Uso y difusión responsable de la información en pandemia: un imperativo ético / The responsible use and dissemination of information in a pandemic: an ethical imperative

La actual pandemia por COVID-19 está generando un impacto sin precedentes en las distintas esferas de la vida, al mismo tiempo que ha puesto en valor la importancia que la disciplina Bioética tiene para el análisis y la deliberación de los desafíos éticos emergentes, previo a la adopción de decisiones razonables y prudentes. Un tema insuficientemente tratado en el curso de esta crisis, cuyos negativos efectos, se consideran, pueden llevar no sólo a interferir los canales de comunicación con la ciudadanía sino a afectar la adherencia esperada de la población a las indicaciones que se necesita que sigan, es la relativa al manejo y comunicación de la información. Asunto especialmente complejo cuando se vive un período de explosión informativa, caracterizada por la Organización Mundial de la Salud como «infodemia¼. Este artículo, reivindicando el imperativo ético y jurídico de actuar responsable en la obtención, uso y difusión de la información que asiste a toda autoridad que desempeña una función social, propone una serie de recomendaciones para alcanzar su efectividad en la práctica.

The current COVID-19 pandemic is producing an unprecedented impact in the different spheres of life, at the same time that it has highlighted the importance that the Bioethics discipline has in analyzing and deliberating of emerging ethical challenges, before making reasonable and prudent decisions. The management and communication of information on this crisis has not been properly addressed, where it is considered that its negative effects may lead not only to interfere with the communication channels with citizens but also affect the expected adherence of the population to the indications that they need to follow. This issue is especially complex when experiencing a period of information explosion, a phenomenon called 'infodemic' by the World Health Organization. This article, claiming the ethical and legal imperative to act responsibly in collecting, using, and disse minating the information that helps any authority that plays a social function, proposes a series of recommendations to achieve its effectiveness in practice.

Resistencia a hormonas tiroideas no asociada a mutación de la isoforma beta del receptor de hormonas tiroideas: caso clínico / Thyroid hormone resistance not associated to mutation on the beta isoform of the thyroid hormone receptor: report of one case

Thyroid hormone resistance (RTH) is inherited as an autosomal dominant trait, with variable clinical presentations. The hallmark of the syndrome is a variable degree of resistance to thyroid hormones, with high levels of circulating thyroid hormones, inappropriately normal or elevated TSH values and a clinical pattern of mixed hypothyroidism and hyperthyroidism. RTH is related in more than 85 percent of cases to thyroid hormone beta receptor mutations. We report a 11 years female with a history of treatment with propylthiouracil (PTU) for hyperthyroidism, presenting with a progressive goiter. Thyroidectomy was performed, removing 233 grams of thyroid tissue showing follicular hyperplasia. After surgery, a fast growth of the remnant thyroid gland was observed along with tachycardia. Laboratory showed a TSH of 38 mU/mL a triiodothyronine level of 300 ng/dL a thyroxin level of 14.8 ug/dL and a free thyroxin of 3.19 ng/dL, suggesting the diagnosis of RTH. The molecular study was negative for mutation of the beta isoform of thyroid hormone receptor. The possible theories that can explain these findings are discussed.

Proposición de consenso para el uso de yodo 131 en el tratamiento de la tirotoxicosis y el cáncer del tiroides / Consensus proposal on the use of iodine-131 in hyperthyroidism and thyroid cancer

A consensus meeting held by the Chilean Endocrinological Society reached to 22 consensus proposals on the use of iodine-131 in hyperthyroidism and thyroid cancer, that are reported in this paper. Some of these propositions are: 1) Hyperthyroidism: A previous 131I uptake test must be performed. A calculated or an ablative dose should be administered. Hypothyroidism must be considered an objective rather than a complication. In patients with cardiovascular risk, normal thyroid function must be attained with propythioturacil. In cases of treatment failure, the dose should not be repeated before six months. It must be used with used with caution in children and teenagers. 2) Thyroid cancer: A iodine free diet is recommended prior to the therapeutic dose. A 100 mCi complementary ablative dose should be given after surgery, with a posterior exploration. This examination must not be done routinely, and if required, a 5 mCi dose should be used. For the treatment of metastases, a dose of 150 to 200 mCi is recommended. There is no radiation risk in hyperthyroidism or thyroid cancer. The only absolute contraindication is pregnancy. Recommendations for radiological protection are formulated. Hospitalization is suggested to protect other people from radiation exposure

Nocardiosis diseminada en tres pacientes inmunocompetentes / Disseminated nocardiosis in 3 immunocompetent patients

Nocardia asteroide infections, an aerobic actinomycete, have several forms and lungs, skin and brain are the organs most frequently involved. When the infection suspected, special staining methods must be ordered to identify the agent. We report three immunocompetent patients with disseminated nocardiosis, 2 presenting with nodular lesions of skin and lungs and one presenting with pulmonary involvement and brain abscesses. The importance of clinical suspicion and early diagnosis of nocardiosis is emphasized

Hiponatremia severa en porfiria aguda: mielinolisis pontina central como complicación de su tratamiento / Acute porphyria: central pontine myelinolysis developing during correction of severe hyponatremia

Two patients developed severe hyponatremia attributed to inappropriate antidiuretic hormone secretion during a crisis of acute porphyria, and were treated with intravenous hypertonic sodium solution. One of them developed clinical and radiological findings of pontine and extrapontine myelinolysis, which may constitute a risk in the treatment of this complication