[Ethics code of the medical college of Chile. Critical analysis of a modification]. / Código de Ética del Colegio Médico de Chile. Análisis crítico de una modificación.

The code of ethics of the Medical College of Chile was modified in December 2019. The amendment was mainly to article 8, which refers to the doctor's duty to care for the pregnant woman and the child she is carrying. The change maintains this duty, but allows doctors to perform abortions, introducing three considerations that act as new principles or values for the medical profession: the plurality of values existing in society, the autonomy of women and what is established by law. This paper is a reflection on codes of ethics, their relationship with values, and with legislation. Also it shows the consequences that this modification represents for the principles governing medical activity, the status of medical specialties, the commitment of doctors to their patients and the validity of the code of ethics.

Crtap and p3h1 knock out zebrafish support defective collagen chaperoning as the cause of their osteogenesis imperfecta phenotype.

Prolyl 3-hydroxylation is a rare collagen type I post translational modification in fibrillar collagens. The primary 3Hyp substrate sites in type I collagen are targeted by an endoplasmic reticulum (ER) complex composed by cartilage associated protein (CRTAP), prolyl 3-hydroxylase 1 (P3H1) and prolyl cis/trans isomerase B, whose mutations cause recessive forms of osteogenesis imperfecta with impaired levels of α1(I)3Hyp986. The absence of collagen type I 3Hyp in wild type zebrafish provides the unique opportunity to clarify the role of the complex in vertebrate. Zebrafish knock outs for crtap and p3h1 were generated by CRISPR/Cas9. Mutant fish have the typical OI patients' reduced size, body disproportion and altered mineralization. Vertebral body fusions, deformities and fractures are accompanied to reduced size, thickness and bone volume. Intracellularly, collagen type I is overmodified, and partially retained causing enlarged ER cisternae. In the extracellular matrix the abnormal collagen type I assembles in disorganized fibers characterized by altered diameter. The data support the defective chaperone role of the 3-hydroxylation complex as the primary cause of the skeletal phenotype.

Código de Ética del Colegio Médico de Chile. Análisis crítico de una modificación / Ethics code of the medical college of Chile. Critical analysis of a modification

The code of ethics of the Medical College of Chile was modified in December 2019. The amendment was mainly to article 8, which refers to the doctor's duty to care for the pregnant woman and the child she is carrying. The change maintains this duty, but allows doctors to perform abortions, introducing three considerations that act as new principles or values for the medical profession: the plurality of values existing in society, the autonomy of women and what is established by law. This paper is a reflection on codes of ethics, their relationship with values, and with legislation. Also it shows the consequences that this modification represents for the principles governing medical activity, the status of medical specialties, the commitment of doctors to their patients and the validity of the code of ethics.

Neonatal retinal hemorrhages and influence of perinatal factors.

We studied fundus oculi in 234 newborns, divided into two groups of mothers and neonates with or without disease. The overall frequency or retinal hemorrhages was 30.3% (71 neonates). In each group, we studied the association between retinal hemorrhage and several variables of labor and the newborn infant. Statistically significant differences were found in the incidence of hemorrhage in one (2.6%) neonate born by cesarean section, as compared with 61 (38%) spontaneous or 9 (25%) forceps delivery.

Familial bilateral optic nerve hypoplasia.

Bilateral optic nerve hypoplasia affected five individuals corresponding to four generations of a family. Two decreased men were also apparently affected. The three patients studied, two women and a girl, presented the same clinical picture: poor visual acuity; small, pale and malformed papilla; two concentric peripapillary halos; and wandering movements of the eyes. Fluorescein angiography performed in the propositus mother showed a faint papillary fluorescence. At variance with the two familial cases reported, the pedigree clearly suggest an autosomal dominant type of inheritance. Similar clinical features found in other patients suggest a stationary nature of the defect.

Cerclaje Cérvico-Ístmico transabdominal: experiencia de 30 años / Cervical-Isthmic transabdominal cerclage: experience of 30 years

RESUMEN Introducción: se define incompetencia cervical como la incapacidad del cuello uterino de retener una gestación en el segundo trimestre, en ausencia de contracciones uterinas. El cerclaje cervical es la intervención que ha demostrado utilidad en el tratamiento de la incompetencia cervical. La principal vía utilizada para cerclaje es la vaginal, sin embargo existe un grupo de pacientes en el que ésta no es posible y debe realizarse un abordaje transabdominal. Este trabajo muestra los resultados y experiencia de 30 años en la instalación de cerclaje por vía abdominal abierta. Se realiza una revisión de la literatura y se discuten sus indicaciones, resultados y complicaciones. Además se analiza la técnica quirúrgica, especialmente las variantes de ella y el momento de realizar la intervención. Métodos: se revisaron datos de 20 pacientes a las que se realizó cerclaje transabdominal, desde el año 1985 hasta la fecha. En todas las cirugías participó el autor principal de este artículo. Resultados: las intervenciones se realizaron entre las 8 y 18 semanas de gestación. Las causas principales fueron la imposibilidad de realizar un cerclaje por vía vaginal, debido a ausencia de cuello por conizaciones amplias o repetidas y amputaciones cervicales o fracaso de cerclajes por vía vaginal previos. Las 20 pacientes tuvieron 23 embarazos, 20 partos (16 mayores de 37 s. y 4 mayores de 34 s.) y 3 abortos. Se obtuvo un 87% de sobrevida fetal. Conclusiones: la utilización de esta técnica es útil en pacientes con imposibilidad de cerclaje por vía vaginal o en fracasos de cerclajes vaginales previos. La literatura revisada no muestra diferencias estadísticamente significativas entre los procedimientos realizados previos o durante la gestación, ni tampoco si se realiza mediante laparoscopía o cirugía abierta.

SUMMARY Introduction: cervical incompetence is defined as the inability of the cervix to retain a pregnancy in the second trimester, in the absence of uterine contractions. Cervical cerclage is the intervention that has proven its usefulness in the treatment of cervical incompetence. The main route used for cerclage is vaginal, however there is a group of patients in which this is not possible and a transabdominal approach must be performed. This work shows the results and experience of 30 years in the installation of cerclage by abdominal open route. A review of the literature is made and its indications, results and complications are discussed. In addition, the surgical technique is analyzed, especially it's variants and the moment of performing the intervention. Methods: data from 20 patients who underwent a transabdominal cerclage from 1985 to date were reviewed. In all the surgeries, the main author of this article participated. Results: the interventions were performed between 8 and 18 weeks of gestation. The main causes were the impossibility of performing a cerclage by vaginal route due to absence of the cervix by extensive or repeated conizations and cervical amputations or failure of previous cerclage by vaginal route. The 20 patients had 23 pregnancies, 20 deliveries (16 over 37 w. and 4 over 34 w.) and 3 abortions. 87% of fetal survival was obtained. Conclusions: the use of this technique is useful in patients with inability to cerclage vaginally or in failures of previous vaginal cerclages. The literature reviewed does not show statistically significant differences between the procedures performed before or during pregnancy, nor whether it is performed by laparoscopy or open surgery.

Proyecto de ley sobre despenalización del aborto: análisis ético / Draft law on the decriminalization of abortion: ethical analysis

El proyecto de ley presentado por el gobierno de Chile en Enero del 2015 al Congreso Nacional, que pretende regular "la despenalización de las interrupciones del embarazo en tres causales", ha provocado mucho impacto en la opinión pública y en las agrupaciones médicas, especialmente en las dedicadas a la atención de la mujer embarazada. El proyecto en una primera mirada busca, sin abandonar el respeto a la vida del que está por nacer, quitar el castigo a la mujer y al médico que practica un aborto sólo en tres causales. Se apoya para ello en principios distintos y contradictorios en cada una de ellas. Una segunda mirada revela que el principio de respetar la vida de los pacientes, que funda a la profesión médica desde sus inicios, se reemplaza por la decisión de la mujer para continuar o no cualquier gestación. En efecto, la manera como se estructura el proyecto permite en definitiva, que sea ella la que determine el estatuto de paciente del hijo/hija que gesta y por lo tanto de merecer el cuidado de los profesionales de la salud. Este trabajo revela ese principio oculto, totalmente opuesto al respeto de la vida de todo ser humano sin discriminación.

The project of law presented by the government of Chile, in January 2015, at the National Congress, which seeks to regulate "the decriminalization of pregnancy termination in three causal", has caused much impact on public opinion and in the medical groups, especially in those dedicated to the care of pregnant women. The project at a first glance looks, without abandoning the respect for the life of an unborn child, to remove the punishment on the female and the doctor who performs an abortion only in three grounds. It bases this on various and contradictory principles in each of the three figures. A second look reveals that the principle of respecting the lives of patients, who founded medical profession since its beginnings, is replaced by the women's decision to continue or not any gestation. In effect, the way how is structured allows definitively, that should be the woman the one that determines the patient's statute of her son or daughter, and therefore of deserving the health professional's care of them. This work reveals a hidden principle, totally opposed to the respect the life of every human being without any discrimination.

[Ontological and ethical status of anencephalic fetus]. / Estatuto ontológico y ético del feto anencefálico: Una perspectiva filosófica.

Due to advances in prenatal techniques, it is now possible to diagnose malformations in utero, such as anencephaly, which in the past was only known at birth. Having knowledge of a malformation before birth, the moment in which almost every individual obtains social and legal protection, puts the malformed fetus in a vulnerable situation toward possible actions that lead to the interruption of pregnancy. The aim of this article is to analyze different positions about the quality and reality of the anencephalic fetus, its human condition and the care that the fetus and mother deserve.

El acto médico: ¿Una creación original? reflexiones sobre su esencia, surgimiento y riesgos a los que se expone / Medical act: an original creation? reflections on its essence, origin and risks of exposure / O ato médico: uma criação original? reflexoes sobre sua essência, surgimento e riscos a que se está exposto

La medicina se constituyó como una actividad enseñable con metodología propia a partir de la escuela hipocrática. Como actividad, se relaciona con todas aquellas que buscan la producción de algo, en este caso la salud de los pacientes, considerada ésta como un bien particular de ellos. El médico entonces -como todo productor- debe traspasar una intervención existente primero en su mente a un sujeto carente de salud o en riesgo de perderla. Este trabajo busca reflexionar sobre cómo consigue el médico concebir en su intelecto una acción que, plasmada en un paciente en particular, constituya para él un efecto considerado curativo. La tesis fundamental en esta reflexión es que, además de utilizar criterios útiles para un hombre considerado universalmente, debe crear una intervención diseñada a la medida de un ser humano particular, poseedor de toda una complejidad personal.

Medicine became a teaching activity with its own methodology since the Hippocratic School. As activity, it relates to those which seek to produce something, in this case the health of patients, considering this as a particular good for them. The physician, then -as all producer- must transfer an existing intervention first in his/her mind to a subject lacking health or in risk of losing it. This study tries to reflect on how the physician achieves to imagine in his/her reasoning an action that, performed in a particular patient, it will constitute in him/her a healing effect. The fundamental thesis in this reflection is that, besides using useful criteria considering a universal human being, he/she must create an intervention designed to suit a specific human being, who has a full personal complexity.

A medicina se constituiu como uma atividade, resultante de ensino com metodologia própria, a partir da escola hipocrática. Como atividade, se relaciona com todas aquelas que buscam a produção de algo, neste caso, a saúde dos pacientes, considerada esta como um bem particular. Desse modo, o médico -enquanto produtor- deve ultrapassar à sua visão primeira, de intervenção junto a um sujeito carente de saúde ou em vías de perdêla. Esse trabalho buscará refletir sobre como o médico consegue conceber uma ação que, plasmada em um paciente com suas particularidades, se constitua de efeito considerado curativo. A tese fundamental desta reflexão é mais que utilizar critérios úteis, considerados universais, para o ser humano, deve-se acreditar em uma intervenção desenhada na medida de um ser humano particular, possuidor de toda uma complexidade pessoal.

Acerca de los errores en medicina / On errors in medicine

Errors in medical practice may seriously harm patients. This damage is not always attributable to the action of a doctor. We must bear in mind that all human activity is susceptible of errors and that the effects of those errors will depend on the target of such activity. Therefore the consequences of doctor's errors will necessarily be the patient's health and the only possible preventive action of professionals is to take the measures to reduce the occurrence of errors to a minimum. This essay is a reflection about the nature of errors in medicine, about when they can be attributed to the action of doctors and from where they arise. We therefore analyze errors in different human activities. We distinguish errors in science, arts and techniques. We also consider errors that arise from the act itself and analyze if this is the source of errors imputable to doctors.

[Percutaneous nephropexy]. / Nefropexia percutánea.

OBJECTIVE: To evaluate the efficacy of percutaneous nephropexy in symptomatic renal ptosis. METHODS: From August 1997 to September 1999, 6 women aged 28-49 years (mean 34.3) with symptomatic renal ptosis underwent percutaneous nephropexy. All patients were evaluated preoperatively by IVP and diuretic renogram in the standing and lying positions. Patient follow-up ranged from 14-34 months (mean 21). RESULTS: Mean operating time was 30 minutes and mean length of hospital stay was 24 hours. Treatment was successful in 5 patients; lumbar pain disappeared and the kidney was fixed in a higher position. CONCLUSIONS: Percutaneous nephropexy can be an alternative to conventional and laparoscopic nephropexy.

Consideraciones éticas del uso de la ultrasonografía 11-14 semanas como tamizaje de aneuploidías en la población Chilena / Nuchal translucency thickness screening for aneuploidies in the Chilean population: ethical considerations

El examen ultrasonográfico entre las 11-14 semanas de gestación para pesquisa de aneuploidías en el feto se está realizando sistemáticamente en muchos centros asistenciales de nuestro país. Si bien la utilidad diagnóstica de este examen está ampliamente validada, surgen dudas sobre sus reales beneficios y los potenciales riesgos de este método, utilizado como tamizaje, en nuestra población. Esta presentación tiene como objetivo hacer una reflexión sobre esos riesgos y beneficios. Se discuten la utilización de este procedimiento sin un adecuado consentimiento informado, y las implicancias que tiene la instauración rutinaria de este método en el control obstétrico de nuestra población, especialmente al considerar las condiciones en las que en muchos centros se realiza este examen.

The ultrasound screening for aneuploidies between the 11 and 14 weeks of gestation is systematically performed in many centers of our country. Although the usefulness of this diagnostic test is well known, concern has been raised regarding its potential risks, when used as a screening method. The aim of this article is to analyze the risk and benefits of this practice in our population, considering the frequent lack of an informed consent and how is this procedure performed in several medical centers in our country.

Estatuto ontológico y ético del feto anencefálico: una perspectiva filosófica / Ontological and ethical statute of anencephalic fetus

Due to advances in prenatal techniques, it is now possible to diagnose malformations in útero, such as anencephaly, which in the past was only known at birth. Having knowledge of a malformation before birth, the moment in which almost every individual obtains social and legal protection, puts the malformed fetus in a vulnerable situation toward possible actions that lead to the interruption of pregnancy. The aim of this article is to analyze different positions about the quality and reality of the anencephalic fetus, its human condition and the care that the fetus and mother deserve.

Informe para el Tribunal Constitucional sobre los aspectos científicos y éticos del uso del levonorgestrel como anticonceptivo de emergencia / Report for the Constitutional Court on the scientific and ethical aspects of the use of the levonorgestrel like emergency contraceptive

Las normas de regulación de la fertilidad, propuestas en el documento del Ministerio de Salud de Chile, plantean diversos problemas biomédicos en el contexto de una cierta visión de la procreación humana, de la sexualidad y de la familia. Hay serias objeciones desde una antropología que respeta la naturaleza personal de la mujer y del hombre, especialmente en el riesgo que existe en la promoción de métodos que podrían afectar la vida de seres humanos inocentes en sus etapas iniciales de desarrollo. Del análisis de la literatura se ha concluido que existen antecedentes científicos importantes, que se analizan en este documento, y que indicarían que el uso de la llamada “píldora del día después” podría estar poniendo en riesgo la vida del embrión humano preimplantacional.

Fertility regulation rules, proposed by the Chilean Health Ministry, involve several biomedical problems within the context of a given view point of human procreation, human sexuality and family. There are serious objection from an anthropology that respects the personal nature of woman and man, particularly in the danger that the life and survival of preimplantational human embryo could be affected by such methods. From an exhaustive analysis of the scientific literature, that are discussed in this document, it was concluded that the so called “emergency contraception pill” could be jeopardizing the life and survival of the preimplantation human embryo.

Testigos de Jehová y transfusion sanguínea: reflexion desde una ética natural

El rechazo por parte de los Testigos de Jehová de recibir transfusiones sanguíneas siempre ha representado para los médicos un conflicto ético y un problema en la relación médico paciente. Las razones de este grupo para rechazar las transfusiones se basan en motivos religiosos por un mandato explícito de Dios que se encontraría en la Biblia. Para ellos el hecho de aceptar esta medida terapéutica les significa una pérdida en el ámbito espiritual de tal importancia que se les presenta como intolerable. Tanto es así, que prefieren morir antes de aceptar una transfusión. Este trabajo analiza este conflicto desde una ética natural, donde un médico buscando la salud de su paciente comprende que ella no es todo lo que aspira un ser de carácter personal. Debe aceptar entonces que algunas medidas terapéuticas, aunque disponibles, pueden ser consideradas como desproporcionadas y no ser implementadas. En todo caso, en esas situaciones, el médico y las instituciones de salud deben establecer todas las medidas para asegurar que este tipo de decisiones se realicen con la debida información, confidencialidad, libertad y en ausencia de toda coacción.

Jehovah's Witnesses rejection on receiving blood transfusion has always represented an ethical conflict for physicians and a problem for doctor-patient relationship. The reason of their rejection, is based on one of God's commandment written in the Bible. For them, the fact of accepting this therapy means such a spiritual loss that it appears to them intolerable and they prefer to die before accepting a transfusion. This paper analyzes this conflict from a natural ethical perspective, where a physician who is seeking for his patient's health, understands that health is not all the good that a being of personal nature seeks. The physician must accept that some therapies, even if available, may be considered as disproportionate and not be implemented. In these situations, the physician and health institutions should establish the necessary dispositions to ensure that this kind of decisions may be taken with proper information, confidentiality, liberty and absence of coercion.

Cesárea versus parto vaginal: una perspectiva ética / Cesarean section and vaginal delivery: an ethical perspective

The increasing number of cesarean sections is worrisome. In this article, several causes that could cause this phenomenon are invoked and a primary cause that explains all others is proposed. The hierarchical analysis of different values such as safety, costs and mother autonomy at the moment of medical decision, is discussed

Cerclaje cérvico-ístmico transabdominal: serie clínica

Se comunica el resultado perinatal de trece pacientes con cerclaje efectuado por vía abdominal. Se revisa la historia, la técnica quirúrgica, las indicaciones y las complicaciones del procedimiento. Hubo un 87 por ciento de sobrevida fetal, resultado comparable con series mundiales publicadas. Se destacan dos casos de indicaciones no publicadas anteriormente y asociadas a incompetencia cervical (fístula cérvicovaginal y útero doble). Se concluye que este procedimiento es útil en pacientes con imposibilidad de cerclaje por vía vaginal o en fracasos de cerclajes previos. El mayor riesgo de complicaciones hace necesario que la indicación de este procedimiento sea decidido en cada caso.

Inicio de la vida humana: la necesidad de una reflexión filosófica / Benginning of human life: the need for a philosophical reflection

The question about the identification of the exact moment when human life begins has a special ethic transcendence. Elements afforded by science are insufficient this objective, because of the nature of the object in study and of the cognoscent subject. This article makes a proposal with arguments afforded by the philosophical reflection

Cerclaje intraabdominal durante el embarazo / Intraabdominal cerclaje during pregnancy

Se presenta el caso de una paciente de 35 años, con antecedentes de 2 partos vaginales; posteriormente, una conización amplia, y luego 3 abortos de segundo trimestre, los dos últimos a pesar de cerclajes con técnica de McDonald. En un sexto embarazo se realizó un cerclaje intraabdominal con cinta de mersilene, el cual tuvo éxito, ya que se obtuvo mediante cesárea un niño de 3.260 g., sin complicaciones. Se analizan las indicaciones del procedimiento. Aparentemente, es el primer caso publicado en nuestro medio