Reconocimiento docente de los valores éticos y morales en la formación curricular de la carrera de odontología de la Universidad de Viña del Mar, Chile / Teaching recognition of ethical and moral values in the curriculum training of the dentistry career of the Universidad de Viña del Mar, Chile

El objetivo de esta investigación es determinar la coherencia entre lo declarado por los programas de estudios de pregrado en la carrera de Odontología de la Universidad de Viña del Mar, en relación a los valores éticos y morales y, cómo son reconocidos efectivamente por los docentes en los estudiantes. El diseño de investigación corresponde a un estudio descriptivo y transversal. Para esto se adaptaron dos instrumentos, el primero: "cuestionario sobre percepción en la categorización de valores" que busca determinar la importancia que le dan los docentes a los valores. Mientras que en el segundo: "Encuesta sobre valores en estudiantes de odontología" solicita que cada docente evalúe la frecuencia con que se manifiestan ciertos valores éticos y morales en sus estudiantes. Se consideraron los 28 académicos que constituyen la totalidad del universo de docentes clínicos de los cursos de 4to y 5to años de la carrera de odontología en el año 2019. Se discuten los resultados comparándolos con experiencias similares en otras instituciones. Los resultados muestran la percepción y el reconocimiento de los valores por parte del cuerpo docente en los estudiantes, donde se identificó que los valores incorporados de mejor manera son la dignidad, el trato humano y el dialogo; mientras que la autocrítica y el conocimiento fueron los menos incorporados, estos son clave para establecer reflexión y mejoras en los planes de estudio. Se marca el punto de inicio para la generación de futuras líneas de investigación que incorporen otros aspectos como la perspectiva de los pacientes, los estudiantes, así como también continuar recabando información para utilizar metodologías que puedan contribuir a la integración de valores y poner en debate la importancia de ellos en la formación de pregrado.

The aim of this article is to determine the coherence between what is declared by the undergraduate study programs in the Dentistry career at the University of Viña del Mar, in relation to ethical and moral values and how they are effectively recognized by teachers in the students. The research design corresponds to a descriptive and cross-sectional study. Two instruments were adapted for this, the first: "questionnaire on perception in the categorization of values" that seeks to determine the importance that teachers give to values. While in the second: "Survey on values in dentistry students" requests that each teacher evaluates the frequency of certain ethical and moral values which are manifested in their students. 28 academics constituting the entire universe of clinical teachers of the 4th and 5th year courses of dentistry career in 2019 were considered. The results were discussed, comparing them with similar experiences in other institutions. Results show the perception and recognition of the values by the teaching staff in the students. These values incorporated in the best way were dignity, humane treatment and dialogue; while self-criticism and knowledge were the least incorporated. These are key values to establish a reflection and subsequent improvements in the study plans. This article marks a starting point for the generation of future lines of research that incorporate other aspects such as the perspective of patients, students, as well as continuing to collect information to use methodologies that can contribute to the integration of values and put them into a debate about the importance of them in undergraduate training.

Casamentos de Longa Duração: Recursos Pessoais como Estratégias de Manutenção do Laço Conjugal / Long-term Marriages: Personal Resources as Maintenance Strategies of Conjugal Bond / Matrimonios a Largo Plazo: Recursos Personales y Estrategias de Mantenimiento del Vínculo Conyugal

Partindo da abordagem da Psicologia Positiva, este estudo teve por objetivo compreender as principais estratégias e recursos pessoais utilizados por casais engajados em casamentos de longa duração para a manutenção do relacionamento conjugal. Foram realizadas 75 entrevistas com 25 casais heterossexuais unidos, em média, havia 39,48 anos, com média de idade de 64,06 anos. A partir da análise de conteúdo, de frequência e considerando o objetivo do estudo, foram analisadas em profundidade as seguintes categorias: compreensão, comprometimento e doação, espiritualidade e afetividade. Os momentos de crise foram superados, sobretudo, por meio da manutenção dos esforços que cada parceiro envidou, a partir dos seus próprios recursos pessoais e de sua individualidade, contribuindo para o fortalecimento do laço conjugal. Concluiu-se que o casamento é mantido por estratégias que são desenvolvidas tanto a partir de recursos pessoais como de elementos compartilhados pelo par, o que indica que a conjugalidade oferece suporte para sua própria permanência ao longo do tempo.(AU)

Starting from the Positive Psychology approach this study aimed to understand the main strategies and personal resources used by couple engaged in long term marriages in order to maintain the marital relationship. Seventy-five interviews with twenty- five heterosexual couples, together on average for 39.48 years, and aging on average 64.06 years, were performed. Beginning from the analysis of content, frequency, and considering the objective of the study the following categories were analysed: comprehension, compromise and giving, spirituality and affection. The moments of crisis have been overcome, especially by maintaining the efforts that each partner has made, from their own personal resources and their individuality, contributing to strengthening the marital bond. It was concluded that the marriage is maintained by strategies that are developed both from personal resources and elements shared by the couple, which indicates that the conjugality offers support to its own permanence over time.(AU)

A partir del enfoque de la Psicología Positiva, este estudio tuvo como objetivo comprender las principales estrategias y recursos personales utilizados por las parejas comprometidas en matrimonios duraderos para mantener la relación conyugal. Fueron conducidas 75 entrevistas con 25 parejas heterosexuales unidas en promedio hace 39.48 años, con una edad media de 64.06 años. A partir del análisis de contenido, frecuencia y teniendo en cuenta el propósito del estudio, se analizaron en profundidad las siguientes categorías: comprensión, comprometimiento y entrega, espiritualidad y afectividad. Los momentos de crisis se superaron, especialmente mediante el mantenimiento de los esfuerzos que cada cónyuge ha hecho, a partir de sus propios recursos personales y su individualidad, lo que contribuye al fortalecimiento del vínculo matrimonial. Se concluye que el casamiento se mantiene por estrategias que se desarrollan a partir de recursos personales y también de elementos compartidos por la pareja, lo que indica que la conyugalidad ofrece soporte para su propia permanencia a lo largo del tiempo.(AU)

Tumor mülleriano mixto heterólogo primario de trompa uterina / Mixed mullerian tumor heterologous primary horn uterine

El tumor mülleriano mixto maligno es una neoplasia inusual que corresponde al 0,1 % - 0,5 % de los tumores malignos ginecológicos. Se presenta el caso de paciente de 73 años de edad que consulta por dolor y tumoración pélvica. Es llevada a mesa operatoria con el diagnóstico de tumor de anexo uterino izquierdo. Se realizó histerectomía total, salpingooforectomía bilateral y omentectomía, más lavado peritoneal. El estudio histopatológico informa tumor mülleriano mixto maligno primario de trompa uterina izquierda. La inmunohistoquimica reportó inmunomarcaje en las células neoplásicas con vimentina, Q7, PAX8, Ki67 15 % y concluye como tumor mixto mülleriano. La enfermedad fue clasificada como en estadio III (FIGO) y se decide quimioterapia sistémica de manera coadyuvante. A los 19 meses posteriores a la cirugía la paciente se encuentra estable y sin muestras de recidiva.

The malignant mixed Mullerian Tumor is an unusual neoplasia which corresponds to the 0.1 - 0.5 % of gynecologic malignancies. The case of female patient of 73-year-old consulting by pain and pelvic tumor arises. It is carried to the operating table with the left uterine annex tumor Diagnostics. He was total hysterectomy, bilateral salpingo-oophorectomy and omentectomy, most peritoneal washing. The histopathological study advises Tumor Mullerian mixed malignant primary left uterine Horn. Immunohistochemistry reported immunomarking in neoplastic cells with vimentin, Q7, PAX8, Ki67 15 % and concludes as mixed Tumor, Mullerian. The disease was classified as stage III (FIGO), and decided way adjuvant systemic chemotherapy. 19 months after the surgery, the patient is stable and no signs of relapse.

La Comisión Nacional de Bioética de Chile: una tarea pendiente: aportes de la experiencia de las comisiones nacionales de bioética de México e Italia / A Comissão Nacional de Bioética do Chile: uma tarefa pendente: contribuições da experiência das comissões nacionais de bioética do México e da Itália / The Bioethics National Commission in Chile: a pending task: contributions from the experience of national bioethics commissions of Mexico and Italy

El objetivo de este trabajo es discurrir sobre los orígenes, naturaleza, integración y funciones de las Comisiones Nacionales de Bioética de México e Italia, con el fin de extraer experiencia que pudiese ayudar al momento de implementar la Comisión Nacional de Bioética de Chile. La investigación es cualitativa-interpretativa, fenomenológica, descriptiva y bibliográfica. Se infiere que la Comisión Nacional Bioética de Chile, para cumplir la función encomendada, debiese considerar la experiencia de otras comisiones, en particular la de México e Italia.

The aim of this study is to reflect on the origin, nature, integration and functions of National Bioethics Commissions of Mexico and Italy, with the goal to draw helpful experience for implementing the National Bioethics Commission in Chile. The study is qualitative-interpretative, phenomenological, descriptive and bibliographical. It is inferred that the National Bioethics Commission in Chile, in order to fulfill the function entrusted, it must consider the experience of other commissions, in particular that of Mexico and Italy.

O objetivo deste trabalho é discorrer sobre as orígens, natureza, integração e funções das Comissões Nacionais de Bioética do México e da Itália, com a finalidade de obter experiência que possa ajudar na ocasião de implementar a Comissão Nacional de Bioética do Chile. A investigação é qualitativa-interpretativa, fenomenológica, descritiva e bibliográfica. Infere-se que a Comissão Nacional Bioética do Chile, para cumprir a função para a qual foi encarregada, deveria considerar a experiência de outras comissões, em particular a do México e da Itália.

In vitro fertilization (IVF) in mammals: epigenetic and developmental alterations: scientific and bioethical implications for IVF in humans

The advent of in vitro fertilization (IVF) in animals and humans implies an extraordinary change in the environment where the beginning of a new organism takes place. In mammals fertilization occurs in the maternal oviduct, where there are unique conditions for guaranteeing the encounter of the gametes and the first stages of development of the embryo and thus its future. During this period a major epigenetic reprogramming takes place that is crucial for the normal fate of the embryo. This epigenetic reprogramming is very vulnerable to changes in environmental conditions such as the ones implied in IVF, including in vitro culture, nutrition, light, temperature, oxygen tension, embryo-maternal signaling, and the general absence of protection against foreign elements that could affect the stability of this process. The objective of this review is to update the impact of the various conditions inherent in the use of IVF on the epigenetic profile and outcomes of mammalian embryos, including superovulation, IVF technique, embryo culture and manipulation and absence of embryo-maternal signaling. It also covers the possible transgenerational inheritance of the epigenetic alterations associated with assisted reproductive technologies (ART), including its phenotypic consequences as is in the case of the large offspring syndrome (LOS). Finally, the important scientific and bioethical implications of the results found in animals are discussed in terms of the ART in humans.

Turismo con células madre y requisitos para su uso clínico: desafíos bioéticos más allá del embrión / Bioethical challenges of stem cell tourism

Stem cells have drawn extraordinary attention from scientists and the general public due to their potential to generate effective therapies for incurable diseases. At the same time, the production of embryonic stem cells involves a serious ethical issue concerning the destruction of human embryos. Although adult stem cells and induced pluripotential cells do not pose this ethical objection, there are other bioethical challenges common to all types of stem cells related particularly to the clinical use of stem cells. Their clinical use should be based on clinical trials, and in special situations, medical innovation, both of which have particular ethical dimensions. The media has raised unfounded expectations in patients and the public about the real clinical benefits of stem cells. At the same time, the number of unregulated clinics is increasing around the world, making direct offers through Internet of unproven stem cell therapies that attract desperate patients that have not found solutions in standard medicine. This is what is called stem cells tourism. This article reviews this situation, its consequences and the need for international cooperation to establish effective regulations to prevent the exploitation of patients and to endanger the prestige of legitimate stem cell research.

Psicanálise e literatura: intersecções / Psicoanálisis y literatura: intersecciones / Psychoanalysis and literature: intersections

O autor examina algumas relações existentes entre a psicanálise e a literatura de ficção, assinalando a mútua influência entre elas. Destaca a importância da busca e do significado da palavra em ambas e a importância de Freud como um estilista ímpar na língua alemã. Aponta ainda o papel da literatura como precursora da investigação científica da alma humana, sendo a psicanálise, nesse sentido, sua herdeira

The author examines relations present between psychoanalysis and fictional literature, highlighting the mutual influence between them. He emphasizes the importance of the search and of the significance of the word in both areas, and the importance of Freud as an unsurpassable stylist in the german language. He also stresses the role of literature as a precursor of scientific investigation of the human soul, having psychoanalysis, in this sense, as its heir

El autor examina algunas relaciones existentes entre el psicoanálisis y la literatura de ficción, señalando la mutua influencia entre ellas. Subraya la importancia de la búsqueda y del significado de la palabra en ambas y la importancia de Freud como un estilista impar en la lengua alemana. Apunta, además, el rol de la literatura como precursora de la investigación científica del alma humana, siendo el psicoanálisis, en ese sentido, su heredera

Características de los pacientes adultos con influenza A (H1N1) hospitalizados en un servicio de emergencia de un hospital nacional, en 2009 / Characteristics of adult patients with influenza A (H1N1) infection admitted to the emergency room in a national hospital, in 2009

Objetivo. Determinar las características clínicas de los pacientes con diagnóstico de influenza A (H1N1). Material y métodos. Se realizó un estudio descriptivo y retrospectivo en los pacientes hospitalizados con sospecha de infección por influenza A (H1N1) en el Servicio de Emergencia del Hospital Nacional Cayetano Heredia (HNCH) de Lima, de mayo a agosto de 2009. La información se tomó de las historias clínicas de los pacientes a su ingreso y se incluyó a pacientes mayores de 14 años con RT-PCR (reacción en cadena de polimerasa en tiempo real) por hisopado nasofaríngeo positivos para influenza A (H1N1). Resultados. De 92 pacientes hospitalizados por sospecha de infección por influenza A (H1N1), 62 fueron positivos. De estos, 40 pacientes fueron varones, la edad promedio fue 35,29 más menos 16,8 años, el tiempo promedio de enfermedad y de hospitalización fueron 5,8 más menos 3,8 y 7,7 más menos 5,7 días, respectivamente. Las principales condiciones médicas asociadas fueron asma, obesidad y gestación. Los síntomas más frecuentes fueron fiebre, tos y disnea; asimismo, se halló linfopenia, trombocitosis y aumento de la actividad sérica de lactato deshidrogenasa (DHL). En la radiografía de tórax, el patrón intersticial fue predominante. Sesenta y un pacientes recibieron oseltamivir y cobertura antibiótica; nueve pacientes desarrollaron síndrome de distrés respiratorio agudo (SDRA), de los cuales cinco fallecieron. Conclusión. Influenza A (H1N1) se presentó con más frecuencia en pacientes adultos jóvenes, con asma como condición médica asociada y un patrón intersticial en la radiografía del tórax.

Objective. To determine the clinical characteristics of patients with Influenza A (H1N1) infection admitted to a general hospital. Methods. A descriptive and retrospective study was carried out in patients with suspected Influenza A (H1N1) infection admitted to the emergency room (ER) in Cayetano Heredia National Hospital, Lima, from May to August 2009. A review of clinical records of these patients more and equal than 14 year-old and with a positive nasopharyngeal swabs (rRT)-PCR for influenza A (H1N1) virus was done. Results. A total of 92 patients were hospitalized. Among them, 62 had a positive (rRT)-PCR. Forty patients were male and mean age was 35,2 more less 16,8 year-old. Mean time of illness and hospital stay were 5,8 more less 3,8 and 7,7 more less 5,7 days, respectively. The main associated clinical conditions were asthma, obesity and pregnancy. The most common symptoms were fever, cough and dyspnea. Lymphopenia, thrombocytosis and increased serum activity of LDH were founded. On chest x-ray, interstitial pattern was the most common finding. All of patients received antibiotics and 61 patients were treated with oseltamivir. Nine patients who developed acute respiratory distress syndrome (ARDS) were transferred to intensive care unit (ICU), and five of them died. Conclusion. Influenza A (H1N1) infection was common in young males, with asthma as a comorbid condition, and an interstitial pattern on chest film.

Bioethical aspects of basic research and medical applications of human stem cells

The new discoveries, the extraordinary dynamism in human stem cell (SC) research, and the great expectations of the benefits in clinical treatment of many diseases are on the edge of unparalleled advances in both: 1) the understanding of basic mechanisms of cell differentiation and development and 2) the translation from basic research to new clinical therapies. Human stem cells are obtained from different sources, such as embryo, fetal, and adult tissues, in vitro induction (iPS cells) or transdifferentiation. The evidence that these cells are pluripotent (or multipotent), meaning they have the ability to differentiate into all body tissues or tissues of the same lineage, raises the possibility that they could regenerate diseased or damaged tissue in diseases that until now have had no effective treatments. Human stem cell research and therapy raise important bioethical considerations because of the human nature of these cells and their peculiar characteristics. Here we discuss the bioethical aspects of basic human SC research and the conditions necessary for the translation of basic preclinical research into clinical use of SC.

The beginning of life of a new human being from the scientific biological perspective and its bioethical implications

The issue of when the human life begins is a very important subject since it has a significant impact on the decisions that we have to take in relation to human beings in development, particularly human embryos. In this article we discuss some of the more relevant biological evidence supporting the fact that beginning human life begins unquestionably at fertilization and the bioethical consequences.

Correlación entre índices de bioimpedancia eléctrica y score Apache II en pacientes con shock séptico / Correlation between indexes of electrical bioimpedance and Apache II score in patients with septic shock

Objetivo: Determinar la correlación entre diversos índices de bioimpedancia eléctrica (IBE) y el score APACHE II (sAII) en pacientes con shock séptico. Material y métodos: Se incluyeron 30 pacientes >14 años con shock séptico de la unidad de cuidados intensivos (UCI) adultos del Hospital Nacional Cayetano Heredia-Perú a quienes se calculó el (sAII) y se midió el ángulo de fase, índice de impedancia y relación LIC/LEC, correlacionándolos posteriormente mediante Pearson y regresión lineal múltiple. Resultados: El 60% fueron varones, la edad promedio fue 60 ± 20,92 años, talla 1,61 ± 0,06m, peso 65,46 ± 8,7 Kg. y tiempo de ingreso a UCI 8,4 ± 5,99 horas. El 86,6% requirió ventilación mecánica, el foco infeccioso más frecuente fue respiratorio (63,3%). El promedio del sAII fue 18,83 ± 9,23, la permanencia en UCI 8,4 ± 5,99 días y la letalidad al mes 50%. Solamente se encontró correlación negativa con significancia estadística (r = -0,46; p = 0,01) entre el ángulo de fase (AF) y el (sAII). Ni el índice de impedancia ni la relación LIC/LEC tuvieron correlación significativa. El mejor predictor de mortalidad fue el AF: todos los que fallecieron tuvieron un AF<6grados (promedio 3,67 ± 0,63), p<0,05. Conclusiones: Únicamente el AF se correlacionó con el score (sAII) y fue el índice que mejor predijo mortalidad en pacientes con shock séptico, siendo superior al score APACHE II (sAII).

Objective: To determine the correlation between various indexes of bioelectrical impedance (IBE) and APACHE II score (sAII) in patients with septic shock. Material and methods: We included 30 patients > 14 years old with septic shock admitted to the Adults intensive care unit (ICU) at the Hospital Nacional Cayetano Heredia û Peru. The (sAII) was calculated and various IBE parameters were measured (phase angle, impedance index and relationship ICF/ECF). Correlations were calculated by multiple linear regression and Pearson. Results: 60% were male, mean age was 60 ± 20.92 years, height 161 ± 6 cm, weight 65.46 ± 8.7 kg and time of admission ICU was 8.4 ± 5.99 hours. 86.6% required mechanical ventilation, the most common infection was respiratory in origin (63.3%). The mean sAII was 18.8 ± 9.2, ICU stay was 8.4 ± 5.99 days and mortality was 50% per month. We only found a statistically significant negative correlation (r = - 0.46, p = 0.01) between the phase angle (FA) and (sAII). Neither the impedance index nor the relationship ICF/ECF had significant correlation. The best predictor of mortality was FA: those who died had an FA <6 degrees (average 3.67 ± 0.63), p <0.05. Conclusions: Only FA correlated with the score (sAII) and was the index that best predicted mortality in patients with septic shock, exceeding the APACHE II score (sAII).

Aportes de la epigenética en la comprensión del desarrollo del ser humano: [revisión] / Contribution of epigenetics to understand human development: [review]

Epigenetics refers to the study of how genes produce their effect on the phenotype of the organism. This article is a review on the scope and importance of recently discovered epigenetic mechanisms on human development and their relationship to perinatal epidemiological issues. It shows a general view and present concepts about epigenetics and its contribution to the comprehension of several physiologic and pathological conditions of human beings. Secondly, it analyzes the evidence coming from epidemiological and animal studies, about the influence of events that occur in the perinatal and early postnatal periods on adult life and the possible epigenetic mechanisms involved. Lastly, it underscores the implications ofthese results of future research and the design of public policies that take into account the importance of events in early life in thefuture development of individuals.