Bioética en tiempos de pandemia COVID-19 / Bioethics in pandemic's time COVID-19

The current CoVID-19 pandemic has changed the world. The role of bioethics is to help us prioritize our values and put them ahead of our personal interests. We have examples of pandemics throughout history, but these happened in completely different living conditions, and decisions were made based on different scenarios. Today, we are facing a society with diverse and especial needs, and advanced technologies that allow us to "save lives". At the same time, our health systems need to make crucial decisions such as who should get the last bed?, the last ventilator?, how to properly manage sensitive populations (e.g., the elderly, patients with chronic or unknown conditions). This is further exacerbated if we consider the limited hospital capacity and lack of basic sanitary resources that countries face. In absence of a definitive treatment and vaccine for this virus, studies that are not properly structured, from an ethics point of view, are being conducted, hence leading to a problematic situation. In this work, we aim to provide a broad overview of the bioethics situation we are facing around the world. It is important to note that at this time there are not sufficient articles of scientific validity available. Resources currently available mostly show experts' opinions on the problem. This is understandable given that the time we have to experiment and find a vaccine for CoVID-19 is rather limited. This pandemic has brought us to a completely new, global situation, and most of us do not have any prior experience with this type of scenarios. In the midst of all, we hope that this global crisis can lead us to a change in society, where we pursue equity and we become more empathetic human beings. This article summarizes the confrontation of the principles of bioethics with the current pandemic situation.

La pandemia de CoVID-19 ha cambiado al mundo. La bioética nos ayuda a ordenar y a colocar nuestros valores por sobre nuestros intereses. La historia nos relata pandemias, pero las condiciones de vida fueron completamente diferentes y las decisiones fueron tomadas en escenarios distintos. Actualmente nos vemos enfrentados a una sociedad con diversas necesidades especiales, una tecnología avanzada que permite "salvar vidas", esto sumado a la imperiosa necesidad de tomar decisiones por parte de los sistemas de salud que están sobrepasados por la situación epidemiológica actual. Así tener que ser parte de la decisión sobre a quién otorgar "la última cama ó "el último ventilador mecánico", además del adecuado manejo de ancianos, pacientes con enfermedades crónicas o sin un pronóstico conocido, se ha vuelto una realidad. Esto se ve vinculado a las deficiencias que afrontan los países en cuanto a la capacidad hospitalaria y de insumos sanitarios básicos. La situación de no tener un tratamiento, una vacuna y la realización de estudios que éticamente no están bien estructurados, llevan a un dilema difícil de resolver. En este artículo se resume el enfrentamiento de los principios de la bioética con la situación de la pandemia actual. Por eso es que decidimos hacer una revisión de lo que sucede a nivel mundial desde el punto de vista bioético, a pesar de que la bibliografía es de escaso contenido científico y se encuentra mayoritariamente como opinión de expertos. Esta pandemia es una condición nueva, no tenemos experiencias, solo esperamos que sirva para una reflexión que lleve a una sociedad más justa y a ser personas mas empáticas.

Neumonía eosinofílica en pediatría, a propósito de dos casos clínicos / Pneumonia eosinofilic in pediatrics, clinical cases

INTRODUCCIÓN: La Neumonía Eosinofílica (NE) es una entidad muy poco frecuente en pediatría y se caracteriza por infiltración de eosinófilos en el intersticio pulmonar y alveolar, pudiendo ser primaria o secundaria, así como también presentar un curso agudo o crónico. OBJETIVO: Presentar dos casos clínicos de NE diagnosticados en el período 2014-2017 en una Unidad de Cuidados Intensivos pediátricos. CASOS CLÍNICOS: Dos lactantes mayores, ambos con antecedente de madre asmática, hospitalizados por in suficiencia respiratoria y diagnóstico de neumonía viral en Clínica Indisa, Santiago, Chile. Ambos presentaron síndrome febril, imágenes de condensación persistentes en la radiografía de tórax y eosinofilia periférica en el transcurso de su enfermedad. Uno de ellos con requerimiento de oxígeno por más de un mes, sin eosinofilia en el lavado broncoalveolar (LBA), al que se le hizo el diagnóstico de NE por biopsia pulmonar. El otro niño requirió ventilación mecánica por 28 días y se hizo diag nóstico de NE por eosinofilia mayor a 20% en LBA. Los dos casos presentaron excelente respuesta a corticoides sistémicos. CONCLUSIÓN: La NE se debe sospechar en el niño con diagnóstico de neumonía con síntomas persistentes sin respuesta al tratamiento, habiéndose descartado otras causas, sobre todo si se asocia a eosinofilia periférica. El diagnostico de NE en pediatría se confirma por eosinofilia mayor a 20% en LBA y en algunos casos es necesaria la biopsia pulmonar.

INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.

Pneumonia eosinofilic in pediatrics, clinical cases. / Neumonía eosinofílica en pediatría, a propósito de dos casos clínicos.

INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.