Valoración de la competencia de los pacientes para tomar decisiones / Assessment of patient competence for making decisions

Para que los enfermos puedan tomar decisiones autónomamente (y que se produzca el consentimiento informado) tiene que haber información, comprensión, libertad y voluntariedad, siendo la competencia un prerrequisito para la autonomía. Los clínicos se enfrentan con frecuencia a pacientes incompetentes para tomar decisiones, pero detectan menos de la mitad de los casos y, además, con frecuencia la evaluación de la competencia no es adecuada. Este artículo ofrece unas pautas para la valoración de la competencia en aquellos pacientes en los que existen dudas sobre si están en condiciones para tomar decisiones sobre su salud. El procedimiento se basa en 5pasos: 1) reconocer las situaciones que requieren una valoración de la competencia; 2) evaluación completa de la competencia; 3) correlacionar el grado de competencia con la complejidad de la decisión a tomar; 4) intentar mejorar la competencia del paciente cuando sea posible, y finalmente 5) establecer quién toma la decisión

For patients to be able to make decisions autonomously (and to grant informed consent), they must have information, understanding, freedom and willingness, with competence a prerequisite for autonomy. Clinicians are often faced with patients lacking competence to make decisions but detect less than half of such cases and often inadequately assess the patients' competence. This article offers guidelines for assessing the competence of patients for whom there are doubts about their ability to make decisions concerning their health. The procedure is based on 5 steps: 1) recognising the conditions that require a competence assessment; 2) fully evaluating the competence; 3) correlating the degree of competence with the complexity of the decision; 4) improving the patient's competence when possible; and 5) establishing who will make the decision

Assessment of patient competence for making decisions. / Valoración de la competencia de los pacientes para tomar decisiones.

For patients to be able to make decisions autonomously (and to grant informed consent), they must have information, understanding, freedom and willingness, with competence a prerequisite for autonomy. Clinicians are often faced with patients lacking competence to make decisions but detect less than half of such cases and often inadequately assess the patients' competence. This article offers guidelines for assessing the competence of patients for whom there are doubts about their ability to make decisions concerning their health. The procedure is based on 5 steps: 1) recognising the conditions that require a competence assessment; 2) fully evaluating the competence; 3) correlating the degree of competence with the complexity of the decision; 4) improving the patient's competence when possible; and 5) establishing who will make the decision.

[Javier Sádaba: A bioethics against suffering]. / Javier Sádaba: una bioética contra el sufrimiento.

The philosopher Javier Sádaba (Portugalete, 1940) is the author of an extensive work in the field of bioethics. It is a procedural bioethics (based on the agreement between the participants, not on absolute truths), casuistry (is based on the analysis of specific problem cases), social (evaluates the context in decision-making), gradual (considers other species, is not "narcissistically human"), and secular (autonomous with respect to religion). Sádaba has also opted for an affirmative bioethics, which seeks to improve the living conditions of humans (in medicine, the quality of life). This is difficult to construct because, for the philosopher, the duty and to establish limits are infinitely easier to elaborate than the specific good and to pursue happiness. In its application to medicine, Sádaba's bioethics focuses on avoiding unnecessary suffering, because suffering does not contribute anything positive and hinders happiness. Likewise, he strives to extract the best of science and open the doors to everything that can bring improvements for the human being, but without ceasing to mention responsibility, because man is capable of the best and the worst. From this perspective, the author is faced with the bioethical issues, leaving the greatest possible margin to freedom of choice.

Delta-aminolevulinic acid is a substrate for the amino acid transporter SLC36A1 (hPAT1).

BACKGROUND AND PURPOSE: delta-Aminolevulinic acid (ALA) is used in cancer patients for photodynamic diagnosis or therapy. Oral administration of ALA has been used in patients with prostate and bladder cancer. The present aim was to investigate the mechanism of intestinal absorption of ALA and its transport via the amino acid transporter SLC36A1. EXPERIMENTAL APPROACH: In vitro investigations of ALA affinity for and uptake via SLC36A1 and SLC15A1 were performed in Caco-2 cell monolayers. Interaction of ALA with SLC15A1 was investigated in MDCK/SLC15A1 cells, whereas interactions with SLC36A1 were investigated in COS-7 cells transiently expressing SLC36A1. KEY RESULTS: ALA inhibited SLC36A1-mediated L-[(3)H]Pro and SLC15A1-mediated [(14)C]Gly-Sar uptake in Caco-2 cell monolayers with IC(50) values of 11.3 and 2.1 mM respectively. In SLC36A1-expressing COS-7 cells, the uptake of [(14)C]ALA was saturable with a K(m) value of 6.8 +/- 3.0 mM and a V(max) of 96 +/- 13 pmol x cm(-2) x min(-1). Uptake of [(14)C]ALA was pH and concentration dependent, and could be inhibited by glycine, proline and GABA. In a membrane potential assay, translocation of ALA via SLC36A1 was concentration dependent, with a K(m) value of 3.8 +/- 1.0 mM. ALA is thus a substrate for SLC36A1. In Caco-2 cells, apical [(14)C]ALA uptake was pH dependent, but Na(+) independent, and completely inhibited by 5-hydroxy-L-tryptophan and L-4,4'-biphenylalanyl-l-proline. CONCLUSIONS AND IMPLICATIONS. ALA was a substrate for SLC36A1, and the apical absorption in Caco-2 cell was only mediated by SLC36A1 and SLC15A1. This advances our understanding of intestinal absorption mechanisms of ALA, as well as its potential for drug interactions.

Formación y evolución del espacio nacional

Étnia, calse y región son tres elementos constantes de nuestra nación. Es imposible comprender los procesos en curso si no se comprende no sólo la multiplicidad del fenómeno nacional, sino también su laberíntica evolutiva histórica.

[Serum alpha-1 antitrypsin levels in patients with Cuban epidemic neuropathy]. / Niveles séricos de alfa-1 antitripsina en pacientes con neuropatía epidemica cubana.

INTRODUCTION: Cuban epidemic neuropathy is an emergent disease that due to its magnitude and health problem it was considered the most devastating outbreak of the XX century of the world. On the other hand it has been reported that the protease inhibitor, in particular alpha 1 antitrypsin has importance for the brain metabolic process and its genetic deficiency was produced peripheric neuropathy. Because of it we should decided to study the serum levels of patients suffering from this disease. PATIENTS AND METHODS: It has been studied serum alpha 1 antitripsin levels in 39 patients with peripheric Cuban epidemic neuropathy, six patients with the mixt variant of the disease and 10 patients with diabetic neuropathy. All patients has no toxic habits like alcohol and tobacco consumption. The quantification of alpha 1 antitrypsin was performed by radial immunodiffusion. RESULTS: When the median values of alpha 1 antitrypsin were compared no significant differences were obtained among the different neuropathies with a significance levels less than 0.05. There was a significant increased of apha 1 antitrypsin with the evolution time of the disease in the patients with the mixt variant and a significant correlation between alpha 1 antitrypsin levels and age with diabetic neuropathy. CONCLUSIONS: This protease inhibitor looks to be involved in the physiopathology of the Cuban epidemic neuropathy with a decreased levels during the initial time of the disease.

Niveles séricos de alfa-1-antitripsina en pacientescon neuropatía epidémica cubana / Serum alpha-1-antitrypsin levels in patients with cuban epidemic neuropathy

Introducción. La neuropatía epidémica cubana (NEC) es una enfermedad emergente que, por la magnitud y trastornos que provoca, se considera como la más devastadora del siglo XX en el mundo. Por otro lado, se ha comunicado que los inhibidores de proteasa, en particular la alfa-1-antitripsina (AAT), tienen importancia en los procesos metabólicos cerebrales y su déficit genético produce neuropatía periférica. Por todo ello, nos decidimos a estudiar los niveles en suero de AAT en pacientes afectados por esta enfermedad. Pacientes y métodos. Se estudiaron los niveles de AAT en el suero de 39 pacientes diagnosticados con NEC periférica, en seis pacientes con la variante óptica de la enfermedad y 10 pacientes con neuropatía diabética. Ningún paciente refirió poseer hábitos tóxicos como consumo de alcohol o tabaco. La cuantificación se realiza por inmunodifusión radial. Resultados. Cuando se compararon los valores medios de AAT no hubo diferencias significativas para los pacientes en distintas neuropatías para el nivel de significación menor a 0,05. Hubo una correlación significativa de aumento de la AAT con los años de evolución de la enfermedad para los pacientes con neuropatía mixta y una correlación significativa entre los niveles de AAT y la edad del paciente en la neuropatía diabética. Conclusiones. Este inhibidor de proteasa parece que se involucra en la fisiopatogenia de la NEC con una disminución en el inicio de la enfermedad (AU)

Evaluation of prostate specific antigen in the prognosis of patients with advanced prostate cancer.

OBJECTIVE: To evaluate the survival rate of patients with advanced prostate cancer in a univariate form, according to the preoperative and first postoperative determination of PSA levels. MATERIALS AND METHODS: From February 1987 to June 1995, 92 patients were submitted to maximum blockage androgen (subcapsular and antiandrogen orchiectomy), independent of clinical symptoms shown upon admission to the Cancer Hospital. The antiandrogens (ciproterone acetate and flutamide) were administered until the patient present progression of the disease. RESULTS: The age of patients varied from 44 to 89, with a median of 70 years old. In the 6th, 36th and 60th months the global survival rate was 80%, 38% and 20%, respectively. The preoperative PSA ranged from 2 to 4017 ng/ml, with a median of 98 ng/ml (98% had PSA greater than or equal to 10 ng/ml). The first postoperative PSA ranged from 1 to 3840 ng/ml, with a median of 20 ng/ml. There was a tendency towards a better survival rate only in patients with initial PSA from 2 to 99 ng/ml (p = 0.06745). The survival rate of patients at 36 months after the initial total blockage androgen, with first PSA level from 1 to 4, 5 to 49 and over 49 ng/ml was 72%, 48% and 8%, respectively (p = 0.00004). In the final examination, 34 (37%) patients were considered stable and 58 (63%) had disease progression. CONCLUSION: The PSA determination performed on the 30th postoperative day is important in the evaluation of advanced prostate cancer prognosis.

[Mortality among the workers of the Instituto Mexicano del Seguro Social from 1983 to 1987]. / La mortalidad de los trabajadores del Instituto Mexicano del Seguro Social de 1983 a 1987.

A study on mortality of 2,268 workers of the Mexican Social Security Institute was done during 1983-1987 in order to obtain accurate information to specifically determine to those, activities which promote the health and improve the life conditions of the workers of the aforementioned institution. This information relates to the first step of the study, so it doesn't lead us to value judgements, because it would fall into speculations. However, it creates an important data to subsequently explore, by means of further studies, in the casualty of the existing results.