[Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile]. / Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile.

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile / Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

O conteúdo lutas no ensino médio: discursos dos professores de Educação Física da fronteira Brasil-Bolívia / The content fights in middle school: speeches of Physical Education teachers from the Brazil-Bolivia border / El contenido luchasen la enseñanza medio: discursos de los maestros de Educación Física de la frontera Brasil-Bolivia

Este trabalho objetivou analisar o discurso dos professores de nível médio sobre a aplicação do conteúdo Lutas nas aulas de Educação Física em Corumbá/MS, cidade fronteiriça Brasil-Bolívia. Nos baseamos metodologicamente no trabalho de Ferreira (2006), ao adaptarmos o seu modelo de pesquisa. Os resultados apontaram que a maioria (83%) dos entrevistados têm o conteúdo no seu plano de ensino. Contudo, a maior parte utiliza procedimentos que não oportunizam vivências. Observamos ainda o predomínio da Capoeira a ser trabalhada, ao contrário das Lutas informais. A maioria entende que o conteúdo em debate não gera violência e agressão, mas que isso dependeria da atitude do professor. Nossos resultados se aproximam do estudo tomado como referência e apontam outras preocupações sobre o tema.

The objective of this study was to analyze the discourse of middle level teachers on the application of content Fights in the classes of Physical Education in Corumbá / MS, border city Brazil-Bolivia. We base methodologically on the work of Ferreira (2006) when adapting his research model. The results showed that the majority (83%) of respondents had the content in their teaching plan. However, the vast majority use procedures that do not provide experience. We also observed the predominance of Capoeira to be worked on, unlike the informal struggles. Most understand that the content under debate does not generate violence and aggression, but that this would depend on the teacher's attitude. Our results approximate the study taken as reference and point out other concerns about the theme.

El trabajo objetivó analizar el discurso de los maestros de nivel medio sobre la aplicación del contenido Luchas en las clases de Educación Física en Corumbá/MS, ciudad fronteriza Brasil-Bolivia. Basamos, metodológicamente, en el trabajo de Ferreira (2006) al adaptar su modelo de investigación. Los resultados apuntaron que la mayoría (83%) de los entrevistados tienen el contenido en su plan de enseñanza. Sin embargo, la gran parte utiliza de procedimientos que no oportunizan vivencias. Observamos también el predominio de la Capoeira a ser trabajada, al contrario con las Luchas informales. La mayoría entiende que el contenido en debate no genera violencia y agresión, pero que eso dependería de la actitud del profesor. Nuestros resultados se aproximan al estudio tomado como referencia y apuntan otras preocupaciones sobre el tema.

Ascitis por carcinoma lobulillar infiltrante bilateral de mama / Ascites due to bilateral invasive lobular carcinoma of the breast

Resumen El cáncer de mama representa sólo 3% de la proporción de cánceres que causan ascitis maligna. Suele relacionarse con el carcinoma lobulillar infiltrante, pues se manifiesta como enfermedad multicéntrica y es propenso a metastatizar a las regiones del peritoneo (en 10% de las admisiones), meninges, serosas, retroperitoneo y órganos ginecológicos; además, es el que con mayor frecuencia metastatiza al tubo gastrointestinal (64%). Por tanto, debe considerarse el diagnóstico de cáncer lobulillar infiltrante en mujeres con ascitis, hidronefrosis o masas pélvicas.

Abstract Breast cancer occupies accounts for 3% of the proportion of cancers that develop malignant ascites. It is usually associated with infiltrating lobular carcinoma. It pre-sents as a multicentric disease. It metastasizes to peritoneal (in 10% of admissions), meninges, serous, retroperitoneum and gynecological organs. In addition, frequently metastasizes to the gastrointestinal tract (64%). Therefore, in women with ascites, hydronephrosis or pelvic masses, the diagnosis of infiltrating lobular cancer should be considered.

Ritonavir-boosted tipranavir demonstrates superior efficacy to ritonavir-boosted protease inhibitors in treatment-experienced HIV-infected patients: 24-week results of the RESIST-2 trial.

BACKGROUND: Tipranavir, a novel protease inhibitor, has demonstrated antiviral activity against protease inhibitor-resistant human immunodeficiency virus type 1 (HIV-1) isolates. The Randomized Evaluation of Strategic Intervention in multi-drug reSistant patients with Tipranavir (RESIST-2) trial is an ongoing, open-label, phase III trial comparing ritonavir-boosted tipranavir (TPV/r) plus an optimized background regimen with an individually optimized, ritonavir-boosted protease inhibitor in treatment-experienced, HIV-1-infected patients. METHODS: Patients at 171 sites in Europe and Latin America who had received > or = 2 previous protease inhibitor regimens, had triple-antiretroviral class experience, had an HIV-1 RNA level > or = 1000 copies/mL, and had genotypically demonstrated primary protease inhibitor resistance were eligible. After genotypic resistance tests were performed, a protease inhibitor and optimized background regimen were selected before randomization. Patients were randomized to receive either TPV/r or comparator protease inhibitor-ritonavir (CPI/r) and were stratified on the basis of preselected protease inhibitor and enfuvirtide use. Treatment response was defined as a confirmed HIV-1 load reduction > or = 1 log10 less than the baseline value without a treatment change at week 24. RESULTS: A total of 863 patients were randomized and treated. At baseline, the mean HIV-1 load was 4.73 log10 copies/mL, and the mean CD4+ cell count was 218 cells/mm3. The preplanned 24-week efficacy analyses of 539 patients demonstrated treatment response rates of 41% in the TPV/r arm and 14.9% in the CPI/r arm (intent-to-treat analysis; P<.0001). The mean CD4+ cell count increased by 51 cells/mm3 in the TPV/r arm and by 18 cells/mm3 in the CPI/r arm. The most common adverse events were mild-to-moderate diarrhea, nausea, and headache. Grade 3 or greater elevations in serum transaminase, cholesterol, and triglyceride levels were more frequent in the TPV/r arm. CONCLUSIONS: TPV/r had superior antiviral activity and increased immunologic benefits, compared with CPI/r, at week 24 among treatment-experienced patients infected with multidrug-resistant HIV-1.