Ética y Humanitarismo: dimensiones morales de la ayuda humanitaria desde la perspectiva de Thomas Pogge

El problema de la pobreza global ha alcanzado proporciones gigantescas. Durante los últimos 20 años la cantidad de muertes por causa del hambre y por enfermedades que podrían ser evitadas han ascendido aproximadamente a 250 millones de personas. Thomas Pogge, sostiene que los Estados ricos tienen la responsabilidad de ayudar a aquellos que se encuentran sumidos en la pobreza severa. Esta responsabilidad –que podría entenderse también como un deber moral– resulta del daño, muchas veces evitable, que el orden institucional global actual ha perpetrado sobre Estados pobres. La existencia de la pobreza global, para este autor, constituye una clara violación de los Derechos Humanos.For the last 20 years the amount of deaths because of hunger and diseases that could be avoided affects approximately 250 million people. Thomas Pogge affirms that the rich countries have the responsibility to help the other countries that are sunk in severe poverty. This responsibility –that could also be understood as moral duty– comes from the damage, often avoidable, that the present global institutional order has perpetrated upon poor States. Global poverty, according to this author, is a clear violation of the human rights, as well as a crime towards humanity.Fil: Belli, Laura Florencia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Programa de Bioética; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Quadrelli, Silvia. Médecins du Monde International; Franci

La bioética y los comités hospitalarios de ética: una introducción

La bioética comienza a conformarse como disciplina especializada hace casi cinco décadas. Los importantes avances experimentados por las ciencias biológicas y médicas, junto con el surgimiento de innovadoras biotecnologías, tornan urgente la adopción de criterios para la toma de decisiones moralmente complejas relacionadas con el ámbito de la salud. Los organismos gubernamentales y los diferentes centros de salud, frente a esta realidad, comprenden la importancia de la tarea de implementación de diversos mecanismos formales para abordar y analizar los problemas éticos que surgen de estos avances dinámicos y cambiantes en el campo de los cuidados médicos. Como resultado se produjo la creación de los comités de bioética, que tienen como finalidad principal alentar el diálogo y el debate sobre cuestiones dilemáticas relacionadas con la ética del cuidado de la salud. Estos comités son grupos interdisciplinarios en los cuales expertos de diferentes profesiones (médicos, enfermeras, psicólogos, filósofos, abogados y otros) analizan diferentes cuestiones de orden bioético con el fin de lograr un acuerdo teniendo siempre como fin la protección de los derechos del paciente. Este presente trabajo, que posee un carácter introductorio a estas temáticas, presentará una breve introducción al surgimiento y posterior desarrollo de la bioética como disciplina y luego se expondrán las funciones y composición de los comités hospitalarios de ética.The birth of bioethics as a discipline can be set approximately five decades ago. The significant scientific progress achieved by biological and medical sciences, along with the emergence of innovative biotechnology, brought to light the need to set criteria for the morally complex decisions that emerged from the health care and medical fields. Government agencies and health centers, faced with this reality, began to understand the importance of the task of implementing formal mechanisms to address and analyze ethical issues arising from these dynamic and ever changing developments in the health care field. The result was the establishment of bioethics committees, which are intended to encourage dialogue and debate on issues related to ethics of health care. These committees are interdisciplinary groups in which experts from different professions (doctors, nurses, psychologists, philosophers, lawyers and others) discuss various bioethical issues in order to reach an agreement with the purpose of protecting patient´s rights. This paper, which has an introductory character, presents a brief introduction to the emergence and development of bioethics as a discipline and explains the functions and composition of hospital ethics committees.Fil: Belli, Laura Florencia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Programa de Bioética; Argentina. Universidad de Buenos Aires. Facultad de Filosofia y Letras; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Quadrelli, Silvia. Hospital Británico; Argentin

¿La verdad, toda la verdad y nada más que la verdad?

La comunicación entre médicos y pacientes es un aspecto fundamental de la atención de los individuos gravemente enfermos, sin embargo la mayoría de los médicos han tenido poca formación en comunicación. Los aspectos de comunicación más valorados por los pacientes son los que los ayudan a ellos y a sus familias a sentirse guiados, los que apuntan a fomentar la confianza y los que alimentan la esperanza. Si bien estas pueden ser consideradas cualidades abstractas, se derivan de un conjunto concreto de habilidades comunicacionales que (al menos hasta cierto punto) puede ser efectivamente enseñado y aprendido. Estas habilidades comunicacionales no son las mismas aptitudes de la “entrevista médica” que la mayoría de los profesionales aprendió en la escuela de medicina, y que están centradas en la consideración de los antecedentes médicos completos y los aspectos sociales y familiares. Las habilidades de comunicación necesarias en el tratamiento de enfermedades potencialmente graves son habilidades de segundo orden que se centran en situaciones difíciles. Una amplia variedad de estudios empíricos documentan que la comunicación médicopaciente es menos que óptima. Los médicos y las enfermeras no llegan a captar la totalidad de la gama de preocupaciones que afectan a las personas con enfermedades potencialmente graves, lo que aumenta el sufrimiento de los pacientes y sus seres queridos. Este trabajo analiza los problemas éticos que se suscitan en torno de esta situación comunicativa.Fil: Quadrelli, Silvia. Hospital Británico; Argentina;Fil: Belli, Laura Florencia. Universidad de Buenos Aires. Facultad de Filosofia y Letras; Argentina; Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina;Fil: Kusminsky, Gustavo. Hospital Universitario Austral, Oncohematologia; Argentina

Epos in prose. Homeric influences in the Histories of Herodotus

I poemi omerici hanno rappresentato nell'approccio critico-interpretativo alle Storie di Erodoto un punto di riferimento importante, in quanto i rapporti tra queste opere sono stati molteplici e a più livelli, dalla struttura narrativa alle scelte tematiche e lessicali. Il lavoro intende concentrarsi sugli influssi omerici nelle Storie intesi non tanto come la ripresa letteraria di un modello, quanto piuttosto come un utile termine di confronto per provare a ricostruire i meccanismi di pubblicazione-esecuzione che hanno caratterizzato un'opera ormai lontana dal genere letterario dell'epos e, al contempo, in costante dialogo con i moduli narrativi, le tematiche e le forme proprie dell'epica. Attraverso l’analisi di alcune scene di sogno, di seduzione, di vestizione e di battaglia si cerca di evidenziare nelle Storie la presenza di elementi ricorrenti che ricordano la struttura delle ‘scene tipiche’, che costituiscono una delle strutture portanti dei moduli narrativi nell'epica; segue un’analisi dei discorsi erodotei che, esaminati con attenzione specifica alla funzione acquisita nei rispettivi contesti narrativi, si rivelano, come quelli omerici, non un puro espediente letterario, ma spiegano, motivano e generano le vicende narrate, facendosi ‘motore’ dell’azione. Si vuole dunque mettere in evidenza come le Storie ‘ereditino’ dai poemi omerici due aspetti fortemente legati al contesto di composizione e trasmissione orale dell’epos arcaico: da un lato le scene tipiche, intese prevalentemente come ‘repertorio’ di elementi che possono essere variamente mescolati per creare situazioni ricorrenti ma, allo stesso tempo, ogni volta differenti; dall’altro i discorsi e la loro funzionalità, che rispecchia una cultura ancora prevalentemente orale, al cui interno la parola pronunciata ha un peso pari, e talvolta maggiore, rispetto all’azione. Partendo dal modello omerico è quindi possibile riconoscere le tracce di un’oralità che ha fortemente influito sulle tecniche di composizione delle Storie e che potrebbe essere riconducibile ad un contesto di diffusione orale, tramite performance, dell’opera erodotea.In the critical approach to Herodotus’ Histories the Homeric poems represent an important reference point; indeed Homeric influences are recognizable in the narrative techniques as well as in the thematic and lexical choices of the Histories. The work focuses on a specific aspect of the ‘Homeric heritage’ in Herodotean work, and it’s based on a ‘functional’ approach. Some Homeric elements, which depend on the oral cognitive and communicative system, typical of epos, are also in Herodotus and their presence could clarify some aspects of the way in which the Histories were composed and published. In the Histories there are recurring elements that recall the structure of typical scenes. Herodotus, therefore, adapts some elements of the epic tradition to the new context of prose historiography and uses the same mechanism of composition to create new recurring motifs that become typical in the Histories. These mechanisms of composition are related to the oral composition and publication of epic poetry: their presence in the Histories can mean a close relationship between Herodotean historiography and orality, especially about the publication of Herodotus' work. And, if we acknowledge that Herodotean historiography is connected to the oral communication system, we can also better understand the function of Herodotean speeches. The speeches of the Histories, like the Homeric ones, are not a rhetorical and literary exercise, but explain, motivate and generate the events narrated. This functionality of speeches reflects an oral culture, in which the spoken word has the same, and sometimes even greater, importance than the action. In conclusion, the comparison with the Homeric model highlights the ‘traces’ of an orality, which has strongly influenced the techniques of composition of the Histories and which could be ascribable to a context of oral publication, through performance, of the Herodotean work

Management and attitudes about IPF (Idiopathic Pulmonary Fibrosis) among physicians from Latin America

Background: The aim of our study was to assess current practice patterns and attitudes towards diagnosis and management of idiopathic pulmonary fibrosis (IPF) patients in Latin America. Methods: A Cross-sectional survey was developed and up to 455 physicians were enrolled. We used a rigorous method of validation using the translated version of the AIR Survey. Results: Mean age was 47.5 years (SD 12.6) with 20.4 years (SD 12.3) of practice. In around 30% of physicians were reported access to radiologist, pathologist and multidisciplinary team. Despite almost all physicians reported that (ATS/ERS/JRS/ALAT) guidelines are useful, half of them prescribed corticoids for treatment of disease. Most respondents (69.9%) reported cough as the presenting symptom. Around 80% considered IPF to be an important clinical disorder, and felt that identifying patients at risk for IPF was important or extremely important. However, only 59.7% felt confident in managing patients with IPF, and similar numbers (60.8%) felt confident about their knowledge. Pulmonologist have more confidence and management of IPF that no pulmonologist. Conclusion: The results of this survey of Latin American physicians could help to fill gaps regarding awareness, management and treatment of IPF and improve earlier diagnosis of IPF

Idelalisib impairs T-cell-mediated immunity in chronic lymphocytic leukemia

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Síndrome de Erasmus

En 1957, L. D. Erasmus comunicó la asociación entre sílice y esclerosis sistémica, destacando la importancia de la exposición a sílice como un factor de riesgo para el desarrollo de esclerodermia ocupacional. Si bien existen reportes de la interacción entre sílice y el sistema inmune, continúa siendo actualmente una asociación infrecuente. El objetivo es presentar un paciente varón de 41 años con esclerosis sistémica e historia de exposición a gran cantidad de polvo de sílice, que desarrolló síndrome de Erasmus. Realizamos además una revisión de la literatura

Acute exacerbation of idiopathic pulmonary fibrosis: International survey and call for harmonisation.

AIM Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is an often deadly complication of IPF. No focused international guidelines for the management of AE-IPF exist. The aim of this international survey was to assess the global variability in prevention, diagnostic and treatment strategies for AE-IPF. MATERIAL AND METHODS Pulmonologists with ILD expertise were invited to participate in a survey designed by an international expert panel. RESULTS 509 pulmonologists from 66 countries responded. Significant geographical variability in approaches to manage AE-IPF was found. Common preventive measures included antifibrotic drugs and vaccination. Diagnostic differences were most pronounced regarding use of KL-6 and viral testing, while HRCT, BNP and D-Dimer are generally applied. High dose steroids are widely administered (94%); the use of other immunosuppressant and treatment strategies is highly variable. Very few (4%) responders never use immunosuppression. Antifibrotic treatments are initiated during AE-IPF by 67%. Invasive ventilation or extracorporeal membrane oxygenation are mainly used as a bridge to transplantation. Most physicians educate patients comprehensively on the severity of AE-IPF (82%) and consider palliative care (64%). CONCLUSION Approaches to the prevention, diagnosis and treatment of AE-IPF vary worldwide. Global trials and guidelines to improve the prognosis of AE-IPF are needed

Integrating Clinical Probability into the Diagnostic Approach to Idiopathic Pulmonary Fibrosis: An International Working Group Perspective

Background. When considering the diagnosis of idiopathic pulmonary fibrosis (IPF), experienced clinicians integrate clinical features that help to differentiate IPF from other fibrosing interstitial lung diseases, thus generating a “pre-test” probability of IPF. The aim of this international working group perspective was to summarize these features using a tabulated approach similar to chest HRCT and histopathologic patterns reported in the international guidelines for the diagnosis of IPF, and to help formally incorporate these clinical likelihoods into diagnostic reasoning to facilitate the diagnosis of IPF. Methods. The committee group identified factors that influence the clinical likelihood of a diagnosis of IPF, which was categorized as a pre-test clinical probability of IPF into “high” (70-100%), “intermediate” (30-70%), or “low” (0-30%). After integration of radiological and histopathological features, the post-test probability of diagnosis was categorized into “definite” (90-100%), “high confidence” (70-89%), “low confidence” (51-69%), or “low” (0-50%) probability of IPF. Findings. A conceptual Bayesian framework was created, integrating the clinical likelihood of IPF (“pre-test probability of IPF”) with the HRCT pattern, the histopathology pattern when available, and/or the pattern of observed disease behavior into a “post-test probability of IPF”. The diagnostic probability of IPF was expressed using an adapted diagnostic ontology for fibrotic interstitial lung diseases. Interpretation. The present approach will help incorporate the clinical judgement into the diagnosis of IPF, thus facilitating the application of IPF diagnostic guidelines and, ultimately improving diagnostic confidence and reducing the need for invasive diagnostic techniques