Editorial

-

Evaluación de los factores de riesgo para el Síndrome de Compartimento Abdominal en el Hospital de Kennedy

Estudió descriptivo de una cohorte de pacientes con patologías y expuestos a los factores de riesgo para el desarrollo de un Síndrome de Compartimiento Abdominal de Octubre de 2008 a Mayo de 2009 en el Hospital de Kennedy, en el que se observo que los grados tempranos de HIA tuvieron una mayor frecuencia.Is a descriptive study of a cohort of patients with a special pathology, expose to a risk factors of develop SCA between October 2008 and May 2009 in Kennedy Hospital. The early types of Intrabdominal Hypertension were more often.Hospital Kenned

Las uniones de hecho en Chile y su regulacion en nuestra legislacion

46 p. La siguiente tesis no es autorizada por el autor para su difusión en formato digitalLa tendencia mundial nos muestra que las personas, en nuestra sociedad, no se están uniendo a través del vínculo matrimonial, escogiendo otros modos de compartir sus vidas. El concepto de familia nuclear se ha esfumado paulatinamente de nuestra realidad, para dar paso a nuevas formas de relacionarse, como la convivencia heterosexual y la unión homosexual, temas de absoluta contingencia a la luz de los cambios que experimentamos. La metodología utilizada en esta presentación, será la de investigación jurídico dogmática, que nos permitirá conocer la íntima relación que existe entre la norma jurídica y el hecho social de las uniones de hecho, y con ello, se espera conocer la historia de este fenómeno, sus diversos conceptos y su regulación tanto en el Derecho comparado como en el Derecho chileno./ ABSTRACT: The world trend show us that people in our society, are not joining across the matrimonial link, choosing other ways of sharing their lives. The concept of nuclear family has faded away gradually of our reality, to give step to new ways of being related, as the heterosexual conviviality and homosexual union, topics of absolute contingency in the light of the changes that we experience. The methodology used in this presentation, will be juridical dogmatic investigation that will allow us to know the intimate relation that exists between the juridical norm and the social fact of the “fact unions”, and with it, expects to know the history of this phenomenon, its diverse concepts and its regulations at the international and national Law

La fijacion del quantum de la indemnizacion pecuniaria del dano moral extracontractual en el ordenamiento juridico chileno

60 p.El daño moral es una de las materias más controvertidas del Derecho Civil, debido a la inexistencia de un concepto unánime, como también, por la escasa normativa sobre daño moral en nuestro Derecho Civil. En este sentido, la labor del juez se ve dificultada, en virtud de esta carencia; logrando desarrollar su tarea, a base de criterios de la jurisprudencia y de la regla de la sana crítica. La protección que otorga la constitución en su artículo 19, en los incisos1º y 4º, a los derechos fundamentales, se ve debilitada por la discrecionalidad que tiene el juez al fijar el quantum del daño moral extracontractual; a diferencia de la contundente cobertura que otorga el recurso de protección a dichas garantías./ ABSTRACT: The moral damage is one of the most controversial areas of Civil Law, due to the lack of a unanimous concept as well, due to poor regulations on moral damage to our civil law. In this sense, the judge's task is made difficult by virtue of this lack, being able to develop their work, based on criteria of jurisprudence and the rule of sound criticism. The protection afforded by the Constitution in Article Nº19, numbers 1 and 4, of the fundamental rights, is undermined by the discretion that the judge have to determinate the quantum of moral damage, as opposed to the overwhelming coverage afforded by the resource protection to such guarantee

Albendazole-induced granulomatous hepatitis: a case report

INTRODUCTION: Drug-related hepatotoxicity is a common medical problem with implications for health systems. It constitutes a cause of acute liver failure and, in many cases, is responsible for the rejection of new pharmacological agents during efficacy and safety studies. Risk factors, as well as pathogenesis of drug-induced liver injury, are poorly understood. The diagnosis of drug-induced liver injury is challenging; it is difficult to define the cause of drug hepatotoxicity due to the heterogeneity of the clinical presentation and the absence of established criteria for accurate and reproducible identification of drug-associated liver toxicity. CASE PRESENTATION: We report the case of a 25-year-old Hispanic woman admitted to our Clinical Hepatology Unit with symptoms of acute hepatitis of unknown etiology. She was diagnosed with albendazole-induced granulomatous hepatitis after ruling out other possible causes, based on laboratory studies, liver biopsy, medical history, detailed drug history, and spontaneous improvement of her liver biochemical profile after medication withdrawal. This diagnosis was supported by the Council for International Organizations of Medical Sciences-Roussel Uclaf Causality Assessment Method, which showed a likely correlation between hepatocellular damage and drug toxicity as the etiology. CONCLUSIONS: Our patient’s suspected diagnosis was albendazole-induced granulomatous hepatitis with confirmatory histologic pattern. This case deserves particular attention due to the wide use of albendazole in our country (Colombia) and the prevalent medical issue of drug-related hepatotoxicity

Experiencia en el manejo quirúrgico del síndrome de compartimento abdominal en el Hospital Occidente de Kennedy

Introducción: El síndrome de compartimento abdominal (SCA) es resultado de una serie de alteraciones fisiológicas locales y sistémicas, producidas por un aumento anormal de la presión intraabdominal, que, en algunos casos, requiere la descompresión quirúrgica de la cavidad abdominal.Métodos: Es un estudio descriptivo, retrospectivo, de una serie de 28 pacientes con SCA que requirieron tratamiento quirúrgico en el Hospital Occidente de Kennedy, entre 1999 y 2003. Evaluamos retrospectivamente el rendimiento de la ecuación de McNelis para predicción de su desarrollo.Resultados: La patología desencadenante más frecuente fue la infección intraabdominal (n=6 21,4%). El tiempo transcurrido entre el diagnóstico y la descompresión quirúrgica fue menor de cuatro horas en el 75% (n=21) de los casos. Las variables que mejoraron significativamente tras la descompresión quirúrgica fueron la presión venosa central (PVC) (T:4,0; p:0,0001), la presión inspiratoria máxima (PIM) (T:2,7; p:0,004), la presión intraabdominal (PIA) (T1,8; p:0 034) y el gasto urinario (T:-2,4; p:0,02). Los niveles de BUN, la creatinina y la inestabilidad hemodinámica no presentaron mejoría. La estancia promedio en la unidad de cuidados intensivos (UCI) fue de once días (SD:9) y la estancia hospitalaria, de dieciocho (SD13). La mortalidad global fue del 67,9% (n=19) y la mortalidad directamente atribuible al síndrome fue del 30% (n=8). El comportamiento de la ecuación de McNelis fue errático.Conclusiones: Las características demográficas y las patologías causantes del síndrome corresponden a las descritas en la literatura. La correlación de las variables fisiológicas asociadas al diagnóstico del síndrome es heterogénea entre diferentes pacientes. La mortalidad del síndrome en nuestra institución está dentro de lo esperado según la literatura mundial. El rendimiento de la ecuación de McNelis parece depender excesivamente del balance hídrico.The abdominal compartment syndrome (ACS) is the result of various physiological alterations produced by an abnormal increase of the intra-abdominal pressure. Some of these patients will undergo a surgical procedure for its management. Methods: This is a retrospective case series of 28 patients with ACS who required surgical treatment at the Hospital Occidente de Kennedy between 1999 and 2003. We assessed retrospectively the behavior of McNelis’s equation for prediction of the development of the ACS. Results: The leading cause of ACS in our study was intraabadominal infection (n=6 21,4%). Time elapsed between diagnosis and surgical decompression was less than 4 hours in 75% (n=21) of the cases. The variables that improved significantly after the surgical decompression were CVP (T: 4,0 p: 0,0001), PIM (T: 2,7; p: 0,004), PIA (T1,8; p:0,034) and Urine Output (T:-2,4; p:0,02). The values of BUN, Creatinine and the cardiovascular instability did not show improvement. The ICU and hospital length of stay were 11 days (SD: 9) and 18 days (SD13) respectively. Global mortality was 67,9% (n=19) and mortality directly attributable to the syndrome was 30% (n=8). The behavior of the McNelis’s equation was erratic. Conclusions: The demographic characteristics as well as disease processes associated with ACS are consistent with the literature. The association between physiological variables and ACS is heterogeneous between patients. Mortality rates attributable to ACS in our institution are within the range described world-wide. The behavior of the McNelis’s equation seems to depend greatly upon fluid balance

Reforming the Federal Regulatory Review Process

For decades, the Office of Information and Regulatory Affairs (OIRA) has overseen the development of federal regulatory policies with a strong emphasis on benefit-cost analysis. Despite its conceptual appeal, this analytic tool consistently shortchanges environmental and public health protection, with especially negative consequences for environmental justice communities. In this article, we address some of those shortcomings, focusing in particular on the standard agency practice of arithmetically discounting regulatory costs and benefits that accrue in the future. We propose that the OIRA abandon this practice as it relates to non-market goods, such as human lives saved, and instead work toward a more flexible and holistic approach to regulatory review. In addition, we urge the OIRA to better address environmental justice concerns by placing greater emphasis on distributional and cumulative impacts, highlighting numerous analytic tools that the OIRA could use or adapt in service of that goal. Finally, we discuss ways in which the OIRA could foster a more inclusive and accommodating administrative culture—one more attuned to the needs of environmental justice communities—by reforming both its external and internal processes

Smart cities and smart communities from an urban-technological perspective

LAUREA MAGISTRALENell'ultimo decennio il termine "smart city" sta diventando più familiare per tante persone. Tuttavia, è un concetto da osservare con maggiore attenzione per poter essere utilizzato correttamente. Raggiungere un livello di intelligenza dei cittadini implica lavorare sostanzialmente su quattro pilastri: "smart living", "smart working ", "smart mobility" e "smart environment". Tutti questi concetti sono diversi fra loro, ma tendono ad allinearsi. Questo progetto valuta la trasformazione di molte città in tutto il mondo e studia varie metodologie utili a raggiungere lo status di "città intelligente". Più in dettaglio, si vuole mostrare come i cittadini sono una parte fondamentale di questo sviluppo e come le loro iniziative, la partecipazione proattiva e il feedback costante, possono contribuire a intraprendere la strada giusta per la generazione di una comunità intelligente. L'obiettivo di questo progetto sarà quello di analizzare le evoluzioni tecnologiche in ognuno dei pilastri menzionati in precedenza e il loro impatto diretto su una comunità che decide di implementarle. Una parte importante di questo lavoro consiste nell'approfondire il funzionamento e l'implementazione del progetto. Alla fine si proverà a dare al lettore una visione a 360 gradi su concetti importanti di questa tesi come smart city, smart community e sulla loro suddivisione come comunità energetica.The ideal solution to a problem can be a simple, tried-and-tested approach, or it can emerge after countless attempts and bring forth something completely new. The previous quote describes the beginning of a new smart way to live. Living in a smart environment means being able to simply and easily access to a stimulating, rich environment filled with opportunities. The design of this environment is focusing on 5 main factors, attempting to create smart living, smart mobility, smart working, smart environment and at the end of all it will finish creating smart people, all of them together at the end, in an implicit way are a smart community. A city could have an abundances of definitions depending of the perspective, however, one of the simplest way to see it is understanding a city as the merger of multiples communities. Cities are in a transformation process, reinventing themselves overtime to advance their economic, social and technological performance and improve their competiveness to manage the ongoing urban changes. Every city faces different problems regarding with their own “core”, meaning that not all of them suffer from the same diseases, therefore, the antidote to improve their performance in order to be efficient, should take in consideration the specific characteristics of each of them. Not all the citizens have the same culture, education system, belonging sense for their city, and other features that historically are part of the idiosyncrasy of each city or community. The new problems that every city have been facing during the last decades, create at the same time a chance to reinvent themselves and be more efficient. Nowadays, each city is targeting to be sustainable, and in other to achieve it they must create the enabling factors, innovate their administration’s processes and their service towards the citizens. The cities have been facing different challenges, from rapid growing population to high energy demand, and high standards of amenities in urban areas. In developed countries, challenges are due to declining birth rates, aging societies demanding better healthcare services, and deterioration of physical infrastructure such as buildings, roads, water supply and sewage systems, and power grid. Moreover, the environmental situation is something that is a global concern, increasing carbon dioxide emissions and frequent natural disasters are urgent issues. A new world, new challenges, new ways and paths require something that reshape people’s life and maybe one accurate answer to solve this situation could be replying successful small smart communities, that can be a trend model for other ones around, and could have a snowball effect in a higher scale, transforming even cities or countries. Thus, smart communities may be viewed as a template of how smart technologies-people can allow local systems to effectively harness these global forces and deploy the results in a positive generation of new opportunities, socially, politically, and economically. A multi-stakeholder model, where in order to reach a level of success all parts should be involved. Therefore, the target of this paper is to analyses the different type of smart cities, smart communities in all their versions, how they work and are composed, their evolution over the time and extract a model with their main features, that could be a guide line for future communities. Finally, do a step into the particular case of energy communities and the technologies that are part of it. Analyzing successful cases in detail, mainly in Italy, and extracting the technological development, features and processes, this paper will be a model of a community that is in the smartening process, in other words, becoming a smart community