O problema da identidade pessoal segundo Derek Parfit

O objetivo do presente trabalho é examinar a teoria do problema metafísico da identidade pessoal em Derek Parfit. Primeiramente apresento três das principais abordagens da identidade pessoal na filosofia contemporânea: a teoria da identidade corpórea, a teoria da continuidade psicológica e a teoria não-reducionista da identidade. Cada uma delas está exposta a controvérsias, e é no bojo destas controvérsias que Parfit apresenta a sua teoria de que a identidade não é o que importa para as pessoas. A tese de Parfit não é uma tese empírica sobre o que as pessoas de fato valorizam, mas sobre o que importa do ponto de vista da racionalidade prática. Posteriormente, apresento as observações de Parfit à teoria da identidade da memória de John Locke, pois é o filósofo precursor do problema da identidade pessoal. Em seguida, apresento a teoria de Parfit, segundo a qual a identidade pessoal não importa Após, exponho uma importante objeção a Parfit, feita por Harold W. Noonan e, examinando seus possíveis méritos, tal objeção parece basear-se em uma leitura equivocada da teoria parfitiana. Por fim concluo que, dada as grandes dificuldades das três principais abordagens, e também porque a objeção de Noonan não parece ter obtido sucesso, a teoria de Parfit parece ser uma posição promissora no debate sobre a identidade pessoal.The aim of this paper is to examine Derek Parfit's theory of the metaphysical problem of personal identity. First, I present three of the main approaches to personal identity in contemporary philosophy: corporeal identity theory, psychological continuity theory, and non-reductionist identity theory. Each is exposed to controversy, and it is in the midst of these controversies that Parfit presents his theory that identity is not what matters to people. Parfit's thesis is not an empirical thesis about what people actually value, but about what matters from the point of view of practical rationality. Later, I present Parfit's remarks to John Locke's theory of identity of memory, as he is the pioneering philosopher on the problem of personal identity. Next, I present Parfit's theory that personal identity does not matter. Afterwards, I raise an important objection to Parfit, made by Harold W. Noonan, and, examining its possible merits, this objection seems to be based on a misreading of the Parfitian theory. Finally, I conclude that, given the great difficulties of the three main approaches, and also because Noonan's objection does not seem to have been successful, Parfit's theory seems to be a promising position in the debate about personal identity

Caracterización clínica, funcional y hemodinámica de la población con hipertensión pulmonar arterial evaluada en el Instituto Nacional del Tórax

Pulmonary Arterial Hypertension is a rare, progressive and devastating disease with severe consequences in quality of life and survival. Aim: A clinical, functional and hemodynamic assessment of patients with pulmonary arterial hypertension and categorization according to severity. Material and methods: Prospective registry of patients with arterial pulmonary hypertension, hemodynamically defined. Clinical evaluation was performed using World Health Organization functional score (I to IV) and Borg dyspnea scale. Six minute walking test, echocardiography and right heart catheterization were used for functional and hemodynamic assessment. Intravenous Adenosine was used to assess vascular reactivity during the hemodynamic evaluation. Results: Twenty nine patients were included (25 women, age range 16-72 years). Pulmonary hypertension was idiopathic in 11, associated to connective tissue disease in seven, associated to congenital heart disease in nine and associated to chronic thromboembolism in two. The mean lapse of symptoms before assessment was 2.9 years and 100% had dyspnea (Borg 5.1). Functional class I, II, III and IV was observed in 0, 5, 21 and 3 patients respectively. Six minutes walking test was 378±113 m. Mean pulmonary pressure was 59.4±12.2 mmHg, cardiac index was 2.57±0.88 and pulmonary vascular resistance index: 1798.4±855 (dyne.sec)/cm5. Nine patients had a mean pulmonary arterial pressure >55 mmHg and a cardiac index <2.1, considered as bad prognosis criteria. Adenosine test was positive in 17%. Conclusions: This group of patients with Pulmonary Arterial Hypertension was mainly conformed by young females, with a moderate to severe disease.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000500007&nrm=is

An overview of care changes in the last 6 year in primary pci in st-elevation myocardial infarction in a tertiary university Brazilian hospital

Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period. Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (ptrend 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (ptrend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (ptrend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality

Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre

Objective As a parallel to the radial approach for left heart catheterisation, forearm veins may be considered for the performance of right heart catheterisation. However, data regarding the application of this technique under ultrasound guidance are scarce. The current study aims to demonstrate the feasibility of right heart catheterisation through ultrasound-guided antecubital venous approach in the highly heterogeneous population usually referred for right heart catheterisation. Methods Data from consecutive right heart catheterisations performed at an academic centre in Brazil, between January 2016 and March 2017 were prospectively collected. Results Among 152 performed right heart catheterisations, ultrasound-guided antecubital venous approach was attempted in 127 (84%) cases and it was made feasible in 92.1% of those. Yet, there was no immediate vascular complication with the antecubital venous approach in this prospective series. Conclusions Ultrasound-guided antecubital venous approach for the performance of right heart catheterisation was feasible in the vast majority of cases in our study, without occurrence of vascular complications

The effects of a flavonoid-rich diet on oxidative stress, inflammation, and lipid profile after elective percutaneous coronary intervention : a randomized clinical trial

Antioxidant-rich foods may decrease oxidative stress and have a direct impact on atherosclerosis by reducing low-density lipoprotein (LDL) oxidation. Our aim was to assess the impact of a flavonoid-rich diet on oxidative stress, inflammatory response, and lipid profile in patients with coronary artery disease submitted to elective percutaneous coronary intervention (PCI). Thirty-three patients submitted to elective PCI were randomly allocated to follow either a flavonoid rich antioxidant (AOX) diet or a control diet based on National Cholesterol Education Program Adult Treatment Panel III recommendations. Patients were followed for 6 months. Dietary intake was recorded at the start and at the end of the follow-up period, as were oxidative stress markers (ferric reducing ability of plasma and protein sulphydryl) and Creactive protein (CRP). Patients randomized to follow the AOX diet had a reduction in energy, carbohydrate, and lipid intake, as well as increased flavonoid intake. Compared to the control group, there were no changes in oxidative stress markers or CRP in the patients following the AOX diet, but these patients had a significant decrease in LDL cholesterol levels. In conclusion, the findings of this study suggest that a flavonoid-based antioxidant-rich diet is not associated with reductions in oxidative stress or inflammatory markers 6 months after percutaneous coronary intervention. Nonetheless, patients in the intervention group experienced significant reductions in LDL cholesterol, which may indicate cardiovascular benefits of AOX diets despite of inflammation and oxidative stress markers

Primary pulmonary lymphoma: a case serie

Los linfomas primarios de pulmón (LPP) son infrecuentes. Sus manifestaciones clínicas y las imágenes son inespecíficas. El retraso diagnóstico puede ser considerable. Objetivo: Analizar los LPP durante el período 2003-2013 en nuestra institución. Sobre 1892 linfomas, 4 fueron LPP (0,21%): 1) linfoma no Hodgkin (n = 2); 2) linfoma Hodgkin (n= 1); 3) linfoma intravascular pulmonar (n = 1). Las manifestaciones clínicas y radiológicas fueron inespecíficas (masa pulmonar y derrame pleural, consolidación con broncograma aéreo y cavitación o bien ausencia de lesiones). Los métodos diagnósticos fueron: 1) punción guiada bajo TAC; 2) videotoracoscopía (VATS) y 3) VATS orientada por PET (tomografia por emisión de positrones) y 4) toracotomía. El tiempo entre la consulta inicial hasta el diagnóstico fue de 45 a 90 días. Este reporte confirma la baja incidencia de LPP, y sus manifestaciones clínicas y radiologías poco específicas. Esto puede contribuir a las demoras en el diagnóstico. El PETpuede mejorar el rendimiento diagnóstico, en especial en ausencia de compromiso pulmonar radiológico evidente.Primary Pulmonary Lymphomas (LPP) are infrequent and their clinical manifestations and images are usually nonspecific. Diagnostic delay may be important. The objective of this study was to analyze the LLP in our institution. Between 2003 and 2013, over 1,892 lymphomas were analyzed in our institution. Only 4 of them (0.21% incidence) were detected as LPP: Non Hodgkin's Lymphoma (n = 2), Hodgkin's Lymphoma (n = 1), and Intravascular Pulmonary Lymphoma (n = 1). Clinical manifestations of the 4 cases presented were unspecific: 1) pulmonary mass and pleural effusion; 2) consolidation with air bronchogram and cavitations; 3) normal images and 4) pulmonary mass. Given these clinical settings, 4 diagnostic methods were used: 1) Computed Tomography-Guided Puncture, 2) Video-Assisted Thoracoscopic Surgery (VATS); 3) VATS guided by positron emission tomography (PET) and 4) thoracotomy. Hence, diagnosis was successfully made between 45 to 90 days from the initial consultation. This report confirms the low incidence of LPP, and its unspecific clinical and radiographic manifestations that may cause delay in diagnosis. PET can contribute to improve diagnostic performance, especially in patients without apparent lung involvement.Fil: Villarroel Saavedra, Julio César. Hospital Italiano; ArgentinaFil: Romanczuk, Máximo. Hospital Italiano; ArgentinaFil: Wainstein, Esteban Javier. Hospital Italiano; ArgentinaFil: Las Heras, Marcos. Hospital Italiano; ArgentinaFil: de Vito, Eduardo. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Svetliza, Graciela. Hospital Italiano; ArgentinaFil: Precerutti, Juan A.. Hospital Italiano; Argentin

Síndrome Coronariana Aguda como apresentação atípica do fenômeno de Roubo Subclávio

Roubo coronariano da subclávia (RCS) é um fenômeno raro que ocorre em pacientes submetidos a cirurgia de revascularização miocárdica com enxerto de artéria torácica interna esquerda (ATIE) e que causa estenose da artéria subclávia ipsilateral e proximal à origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atípico de síndrome do RCS, manifestando-se como síndrome coronariana aguda no pós-operatório de cirurgia vascular.Palavras-chave: Síndrome coronariana aguda; angioplastia; síndrome do roubo coronário-subclávi

Síndrome Coronariana Aguda como apresentação atípica do fenômeno de Roubo Subclávio

Roubo coronariano da subclávia (RCS) é um fenômeno raro que ocorre em pacientes submetidos a cirurgia de revascularização miocárdica com enxerto de artéria torácica interna esquerda (ATIE) e que causa estenose da artéria subclávia ipsilateral e proximal à origem da ATIE. Relatamos o caso de um paciente masculino de 65 anos que apresentou quadro atípico de síndrome do RCS, manifestando-se como síndrome coronariana aguda no pós-operatório de cirurgia vascular. Palavras-chave: Síndrome coronariana aguda; angioplastia; síndrome do roubo coronário-subclávi