Problemática e ideologías de la responsabilidad médica en España (1850-1949)

In this paper the positions and proposals are reconstructed as put forward in Spain among the medical profession in the last century and the first half of the present one, regarding the problems of medical liability, especially in respect of its juridical implications. The confrontation and alternation of the points of view expressed by different authors are examined, as well as mental and professional attitudes and certain burning and polemical issues in the general debate, such as the legitimation of the ordinary jurisdictional authorities to judge and evaluate medical doctors or the type of medical action suited to be brought before a courtroom and judged. The article describes the position held by institutional and corporative representatives of the profession —who mace á wide spectrum of claims, from special jurisdiction to the prerogative of legal irresponsibility due to ordinary imprudence or assistential negligence— highlighting the differences in approach between about the 1928 Penal Code and Gregorio Marañón's doctrine in this respect.En este artículo se reconstruyen las posturas y propuestas formuladas, entre mediados del siglo pasado y fines de los años cuarenta, en España, en torno a la problemática de la responsabilidad médica, en especial la de naturaleza jurídica. Se examina la confrontación y la alternancia de puntos de vista enunciados a partir de distintos autores, mentalidades profesionales y coyunturas, a propósito de ciertos aspectos conflictivos como la legitimidad de los órganos jurisdiccionales ordinarios para juzgar y valorar a los médicos, los tipos de actos que podían enjuiciarse y valorarse, y las modalidades más adecuadas para enjuiciarlos y valorarlos. El trabajo describe los planteamientos de representantes institucionales y corporativos de la medicina —que reivindicaban desde fueros especiales hasta la prerrogativa de la irresponsabilidad legal por imprudencias y negligencias asitenciales—, las diferencias de enfoque entre juristas y galenos, la polémica desatada por el Código Penal de 1928, y la doctrina de Gregorio Marañón a este respecto

CNApp, a tool for the quantification of copy number alterations and integrative analysis revealing clinical implications.

Somatic copy number alterations (CNAs) are a hallmark of cancer, but their role in tumorigenesis and clinical relevance remain largely unclear. Here, we developed CNApp, a web-based tool that allows a comprehensive exploration of CNAs by using purity-corrected segmented data from multiple genomic platforms. CNApp generates genome-wide profiles, computes CNA scores for broad, focal and global CNA burdens, and uses machine learning-based predictions to classify samples. We applied CNApp to the TCGA pan-cancer dataset of 10,635 genomes showing that CNAs classify cancer types according to their tissue-of-origin, and that each cancer type shows specific ranges of broad and focal CNA scores. Moreover, CNApp reproduces recurrent CNAs in hepatocellular carcinoma and predicts colon cancer molecular subtypes and microsatellite instability based on broad CNA scores and discrete genomic imbalances. In summary, CNApp facilitates CNA-driven research by providing a unique framework to identify relevant clinical implications. CNApp is hosted at https://tools.idibaps.org/CNApp/

Tumour initiating cells and IGF/FGF signalling contribute to sorafenib resistance in hepatocellular carcinoma

Objective: Sorafenib is effective in hepatocellular carcinoma (HCC), but patients ultimately present disease progression. Molecular mechanisms underlying acquired resistance are still unknown. Herein, we characterise the role of tumour-initiating cells (T-ICs) and signalling pathways involved in sorafenib resistance. Design: HCC xenograft mice treated with sorafenib (n=22) were explored for responsiveness (n=5) and acquired resistance (n=17). Mechanism of acquired resistance were assessed by: (1) role of T-ICs by in vitro sphere formation and in vivo tumourigenesis assays using NOD/SCID mice, (2) activation of alternative signalling pathways and (3) efficacy of anti-FGF and anti-IGF drugs in experimental models. Gene expression (microarray, quantitative real-time PCR (qRT-PCR)) and protein analyses (immunohistochemistry, western blot) were conducted. A novel gene signature of sorafenib resistance was generated and tested in two independent cohorts. Results: Sorafenib-acquired resistant tumours showed significant enrichment of T-ICs (164 cells needed to create a tumour) versus sorafenib-sensitive tumours (13 400 cells) and non-treated tumours (1292 cells), p<0.001. Tumours with sorafenib-acquired resistance were enriched with insulin-like growth factor (IGF) and fibroblast growth factor (FGF) signalling cascades (false discovery rate (FDR)<0.05). In vitro, cells derived from sorafenib-acquired resistant tumours and two sorafenib-resistant HCC cell lines were responsive to IGF or FGF inhibition. In vivo, FGF blockade delayed tumour growth and improved survival in sorafenib-resistant tumours. A sorafenib-resistance 175 gene signature was characterised by enrichment of progenitor cell features, aggressive tumorous traits and predicted poor survival in two cohorts (n=442 patients with HCC). Conclusion: Acquired resistance to sorafenib is driven by T-ICs with enrichment of progenitor markers and activation of IGF and FGF signalling. Inhibition of these pathways would benefit a subset of patients after sorafenib progression

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic

Las reclamaciones judiciales por mala praxis médica

Área de Salud, Economía y Socieda

El control de la prensa sobre la profesion médica: El caso de El País

El control social sobre la medicina se ha convertido en uno de los temas de mayor relevancia sociológica en lo concerniente a esta profesión. En este artículo se explora y describe uno de los canales a través de los cuales se desarrolla dicho control: la prensa. Con tal objeto se realiza un análisis de contenido centrado en el diario "El País", que abarca el universo de noticias, cartas de lectores, editoriales, etc., publicados en el lustro 1985-89, referidos a negligencias y conductas medicas incorrectas o lesivas. El análisis muestra que estos textos son de recurrente aparición (4,8 de media mensual), concluyéndose que la prensa ha sido un factor preponderante en la apertura, esclarecimiento y sensibilización de los ciudadanos y pacientes hacia esta problemática, y ha contribuido a alterar el imaginario colectivo sobre los galenos

Las asociaciones de consumidores y usuarios y la Sanidad

Área de Salud, Economía y Socieda

Salud reproductiva y sexualidad: el Estado, la sociedad civil y otros actores sociales

Área de Salud, Economía y Socieda

Servicios de salud y sectores populares: los años del proceso

Área de Salud, Economía y Socieda