renal masses in adolescents are uncommon. It is needed high clinical suspicion, a thorough physical examination and imaging techniques aid. Conventionally, histopathology determine diagnosis, although in some cases when doubt last, it is necessary perform immunohistochemistry. Renal Cell Carcinoma is the most prevalent in youth's renal masses, but there are indistinguishable conditions on imaging that raise a defiant clinical scenario; it is the purpose to provide a clinical guidance tool in the approach of Metanephric adenoma and contribute to the development of knowledge in a scarcely documented clinicopathological entity that doubtlessly will reverberate in best clinical practice and echo at science, social and economics.

Doação de gametas: questões sociais e éticas (não) respondidas em Portugal / Gamete donation: (un)answered social and ethical issues in Portugal / Donación de gametos: cuestiones sociales y éticas (no) respondidas en Portugal

Resumo: Conhecer a discussão em torno dos desafios sociais e éticos da doação de gametas é fundamental para a boa governança das técnicas de reprodução assistida. Neste artigo, analisam-se os tópicos que orientaram o debate nas organizações de ética portuguesas, discutindo as suas conexões com os temas abordados internacionalmente. Para tal, em março de 2018, pesquisamos sistematicamente os websites do Conselho Nacional de Procriação Medicamente Assistida e do Conselho Nacional de Ética para as Ciências da Vida. Procedemos à análise de conteúdo temática de 25 documentos. Os resultados indicam que o debate se centrou na acessibilidade, no anonimato e na compensação de doadores e, em menor extensão, nas responsabilidades profissionais. Observaram-se posicionamentos heterogêneos e tensões entre múltiplos direitos e princípios éticos associados a receptores, a pessoas nascidas com recurso à doação de gametas e a doadores. Esses têm em comum três alegações: a escassez de evidência científica; as experiências de outros países; e regulamentações oriundas de entidades internacionais. Na literatura abordam-se tópicos adicionais, nomeadamente: uma via dupla que conjugue anonimato/identificação de doadores; implementação de sistemas de registo reprodutivo para receptores e doadores; limites do rastreio genético a doadores; doação por familiares/conhecidos; e o papel dos doadores na decisão quanto ao destino de embriões criopreservados e na escolha das características dos receptores dos seus gametas. Há espaço para expandir o debate e promover a pesquisa em torno das implicações sociais e éticas da doação de gametas, considerando a participação de todos os cidadãos.

Abstract: Awareness of the discussion surrounding the social and ethical challenges regarding gamete donation is crucial for good governance of assisted reproduction techniques. In this article, we analyze the topics that guided the debate in the Portuguese ethics organizations, discussing their connections with themes addressed internationally. To that end, in March 2018, we systematically searched the websites of the National Council of Medically Assisted Procreation and of the National Ethics Council for Life Sciences. We carried out a thematic content analysis of 25 documents. Results indicate that the debate was focused on accessibility, anonymity and donors' compensation and, to a lesser extent, on professional responsibilities. We observed heterogeneous positions and tensions between multiple rights and ethical principles associated with recipients, donor-conceived individuals and donors. These invoke three similar arguments: the scarcity of scientific evidence; experiences from other countries; and regulations from in international entities. Literature addressed additional topics, namely: a double track that combines donor anonymity/identification; the implementation of reproduction registries for recipients and donors; limits to the genetic screening of donors; donations by family members/acquaintances; and donors' role in decisions regarding the fate of cryopreserved embryos and in choosing the characteristics of recipients of their gametes. There is room to expand the debate and to promote research on the social and ethical implications of gamete donation, considering the participation of all citizens.

Resumen: Conocer la discusión en torno a los desafíos sociales y éticos de la donación de gametos es fundamental para el buen gobierno de las técnicas de reproducción asistida. En este artículo se analizan los temas que orientaron el debate en las organizaciones de ética portuguesas, discutiendo sus conexiones con los temas abordados internacionalmente. Para este fin, en marzo de 2018, investigamos sistemáticamente las páginas webs del Conselho Nacional de Procriação Medicamente Assistida y del Conselho Nacional de Ética para as Ciências da Vida. Asimismo, procedimos al análisis de contenido temático de 25 documentos. Los resultados indican que el debate se centró en la accesibilidad, anonimato y compensación de donadores y, en menor extensión, en las responsabilidades profesionales. Se observaron posicionamientos heterogéneos y tensiones entre múltiples derechos y principios éticos, asociados a receptores, a personas nacidas gracias a la donación de gametos y a donadores. Estos tienen en común tres alegaciones: la escasez de evidencias científicas; las experiencias de otros países; y las regulaciones procedentes de entidades internacionales. En el literatura se abordan temas adicionales, en particular: una vía doble que conjugue anonimato/identificación de donadores; implementación de sistemas de registro reproductivo para receptores y donadores; límites del rastreo genético a donadores; donación por familiares/conocidos; y el papel de los donadores en la decisión respecto al destino de embriones criopreservados y en la elección de las características de los receptores de sus gametos. Existe espacio para abrir más el debate y promover la investigación en torno de las implicaciones sociales y éticas de la donación de gametos, considerando la participación de todos los ciudadanos.

Comportamiento fractal de infecciones asociadas al cuidado de la salud en el Hospital de Meissen ESE II Nivel, para los años 2011, 2012 y 2013 / Fractal behavior of infections associated with health care at Meissen Hospital ESE II Level, for the years 2011, 2012 and 2013

Introducción: la dimensión fractal estadística ha sido de utilidad para la caracterización de diversos fenómenos, incluyendo la dinámica cardiaca fetal y del adulto, así como comportamientos asociados al sistema inmune. Las Infecciones Asociadas al Cuidado de la Salud son un problema de salud de alta importancia a nivel mundial. Objetivo: establecer el comportamiento fractal estadístico de la frecuencia de aparición de Infecciones Asociadas al Cuidado de la Salud. Material y métodos: Se aplicó la ley de Zipf-Mandelbrot a la distribución de frecuencias de aparición agrupadas por especialidad de Infecciones Asociadas al Cuidado de la Salud en el Hospital Meissen ESE II Nivel, para los años 2011, 2012 y 2013. Se calculó la dimensión fractal estadística para cada año, hallando los rangos en los que se desenvuelve la dinámica en estos años y posteriormente se realizaron simulaciones de estas dinámicas anuales. Resultados: Se observó un comportamiento a escala de la dinámica de aparición de Infecciones Asociadas al Cuidado de la Salud por especialidad, los valores de la dimensión fractal fue de 0,6104, 0,7560 y 0,4332 para los años 2011, 2012 y 2013 respectivamente. Conclusión: La ley de Zipf/Mandelbrot permite caracterizar de forma objetiva y reproducible el comportamiento de la frecuencia de aparición de las Infecciones Asociadas al Cuidado de la Salud en el tiempo; las dimensiones fractales acotadas consecutivas en el tiempo permitirían generar predicciones, constituyendo una herramienta de ayuda para la vigilancia epidemiológica y la clínica.

Introduction: The statistical fractal dimension has been useful for the characterization of diverse phenomena, including the fetal and adult cardiac dynamics, as well as the behaviors associated with the immune system. Health Care Associated Infections are a major health problem worldwide. Objective: to establish the statistical fractal behavior of the frequency of occurrence of Health Care Associated Infections. Material and methods: The Zipf-Mandelbrot law was applied to the frequency distribution of occurrences grouped by Health Care Associated Infections in II level at Meissen ESE Hospital for the years 2011, 2012 and 2013. The statistical fractal dimension was calculated for each year, finding the ranges in which the dynamics develops in these years and later simulations of these annual dynamics were carried out. Results: Scale behavior of the dynamics of occurrence of Health Care Associated Infections by specialty was observed; the values of fractal dimension were 0.6104, 0.7560 and 0.4332 for the years 2011, 2012 and 2013 respectively. Conclusion: The law of Zipf / Mandelbrot allows to characterize objectively and reproducibly the behavior of the frequency of occurrence of Health Care Associated Infections over time; the consecutive bounded fractal dimensions over time would allow predictions to be generated, constituting an aid tool for epidemiological and clinical surveillance.

Cooperation with evil, the theory of action and the contraception mandate / Cooperación con el mal, la teoría de la acción y el mandato de anticoncepción / Cooperação com o mal, a teoria de ação e o mandato de contracepção

Abstract The debate concerning the so-called U.S.Health and Human Services (HHS) Contraception Mandatehas been adequately framed, in the academic field, within the traditional ethical doctrine oncooperation with evil. This principle will allow us to conclude whether employers may ethically comply with the onerous existing law or not. The discussion has been quite heated, because the practical conclusions authors have reached vary widely, depending on which interpretation of the theory they rely on. In this paper, some of these explanations are addressed and analyzed from the standpoint of the Thomistic theory of action, which is now the most common point of view. This work concludes that, although theContraception Mandatewill most likely be repealed by the current U.S. administration, as things once stood, compliance with it may have been ethically licit in some cases.

Resumen El debate académico sobre el llamadoU.S. Health and Human Services (HHS) Contraception Mandatese ha enmarcado, adecuadamente, en el contexto de la doctrina clásica acerca de lacooperación al mal. Este principio ayuda a discernir si las empresas y los empleadores estadounidenses deberían o no, éticamente, obedecer a tal ley injustamente impuesta. La discusión ha sido muy acalorada, porque las conclusiones a las que han llegado los distintos autores son muy variadas, en función de cuál ha sido la interpretación de esta doctrina en cada caso. En el presente artículo hemos tratado de examinar y analizar alguno de estos intentos de explicación, desde la perspectiva de la teoría tomista de la acción -que hoy en día es el punto de vista más común-. El trabajo concluye que, aunque elMandateprobablemente vaya a ser derogado por el actual gobierno de los Estados Unidos, tal como estaban las cosas, la obediencia de esta ley podría haber sido éticamente lícita en algunos casos.

Resumo O debate acadêmico sobre o chamado Mandato de Contracepção, do U.S. Health and Human Services (HHS), foi enquadrado, adequadamente, no contexto da doutrina clássica sobre a cooperação com o mal. Esse princípio ajuda a discernir se as empresas e os empregadores norte-americanos deveriam ou não, eticamente, obedecer a tal lei imposta injustamente. A discussão tem sido muito acalorada porque as conclusões a que diferentes autores chegaram são muito variadas, em função da interpretação dessa doutrina em cada caso. No presente artigo, buscamos examinar e analisar algumas dessas tentativas de explicação, a partir da perspectiva da Teoria Tomista da Ação - que, atualmente, é o ponto de vista mais comum. O trabalho conclui que, ainda que o mandato seja provavelmente revogado pelo atual governo dos Estados Unidos, assim como estavam as coisas, a obediência a essa lei poderia ter sido eticamente lícita em alguns casos.

Glande Peneano ­ Teoría Integral y su Relación con la Triada Disfuncional (Glande Frío, Blando o Doloroso) / Penis Glans ­ Integral Theory and its Relationship with Dysfunctional Triad (Cold, Soft and Painful Glans)

El glande peneano forma parte de un ingenioso diseño evolutivo que convirtió el pene en una compleja maquina hidráulica bicameral para la intromisión exitosa en la vagina. El objetivo del glande es tener un extremo blando, recubierto con una piel de terminales altamente sensitivas que forma parte de un tercer cuerpo cilíndrico, que debe colaborar en la tumescencia peneana sin interferir ni en la eyección del semen, ni en la evacuación de la orina, al estar las funciones reproductivas y urinarias compartidas por el mismo órgano. Los cuerpos cavernosos y el esponjoso, incluyendo el glande, comparten anatomía y fisiología en lo referente a trabéculas, túnica albugínea y llenado de sangre, pero no son idénticos en función, por lo que conceptos como rigidez axial, distribución de receptores o venoclusión varían de una a otra cámara. Adicionalmente a su discreta colaboración en la erección, el glande es el origen del llamado reflejo eyaculatorio, que es básico en el proceso sexual humano. La disfunción de esa porción terminal, incluye tres situaciones patológicas que son el glande frío, blando o doloroso, con etiología común, relacionada con factores como trauma, disfunción eréctil o cirugías tales como prostatectomía radical o cirugía uretral, con muy pocos tratamientos específicos disponibles en la actualidad y que sin embargo deberán ir mejorando por la inusitada frecuencia de esos padecimientos

The glans arises from a clever evolving design through which that the penis was transformed into a complex bicameral hydraulic machine for successful intervention in the vagina; aiming to maintain a highly sensitive at soft end, being part of a third cylindrical body and functioning as an aid in the tumescence with no interference with the evacuation of urine or semen, as the reproductive and urinary functions are shared by the same body. The previous asseveration implies that corpora cavernosa and spongiosum, including glans, share anatomy and physiology, trabeculation, tunica albuginea and blood filled, although not identical in function yet concepts as axial rigidity, sensory receptors distribution or venoclussion, they are different from each other and dysfunction in this terminal portion, includes three pathological situations: cold, soft or painful glans, with common etiology related to factors such as trauma, erectile dysfunction and surgeries such as radical prostatectomy or urethral surgery, with few specific treatments currently available, yet they should be improving by the unusual frequency of these conditions.

Maternidad sin padre: ¿Alguien piensa en el hijo? / Maternity without a father: Does anyone think of the son?

La procreación, misterio y realidad,encierra esperanzas e incertidumbres. Su marco ha sido modificado por las nuevas técnicas de reproducción asistida,que abren escenarios antes inimaginables. Aquí una reflexión lúcida sobre uno de los inconvenientes planteados,originalmente publicada en Políticaplus (http://bit.ly/2jc8yqG) que comparte la nota con INMANENCIA.

Técnicas de reproducción humana asistida heterólogas: el derecho a conocer los orígenes: ¿Legislación versus subjetividad? / Heterologous assisted reproductive techniques: the right to know the origin: Legislation versus subjectivity? / Técnicas de reprodução humana assistida heterólogas: o direito de conhecer as origens: Legislação versus subjetividade?

Las técnicas de reproducción humana asistida, y en particular las heterólogas, plantean una serie de problemas que se ubican en el cruce tripartito de la ciencia, el derecho y la subjetividad. En este artículo investigamos la relación entre la legislación recientemente aprobada en Argentina respecto del anonimato relativo del donante y las respuestas de los usuarios de técnicas heterólogas -en este caso, la ovodonación-, en cuanto al derecho a conocer el origen genético. Analizamos el dilema entre el texto de la ley, que propicia la comunicación del origen genético al nacido mediante dichas técnicas, y los factores subjetivos que gravitan en la decisión de dar a conocer la información o guardar el secreto. En consecuencia, planteamos que la revelación del origen genético constituye una decisión ética que requiere asumir una responsabilidad subjetiva. Para abordar una problemática de tal complejidad ponemos a dialogar los datos relevados por dos estudios empíricos, con aportes teóricos tomados del Derecho, la bioética narrativa, la antropología y el psicoanálisis.

Assisted reproduction techniques, in particular of heterologous type, open a variety of issues in the intersection of science, rights and subjectivity. In this paper we focus on the relation between the recently approved Argentinian legislation and the responses given by users of heterologous techniques -in this case, oocyte donation- with regard to the right to know the genetic origin. We analyse the dilemma between the law, which promotes the communication of the genetic origin to the subject born by such techniques, and the subjective factors that gravitate in the decision either to disclose the information, or keep it as a secret. Consequently, we argue that the disclosure of the genetic origin is an ethical decision, which requires the assumption of subjective responsibility. To deal with such a complex issue, we cross the data obtained in two empirical studies with theoretical contributions from legal studies, narrative bioethics, anthropology and psychoanalysis.

As técnicas de reprodução humana assistida, e em particular as heterólogas, apresentam uma série de problemas que se localizam no cruzamento tripartite da ciência, do direito e da subjetividade. Neste artigo investigamos a relação entre a legislação recentemente aprovada na Argentina a respeito do anonimato relativo ao doador e as respostas dos usuários de técnicas heterólogas -neste caso, a ovodoação-, e quanto ao direito de conhecer a origem genética. Analisamos o dilema entre o texto da lei, que propicia a comunicação da origem genética ao nascido mediante referidas técnicas, e os fatores subjetivos que gravitam na decisão de dar a conhecer a informação ou guardar o segredo. Em consequência, propomos que a revelação da origem genética constitui uma decisão ética que requer assumir uma responsabilidade subjetiva. Para abordar uma problemática de tal complexidade colocamos a dialogar os dados relevados por dois estudos empíricos, com contribuições teóricas tomadas do Direito, da bioética narrativa, da antropologia e da psicanálise.

Anonimato e segredo na reprodução humana com participação de doador: mudanças em perspectivas / Anonymity and secrecy in human reproduction with donor participation: shifts in perspectives

As tecnologias reprodutivas, ao separar a sexualidade da reprodução, interferiram não somente nas relações entre os sexos, mas também nas relações de filiação, possibilitando o surgimento de configurações familiares decorrentes do acesso a material genético de terceiros (doadores de óvulos, sêmen ou embrião). O segredo e o anonimato que sempre envolveram os doadores de gametas têm sido desafiados. Nos últimos vinte anos, diversos países alteraram sua legislação adotando a identidade aberta do doador de material genético. A possibilidade de conhecer e ter acesso a esta identidade (chegando à maioridade) ou mesmo a busca por meios irmãos pode ser uma realidade em muitos países para crianças nascidas por meio do acesso à tecnologia reprodutiva. O artigo enfatiza a questão do segredo e do anonimato envolvendo o uso de material genético de terceiros em tecnologias reprodutivas. A discussão é explorada por meio do debate ocorrido no Reino Unido relativo à abolição do anonimato e suas implicações sob a perspectiva dos doadores, dos casais demandantes e da criança concebida. O estudo reflete ainda sobre as concepções de família envolvidas nessa discussão.

Reproductive technologies, when separating sexu ality from reproduction, interfered not only in the relationships between the sexes, but also in the relationships of filiation, enabling the emergence of family settings due to the access to genetic ma terial from others (egg, semen or embryo donors). The secrecy and anonymity that have always in volved gamete donors have been challenged. In the last twenty years, various countries changed their legislation, adopting the policy of open identity of the donor of the genetic material. The possibility to know and have access to this identity (when reach ing adulthood) or even the search for half-brothers can be a reality in many countries for children born through access to reproductive technology. The article emphasizes the matter of secrecy and ano nymity involving the use of genetic material from others in reproductive technologies. The argument is set up through the debate in the United Kingdom concerning the abolition of the anonymity and its implications under the perspective of donors, claim ant couples and the child. The study also reflects on the conceptions of family involved in this debate.

Influence of artificial insemination with donor sperm on the pregnancy outcomes and safety of the offspring / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the factors influencing the pregnancy outcomes of artificial insemination with donor sperm (AID), improve the pregnancy rate, and evaluate the safety of the offspring.</p><p><b>METHODS</b>We retrospectively analyzed 7,761 cycles of AID for 5,109 infertile couples performed between July 1, 2005 and June 30, 2013 in the Center of Reproductive Medicine of Shenyang No 204 Hospital, the outcomes of pregnancy, and the incidence of birth defects.</p><p><b>RESULTS</b>Totally, 2 252 clinical pregnancies were achieved by AID, in which the pregnancy rate per cycle was 29. 02% and the cumulative pregnancy rate was 44. 08%. The clinical pregnancy rate was remarkably higher in the females of ≤ 35 years than in those of > 35 years old (30.31% vs 20.18%, P < 0.01), in the women with < 5-year infertility than in those with > 5-year infertility (30.83% vs 28.16%, P < 0.01), and in the patients of the ovarian stimulation group than in those of the natural cycle group (33.22% vs 28.68%, P < 0.01) The clinical pregnancy rate was the highest in the first treatment cycle (29.87%), with statistically significant difference from the fourth cycle (23.61%) (P < 0.05), but not between the other cycles (P > 0.05). There were 28 cases of birth defects in the offspring (1.40%), including 6 cases (21.43%) involving the cardiovascular system, 4 (14.29%) involving the musculoskeletal system, 3 (10.71%) involving the urogenital system, 3 (10.71%) involving the central nervous system, 2 cases (7.14%) of cleft lip and palate, 2 (7.14%) involving the respiratory system, 2 (7.14%) involving the gastrointestinal digestive system, and other anomalies.</p><p><b>CONCLUSION</b>Female age, infertility duration, and ovarian stimulation treatment are important factors influencing the clinical pregnancy rate of AID. Artificial insemination with cryopreserved donor sperm does not increase the incidence of birth defects, which is considered as a relatively safe technique of assisted reproduction.</p>

O casal homossexual e a inseminação artificial heteróloga / The homosexual couple and the artificial heterologous insemination

Objetivos: Avaliar o perfil epidemiológico de pacientes submetidas à inseminação artificial heteróloga (IAH), estabelecer a taxa de gravidez e de gestação múltipla e reconhecer a prevalência dos casais homossexuais como elemento de indicação. Metodologia: Estudo descritivo, retrospectivo e quantitativo feito de janeiro de 2009 a outubro de 2014, na Clínica Fértile – Reprodução Humana, que avaliou os procedimentos de IAH. Resultados: Foram analisadas 67 pacientes submetidas a 156 ciclos de tratamento, média de 2,3 procedimentos por paciente. A faixa etária mais prevalente situou‐se entre 18 e 35 anos (55,2%). A principal indicação foi o fator masculino (70,1%). O padrão espermático mais prevalente foi entre 1 e 5 milhões de espermatozoides/mL (53,9%). A taxa de gravidez por ciclo foi de 17,3%. Foram obtidas 7 gestações múltiplas (4,48%). Das 67 pacientes, 9 procuraram a IAH por serem casais homossexuais (13,5%). Conclusão:O perfil epidemiológico foi idade entre 18 e 35 anos, indicação principal o fator masculino e padrão espermático entre 1 e 5 milhões. A taxa de gravidez por ciclo foi de 17,3% com uma taxa de gestações múltiplas de 4,48%. A prevalência de casais homossexuais durante o estudo foi de 13,5%.

Aims: To evaluate the epidemiological profile of patients undergoing heterologous artificial insemination (HAI), establish the rate of pregnancy and multiple pregnancy and recognize the prevalence of homosexual couples as an indication element for the procedure. Methods: A descriptive, retrospective and quantitative study conducted from January 2009 to October 2014, in the Fertile Clinic ‐ Human Reproduction assessing the HAI procedures. Results: We analyzed 67 patients who underwent 156 cycles of treatment with an average of 2.3 procedures per patient. The most prevalent age group was among 18 and 35 representing 55.2%. The main indication for the procedure was the male factor (70.1%). In most prevalent standard sperm concentration was between 1 and 5 million sperm/ml (53.9%) The cycle for pregnancy rate was 17.3%. Seven obtained multiple pregnancies (4.48%) and 5 of these were twins (3.2%) and 2 triplets (1.28%). Of the 67 patients, nine sought to HAI for being homosexual couples representing a rate of 13.5% of patients. Conclusion: The epidemiological profile was represented as follows: age among 18 and 35, the main indication was the male factor and the spermatic standard donated semen was between 1 and 5 million. The cycle for pregnancy rate was 17.3% with a rate of multiple pregnancies of 4.48%, 3.2% were twins and 1.28% triplets. The prevalence of homosexual couples during the study was 13.5%.

Factors affecting the success rate of artificial insemination with donor sperm / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore various factors affecting the clinical pregnancy outcomes of artificial insemination with donor sperm (AID).</p><p><b>METHODS</b>We retrospectively analyzed 15,744 cycles of AID in 6302 women and investigated the association of the clinical pregnancy outcomes of AID with the treatment protocols, the times of insemination per cycle, the age of the infertile women, the status of the oviduct, and the number of AID cycles.</p><p><b>RESULTS</b>The pregnancy rate of AID was higher in the chlomiphene-treated women than in those of the natural cycle group (P = 0.003) but showed no significant differences either between the chloramiphene and human menopause gonadotropin (HMG) or between the HMG and natural cycle groups (P > 0.05), and so was it in the women that had received AID twice per cycle before and after ovulation (26.3%) than in those that had undergone only once before (7.0%) or after ovulation (23.7%) (P < 0.05). However, the pregnancy rate was remarkably lower in the women aged 35-40 years (16.5%), especially in those over 40 years (1.2%), than in those under 35 years (26.0%) (P < 0.05). There was no significant difference in the success rate of AID between the women with oviductal adhesion and those without (27.4% vs. 28.1%, P > 0.05). The pregnancy rate of the first cycle of AID (27.6%) was markedly higher than those of the second (24.7%), third (23.9%), and fourth (23.1%) (P < 0.01), but with no significant differences among the latter three cycles (P > 0.05), while that of the fifth cycle (19.0%) was remarkably lower than those of the first four (P < 0.01).</p><p><b>CONCLUSION</b>The age of the infertile women is an important factor affecting the success rate of AID. AID twice per cycle is better than once only. For those without oviductal factors, at least 4 cycles of AID are required before in vitro fertilization.</p>

Direito ao conhecimento da origem biológica na reprodução humana assistida: reflexões bioéticas e jurídicas / Right to knowledge of biological origin in human assisted reproduction: bioethical and legal reflections

Este artigo discute o direito ao conhecimento da origem biológica da pessoa gerada por técnica de reprodução humana assistida, apresentando argumentos e problemas envolvidos nesse complexo processo que inclui diferentes interesses. Nesse sentido, foi desenvolvido um estudo hipotético-dedutivo, com base referencial teórica sustentada na bioética e no direito, na medida em que esses dois campos se interseccionavam quanto à natureza da matéria. O estudo avança, ainda, abordando os riscos decorrentes dos avanços tecnológicos e das expectativas dos sujeitos envolvidos, inclusive a vulnerabilidade, o consentimento para doação de gametas e o anonimato dos doadores. Discute, também, os conceitos de "identidade genética" e direito ao conhecimento da "origem biológica", traçando analogia com a legislação brasileira relativa à adoção. Por fim, trata do chamado "pertencimento do segredo", refletindo sobre os argumentos encontrados na literatura afim, inclusive o contexto de "desbiologização" atualmente defendido pelos tribunais superiores...

Este artículo aborda el derecho al conocimiento del origen biológico de la persona generada por técnica de reproducción humana asistida, presentando los argumentos y problemas implicados en este complejo proceso que involucra diferentes intereses. En este sentido, se ha desarrollado un estudio hipotético-deductivo, con sustento teórico en bioética y derecho, y la intersección de estos dos campos respecto a la naturaleza del tema. El estudio avanza, haciendo relación a los riesgos de los avances tecnológicos y las expectativas de los participantes, la vulnerabilidad, el consentimiento para la donación de gametos y el anonimato de los donantes. Son analizados también los conceptos de "identidad genética" y el derecho a conocer el "origen biológico", haciendo una analogía con la legislación brasileña relativa a la adopción. Por último, se aborda la llamada "pertenencia del secreto ", al reflexionar sobre los argumentos de la literatura al respecto, incluyendo el contexto de " desbiologización " actualmente defendida por los tribunales superiores...

Correlación cito-histológica del tumor papilar de la glándula pineal. Presentación de un caso / Papillary pineal tumor: cyto-histological correlation. Case report

En la última revisión de la Organización Mundial de la Salud (OMS) en relación a los tumores del sistema nervioso central (SNC), se describieron nuevas entidades, como el Tumor Papilar de la Glándula Pineal. Esta lesión de rara aparición, se ha identificado en adultos jóvenes. El diagnóstico de estos tumores es complejo ya que depende de su ubicación, edad de aparición y el aspecto histológico; éste último tiene similitudes con otras lesiones como el ependimoma papilar o el papiloma/carcinoma de plexos coroides. Citológicamente presentan características claras que pueden ayudar al diagnóstico a través de la impronta en el estudio intraoperatorio; reconocer ciertos criterios con éste importante y sencillo método diagnóstico ha sido la motivación principal para el estudio de entidades poco frecuentes del SNC, además de corroborar el necesario trabajo de un equipo multidisciplinar.

In the latest revision of the central nervous system tumors (CNS) of the World Health Organization (WHO), new entities has been described, as papillary tumor of the pineal region. This rare lesion has been identified in young adults. The diagnosis of these tumors is complex, depends on the location, age of onset and histological appearance. Histological characteristics have similarities with other lesions such as papillary ependymoma, papiloma / choroid plexus carcinoma. Cytologically have clear characteristics that can aid in the diagnosis through the smears on the intraoperative study. Certain criteria for recognize this important and simple diagnostic method has been the main motivation for the study of CNS rare entities, as our case, in addition to corroborating the necessary work of a multidisciplinary team.