Medicina-buenos Aires最新文献

Introduction: Surrogacy, understood as the act of carrying a pregnancy on behalf of another person, has expanded as an assisted reproductive technology. Its regulation varies widely: some countries permit it, while others prohibit it altogether. In Argentina, there is no specific legislation regulating surrogacy, leading to significant legal uncertainty. The objective of this work is to analyze the ethical, legal, clinical, and social aspects of surrogacy in Argentina, based on a literature review and the institutional experience of a private hospital in Buenos Aires City.

Materials and methods: A literature review and a descriptive analysis of the institutional experience in response to the increasing demand for surrogacy were conducted. Clinical care protocols, as well as legal and bioethical considerations, were evaluated.

Results: A steady increase in surrogacy cases was observed, including the arrival of families from various countries with differing laws and regulations. This prompted the development of specific institutional protocols, including prenatal interviews, informed consent procedures, psychological support, and newborn identification protocols. Clinical scenarios varied in complexity: some gestational carriers provided colostrum, others requested no contact with the newborn, some intended parents pursued induced lactation, and in certain cases, admission to neonatal intensive care units was required.

Discussion: Surrogacy raises multiple bioethical (autonomy, consent, commodification), legal (regulatory gaps, determination of parentage), and clinical (emotional impact, child neurodevelopment) dilemmas. The need for comprehensive legislation is emphasized -one that ensures altruistic practice, prohibits commercialization, guarantees rights, and fosters an intersectoral approach involving the State, judicial system, healthcare institutions, and civil society.

Hereditary angioedema (HAE) is a rare autosomal dominant disease, characterized by episodes of edema involving the skin, gastrointestinal tract and larynx. HAE has a 15% to 50% historical asphyxia mortality. It is the consequence of C1 inhibitor deficiency. The identification of bradykinin as the principal mediator of the disease has led to the development of new drugs for the treatment of HAE. HAE treatment is agreed in international consensus. A therapeutic guide for the treatment of the disease was published in Medicina (Buenos Aires) in 2012, but new and relevant diagnostic and therapeutic advances have been described subsequently. We here update the pharmacology of new drugs available for the treatment of HAE in Argentina, as well as briefly describe the new forms of the disease.

Introduction: Adverse events in healthcare can have significant emotional and psychological consequences for the professionals involved, known as "second victims." These effects include guilt, anxiety, and depression, which can affect their performance and well-being. This highlights the need for effective interventions to mitigate the effects of these events on professionals.

Materials and methods: A bibliometric analysis was conducted on the second victim experience to evaluate the use and validity of the SVEST (Second Victim Experience and Support Tool) in recent studies. Key publications were reviewed to analyze the application of SVEST and the effectiveness of support strategies implemented in healthcare organizations.

Results: The analysis confirmed that SVEST is a reliable tool for measuring the emotional impact on second victims and for assessing the quality of the support they receive. Studies highlighted the effectiveness of peer support programs and leadership training as key strategies to mitigate the negative consequences of adverse events.

Discussion: The findings underscore the importance of establishing structured support systems within healthcare organizations to create a more supportive and resilient environment. Support and training initiatives significantly contribute to the well-being and performance of affected healthcare professionals, enhancing their ability to cope with the emotional effects of adverse events and strengthening their professional practice.

Autoimmune polyglandular syndrome type 2 (APS-2) is a rare and complex clinical entity, whose etiology and evolution are not fully understood. We present the case of a 78-year-old male, followed and treated for Addison's disease for 45 years, in whom macrocytosis with a hemoglobin level of 11.8 g/dL was detected during a routine evaluation. The immunological vitamin B12 deficiency led to the diagnosis of Biermer's disease, while the thyroid, diabetic and liver immunological evaluations were negative. Treatment was started with periodic injections of vitamin B12 and hormone replacement therapy (glucocorticoids and mineralocorticoids) was adjusted, which produced a favorable clinical response with progressive normalization of macrocytosis and hemoglobin levels. Long-term follow-up confirmed clinical stability and effective control of the autoimmune evolution. APS-2 is defined as the coexistence of autoimmune Addison's disease with autoimmune thyroid diseases (such as Graves' disease or Hashimoto's thyroiditis) and/or type 1 diabetes mellitus, in the absence of hypoparathyroidism. Various genetic and environmental factors appear to contribute to its development, although its exact etiology remains unknown. This clinical case supports the recommendation of active screening for autoimmune disorders in patients with Addison's disease.

Tuberculosis (TB) in Argentina has been on the rise in recent years, with a higher notification rate in the 15 to 49-year-old age group. Although it is estimated that the incidence of TB in pregnant and postpartum individuals is higher than in the general population, there is insufficient data in our country. Congenital transmission is very rare. We report a case of congenital TB transmission diagnosed through epidemiological criteria and molecular methods. We emphasize the importance of implementing TB screening algorithms in pregnancy, tailored to the populations served and the resources available, and we highlight the contribution of genomic sequencing at clinical and epidemiological levels.