Consideraciones clínicas y éticas en la implementación de rehabilitaciones implantoprotésicas en el adulto mayor / Clinical and ethical considerations in the implementation of dental implants rehabilitations in senior adults

La falta de equidad y justicia en la distribución de alta tecnología no excluye la salud pública en casos donde la disponibilidad es inferior a la demanda. Dentro de la estomatología, la implantología en Cuba dispone de recursos limitados y la valoración multidisciplinaria para rehabilitar mediante implantes dentales al adulto mayor depende de factores objetivos y subjetivos. En el presente artículo, en la medida que se identifican los factores que determinan en la exclusión de adultos mayores para rehabilitarse mediante implantes dentales; se pretende como objetivo exponer consideraciones clínicas y éticas a considerar para una justa y eficaz selección. Se concluyó que los factores subjetivos influyen en los bajos índices de ingresos de adultos mayores para rehabilitarse, y que la consulta multidisciplinaria debe impartir equidad y justicia en la selección considerando la calidad de vida como un factor primordial para alcanzar un envejecimiento saludable(AU)

The lack of justness and justice in the distribution of high technology don't exclude the public health in cases where the readiness is inferior to the demand. Inside of dentistry, the implantology has in our country limited resources, and the multidisciplinary assesment to rehabilitate by means of dental implant to senior adult it depends on objective and subjective factors. In this article, in the measure that the factors which determine an bigger exclusion of senior adult are identified to become rehabilitated by means of dental implant; it is sought as objective to expose clinical and ethical considerations to consider for a fair and effective selection. Was concluded that in spite of having an established systematical diagnoses, subjective factors influence in the low index of senior adult to become rehabilitated, and that the multidisciplinary consultation should impart justness and justice in the selection considering the quality of life like a primordial factor to reach a healthy(AU)

Beware of mereologists bearing gifts: prolegomena to a medical metaphysics.

This essay considers implications of formal mereologies and ontologies for medical metaphysics. Edward Fried's extensional mereological account of the human body is taken as representative of a prominent strand in analytic metaphysics that has close affinities with medical positivism. I show why such accounts fail. First, I consider how Fried attempts to make sense of the medical case of Barney Clark, the first recipient of an artificial heart, and show that his analytic metaphysical categories do not have the right kind of fit with the case. A proper medical metaphysic should involve a richer two way dialogue with medicine, and it should not just "apply" formal accounts worked out in other settings. Second, I argue that any effort to account for real wholes with extensional mereological sums requires all sorts of ad hoc, supplementary mechanisms that do the real work, and the full repertoire of these mechanisms involves inconsistencies and semantic shifts. Finally, I consider an alternative strand of work on non-extensional whole/part relations that is closer to medicine and that can deepen reflection on some core problems in bioethics, for example, associated with the determination of death when an organism ceases to function as a whole. In addition to the utility such formal ontologies have for addressing traditional problems such as the determination of death, philosophers of medicine should appreciate the increasingly influential role such formal tools are playing in the development of data system ontologies. Assumptions integral to these ontologies have far reaching implications for the way future research and practice in medicine will be conducted, and much greater critical reflection is needed on the full range of issues associated with the development and use of such medical ontologies.

Prolegomena to any future mereology of the body.

Many bioethical arguments rely implicitly on the assumption that the concept of "human part" is one on which everyone must agree, because it is unambiguous. But various parties interpret this "unambiguous" term in incompatible ways, leading to contention. This article is an informal presentation of a topomereological system on whose preferred interpretation several distinct but related meanings of "human part" can be isolated: part of a human body, part of the completion of a human body, and part of a human being. A case is analyzed (the first total artificial heart (TAH) implantation), demonstrating in the process much of the apparatus of the system. By means of a casuistic methodology, the analysis is translated into recommendations for the ethical conduct of future TAH research. The more general conclusion, however, is that formal methods may provide useful tools for clarifying thought processes and organizing arguments in debates over bioethical issues.

Polyacrylamide hydrogel injection in the management of human immunodeficiency virus-related facial lipoatrophy: a 2-year clinical experience.

BACKGROUND: Facial lipoatrophy is defined as the reduction in buccal and orbital fat pads along with a more global loss of fat within the subcutaneous tissue. It is the most common and distressing sign of human immunodeficiency virus-associated lipodystrophy. Injectable polyacrylamide hydrogel (Aquamid) is a synthetic nonbiodegradable polymer consisting of a minor backbone of 2.5 percent cross-linked polyacrylamide and 97.5 percent nonpyrogenic water and is used for cosmetic facial contour correction. Favorable results with maximum aesthetic gains with the use of polyacrylamide hydrogel for reconstruction of facial lipoatrophy on the face in significantly immunocompromised individuals are being reported. These results are attributable to its use in limited volume injected at multiple sites and in multiple sittings. METHODS: Aquamid has been used for the correction of severe nasolabial folds and mid and lower facial volume loss in patients affected by human immunodeficiency virus-associated lipodystrophy. Fifty patients were enrolled and treated, with a mean follow-up of 13.1 months. Results were evaluated clinically, by standardized ultrasonography, and by psychological tests (visual analogue scale, Beck Depression Inventory, and Assessment of Body Change and Distress questionnaire) to quantify patient satisfaction. RESULTS: No significant side effects or issues such as swelling, infections, allergies, or nodule formation were noted over the follow-up period. CONCLUSION: Aquamid has provided a minimally invasive, effective, long-lasting facial contour correction that significantly improves the quality of life in human immunodeficiency virus-infected patients.