Abstract This research aims to evaluate the effect of experimental variables in the study of chloride degradation of steel fiber reinforced concretes (SFRCs). The information was collected from different literary sources to be treated through Taguchi's experimental design and regression analysis. The results show that the most influential factors in the degradation of SFRCs by chloride are the load during degradation and the crack width, residual resistance, and maximum flexural load. However, others, such as the water/cement ratio, fiber volume, chloride concentration, and degradation time, showed little influence on the mechanical response of the SFRCs.

Resumo O objetivo desta pesquisa é avaliar o efeito de variáveis experimentais no estudo da degradação de cloretos de concretos reforçados com fibras de aço (SFRCs). As informações foram coletadas de diferentes fontes literárias e tratadas por meio do ábaco experimental de Taguchi e da análise de regressão. Os resultados mostram que os fatores mais influentes na degradação dos SFRCs degradados por cloreto são a carga durante a degradação e a abertura da fissura, fatores que impactam estatisticamente na resistência residual e na carga máxima de flexão. No entanto, outros como relação água/cimento, volume de fibras, concentração de cloretos e tempo de degradação mostraram pouca influência na resposta mecânica dos SFRCs.

Resumen La presente investigación tiene como objetivo evaluar el efecto de variables experimentales en el estudio de la degradación por cloruros de concretos reforzados con fibras de acero (SFRCs). La información fue recopilada de diferentes fuentes literarias para después ser tratada mediante el diseño experimental de Taguchi y análisis de regresión. Los resultados muestran que los factores más influyentes en la degradación de SFRCs degradados por cloruro son la carga durante la degradación y el ancho de fisura, factores que impactan estadísticamente sobre resistencia residual y la carga máxima a flexión. Sin embargo, otros como la relación agua/cemento, el volumen de fibras, la concentración de cloruros y el tiempo de degradación demostraron poca influencia sobre la respuesta mecánica de los SFRCs.

Obstructive sleep apnea syndrome (OSAS) is a common disorder associated with multiple adverse health consequences and its prevalence is increasing in parallel with global rising in obesity. Methods: We have developed a systematic review to examine obstructive sleep apnea syndrome prevalence studies in adults in the general population. We included the cross-sectional studies and the cross-sectional components of longitudinal studies that objectively measured OSAS in adults using laboratory instruments. Forty studies out of 8,876 articles found by systematically searching in PubMed and other databases were included in this review. Results: Substantial methodological heterogeneity in population prevalence studies has been observed, determining a wide variation in OSAS prevalence defined at an apnea-hypopnea index (AHI) ≥ 5 events/hour, the average OSAS prevalence was 36.9% (CI95% 28.3-45.4%) in men and 24.0% (CI95% 16.3-31.6%) in women. The OSAS prevalence has increased over the time. OSAS is more prevalent in men than in women and increases with age and obesity. Excessive daytime sleepiness has been suggested as the most important symptom associated to OSAS, but only a fraction of subjects with AHI ≥ 5 events/hour report daytime sleepiness. Conclusion: The prevalence of OSAS has increased in epidemiological studies over time. The differences in reported prevalence of obstructive sleep apnea are probably due to different diagnostic equipment, operational definitions, study design and characteristics of included subjects, including effects of the obesity epidemic.

Resumen El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) es un trastorno respiratorio común asociado con múltiples consecuencias adversas para la salud y su prevalencia ha aumentado en paralelo con el aumento de la obesidad en la población. Métodos: revisión sistemática que examina los estudios de prevalencia de SAHOS en la población general. Se incluyeron los estudios transversales y los componentes transversales de los estudios longitudinales que midieron objetivamente la prevalencia de SAHOS en adultos empleando instrumentos de laboratorio. Se evaluaron cuarenta estudios poblacionales de las 8.876 publicaciones encontradas en la búsqueda sistemática realizada en PubMed y otras bases de datos. Resultados: Se ha observado importantes diferencias metodológicas en los estudios poblacionales, lo cual ha determinado una amplia variación en la prevalencia de SAHOS reportada, con un valor promedio de 36,9% (IC95% 28,3-45,4%) en hombres y 24,0% (IC 95% 16,3-31,6%) en mujeres. Se ha reportado un aumento en la prevalencia de SAHOS en el curso del tiempo desde 1987 hasta el 2020. Esta condición es más prevalente en varones, aumenta progresivamente con la edad y se asocia a la obesidad. La somnolencia diurna excesiva se ha asociado al diagnóstico de SAHOS, pero sólo una fracción de los sujetos con índice de apnea-hipopnea ≥ 5 eventos/hora presentan somnolencia diurna. Conclusión: La prevalencia de SAHOS ha aumentado en los estudios poblacionales realizados en el curso del tiempo. La variabilidad reportada en la prevalencia de SAHOS probablemente esté relacionada con los diferentes equipos y definiciones operacionales empleados en el proceso diagnóstico, y las características de los sujetos examinados, incluyendo el importante aumento de la obesidad en la población.

Recognizing the role of technology in the development of medicine and the impact of telecommunication advances, we reflect on the meaning and ethics of the use of Telemedicine, both in its general dimension for the use and distribution of knowledge, as well as in the delivery of health actions, scientific research, and data management. Teleconsultation is discussed in greater detail, analyzing its process and application, reviewing its possible advantages and disadvantages, from the point of view of providers and patients. We highlight the need to carry out an appropriate evaluation of each instance, from the point of view of both the patient and the professional who uses it. The importance of maintaining a doctor-patient relationship in agreement with the nature and practice of Medicine, respecting people’s dignity, is emphasized. We mention the ethical conditions that must be bore in mind for the proper use of telemedicine. We discuss the eventual influence that this practice will have on the concept and practice of medical care, while suggesting the need to legislate on the matter.

Abstract Congenital disorders of glycosylation (CDG) are metabolic hereditary diseases caused by defects in the synthesis of glycoconjugates. CDG have been described in sugar-nucleotide biosynthesis and transporter, glycosyltransferases, vesicular transport, as well as in lipid biosynthesis and glycosylphosphatidylinositol anchors. PMM2-CDG is caused by mutations in the phosphomannomutase-2 (PMM2) gene and shows autosomal recessive inheritance. It affects all organs and tissues, ranging from severe psychomotor retardation to moderate intellectual disability. Alterations in the primary haemostatic system have been reported in these patients and they can lead to severe bleeding or excessive thrombosis with subsequent vascular insufficiency. Despite of being the most common CDG, platelet glycosylation and sialylation defects in PMM2-CDG patients remain incompletely characterized. In this study, we applied a lectin-based flow cytometry approach to report the first characterization of the highly glycosylated platelet membrane glycan profile in a PMM2-CDG patient. In the PMM2-CDG patient’s platelet samples, a decreased binding of SNA lectin, indicative of reduced terminal α-2-6 sialic acid content, and an increased binding of PNA lectin, suggesting desialylation of β-1-N-acetylgalactosamine residues, were observed. Reduced expression of terminal sialic acids in platelet membrane glycoproteins may contribute to the increased risk of hemorrhage reported in these patients by promoting platelet clearance and thrombocytopenia.

Conscientious Objection arises as a response to a regulation that is judged as immoral. Faced with a law that is considered unfair, the citizen can respond accepting it against his will, exercising conscientious objection on a personal level or, collectively reaching civil disobedience or revolutionary violence. This is an old discussion known since ancient Greece. The current enactment of laws that allow actions previously judged as crime, and that contravene medical tradition, reactivated the discussion about such objection. Some people, such as Savolescu, who denies the legitimacy of conscientious objection invoked by doctors, arguing that it is inefficient, leads to inequality and is inconsistent. He proposes that the values of these professionals can be tolerated privately but should not be determinant in the public sphere. These arguments are critically examined, mentioning pertinent answers from theoretical and practical points of view. We highlight that ethics should not differ in public and private spheres and the principles should be the same, but exercised in different fields. It is concluded that conscientious objection is acquiring legitimacy and that it is necessary to reflect on the underlying reasons that lead to invoke it. It should be considered a civilized resource against determinations of power that are considered to be an attempt against personal values and moral integrity.

In our country there are few data about the treatment patterns and the survival of the Biologic Disease Modifying Antirheumatic Drugs (bDMARD) in patients with Rheumatoid Arthritis (RA). The objective of our study was to evaluate the survival of the 1st and 2nd biological agent, determine the causes of suspension and factors that influence on the survival of these agents. Material and methods: A retrospective multicenter study was conducted. We included patients ≥18 years of age who met the ACR/EULAR 2010 criteria for RA and who started in 1st and/or 2nd bDMARD between 01/2006 and 06/2017, the data collection was done by reviewing clinical charts The sociodemographic and clinical variables were recorded. Results: We included 347 patients with a median age of 57.8 years, 89.6% women, 96.5% had positive Rheumatoid Factor (RF). 53.9% of patients discontinued treatment with 1st bDMARD, thirty-eight patients (41.3%) discontinued the 2nd bDMARD. The most frequent cause of suspension of the first biological was the lack of provision, while the second biological was inefficacy. The median survivals were: for the 1st bDMARD 31 months (95% CI: 21.8-40.1) and for the 2nd bDMARD 11 months (95% CI: 4-17.9), we did not observe significant differences in survival between the different agents. The independent factors associated with lower survival of the 1st bDMARD were smoking and lower age and the 2nd bDMARD was to have discontinued the first biological agent due to an adverse event. Conclusion: The median survivals of the 1st bDMARD and the 2nd bDMARD were 2.6 years and less than 1 year, respectively. Unlike other cohorts of developed countries the most frequent cause of suspension of the first biological was the lack of provision of the drug by the payer, while the second biological was inefficacy.

En nuestro país existen pocos datos acerca de los patrones de tratamiento y la sobrevida de las Drogas Modificadoras de la Artritis Reumatoidea biológicas (DMARb) en pacientes con Artritis Reumatoidea (AR). El objetivo de nuestro estudio fue estimar la sobrevida del 1° y 2° agente biológico, determinar sus causas de suspensión y evaluar factores que influyan en la sobrevida de estos agentes. Material y métodos: Se realizó un estudio multicéntrico retrospectivo. Se incluyeron pacientes ≥18 años de edad que cumplieran con criterios ACR/EULAR 2010 para AR y que iniciaron su 1° y/o 2° DMARb entre 01/2006 y 06/2017, la recolección de datos se realizó mediante la revisión de historias clínicas. Se consignaron variables sociodemográficas y clínicas. Resultados: Se incluyeron 347 pacientes con edad mediana de 57,8 años, 89,6% mujeres, 96,5% tenían Factor Reumatoideo (FR) positivo. El 53,9% de los pacientes discontinuaron el tratamiento con la 1°DMARb, treinta y ocho pacientes (41,3%) discontinuaron el 2° DMARb. La causa más frecuente de suspensión del primer biológico fue la falta de provisión, mientras que la del segundo biológico fue la ineficacia. Las supervivencias medianas fueron: para la 1° DMARb 31 meses (IC 95%: 21,8-40,1) y para 2° DMARb 11 meses (IC 95%: 4-17,9), no observamos diferencias significativas en la supervivencia entre los distintos agentes, los factores independientemente asociados a menor supervivencia del 1° DMARb fueron el tabaquismo y menor edad y del 2° DMARb fue haber discontinuado el primer agente biológico debido a evento adverso. Conclusión: Las supervivencias medianas del 1° DMARb y del 2° DMARb fueron 2,6 años y menor a 1 año, respectivamente. A diferencia de otras cohortes de países desarrollados, la causa más frecuente de suspensión del primer biológico fue la falta de provisión de la medicación por parte del pagador, mientras que la del segundo biológico fue la ineficacia.

Objectives: To evaluate and compare the efficacy and long-term survival of biological disease-modifying drugs (b-DMARDs) in Axial Spondyloarthritis (axSpA) using the LUNDEX index and to determine the variables associated with the discontinuation of these drugs. Material and methods: Cross-sectional multicenter study. Patients with axSpA in treatment with b-DMARDs were included. Sociodemographic, therapeutic and clinical variables were recorded. The dates of initiation of treatment with b-DMARDs, concomitant treatment, suspension or change of treatment, and causes of suspension were recorded. Therapeutic efficacy was defined according to BASDAI at 6, 12 months and then annually from the initiation of b-DMARDs. The LUNDEX index was calculated in these periods. Statistical analysis: Descriptive statistics. Student’s test and Chi² test or Fisher’s exact test. Curves of Kaplan-Meier and Log-Rank. Proportional regression analysis of Cox. Results: 101 patients with axSpA were studied, 80.2% men, with a median age of 42 years (IQR 35-54.5) and a median disease duration of 19.3 years (IQR 9.4-28.8). 26.7% of patients didn´t have health insurance. The frequency of the anti-TNFα agent used as 1st b-DMARD was: Etanercept (ETA) 44.6%, Adalimumab (ADA) 41.6%, Infliximab 7.9%, and Certolizumab 5.9%. In 32.7% of the cases, the b-DMARD was administered in combination with a c-DMARD (conventional disease-modifying drug). The mean survival was 66.2 months (95% CI: 51.8-80.5). As ETA and ADA were used in 85% of the patients, comparisons were made only between these two agents. The mean survival time was significantly lower for ETA vs ADA (X 53.18 ±8.8 vs X 74.8±8.9, Log-Rank p=0.02), being the main cause of suspension, the lack of drug provision. The average survival time for those who didn´t have health insurance was significantly lower X 31.9 months (95% CI: 19-45) in comparison to those patients who had health insurance X 72.3 months (95% CI: 55.3-89.3), p=0.03. After adjusting for confounding factors, the lack of health insurance was the only variable independently associated with a lower survival of the b-DMARD (HR 2.54, 95% CI: 1.18 to 5.75). The global LUNDEX was 52.7% at 6 months and 46.9% at 12 months. Conclusions: The average survival of the 1st b-DMARD was 5.5 years. The lack of health insurance was the only variable that negatively influenced the survival of the treatment with the 1st b-DMARD in patients with axSpA.

Objetivos: Evaluar y comparar la eficacia y la sobrevida a largo plazo de las Drogas Modificadoras de la Enfermedad-biológicas (DME-b) en Espondiloartritis Axial (EsPax) mediante el índice LUNDEX y determinar las variables asociadas a la discontinuación de las mismas. Material y métodos: Estudio multicéntrico de corte transversal. Se incluyeron pacientes con EsPax en tratamiento con DME-b. Se registraron variables sociodemográficas, terapéuticas y clínicas. Se consignaron fechas de inicio del tratamiento con DME-b, tratamiento concomitante, suspensión o cambio de tratamiento, y causas de suspensión. La eficacia terapéutica se definió según BASDAI a los 6, 12 meses y luego anualmente a partir del inicio de la DME-b. Se calculó el índice LUNDEX en estos períodos. Análisis estadístico: Estadística descriptiva. Test de Student y test Chi² o test exacto de Fisher. Curvas de Kaplan-Meier y Log-Rank. Análisis de regresión proporcional de Cox. Resultados: Se estudiaron 101 pacientes con EsPax, 80,2% varones, con una edad mediana de 42 años (RIC 35-54,5) y un tiempo mediano de evolución de la enfermedad de 19,3 años (RIC 9,4-28,8). El 26,7% de los pacientes no tenían seguro de salud. Los agentes anti-TNFα utilizados como 1º DME-b en orden de frecuencia fueron: Etanercept (ETN) 44,6%, Adalimumab (ADA) 41,6%, Infliximab 7,9% y Certolizumab 5,9%. En el 32,7% de los casos, la DME-b se administró en combinación con una droga modificadora de enfermedad convencional. La sobrevida media fue de 66,2 meses (IC 95%: 51,8-80,5). Debido a que ETN y ADA se utilizaron en el 85% de los pacientes estudiados, se realizaron comparaciones solamente entre estos agentes. El tiempo medio de supervivencia acumulada fue significaticamente menor para ETN versus ADA (X 53,18±8,8 vs X 74,8±8,9, Log-Rank p=0,02), siendo la causa principal de suspensión, la falta de provisión de la medicación. El tiempo promedio de supervivencia para aquellos que no tenían seguro de salud fue significativamente menor X 31,9 meses (IC 95%: 19-45) con respecto a aquellos pacientes con dicho seguro X 72,3 meses (IC 95%: 55,3-89,3), p=0,03. Luego de ajustar por factores confundidores, la falta de un seguro de salud fue la única variable asociada en forma independiente con menor supervivencia del DME-b (HR 2,54, IC 95%: 1,18-5,75). El LUNDEX global fue del 52,7% a los 6 meses y del 46,9% a los 12 meses. Conclusiones: La sobrevida promedio del 1º DME-b fue de 5,5 años. La falta de cobertura de salud fue la única variable que influyó negativamente en la sobrevida del tratamiento con el 1º DME-b en pacientes con EsPax.

Objectives: To evaluate the treatment patterns of DME-b (Disease-Modifying Drugs-biological), their accumulated survival and their long-term efficacy in patients with psoriatic arthritis (PsA) using the LUNDEX index. Materials and methods: Retrospective multicentre study. We included patients diagnosed with PsA who started treatment with DME-b. Sociodemographic and clinical data were collected. BMI-D start dates, concomitant treatment, suspension or change of treatment, and reasons for suspension were recorded. The therapeutic response was defined according to MDA (Minimal Disease Activity), at 6, 12 months and annually from the beginning of DME-b. Statistical analysis: Student test and Chi². Curves of Kaplan Meier and Log Rank. Cox regression analysis. Results: We included 72 patients with PsA, 39 (54.2%) male. The median age was 54.5 years (IQR 45-61) and the median time of evolution of the disease was 11 years (IQR 6-15). 71.2% (n=42) presented comorbidities. The first DME-b was in decreasing order of frequency: Adalimumab (45.8%), Etanercept (36.1%), Certolizumab (5.6%), Infliximab (4.2%), Ustekinumab (4.2%), Abatacept (2.7%) and Golimumab (1.4%). 15 patients (25.4%) received DME-b monotherapy. The mean survival was 82 months (SD±7.4). The LUNDEX of the first biological was 24.7% at 6 months and 44.3% per year. The mean survival of Adalimumab was 90 months (SD±10.4) and Etanercept 79 months (SD±12). Older patients had a lower survival of the drug [≥55 years: X59.8 (SD±10.5) vs <55 years: X101.2 (SD±9.7), p=0.006]. After adjusting for different confounders, age ≥55 years was significantly maintained at lower survival [HR=1.064 (CI=1.01-1.11) p=0.005]. The LUNDEX was lower in obese vs. non-obese (16% vs. 66% per year, p=0.89, 10.5 vs 74.9% at 2 years, p=0.011 and 5.9 vs 81.8% at 3 years, p=0.005). Conclusions: The average survival of the first DME-b was 6.8 years. The only variable associated with lower survival was the older age.

Objetivos: Evaluar los patrones de tratamiento de las DME-b (Drogas Modificadoras de la Enfermedad-biológicas), su sobrevida acumulada y su eficacia a largo plazo en pacientes con Artritis Psoriásica (APs) utilizando el índice LUNDEX. Materiales y métodos: Estudio multicéntrico retrospectivo. Se incluyeron pacientes con diagnóstico de APs que hayan iniciado tratamiento con DME-b. Se recolectaron datos sociodemográficos y clínicos. Se consignaron fechas de inicio de DME-b, tratamiento concomitante, suspensión o cambio de tratamiento, y razones de suspensión. La respuesta terapéutica se definió acorde a MDA (Minimal Disease Activity), a los 6, 12 meses y anualmente a partir del inicio de DME-b. Análisis estadístico: Test de Student y Chi². Curvas de Kaplan Meier y Log Rank. Análisis de regresión de Cox. Resultados: Se incluyeron 72 pacientes con APs, 39 (54,2%) de sexo masculino. La edad mediana fue de 54,5 años (RIC 45-61) y el tiempo mediano de evolución de la enfermedad de 11 años (RIC 6-15). 71,2% (n=42) presentaron comorbilidades. El primer DME-b fue en orden decreciente de frecuencia: Adalimumab (45,8%), Etanercept (36,1%), Certolizumab (5,6%), Infliximab (4,2%), Ustekinumab (4,2%), Abatacept (2,7%) y Golimumab (1,4%). 15 pacientes (25,4%) recibieron DME-b en monoterapia. La sobrevida media fue de 82 meses (DE±7,4). El LUNDEX del primer biológico fue 24,7% a los 6 meses y 44,3% al año. La sobrevida media de Adalimumab fue de 90 meses (DE±10,4) y de Etanercept 79 meses (DE±12). Los pacientes añosos presentaron menor sobrevida de la droga [≥55 años: X59,8 (DE±10,5) vs <55 años: X101,2 (DE±9,7), p=0,006]. Luego de ajustar por diferentes confundidores, la edad ≥55 años se mantuvo significativamente a menor sobrevida [HR=1,064 (IC=1,01-1,11) p=0,005]. El LUNDEX fue menor en obesos vs no obesos (16% vs 66% al año, p=0,89; 10,5 vs 74,9% a los 2 años, p=0,011 y 5,9 vs 81,8% a los 3 años, p=0,005). Conclusiones: La sobrevida promedio del primer DME-b fue de 6,8 años. La única variable asociada a menor sobrevida fue la mayor edad.

Osteomyelitis is defined as a progressive inflammation of the bone, which occurs most frequently in the long bones of the body. Its etiology is related to local and / or systemic factors that include anemia. Osteomyelitis resulting from sickle cell anemia results in the blood being more viscous producing a low blood flow leading to ischemic attack and bone necrosis. Patient presented with increased volume in the left preauricular region following one month of evolution, soft, fluctuating, ill-defined limits, 5x4 cm in diameter, afebrile, without discoloration. He had trismus, tenderness and had been admitted to the emergency room five months earlier, for osteomyelitis with subgaleal abscess. Patient`s background included anemia and treatment for chronic alcoholism. The patient was hospitalized with intravenous treatment of cloxacilline, resulting in increased preauricular volume with defined limits. Results following a biopsy showed condyle osteomyelitis. Osteomyelitis presented in the condyle may be the recurrence of osteomyelitis or may have been caused by the anemia. However, frontoparietal osteomyelitis has no apparent cause and could be associated with anemia.

La osteomielitis se define como una inflamación progresiva del hueso, que se produce con mayor frecuencia en los huesos largos del cuerpo. Su etiología se relaciona con factores locales y/o sistémicos los que incluyen la anemia. La osteomielitis resultante de la anemia de células falciformes genera que la sangre sea más viscosa produciendo un bajo flujo sanguíneo conduciendo a infarto isquémico y necrosis del hueso, rara vez causado en los huesos faciales. Paciente ingresado a urgencia por un aumento de volumen en la región preauricular izquierda de un mes de evolución, blando, fluctuante, límites mal definidos, de 5x4 cm de diámetro, afebril, sin cambios de coloración. Presentaba trismus y dolor a la palpación. Hace cinco meses había sido tratado por una osteomielitis frontoparietal izquierda con absceso subgaleal. Antecedentes mórbidos del paciente: alcohólico crónico y anemia en tratamiento. El paciente fue hospitalizado con tratamiento de Clocaxiclina endovenoso, coleccionándose en la región preauricular. Se realizó la biopsia dando como resultado osteomielitis de cóndilo mandibular. La osteomielitis presentada en el cóndilo mandibular pudo ser recidiva de la osteomielitis anterior o haber sido causada por la anemia. Sin embargo, la osteomielitis frontoparietal se presentó sin causa aparente, pudiendo relacionarla con la anemia que cursaba.

“Voluntary termination of pregnancy” can refer to actions intended to make a delivery easier, to provide medical care to the fetus, or to protect the life or health of the mother. All of these are proper medical actions and are by definition voluntary. In other cases, the expression denotes a termination of pregnancy before the embryo or fetus is viable, leading to the death of the latter. This action is constitutive of abortion under current Chilean law. The product of conception living being, who develops in the womb during pregnancy, is an individual, both in the sense that it is different from its mother and father, and in that it is a biological individual. For these reasons, such living being constitutes another patient in itself. The free and voluntary medical action of health care professionals is geared toward disease prevention or health recovery and medical terminations of pregnancy, as distinguished from abortion, are not criminalized in our country. Therefore, the idea of legalizing abortive terminations of pregnancy so that they become “legitimate health care services” is a call to the medical community, which should engage in a debate about the meaning and consequences of an eventual mandate of the State that would be at odds with the Hippocratic tradition. A woman can feel that her health is at risk due to her pregnancy, and she certainly has the right to request medical help. Health professionals should care both at the medical and emotional level for all those who require their services, especially when such persons are undergoing situations of vulnerability and distress. When requested to perform an abortion, the physician faces dilemmas that should be addressed in line with the present state of the medical art.

Social, technical and legal conditions of the current practice of medicine make it necessary to insist on certain actions and circumstances that may jeopardize the confidentiality of information, offered by patients to their health providers. Therefore, some effects of the current Chilean law are analyzed in this respect, regarding access to data from the clinical record of a patient. Also, the risks of putting certain data on social networking sites are analyzed, as well as some of its effects on clinical practice. The reasons because of mandatory reporting of diseases, meaning danger to public health, is allowed, are mentioned. We also discuss the difficulties involved in managing the results of preventative health screenings and its knowledge by third parties, as well as some possible violations of personal privacy, regarding dissemination of some people health information and its further mention or figuration in mass media. We conclude that it is a must for both physicians and other health team members, to safeguard confidentiality of data to which they have had access, as well as the need to know the relevant law, in order to respect human dignity of patients, each one as a person. We address the attention to the possibility that, practicing in a different way, it could endanger the reliability of clinical records, also impairing the quality of people’s health care.

Transparency as a general rule for all our professional acts casts doubts about the statement of the Hippocratic Oath that says "Whatever I see or hear in the lives of my patients, I will keep secret, as considering all such things to be private". Medical secrecy protects the intimacy of patients, who reveal to their physicians their most hidden secrets aiming to recover their health. Therefore, physicians should receive those secrets with reverence and care, as servers and not as their owners. The values associated with the respect for personal intimacy are the anthropological basis of medical confidentiality. A medical act is performed by definition between two equally honorable individuals. Therefore, the professional honors the trust of his patient, maintaining strict confidence of what is revealed. Therefore, medical secrecy must be strengthened rather than weakened, pursuing common wealth and dignity.

This work objective is to develop a simple media to visualize the world system evolution based in the knowledge advance. To achieve this, we pose that knowledge has been precursor of technology and therefore of the social evolution and the conformation of the world system during the major part of history. The employed methodology was the revision of the great global representative phenomena of the international politics through the use of the Kondratieff theory of long cycles and following the Modelski & Thompson (1996) proposal of the existence of at least twenty. Kondratieff waves (K-1 to K20) traceable. Using these theoretical elements in the global context, in conjunction with a model proposed for the causal relationships of the most representative variables of the phenomena, we obtained condensed graphics that allow the easy visualization of the evolution of the world system.

El objetivo de este trabajo es desarrollar un medio sencillo para visualizar la evolución del sistema mundial, a partir del avance del conocimiento. Para lo cual, planteamos que el conocimiento ha sido el precursor de la tecnología y por lo tanto de la evolución social y de la conformación del sistema mundial a lo largo de la mayor parte de la historia. La metodología empleada fue la revisión de los grandes fenómenos globales representativos de la situación de la política internacional, tomando como eje la teoría de ciclos largos de Kondratieff, y siguiendo el planteamiento de Modelski & Thompson (1996) de la aparente existencia de al menos veinte ondas Kondratieff (K-1 a K-20) rastreables. Usando estos elementos teóricos en el contexto global, en conjunto con un modelo propuesto para las relaciones causales entre las variables más representativas del fenómeno, obtuvimos una primera versión de gráficos condensados que permiten visualizar la evolución del sistema mundial fácilmente.

Health Care at population level is a complex problem. Having this in mind, the purpose of this paper is to focus on the goods that are ethically relevant in the process of caring for health at this level. We briefly analyze some of the Chilean health statistics that, although they show important improvements along the years, demonstrate that certain conditions are to be deemed as inadequate by both healthcare providers and patients. Ethics is a central component to determine how to structure and organize health care systems and how they should operate. We emphasize Human Dignity as an ethical corner stone of the Health Care System, along with other important values such as Justice and Humanization, under the scope of the Ends of Medicine, and other components such as technical competence of providers and the financing of the whole process. We conclude that as far as a health care system is organized in a way that medical practice is well ordered, primarily and fundamentally according the Ends of Medicine and the good of persons, such a health care system is ethically adequate.

This study was carried out in the low alluvial plain of the state of Tabasco, specifically in the oil district of Cinco Presidentes. The objective was to determine the range of polycyclic aromatic hydrocarbon (PAHs) concentrations in soils used for different purposes in an oil zone, in order to identify the origin of the organic compounds. Gas chromatography coupled with a mass spectrophotometer (CG-MS) in the selective ion (SIM) detection mode identified 30 aromatic compounds in the soil samples. PAH concentrations varied in relation to the use of the soil. Soils used for cattle rearing presented approximately 70 ng g-1, whereas of the soils with natural vegetation, that with popal-apompal presented the greatest concentration (45 ng g-1). Coconut palm soils recorded a concentration of 10 ng g-1. These results agree with the concentrations reported for other soils in tropical regions. There are different sources of pollution in the area that markedly affect the abundance and concentration of PAHs in the soils.

El presente trabajo de investigación se realizó en la zona de la planicie aluvial baja del estado de Tabasco, específicamente en el distrito petrolero de Cinco Presidentes. El objetivo fue conocer el intervalo de concentraciones de hidrocarburos aromáticos policíclicos (HAPs) presentes en suelos con diferentes usos, bajo la influencia de una zona petrolera, con el fin de tipificar el origen de dichos compuestos orgánicos. En las muestras de suelos se identificaron 30 compuestos aromáticos por cromatografía de gases acoplada a un espectrofotómetro de masas (CG-MS) en el modo de monitoreo de ión selectivo (SIM). Las concentraciones de HAPs varían en función al uso de suelo. El de uso ganadero presentó aproximadamente 70 ng g-1, mientras en los suelos con vegetación natural, el que presento la más alta concentración fue el popal-apompal (45 ng g-1). En tanto que en los cocoteros se detectó una concentración de 10 ng g-1. Éstos resultados coinciden con las concentraciones reportadas en otros suelos de regiones tropicales. Existen diferentes fuentes de contaminación en la zona que inciden en gran medida en la abundancia y concentración de los HAPs en el suelo.