Relación médico paciente: La bioética y el cuidado en medicina

A lo largo de la historia de la medicina, el médico ha desempeñado principalmente tareas de asistencia y consuelo. Entre los siglos XV y XVII se realiza un cambio en la concepción de la medicina que acompaña a la transformación del conocimiento, poner remedio se transforma muy rápidamente en poner un remedio, una medicina. En la actualidad, imbuidos del mismo espíritu, entendemos que apartar todo daño y maleficio significa apartar la enfermedad. La bioética nos propone acercarnos al médico y hallar conductas éticas en que se manifieste el hombre en su plenitud, íntegro, con capacidad de vivir su historia y proyectarse al porvenir, tal cual lo pedía Potter, su fundador. Esto muchas veces implica curar, reparar, extraer el daño, pero sobre todo obliga al médico a cumplir con su vocación más antigua: cuidar. Pero ¿cómo pensar el cuerpo de otra manera y la enfermedad de otra manera? Proyectar un mundo con el enfermo compartiendo un espacio con él, el cuidado de ese espacio común, de ese proyecto común. Esto es la medida no sólo del ejercicio de la humanidad del médico, sino de su ética. Debemos hablar de una ética del cuidado en medicina. Esto significa básicamente estar atentos a que el paciente es un otro que necesita de nosotros, que acude al médico a pedir ayuda; negársela, omitir acciones, o realizar acciones en beneficio de terceros, sería claramente optar por una conducta no ética, inmoral. Reflexionar frente al enfermo muriente y sobre todo al enfermo sufriente, se convierte en el mayor desafío para el médico. Practicar la ética del cuidado no es otra cosa que acompañar al enfermo en el camino hacia el futuro, sea este de vida o de muerte, teniendo presente lo que decía Erik Cassel "El médico pocas veces cura, algunas alivia, pero siempre debe consolar".Along the history of the medicine the doctor has recovered principally tasks of assistance and consolation. Between centuries XV and seventeenth makes a change conception of medicine accompanying transforming knowledge. Remedying changes very quickly put a remedy medicine. Today, imbued with the same spirit, we understand that aside from damage and remove disease spell means. Bioethics is proposing to approach the medical and ethical behaviors find that the man is revealed in its fullness, integrity, ability to live with their history and projected into the future, as he asked what Potter, its founder. his often involves heal, repair, remove the damage, but all require a doctor to fulfill their oldest vocation: to care. But how do you think of another way the body and illness differently? Projecting a world with the patient sharing a room with him, caring for the common space, the joint project. This is a measure not only the exercise of the humanity of the doctor, but his ethics. We speak of an ethic of care in medicine This means to be basically attentive that the patient is an other one who needs from us, that it comes to the doctor to ask for help, deny it, ignore actions, or actions for the benefit of others, would clearly opt for unethical conduct, immoral. To reflect in front the sick dying and specially the suffering sick, becomes the biggest defy for the doctor. While the cure, as we understand it today, is supported on the science, care is supported by the trust. The medicine can not take care of, is knowledge, a science, the doctor can only do so, in reality the team doctor, because the doctor today can not be working alone. Practicing ethics of care is nothing to accompany the patient on the road to the future, be it life or death, bearing in mind what Erik Cassel said "The doctor rarely cures, some relief, but should always console".Fil: Pfeiffer, Maria Luisa Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina; Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina; Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Programa de Bioética; Argentina;Fil: Molinari, Luciana. Asociación Argentina de Medicina Respiratoria. Comité de Bioética; Argentina

A POLÍTICA PÚBLICA DE SAÚDE E OS MIGRANTES: DESAFIOS DA EDUCAÇÃO EM SAÚDE

The article analyzes the role of Health Education in migratory contexts. Initially, there is a thought about health rights and migrants, which during their mobility process go through aggravated lack of this right. Then, it is presented an approach of the Brazilian Public Health Policy towards migrants, considering today as the new users of the health system and finally, the fundamental importance of Health Education within the Public Health Policy is analyzed as an instrument for the promotion and prevention of migrants' health. The method adopted presents a predominantly bibliographic analysis.El artículo analiza el papel de la educación sanitaria en contextos migratorios. Inicialmente, hay una reflexión sobre el derecho a la salud y los migrantes, que en el curso del proceso de movilidad muchos pasan por significativas privaciones con relación a ese derecho. Luego, se presenta un enfoque de la Política de Salud Pública brasilera hacia los migrantes, considerado hoy como nuevos usuarios del sistema de salud y, por último, se analiza la importancia fundamental de la Educación en Salud dentro de la Política de Salud Pública como un instrumento para la promoción y prevención de salud de los migrantes. El método adoptado presenta un análisis predominantemente bibliográfico.O artigo analisa o papel da Educação em Saúde em contextos migratórios. Inicialmente, se faz uma reflexão sobre o direito à saúde e os migrantes, pois no decorrer do processo de mobilidade muitos passam por significativas privações em relação a esse direito. Na sequência, apresenta-se uma abordagem da política pública de saúde brasileira em relação aos migrantes, considerados hoje, os novos usuários do sistema de saúde e por fim, analisa-se a fundamentalidade da Educação em Saúde como política pública e instrumento de promoção e prevenção da saúde dos migrantes. O método adotado apresenta uma análise predominantemente bibliográfica

Functional respiratory evolution in two patients with emphysema and pulmonary fibrosis

La combinación de enfisema y fibrosis pulmonar es una condición frecuentemente subdiagnosticada. Los estudios funcionales aislados pueden generar interpretaciones inadecuadas. No hemos hallado comunicaciones de casos que documenten la evolución espirométrica de estos pacientes. Se presentan dos casos de fibrosis y enfisema combinados que permiten observar la evolución funcional a largo plazo y comprender los valores espirométricos actuales en forma más precisa. Los hallazgos más relevantes son: 1) espirometría con discretas alteraciones funcionales en presencia de disnea marcada y, en un paciente, necesidad de oxigenoterapia crónica, 2) evolución funcional con seudonormalización del patrón espirométrico obstructivo inicial, posiblemente como consecuencia del desarrollo de fibrosis. Un defecto obstructivo leve en un paciente con diagnóstico de obstrucción crónica al flujo aéreo y marcado deterioro de su condición clínica y clase funcional debería alertar sobre la posibilidad de fibrosis pulmonar asociada. La tomografía y la disponibilidad de estudios funcionales previos permiten comprender esta condición.Combined pulmonary fibrosis and emphysema (CPFE) is a frequently under-diagnosed condition. Isolated pulmonary function tests (PFT) can give rise to misinterpretations. We have found no reports on these patients’ spirometric progression. We describe two cases of CPFE, showing long-term functional evolution to have a more accurate understanding of current spirometric values. The most relevant findings are: 1) spirometry with discrete functional alterations in the presence of a marked dyspnea and the need, in one patient, for chronic oxygen therapy; and 2) functional evolution reflecting “pseudonormalisation” of the initial obstructive spirometric pattern, possibly as a result of fibrosis development. A mild obstructive defect in a patient with chronic airflow limitation and marked impairment of his/her clinical status and functional class should alert on the possibility of associated pulmonary fibrosis. A computed tomography (CT) and previous PFTs will allow a better understanding of this condition.Fil: Arce, Santiago C.. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Molinari, Luciana. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Hospital Británico de Buenos Aires; ArgentinaFil: de Vito, Eduardo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

Relato de um caso com rápida evolução e desfecho satisfatório em criança com provável Síndrome de Guillain- Barré

Introduction: Guillain-Barré Syndrome (GBS) is the most frequent cause of acute and sub-acute flaccid paralysis after polio eradication. Although rare, it is recognized as the leading cause of flaccid paralysis among the admissions to pediatric intensive care for acute neuromuscular diseases. Objective: To report the case of a 14-month-old male patient with a probable diagnosis of GBS with acute, myelinated motor sensitive neuropathy, with probable secondary axonal involvement, with rapid clinical recovery. Case Report: A male patient admitted in a reference hospital in the Federal District, Brazil, residing in the Integrated Development Region of the Federal District and Surroundings. The child was 14 months old and 8.6 kg, with an updated vaccination status and neuropsychomotor development appropriate for his age, with a condition of paresis in the lower limbs, without cognitive changes. After 14 hours of admission, due to the worsening of his clinical situation and the albumino-cytological dissociation identified by the analysis of cerebrospinal fluid, it was started immunotherapy with intravenous human immunoglobulin, 0.7g/kg/day for three days. Twenty four hours after start of treatment, the child showed a clinical improvement of his general condition. The patient was discharged after five days of hospitalization. After 76 days of discharge, there was a significant improvement in neuropsychomotor development, despite a slight delay in its development. Conclusion: Due to the rarity of Guillain-Barré Syndrome among young children, it is important that health professionals remain sensitive to capture and treat unusual cases in a timely manner. We also recommend that the identified cases be monitored carefully, in order to check if the Guillain-Barré Syndrome, and its variants, can explain developmental disorders a posteriori.Introdução: A Síndrome de Guillain-Barré (SGB) é a causa mais frequente de paralisia flácida aguda e subaguda desde a erradicação da poliomielite. Embora rara, é reconhecida como a principal causa de paralisia flácida entre pessoas internadas em terapia intensiva pediátrica por doenças neuromusculares agudas. Objetivo: Relatar um caso de paciente do sexo masculino, com 14 meses de idade, com diagnóstico provável de Síndrome de Guillain-Barré com neuropatia sensitivo motora, aguda, mielínica, com provável comprometimento axonal secundário, com rápida evolução e melhora.   Descrição do caso: Foi admitido em hospital público maternoinfantil de referência para o Distrito Federal um paciente masculino, residente na Região Integrada de Desenvolvimento do Distrito Federal e Entorno. A criança tinha 14 meses de idade e 8,6kg, situação vacinal atualizada e desenvolvimentoneurospicomotor adequado para a idade, com quadro de paresia em membros inferiores, sem alterações cognitivas. Após 14 horas da admissão, diante do agravamento do quadro clínico e da dissociação albomino-citológica identificada pela análise de líquido cefalo-raquidiano foi iniciada imunoterapia (imunoglobulina humana endovenosa, 0,7g/kg/dia por três dias). Após 24 horas do início do tratamento, a criança apresentou melhora em seu estado geral. O paciente teve alta hospitalar após cinco dias de internação. Após 76 dias da alta, foi constatada melhora significativa no desenvolvimento neuropsicomotor, apesar de leve atraso em seu desenvolvimento até o momento.   Conclusão: Diante da raridade de casos em crianças, é importante que os profissionais de saúde se mantenham sensíveis a captar e tratar os casos de maneira oportuna. Recomendamos ainda que os casos identificados sejam acompanhados cuidadosamente, afim de verificar se a SGB, esuas variantes, podem explicar transtornos de desenvolvimento à posteriori

COVID Feel Good-An Easy Self-Help Virtual Reality Protocol to Overcome the Psychological Burden of Coronavirus

Background: Living in the time of the COVID-19 means experiencing not only a global health emergency but also extreme psychological stress with potential emotional side effects such as sadness, grief, irritability, and mood swings. Crucially, lockdown and confinement measures isolate people who become the first and the only ones in charge of their own mental health: people are left alone facing a novel and potentially lethal situation, and, at the same time, they need to develop adaptive strategies to face it, at home. In this view, easy-to-use, inexpensive, and scientifically validated self-help solutions aiming to reduce the psychological burden of coronavirus are extremely necessary. Aims: This pragmatic trial aims to provide the evidence that a weekly self-help virtual reality (VR) protocol can help overcome the psychological burden of the Coronavirus by relieving anxiety, improving well-being, and reinforcing social connectedness. The protocol will be based on the 'Secret Garden' 360 VR video online (www.covidfeelgood.com) which simulates a natural environment aiming to promote relaxation and self-reflection. Three hundred sixty-degree or spherical videos allow the user to control the viewing direction. In this way, the user can explore the content from any angle like a panorama and experience presence and immersion. The 'Secret Garden' video is combined with daily exercises that are designed to be experienced with another person (not necessarily physically together), to facilitate a process of critical examination and eventual revision of core assumptions and beliefs related to personal identity, relationships, and goals. Methods: This is a multicentric, pragmatic pilot randomized controlled trial involving individuals who experienced the COVID-19 pandemic and underwent a lockdown and quarantine procedures. The trial is approved by the Ethics Committee of the Istituto Auxologico Italiano. Each research group in all the countries joining the pragmatic trial, aims at enrolling at least 30 individuals in the experimental group experiencing the self-help protocol, and 30 in the control group, over a period of 3 months to verify the feasibility of the intervention. Conclusion: The goal of this protocol is for VR to become the 'surgical mask' of mental health treatment. Although surgical masks do not provide the wearer with a reliable level of protection against the coronavirus compared with FFP2 or FFP3 masks, surgical masks are very effective in protecting others from the wearer's respiratory emissions. The goal of the VR protocol is the same: not necessarily to solve complex mental health problems but rather to improve well-being and preserve social connectedness through the beneficial social effects generated by positive emotions

Sugarcane (Saccharum X officinarum): A Reference Study for the Regulation of Genetically Modified Cultivars in Brazil

Global interest in sugarcane has increased significantly in recent years due to its economic impact on sustainable energy production. Sugarcane breeding and better agronomic practices have contributed to a huge increase in sugarcane yield in the last 30 years. Additional increases in sugarcane yield are expected to result from the use of biotechnology tools in the near future. Genetically modified (GM) sugarcane that incorporates genes to increase resistance to biotic and abiotic stresses could play a major role in achieving this goal. However, to bring GM sugarcane to the market, it is necessary to follow a regulatory process that will evaluate the environmental and health impacts of this crop. The regulatory review process is usually accomplished through a comparison of the biology and composition of the GM cultivar and a non-GM counterpart. This review intends to provide information on non-GM sugarcane biology, genetics, breeding, agronomic management, processing, products and byproducts, as well as the current technologies used to develop GM sugarcane, with the aim of assisting regulators in the decision-making process regarding the commercial release of GM sugarcane cultivars

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016