Limitación bioética del esfuerzo terapéutico en pediatría / Bioethics limitation of therapeutic effort in pediatrics

Teniendo en cuenta que la demanda de la sociedad ha cambiado pasando de pedir la máxima eficacia, a pedir la máxima ayuda en base al respeto de su voluntad y el conocimiento de su necesidad, la limitación del esfuerzo terapeútico (LET) es una de las decisiones más complejas a las que hoy en día se enfrenta el profesional en la atención a las personas enfermas. Por ello, debería ser un objetivo institucional el conocer las limitaciones de la práctica, evaluarlas e incentivar la mejora y en los casos dudosos, recurrir al los Comités de Bioética Asistencial (CBA) para asesorar en la elaboración de protocolos de actuación en los casos en que el profesional o el equipo terapéutico se encuentre ante un dilema ético(AU)

Given that the demand of society has shifted to seek maximum efficiency, maximum help based on the patient autonomy respect and awareness of its necessity, the limitation of therapeutic effort is one of the decisions more complex. Therefore, it should be an institutional objective to know the limitations of practice, assess and encourage improvement and in doubtful cases, resort to Assistive Bioethics Committees to advise on the development of clinical protocols in cases which the professional or the therapeutic team is faced with an ethical dilemma(AU)

[Bioethics limitation of therapeutic effort in pediatrics]. / Limitación bioética del esfuerzo terapéutico en pediatría.

Given that the demand of society has shifted to seek maximum efficiency, maximum help based on the patient autonomy respect and awareness of its necessity, the limitation of therapeutic effort is one of the decisions more complex. Therefore, it should be an institutional objective to know the limitations of practice, assess and encourage improvement and in doubtful cases, resort to Assistive Bioethics Committees to advise on the development of clinical protocols in cases which the professional or the therapeutic team is faced with an ethical dilemma.

[Study of LDL receptors and response to lovastatin therapy in familial homozygotic hypercholesterolemia]. / Estudio de receptores del colesterol LDL y respuesta del tratamiento con lovastatina en la hipercolesterolemia familiar homocigota.

This study shows the results obtained with lovastatin as a combined therapy with probucol and cholestyramine on the lipid profile of two patients with homozygous familial hypercholesterolemia. Both have been diagnosed according to the clinical and biochemical criteria (tipe IIa hypercholesterolemia) as well as by the cholesterol or low density lipoprotein (LDL-C) receptor analysis. After the initial probucol and cholestyramine treatment we observed a drop of total cholesterol (T-C) of 41.7% and 46% as well as LDL-C of 51.6% and 49.3% in both patients. Respectively when lovastatin were associated an additional drop of T-C of 23.7%, LDL-C of 23.2%, high-density lipoprotein cholesterol (HDL-C) of 22.4% and the apoprotein B (Apo B) of 37% were obtained in one patient (receptor-defective) but no change in the lipid profile were obtained in the other patient (receptor-negative). No adverse effects were observed with this drug. This drug could be of help as a combined therapy in the treatment of homozygous familial hypercholesterolemia, even though the treatment of choice is the LDL-plasma feresis and/or liver transplantation. We expound the difficulties relate to LDL receptor study in homocygous receptor-negative patients.