Médicos -Centíficos en Chile: ¿Una especie en extinción? / Physicians in biomedical research in Chile: A species under risk of extinction?

Several studies have reported a progressive reduction in the number of grant applications and research projects approved by medical doctors (MD) in the United States. The overall trend and current situation of MDs actively involved in biomedical research in Chile has not been defined. Thus, we analyzed the professional profile of the principal investigators (PI) that have led research grants approved by the Technology and Medical Sciences study groups of the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT), during the last 20 years. The results show that the projects led by MDs corresponded to 80percent in 1984, decreasing to 50percent in 2003, with further reduction projected for the next years. We think that the physician doing biomedical research represents a human resource indispensable to preserve a genuine academic environment within medical schools; thus, it is necessary to design and apply strategies to reverse this worrying trend of less MDs actively involved in research in Chile. Among these, we consider important to stimulate research activities at both the undergraduate and postgraduate levels of MD training particularly increasing the flexibility of the postgraduate fellowship programs. In addition, it is necessary to support both in terms of money and spare time those physicians who are beginning an academic career involved in biomedical research. Finally, we consider important that non-academic institutions (e.g., pharmaceutical companies, health medical organizations, and philanthropic foundations) should also support academic development and biomedical research in our medical schools.

Medicina en televisión: ¿un problema ético? / Medicine in television: an ethical problem?

Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice.

Disminución del volumen plasmático y cambios en hormonas vasoactivas en embarazadas de bajo peso / Reduced plasma volume and changes in vasoactive hormones in underweight pregnant women

Background: Pregnant women with low weight/height (wt/ht) have lower plasma volume and reduced birth weight than women with normal wt/ht. Aim: To explore the hormonal mechanisms involved in these alterations. Patients and methods: Plasma volume, and several hormones related to plasma volume regulation were determined in 24 near term pregnant women with low wt/ht and in 30 with normal wt/ht. Results: Newborns's weight, height and ponderal index were reduced in the low wt/ht group. Plasma volume (3042 ñ 101 vs 3631 ñ 101 ml, p< 0.001); plasma renin activity (7.5 ñ 0.9 vs 11.1 ñ 0.9 ng/ml/h, p< 0.01) and aldosterone (428 ñ 47 vs 710 ñ 58 pg/ml, p< 0.001) were significantly reduced in the low wt/ht group. Similar reductions were observed in serum estradiol and progesterone levels. Urinary kallikrein activity (354 ñ 112 vs 824 ñ 134 nmoles/24 h, p< 0.05), 6-keto-prostaglandin F1a (561 ñ 90 vs 1121 ñ 165 ng/24 h, p< 0.05) and thromboxane B2 (110 ñ 29 vs 280 ñ 29 ng/24 h, p< 0.05) were also reduced in low wt/ht women. Conclusions: We postulate that the reduced levels of vasoactive hormones observed in pregnant women with low wt/ht may interfere with plasma volume expansion and, in turn, cause low birth weight

Síndrome hipertensivo del embarazo: estudio caso control de la incidencia y recurrencia / Hypertension syndrome in pregnancy: case-control study of the incidence and recurrence

En un estudio caso-control retrospectivo, analizamos la incidencia, resultado perinatal y riesgo de recurrencia del síndrome hipertensivo del embarazo (SHE) en un grupo de nulíparas que tuvieron su parto en el Hospital Clínico de la Universidad Católica durante los años 1988-1990. SHE se observó en 328/3127 (10.5 por ciento) de los partos. El 45 por ciento correspondió a hipertensión transitoria (HT), 49 por ciento tuvo preeciampsia (PE), 3.5 por ciento hipertensión crónica y 2.5 por ciento fueron hipertensas crónicas con PE sobreagregada. Los resultados perinatales de las madres con HT fueron semejantes a los observados en el grupo control, mientras que las con PE tuvieron un riesgo aumentado de parto prematuro, recién nacidos pequeños para la edad gestacional y con Apgar bajos. Hubo un 36 por ciento de recurrencia de SHE, comparado con un 2.2 por ciento de SHE observado en las mujeres que estuvieron normotensas en la primera gestación. El OR para PE fue de 16 [CI 1,9-363] si en el primer embarazo también hubo PE