Por qué investigar en bioética? / Why should we research in bioethics?

This article reviews the conceptual evolution of bioethics, conditioned by cultural changes. The discipline could be strengthened with new analytical methodologies and with an empirical approach. The dangers of a purely descriptive bioethics, solely linked to practical experience are also discussed. This may cause the loss of the regulatory frame, that allows bioethics to enrich medical practice from a humane and moral viewpoint. Therefore, there is a need to find the balance between the theoretical analysis and an empirical approach, to face the growing complexity of contemporary ethical problems.

[Clinical research in Chile: How to improve its worrying evolution?]. / Investigación clínica en Chile: cómo superar una inquietante evolución?

There is still great collective paucity in our society in appreciating the importance of scientific work for the development of the nation. In this context, relevant clinical research has ben greatly discouraged. The Ministry of Education and the National Commission for Technical and Scientific research (CONICYT) have been committed, with no outstanding results however, to encourage these activities, specially sustaining individual projects originated in the traditional universities. Precarious conditions persist as manifested by meager budgets for investigation. Public health policies and organization are scarcely endorsed in locally generated clinical or public health knowledge. Postgraduate training programs, specially doctorates, needed to increase the academic human resources with a consistent scientific potential, are very limited. Recent governmental initiatives, altogether with specific proposals waiting for implementation, would certainly contribute to optimize and promote the revival of our impoverished scenarios in clinical research.

[Initial therapy of primary nephrotic syndrome in children: evaluation in a period of 18 months of two prednisone treatment schedules. Chilean Co-operative Group of Study of Nephrotic Syndrome in Children]. / Cuadro inicial del sindrome nefrósico primario del niño: evaluación a 18 meses de dos esquemas de tratamiento con prednisona. Groupo Cooperativo Chileno de Estudio del Sindrome Nefrósico del Niño.

Ninety six patients aged from 6 months to 15 years and were admitted to Chilean hospitals with the diagnosis of primary nephrotic syndrome in a period of 30 months. These patients were randomly separated in two groups, group A received prednisone for 8 weeks and group B received the same drug during 12 weeks. All patients were evaluated at 6, 12 and 18 months after the end of treatment. The moment and number of relapses per patient, accumulated percentage of relapses, relapse rate per 100 patients, total number of relapses and complications were assessed. Frequent relapsers were subjected to a kidney biopsy, leaving in the protocol only those patients that had minimal changes. Patients resistant or dependent to steroid therapy were discarded. Thus we report the results of 56 treated patients followed during 18 months. No differences in analyzed parameters were observed between the two treatment groups. It is concluded that these preliminary results do not support the prolongation of prednisone treatment in children with primary nephrotic syndrome.

[Training in internal medicine and its specialties: universities' proposals]. / Formación en Medicina Interna y sus subespecialidades: propuestas de las universidades.

Medical School graduates can enter a medicine subspecialty training program upon completion of a 3 year Internal Medicine residency. The Ministry of Health has contributed to postgraduate training by defining the type of physician the country needs, and by financial support of specially (Internal Medicine) training. Before 1995, when applicants began being charged a fee, finding for subspecialty training was provided exclusively by the universities. Currently, 450 training post are available for 550 graduates from all medical schools. Of these, 59 are in Internal Medicine and 58 in its subspecialties. A quantitative analysis of 40 years of training programs in Internal Medicine by the traditional medical schools shows that only the Catholic University of Chile Medical School privileges subspecially training whereas all other schools favor general Internal Medicine training. A high number of Internal Medicine trainees never take final examination. Nevertheless, training through practice, not necessarily in a university setting, accounts for 67% of Autonomous National Corporation for Certification of Medical Specialties. CONACEM accredited subspecialists. About 63% of those who finish an Internal Medicine training program decide to go into subspecialization. It is felt that subspecialization involves technical as well as non-professional aspects, such as a philosophical stance towards the search for truth through research and creativity. An integral education in a subspecialty can only be given by the university. Non-university centers, however, can contribute to subspecialization by allowing trainees to gain access to newer technology or to larger numbers of patients. A critical question is how many subspecialists should exist in relation to the number of generalists and according to the country's health requirements. In my personal view, the proportion of subspecialists is excessive. The decision to subspecialize should not be exclusively a personal choice, but should take into account the interests of all other participants in the process of subspecialization. Therefore, a definition must be reached as to the number and type of subspecialty training programs offered in the country. These programs should be made more flexible, to allow for a shortened specialty training, which in turn depends from the type of pregraduate training delivered. Some of the problems requiring an urgent solution in the specialization process are: 1) finding should be shared in some proportion by all those who will benefit from the subspecialist's action, including private hospitals and HMOS; 2) There should be a clear-cut central health policy, that will be respected by the decentralized State Health Services, with fulfillment of the teaching agreements, respect for the assigned clinical fields, and for the accredited teaching capacity; 3) Unauthorized or "parallel" training must be stopped and the role of scientific societies or of State Health Services must be clarified, 4) The institutional involvement of a number of academicians must be reinforced.

[Renal scintigraphy with Tc99m DMSA (dimercaptosuccinic acid) in acute pyelonephritis]. / Cintigrafía renal con Tc99m DMSA (acido dimercaptosuccínico) en pielonefritis aguda.

Twenty patients, 6 months to 11 year old, with clinically recognized acute pyelonephritis, were evaluated with Tc99m DMSA renal scintigraphy in the first 15 days of their illness to validate this method in the detection of the acute renal inflammatory disease. In 85% of Tc99m DMSA scintigraphies some kind of abnormality (focal or diffuse, unilateral or bilateral) was observed. Second renal images obtained at an average 8.5 months later, showed total disappearance of abnormal findings in 42%; partial regression in 50% and no changes in 8% of these cases. Tc99m DMSA scintigraphy seems to be a good diagnostic tool to confirm acute renal compromise in urinary tract infections. Besides follow up examinations, at least three months later with this same method, were able to confirm sustained renal lesions.

[Renal artery thrombosis in newborn infants undergoing umbilical artery catheterization]. / Trombosis de arteria renal en recién nacidos sometidos a cateterización de la arteria umbilical.

A prospective study to detect renal artery thrombosis by radionuclide renal scintigraphy in newborn infants who underwent umbilical arterial catheterization over a one year period was done: 62 babies were catheterized, 92% were preterm and 85% had severe respiratory distress syndrome that required mechanical ventilation, 25/62 (40.3%) survived and in all of them Tc-99m DMSA scans were taken at a median of 5 days after withdrawal of the umbilical artery catheters (range 9 h to 29 days). A baby with renovascular hypertension had a DMSA scan which showed segmental vascular defect in one kidney. Another patient had left iliac artery thrombosis and two others showed evidence of transient vasospasm. Death occurred in 37/62 (59.7%), 92% of whom underwent autopsy studies which showed aortoiliac thrombosis in 8.8%, all of them without clinical symptoms. Other 12 newborn infants who died without previous umbilical artery catheterization had no evidence of thrombosis at autopsy.

Apendicitis producida por actinomicosis / Apendicitis caused by actinomycosis

Se presenta un caso clínico de Actinomicosis Apendicular. Se hace una revisión de su epidemiología clínica, frecuencia y tratamiento a seguir posteriormente

Compromiso renal en la lues congenita. / Renal involvement in congenital lues

Se presenta un caso de lues congenita con compromiso renal en un paciente de 2.1/2 meses de edade,lo que se manifiesta con un sindrome nefritico agudo con componente nefrosico. Se revisa la patogenia del dano renal en esta enfermedad y se describe su tratamiento. Se destacan algunos aspectos de control y manejo de la embarazada VDRL

Hipertension esencial: un desafio para el pediatra. / Essential hypertension: a challenge for the pediatrician

Se plantea el interes de reconocer la hipertension esencial desde los primeros anos de vida, haciendose indispensable para ello contar con tablas de distribucion de presion arterial confiables. Se discuten las tablas propuestas recientemente. Se relacionan los niveles de presion arterial con diversos parametros: edad, tamano corporal, obesidad, herencia, raza, dieta y situacion socioeconomica. Se dan cifras de prevalencia de hipertension arterial pediatrica en Estados Unidos de America, America del Sur y Europa. Se recomienda la actitud mas conviniente ante pacientes con factores de riesgo de enfermedad cardiovascular

Blood pressure levels in urban school-age population in Chile.

Two blood pressure (BP) measurements separated by 3 months were performed according to international guidelines on 2976 students (11 to 19 years) of different economic levels. Obesity was defined based upon height and weight. With the first measurements, 59th and 95th percentile value distribution curves were defined. Systolic hypertension (SH) was found in 9.5%; 10.2% were males and 8.9% females. The sample showed that 8.1% were obese (240 cases); among them the incidence of SH increased to 28.8% (69 cases) (p less than 0.01). In the entire sample, diastolic hypertension (DH) was 4.3%; males, 2.7%, and females, 5.5% (p less than 0.01). Among obese students, DH increased to 8.3% (20 cases) (p less than 0.01), and showed prevalence figures of 5.8% for obese males and 10.3% (14 cases) for obese females. After a second measurement, DH for the sample decreased to 1.8%. Salt intake and familial antecedents of high BP showed differences between hypertensive and normal populations.