Wake effects and temperature plumes: Coping with non-knowledge in the expansion of wind and geothermal energy.

Energy transitions are knowledge-intensive processes where a multitude of actors are trying to cope with inevitable knowledge gaps, surprises, and uncertainties. In this context, we focus on two techno-physical phenomena that are gaining practical relevance with the expansion of wind and geothermal energy extraction, and are surrounded by significant unknowns: wake effects and temperature plumes. Both phenomena can potentially affect the efficiency of energy production, but the extent of their impact is not yet known. Based on 28 semi-structured interviews with experts in the fields of wind and geothermal energy, we explore how different central actors perceive and interpret non-knowledge of wake effects and temperature plumes, and how they deal with it. We show that there are strategies for either using non-knowledge as a basis for action or simply ignoring it and sweeping knowledge gaps under the rug. Both strategies serve the function of protecting agency and keeping things going.

Modulation of human frontal midline theta by neurofeedback: A systematic review and quantitative meta-analysis.

Human brain activity consists of different frequency bands associated with varying functions. Oscillatory activity of frontal brain regions in the theta range (4-8 Hz) is linked to cognitive processing and can be modulated by neurofeedback - a technique where participants receive real-time feedback about their brain activity and learn to modulate it. However, criticism of this technique evolved, and high heterogeneity of study designs complicates a valid evaluation of its effectiveness. This meta-analysis provides the first systematic overview over studies attempting to modulate frontal midline theta with neurofeedback in healthy human participants. Out of 1261 articles screened, 14 studies were eligible for systematic review and 11 for quantitative meta-analyses. Studies were evaluated following the DIAD model and the PRISMA guidelines. A significant across-study effect of medium size (Hedges' g = .66; 95%-CI [-0.62, 1.73]) with substantial between-study heterogeneity (Q(16) = 167.43, p < .001) was observed and subanalysis revealed effective frontal midline theta upregulation. We discuss moderators of effect sizes and provide guidelines for future research in this dynamic field.

Evolutive study of rheumatic carditis cases treated with corticosteroids in a Public Hospital / Estudo evolutivo de casos de cardite reumática tratados com corticosteróides em um hospital público

Background: Rheumatic carditis is a challenge for treatment and secondary prophylaxis, due to severe valve sequelae. Objective: To evaluate the cases of rheumatic carditis in patients under 18 years old treated with corticosteroids.Methods: An observational, longitudinal and retrospective study was carried out on the profile of patients, in the period of 2000-2015. We selected those who received corticosteroid therapy at immunosuppressive doses, for the treatment of carditis and were aged 5 to 18 years. Data were extracted from medical records. Calculations of: averages, standard deviations, medians and interquartile ranges, ratios and 95% confidence intervals were obtained. Chi-square and Wilcoxon tests were applied for comparisons. The level of significance was 5%. Results: Of the 93 cases, 93.53% developed moderate or severe carditis. Mitral regurgitation was detected in 100% of the sample. Pulse therapy was administered in 11.83%. Surgery was performed in 23.69% of patients: mitral, aortic and/or tricuspid valve repair or replacement. The evolution of the cases was favorable in 70.96%. There was a good response among those who received only clinical treatment and those who belonged to the surgical group. The comparison of the initial and posterior valve lesions to the corticoid use was statistically significant (p < 0.001). A difference between the ejection fraction medians was observed (p = 0.048). Hospitalization was required twice or more for 45.16% of the patients. The mortality rate was 5.38%.Conclusions: The patients showed significant clinical improvement. The treatment was effective, reducing trivalvular impairment

Ética del cuidado en medicina / Ethics of Care in Medicine

Curar y cuidar son la misma palabra que significa ocuparse con esmero, con preocupación, con celo del enfermo. Usamos curar cuando es posible restaurar la salud perdida, si sólo podemos acompañar en el dolor, el sufrimiento y la muerte usaremos cuidar. El lugar auténtico desde donde el médico ejercerá este cuidado es su encuentro con el enfermo. Este es un espacio nuevo que debe ser constituido con el aporte genuino de ambos. Sólo el tacto y la escucha atenta posibilitan ese cuidado

Curar e cuidar são a mesma palavra que significa se ocupar com esmero, com preocupação, com fita-cola do doente. Usamos curar quando é possível restaurar a saúde perdida, se só podemos acompanhar na dor, o sofrimento e a morte usaremos cuida. O lugar autêntico onde o médico irá exercer este cuidado é seu encontro com os doentes. Este é um novo espaço que deve ser constituído com a genuína contribuição de ambos. Só o tacto e a escuta atenta possibilitam esse cuidado

Cure and care are the same word meaning to deal with carefully, with concern, with the zeal of the sick. We use to cure when it is possible to restore lost health. If we can only accompany in pain, suffering and death will use care. There is an authentic place where the doctor will exercise this care: his encounter with the sick. This is a new space which must be constituted with a genuine contribution of both. Only touch and attentive listening enable this care

El deber moral de los estados y ciudadanos de preservar la sustentabilidad / O dever moral dos estados e dos cidadãos para preservar a sustentabilidade / The moral duty of states and citizens to preserve the sustainability

Considerando que formular el deber ser de las cosas - la ética - es una de las tareas de la Filosofía este trabajo busca claves interdisciplinarias para establecer el deber ser ambiental. Para ello analiza algunos problemas que afectan al ambiente como espacio "natural" y humano. ¿Dónde hallar la clave en la economía, la ciencia, la política? Si bien la reflexión tiene un origen ético y busca respuestas políticas, se detendrá sobre todo en el concepto de sustentabilidad...

Considerando que formular o dever ser das coisas - a ética - é uma tarefa da Filosofia, o presente trabalho busca chaves interdisciplinares para estabelecer o dever ser ambiental. Para tanto, analisa alguns problemas que afetam o meio ambiente como espaço "natural" e humano. Onde encontrar a chave da economia, da ciência, da política? Ainda que a reflexão tenha uma origem ética e busque respostas políticas, se deterá sobretudo no conceito de sustentabilidade...

Taking into consideration that formulating what the nature of things must be - ethics - is a Philosophy task, this work looks for interdisciplinary keys to establish the environmental must-be. To do this, it analyzes some problems which affect the environment as a "natural" and human space. Where can we find the economy, science and politics key? Although the reflection has an ethical origin and seeks political responses, it will address all the concept of sustainability...

Relación médico paciente: la bioética y el cuidado en medicina

A lo largo de la historia de la medicina, el médico ha desempeñado principalmente tareas de asistencia y consuelo. Entre los siglos XV y XVII se realiza un cambio en la concepción de la medicina que acompaña a la transformación del conocimiento, poner remedio se transforma muy rápidamente en poner un remedio, una medicina. En la actualidad, imbuidos del mismo espíritu, entendemos que apartar todo daño y maleficio significa apartar la enfermedad. La bioética nos propone acercarnos al médico y hallar conductas éticas en que se manifieste el hombre en su plenitud, íntegro, con capacidad de vivir su historia y proyectarse al porvenir, tal cual lo pedía Potter, su fundador. Esto muchas veces implica curar, reparar, extraer el daño, pero sobre todo obliga al médico a cumplir con su vocación más antigua: cuidar. Pero ¿cómo pensar el cuerpo de otra manera y la enfermedad de otra manera? Proyectar un mundo con el enfermo compartiendo un espacio con él, el cuidado de ese espacio común, de ese proyecto común. Esto es la medida no sólo del ejercicio de la humanidad del médico, sino de su ética. Debemos hablar de una ética del cuidado en medicina. Esto significa básicamente estar atentos a que el paciente es un otro que necesita de nosotros, que acude al médico a pedir ayuda; negársela, omitir acciones, o realizar acciones en beneficio de terceros, sería claramente optar por una conducta no ética, inmoral. Reflexionar frente al enfermo muriente y sobre todo al enfermo sufriente, se convierte en el mayor desafío para el médico. Practicar la ética del cuidado no es otra cosa que acompañar al enfermo en el camino hacia el futuro, sea este de vida o de muerte, teniendo presente lo que decía Erik Cassel "El médico pocas veces cura, algunas alivia, pero siempre debe consolar".(AU)

Along the medicine history the doctor has mainly performed tasks of assistance and consolation. Between the fifteenth and seventeenth centuries the evolving knowledge brought a change in the concepts of medicine. To assist patients very quickly starts to mean prescription of a medication. Today, imbued with the same spirit, we understand that removing a damage and spell means removing the disease. Bioethics teaches to find ethical behaviors in the doctors like men showing their integrity, ability to live with their history and projections into the future, as Potter, its founder, proposed. This often involves healing, repairing, removing the damage, but overall it requires that the doctors fulfill their oldest vocation: to care. But, how can the doctors think the body as well as the illness in a different way? By projecting a world with the patient, sharing the same space with him, taking care for the common space, the joint project. This is a measure not only of the doctors humanitarian practice, but also of his ethics. We should speak of an ethics of medical care. This means to be basically attentive that the patient is a person who needs us, who comes to the doctor asking for help. If the help is denied, actions are not taken, or the actions are for the benefit of others, this would clearly mean an unethical, immoral conduct. The biggest challenge for the doctor is to meditate in front of a dying patient and especially a suffering patient. Practicing ethical of care is to accompany the patient on the road to the future, be it life or death, bearing in mind what Erik Cassel said "The doctor rarely cures, sometimes alleviates, but should always console".(AU)

Relación médico paciente: la bioética y el cuidado en medicina / Physician Patient Relationship. Bioethics and Medical Care

A lo largo de la historia de la medicina, el médico ha desempeñado principalmente tareas de asistencia y consuelo. Entre los siglos XV y XVII se realiza un cambio en la concepción de la medicina que acompaña a la transformación del conocimiento, poner remedio se transforma muy rápidamente en poner un remedio, una medicina. En la actualidad, imbuidos del mismo espíritu, entendemos que apartar todo daño y maleficio significa apartar la enfermedad. La bioética nos propone acercarnos al médico y hallar conductas éticas en que se manifieste el hombre en su plenitud, íntegro, con capacidad de vivir su historia y proyectarse al porvenir, tal cual lo pedía Potter, su fundador. Esto muchas veces implica curar, reparar, extraer el daño, pero sobre todo obliga al médico a cumplir con su vocación más antigua: cuidar. Pero ¿cómo pensar el cuerpo de otra manera y la enfermedad de otra manera? Proyectar un mundo con el enfermo compartiendo un espacio con él, el cuidado de ese espacio común, de ese proyecto común. Esto es la medida no sólo del ejercicio de la humanidad del médico, sino de su ética. Debemos hablar de una ética del cuidado en medicina. Esto significa básicamente estar atentos a que el paciente es un otro que necesita de nosotros, que acude al médico a pedir ayuda; negársela, omitir acciones, o realizar acciones en beneficio de terceros, sería claramente optar por una conducta no ética, inmoral. Reflexionar frente al enfermo muriente y sobre todo al enfermo sufriente, se convierte en el mayor desafío para el médico. Practicar la ética del cuidado no es otra cosa que acompañar al enfermo en el camino hacia el futuro, sea este de vida o de muerte, teniendo presente lo que decía Erik Cassel "El médico pocas veces cura, algunas alivia, pero siempre debe consolar".

Along the medicine history the doctor has mainly performed tasks of assistance and consolation. Between the fifteenth and seventeenth centuries the evolving knowledge brought a change in the concepts of medicine. To assist patients very quickly starts to mean prescription of a medication. Today, imbued with the same spirit, we understand that removing a damage and spell means removing the disease. Bioethics teaches to find ethical behaviors in the doctors like men showing their integrity, ability to live with their history and projections into the future, as Potter, its founder, proposed. This often involves healing, repairing, removing the damage, but overall it requires that the doctors fulfill their oldest vocation: to care. But, how can the doctors think the body as well as the illness in a different way? By projecting a world with the patient, sharing the same space with him, taking care for the common space, the joint project. This is a measure not only of the doctors' humanitarian practice, but also of his ethics. We should speak of an ethics of medical care. This means to be basically attentive that the patient is a person who needs us, who comes to the doctor asking for help. If the help is denied, actions are not taken, or the actions are for the benefit of others, this would clearly mean an unethical, immoral conduct. The biggest challenge for the doctor is to meditate in front of a dying patient and especially a suffering patient. Practicing ethical of care is to accompany the patient on the road to the future, be it life or death, bearing in mind what Erik Cassel said "The doctor rarely cures, sometimes alleviates, but should always console".

Variações eletrocardiográficas em pacientes portador de cardiopatia hipertrófica em uso de CDI / Eletrocardiographic changes in patients with hypertrophic cardiomyopathy using ICD

A cardiomiopatia hipertrófica (CMH) é uma forma relativamente comum e complexa de doença cardíaca genética, sendo considerada a maior causa de morte súbita (MS) cardíaca em pessoas jovens, incluindo atletas, respondendo por 36% dos casos em jovens atletas nos Estados Unidos (EUA). O implante decardioversor-desfibrilador (CDI) tem demonstrado alta eficácia na prevenção desse evento. Para avaliação diagnóstica da CMH, o eletrocardiograma (ECG)representa ferramenta bastante útil, pois se encontra alterado em 75% a 95% dos casos clínicos. Após o implante do CDI, como demonstrado no caso relatado, são observadas variações no ECG que podem explicar a mudança benéfica na fisiopatologia obstrutiva da CMH.

Hypertrophic cardiomyopathy (HCM) is a relatively common and complex genetic heart disease, rated as main cause of sudden cardiac death (SCD) in young people, including athletes, accounting for 36% of these cases in young athletes in the United States(USA). IDC implants have proved highly effective for preventing such events. For diagnostic evaluations of CMH, the electrocardiogram (ECG) is a very useful tool, being altered in 75% to 95% of clinical cases. After an ICD implant, as demonstrated in this case report, variations in the ECG are noted that could explain the beneficial alteration in the pathophysiology of obstructive HCM.

Análise das metas terapêuticas na prevenção secundária de DAC após CRM / Analysis of treatment goals in secondary prevention of CAD after CABG

Fundamentos: O controle dos fatores de risco cardiovascular em pacientes com doença arterial coronariana (DAC) é um grande desafio, principalmente nos pacientes mais graves nos quais as metas terapêuticas são mais rigorosas.Objetivo: Analisar a obtenção das metas terapêuticas e a prescrição das medicações nos pacientes portadores deDAC após revascularização miocárdica (CRM). Métodos: Analisados os prontuários de 68 pacientes submetidos à CRM, com pelo menos um ano deacompanhamento após a cirurgia. Pacientes submetidos à troca valvar associada foram excluídos da análise.Resultados: Quarenta e cinco (66,2%) pacientes eram do sexo masculino com média de idade de 60,3±9,1 anos. Aprincipal indicação para CRM foi angina instável (62%). Noventa e quatro por cento dos pacientes eram hipertensos, 28% diabéticos, 50% dislipidêmicos e 50% tinham história prévia de infarto agudo do miocárdio. A média da fração de ejeção foi 60±13%. A lesão do troncoda coronária esquerda ocorreu em 29% dos pacientes e o número médio de enxertos foi 2,7±0,75. Após um ano de pós-operatório, 73,0% dos pacientes usavam IECA, 86,6% betabloqueador, 83,0% AAS e 96,6% estatina. No pós-operatório, o controle dos fatores de risco foi obtido nas proporções: PAS<140mmHg (55,9%), PAD<90mmHg (62,7%), glicose<100mg% (41,1%), colesteroltotal<200mg% (70,9%),LDL<100mg% (57,7%) ou LDL<70mg% (28,8%), HDL>45mg% (32,0%) etriglicerídeos<150mg% (47,8%).Conclusão: Os pacientes após um ano de CRM apresentam índices de controle pressórico, glicêmico e lipídico inadequados. O uso das medicações para DAC foi considerado adequado, exceto para o uso de IECA que poderia ser mais utilizada.

"progreso" biotccnológico y pobreza: una reflexión ética / Biotecholocical progress and poverty: an ethical reflection / "progresso"bioteecnológico e pobreza: uma reflexão ética

Nuestra cultura asocia progreso con desarrollo científico y, sobre todo, con desarrollo tecnológico. En el contexto latinoamericano, esta asociación no es tan definitiva como parece serlo para los países "desarrollados". Cuando se quiere integrar a la realidad latinoamericana la ecuación progreso-biotecnología aparecen conflictos de todo tipo, especialmente éticos, como el de transformar las tradiciones agrícolas con las semillas transgénicas y utilizar a nuestros pueblos como sujetos de experimentación. Aprovecharse de las desventajas que sufre la mayoría de la población mundial, entre ellos los latinoamericanos, en beneficio de unos pocos no tiene ningún justificativo ético. La propuesta es convertir a estos pueblos en protagonistas. Ellos no deben ser depositarios de una tradición cultural que muchas veces les es ajena.

Our culture associates progress with scientific development and particularly with technological development. In the Latin American context, this association is not as definitive as it seems to be for the "developed" countries. When attempting to integrate the biotechnological-progress equation into the reality of life in Latin America, all sorts of conflicts emerge, especially ethical ones, such as transforming agricultural traditions with genetically modified seeds and using our people as objects of experimentation. There is no ethical justification for taking advantage of the difficulties suffered by the majority of the world's population, including Latin Americans, for the benefit of only a few. The proposal is to turn these communities into protagonists. They should not be recipients of a cultural tradition that often is foreign to them.

Nossa cultura associa progresso com desenvolvimento científico e, sobretudo, com desenvolvimento tecnológico. No contexto latino-americano, essa associação não é tão definida como parece ser para os países "desenvolvidos". Quando se quer integrar à realidade latino-americana a equação progresso-biotecnologia, aparecem conflitos de todo tipo, especialmente éticos, como o de transformar as tradições agrícolas com as sementes transgênicas e utilizar nossos povos como sujeitos de experimentação. Aproveitar-se das desvantagens que sofre a maioria da população mundial, entre eles os latino-americanos, em benefício de poucos não tem nenhuma justificativa ética. A proposta é converter esses povos em protagonistas. Eles não devem ser depositários de uma tradição cultural que, muitas vezes, não lhes pertence.

Avaliação clínica e funcional tardia de arritmias em crianças operadas de Tetralogia de Fallot / Late clinical and functional assessment of arrhythmias in children after repair of Tetralogy of Fallot / Evaluación clínica y funcional tardía de arritmias en niños operados de tetralogía de Fallot

FUNDAMENTO: Arritmias cardíacas são a maior causa de morte súbita tardia em pacientes operados de Tetralogia de Fallot (TF). OBJETIVO: Avaliar a ocorrência de arritmias cardíacas em crianças e adolescentes operados de TF, associando-as aos aspectos clínicos e de exames complementares. MÉTODOS: Estudo transversal em 37 pacientes submetidos a cirurgia de TF no Instituto Estadual de Cardiologia Aloysio de Castro (RJ). Após revisão de prontuários e avaliação clínica, os pacientes foram submetidos a eletrocardiograma (ECG), ecocardiograma (Eco), Holter 24h (Holter) e teste ergométrico (TE), sendo os resultados submetidos a análise estatística. RESULTADOS: Estudados 37 pacientes, 54 por cento masculinos, idade 9,7 ± 3,5 anos, seguimento médio de 4,7 ± 1,9 anos. Alterações mais prevalentes: ECG: bloqueio de ramo direito (89 por cento); Eco: insuficiência pulmonar grave (43 por cento), estenose pulmonar leve (73 por cento), hipertrofia ventricular direita (HVD) moderada (57 por cento). No TE, baixa capacidade de exercício (90 por cento), déficit cronotrópico (40 por cento), arritmias (20 por cento). Ao Holter, 59 por cento apresentaram arritmias: ventriculares 44 por cento, supraventriculares 38 por cento e ambas 24 por cento, com predomínio de extrassístoles pouco frequentes e benignas. Cinco pacientes (15 por cento) apresentaram extrassístoles polimórficas. Houve associação entre arritmia ventricular e HVD moderada e grave (p=0,026) e também com gradiente ventrículo direito-artéria pulmonar (VD/AP) > 45 mmHg (p=0,004). Através da Regressão Logística, o aumento do gradiente VD/AP foi fator preditivo independente para arritmia ventricular (p=0,017). CONCLUSÃO: Arritmias cardíacas foram um achado comum em grande parte de crianças e adolescentes após reparo cirúrgico de TF, porém pouco frequentes e benignas, na maioria dos casos. O gradiente pressórico VD-AP foi considerado forte preditor para arritmia ventricular.

BACKGROUND: Cardiac arrhythmias are the major cause of late sudden death in patients undergoing repair of Tetralogy of Fallot (TF). OBJECTIVE: To evaluate the occurrence of cardiac arrhythmias in children and adolescents undergoing repair of TF, and to associate them with clinical aspects and laboratory tests. METHODS: Cross-sectional study of 37 patients undergoing repair of TF at Instituto Estadual de Cardiologia Aloysio de Castro (Rio de Janeiro). After review of the medical records and clinical assessment, the patients underwent electrocardiography (ECG), echocardiography (Echo), 24-h Holter monitoring and exercise test (ET), whose results were subjected to statistical analysis. RESULTS: A total of 37 patients of whom 54 percent were males with a mean age of 9.7 ± 3.5 years and mean follow-up period of 4.7 ± 1.9 years were studied. The abnormalities most frequently found were: on ECG: right bundle branch block (89 percent); Echo: severe pulmonary regurgitation (43 percent), mild pulmonary stenosis (73 percent), moderate right ventricular hypertrophy (RVH, 57 percent); on ET: low exercise capacity (90 percent), impaired chronotropic response (40 percent), arrhythmias (20 percent); on Holter monitoring: arrhythmias (59 percent, of which 44 percent were ventricular, 38 percent supraventricular, and 24 percent both ventricular and supraventricular, with predominance of infrequent and benign ventricular premature beats). Five patients (15 percent) presented with multiform ventricular premature beats. There was an association of ventricular arrhythmia with moderate and severe RVH (p=0.026), as well as with right ventricle-to-pulmonary artery gradient (RV/PA) > 45 mmHg (p=0.004). The logistic regression analysis showed that increased RV/PA gradient was an independent predictor of ventricular arrhythmia (p=0.017). CONCLUSION: Cardiac arrhythmia was a common finding in a large proportion of children and adolescents after surgical repair of TF; however, it was infrequent and benign in most of the cases. The RV/PA gradient was considered a strong predictor of ventricular arrhythmia.

FUNDAMENTO: Arritmias cardíacas son la mayor causa de muerte súbita tardía en pacientes operados de Tetralogía de Fallot (TF). OBJETIVO: Evaluar la ocurrencia de arritmias cardíacas en niños y adolescentes operados de TF, asociándolas a los aspectos clínicos y de exámenes complementarios. MÉTODOS: Estudio transversal en 37 pacientes sometidos a cirugía de TF en el Instituto Estadual de Cardiología Aloysio de Castro (RJ). Tras revisión de prontuarios y evaluación clínica, los pacientes fueron sometidos a electrocardiograma (ECG), ecocardiograma (Eco), Holter 24h (Holter) y prueba ergométrica (PE), siendo los resultados sometidos al análisis estadístico. RESULTADOS: Estudiados 37 pacientes, el 54 por ciento masculinos, edad 9,7 ± 3,5 años, seguimiento promedio de 4,7 ± 1,9 años. Cambio más prevalentes: ECG: bloqueo de rama derecha (89 por ciento); Eco: insuficiencia pulmonar severa (43 por ciento), estenosis pulmonar ligera (73 por ciento), hipertrofia ventricular derecha (HVD) moderada (57 por ciento). En la PE, baja capacidad de ejercicio (90 por ciento), déficit cronotrópico (40 por ciento), arritmias (20 por ciento). Al Holter, el 59 por ciento presentó arritmias: ventriculares el 44 por ciento, supraventriculares el 38 por ciento y ambas el 24 por ciento, con predominio de extrasístoles poco frecuentes y benignas. Cinco pacientes (15 por ciento) presentaron extrasístoles polimórficas. Hubo asociación entre arritmia ventricular y HVD moderada y severa (p=0,026) y también con gradiente ventrículo derecho-arteria pulmonar (VD/AP) >45 mmHg (p=0,004). A través de la Regresión Logística, el aumento del gradiente VD/AP fue factor predictivo independiente para arritmia ventricular (p=0,017). CONCLUSIÓN: Las arritmias cardíacas fueron un hallazgo común en gran parte de los niños y adolescentes tras reparación quirúrgica de TF, sin embargo, poco frecuentes y benignas, en la mayoría de los casos. El gradiente de presión VD-AP se consideró como un fuerte predictor para arritmia ventricular.

Late clinical and functional assessment of arrhythmias in children after repair of Tetralogy of Fallot.

BACKGROUND: Cardiac arrhythmias are the major cause of late sudden death in patients undergoing repair of Tetralogy of Fallot (TF). OBJECTIVE: To evaluate the occurrence of cardiac arrhythmias in children and adolescents undergoing repair of TF, and to associate them with clinical aspects and laboratory tests. METHODS: Cross-sectional study of 37 patients undergoing repair of TF at Instituto Estadual de Cardiologia Aloysio de Castro (Rio de Janeiro). After review of the medical records and clinical assessment, the patients underwent electrocardiography (ECG), echocardiography (Echo), 24-h Holter monitoring and exercise test (ET), whose results were subjected to statistical analysis. RESULTS: A total of 37 patients of whom 54% were males with a mean age of 9.7 ± 3.5 years and mean follow-up period of 4.7 ± 1.9 years were studied. The abnormalities most frequently found were: on ECG: right bundle branch block (89%); Echo: severe pulmonary regurgitation (43%), mild pulmonary stenosis (73%), moderate right ventricular hypertrophy (RVH, 57%); on ET: low exercise capacity (90%), impaired chronotropic response (40%), arrhythmias (20%); on Holter monitoring: arrhythmias (59%, of which 44% were ventricular, 38% supraventricular, and 24% both ventricular and supraventricular, with predominance of infrequent and benign ventricular premature beats). Five patients (15%) presented with multiform ventricular premature beats. There was an association of ventricular arrhythmia with moderate and severe RVH (p=0.026), as well as with right ventricle-to-pulmonary artery gradient (RV/PA) > 45 mmHg (p=0.004). The logistic regression analysis showed that increased RV/PA gradient was an independent predictor of ventricular arrhythmia (p=0.017). CONCLUSION: Cardiac arrhythmia was a common finding in a large proportion of children and adolescents after surgical repair of TF; however, it was infrequent and benign in most of the cases. The RV/PA gradient was considered a strong predictor of ventricular arrhythmia.

Derecho a la privacidad: protección de los datos sensibles / The right to privacy: protecting the sensitive data

La privacidad sufre hoy embates provenientes de diferentes ámbitos. Uno de ellos, quizá el menos visible, es el que se refi ere a los datos sensibles. ¿De dónde proviene esta necesidad de salvaguardar la intimidad y plasmarla en el derecho a la privacidad? Desde sus orígenes, este derecho se va constituyendo como protección a la vida privada en contraposición con la vida pública. Veremos en este trabajo la necesidad de los límites a este derecho así como la de tener en cuenta las diferencias entre lo que podríamos considerar conflictos individuales y el derecho a la privacidad, en relación especialmente con los datos sensibles.

El trasplante de órganos: valores y derechos humanos / El trasplante de órganos: valores y derechos humanos

Hay muchos elementos constitutivos de la técnica de los trasplantes, que la vuelven paradigmática para un análisis tanto filosófico como ético.Encontramos encarnados en ella varios elementos del paradigma cultural vigente: el sustento tecnológico para la práctica médica, la preeminencia de conductas pragmáticas, un modelo del médico técnico con permiso de meterse en el cuerpo y mutilarlo, el cuerpo como máquina, la posibilidad de la inmortalidad, la libertad como elección.Este trabajo muestra que la práctica del trasplante sería imposible sin la aceptación, sin discusión, de esos supuestos que nuestra cultura considera valiosos. Además, elabora éticamente estos supuestos y sus consecuencias.

La investigacion genetica y el derecho a la vida / Genetic research and life right's

Lo primero que se pregunta en este trabajo es qué es lo que mueve a investigar. La investigación es el modo propio como se manifiesta la ciencia moderna, otra de cuyas características es su condición de empresarial. La unión de estos dos elementos nos enfrenta a dos cuestiones clave: la responsabilidad de los científicos y el límite de la ciencia. La Declaración de Helsinki establece claramente ciertos límites y nos mueve a la práctica de dos virtudes olvidadas: la precaución y la prudencia