bluuebunny/crossref_metadata_2025 huggingface dataset:
Il principio morale dell’atto a duplice effetto e il suo uso in bioetica
Authors: Virdis Andrea
Published: September 2016

morale per esprimere le varie dimensioni del ragionamento morale e descrivere le condizioni necessarie perché si possa porre un atto, in tutte quelle situazioni in cui capita di dover scegliere di compiere un dato bene, accettando, accanto agli effetti positivi voluti, gli effetti negativi collaterali che possono derivare dalla scelta di quel bene. L’ambito di applicazione di tale principio è assai vasto ed esso è stato accolto anche all’interno della bioetica e applicato in relazione alle questioni di inizio e fine vita (particolarmente nell’ambito della bioetica clinica), della ricerca scientifica e della difesa dell’ambiente. Il ricorso a tale principio, tuttavia, non è esente da fraintendimenti, in primo luogo, di carattere metodologico: il processo di applicazione, infatti, è di per sé equivoco nel momento in cui il principio stesso si pone come giustificazione morale dell’atto, piuttosto che come criterio guida. L’obiettivo di questo articolo è quello di chiarire quale sia l’utilità del PADE e, soprattutto, se ed in quali termini si debba ricorrere ad esso in bioetica, al fine di arrivare alla soluzione di taluni problemi dall’agire morale che sorgono nell’ambito medico. Attraverso una disamina di alcuni casi paradigmatici, l’Autore sottolinea il valore essenzialmente strumentale del PADE, mettendo in luce come il contributo maggiore che viene da questo principio è quello di essere fondamentalmente un aiuto per affinare l’analisi dell’atto, in quelle situazioni in cui l’esito di talune azioni può produrre degli effetti collaterali. ---------- The principle of the act with double effect (PADE) rises in moral theology to express the various dimensions of the moral reasoning and to describe necessary conditions so that an action can be set, in all those situations in which it happens one must choose to achieve a given good, accepting, besides the intended positive effects, the negative side effects that can derive from the choice of that good. The sphere of application of such principle is wide and it has also been welcomed into bioethics and applied in relationship to the issues of beginning and end of life (particularly within the clinical bioethics), scientific research and environmental protection. The recourse to such principle, yet, is not exempted by methodological misunderstanding: the process of application, in fact, is by itself equivocal in the moment in which the same principle sets it as moral justification of the action, rather than as guide criterion. The aim of this paper is to clarify what the utility of the PADE is and, above all, whether and in what terms it must be used in bioethics, to reach the solution of some moral problems rising from medical context. Through an examination of some paradigmatic cases, the author underlines the instrumental value of the PADE, showing how the main contribution that comes from this principle is that of being basically an aid to sharpen the analysis of the act in all those situations in which the result of some actions can produce some side effects.
Il Protocollo di Groningen / The Groningen Protocol
Authors: Fiori Angelo
Published: September 2016

Non disponibile / Not available
Gravidanza ed ambito lavorativo
Authors: Di Simone Nicoletta
Published: September 2016

Non disponibile / Not available
Legge morale e legge civile a difesa dell’uomo in Giovanni Paolo II
Authors: Palazzani Laura
Published: September 2016

L’autore analizza nella prospettiva della filosofia del diritto la questione del rapporto tra diritto e morale nella Evangelium Vitae. In particolare si sofferma ad analizzare le teorie che tematizzano la neutralità del diritto (nella pretesa di separare il diritto dalla morale pluralistica), quali la teoria liberalelibertaria che identifica il diritto con la garanzia dell’autonomia individuale e la teoria democratico-procedurale che fa coincidere il diritto con il voto di maggioranza. Giovanni Paolo II critica i percorsi postmoderni del diritto, riprendendo sul piano filosofico e teologico la dottrina del diritto naturale (in contrapposizione al giuspositivismo), che riconosce nell’uomo i diritti inviolabili e la dignità intrinseca. Nell’orizzonte giusnaturalista, esiste un dovere morale da parte del cittadino a criticare e a non obbedire alle leggi ingiuste e da parte del giurista e del politico ad operare per abrogare, riformarle e riformularle, al fine di adeguare il diritto positivo alle esigenze intrinseche della natura umana. ---------- The author analysis the question of the relation between law and ethics in Evangelium Vitae in the perspective of the philosophy of law. In particular, it focuses on the theories that speak about neutrality of law (separating law from moral pluralism), such as libertarian-liberalism which identifies law with individual autonomy and procedural democracy which identifies law with opinions of majority. John Paul II criticizes postmodern patterns of law, reaffirming on philosophical and theological level the doctrine of natural law (against legal positivism) which recognises in human being the inviolable rights and intrinsic dignity. In this perspective, there is a moral duty on the part of citizen to criticize and not to obey to unjust laws and on the part of jurist and politician to work for an abolition, reform and reformulation of law, to adequate positive law to the intrinsic instances of human nature.
Il dibattito in bioetica - Una riflessione sul "caso Welby"
Authors: Dovio Andrea
Published: September 2016

Non disponibile / Not available
Islam ed eutanasia
Authors: Atighetchi Dariusch
Published: September 2016

L’eutanasia è generalmente vietata sia dai documenti giuridico-religiosi che dai codici penali degli Stati musulmani. Il divieto riguarda soprattutto l’eutanasia attiva, mentre circa gli altri tipi di eutanasia non mancano differenti posizioni di fronte a casi particolari. Infatti, molte fonti ritengono che quando la morte è sicura ed i trattamenti medici sono futili, diventa inutile allungare l’agonia; tuttavia, in questi casi la maggioranza dei documenti richiede di mantenere idratazione e nutrizione artificiale oltre alle cure contro il dolore. La morte tecnologica è spesso criticata in quanto manipola innaturalmente il rapporto con la morte. Ad esempio, in caso di stato vegetativo persistente parecchi esperti islamici richiedono il distacco da tutti gli strumenti di supporto vitale. Anche se ciò accorcia la vita, si preferisce un rapporto più naturale con la morte. ---------- Both the legal-religious documents and the criminal codes of the Muslim states generally forbid euthanasia. The prohibition regards above all active euthanasia while about other types of euthanasia there are different positions according to special cases. Many sources, indeed, consider that when the death is sure and medical treatments are futile, it becomes useless to prolong the agony; however, in these cases the majority of documents requires to keep hydration and artificial nutrition in addition to cares against pain. The technological death is often criticized because it unnaturally manipulates the relationship with death. For example, in the case of persistent vegetative state many Islamic experts require withdrawing all life support tools. Even if it abbreviates life, a more natural relationship with death is preferred.
La Legge 194 di fronte alle decisioni della Corte Costituzionale
Authors: Casini Carlo , Casini Marina
Published: September 2016

Il contributo prende in esame le numerose decisioni della Corte Costituzionale riguardanti la legge 194 del 1978 che ha introdotto la disciplina dell’aborto in Italia. La principale impugnazione riguarda il principio di autodeterminazione della donna, ma vengono in questione anche la mancata previsione dell’obiezione di coscienza del giudice tutelare; il ruolo subordinato ed eventuale del padre del concepito nelle procedure che portano all’autorizzazione dell’aborto; la pretesa lesione dei diritti dei genitori rispetto alla minorenne che intende abortire; il diverso trattamento delle minorenni rispetto alle maggiorenni; la mancanza di difesa del concepito dinanzi al giudice tutelare. Gli Autori esaminano anche le decisioni che riguardano l’ammissibilità dei referenda proposti contro la Legge 194, perché consentono di cogliere elementi dai quali traspare il pensiero della Corte in ordine alla L. 194/1978 sia sotto il profilo dell’interpretazione, sia sotto quello della costituzionalità. Nonostante ripetute richieste di intervento, la Corte ha sempre evitato di pronunciarsi sul punto più critico della legge, ovvero la disciplina dell’aborto infratrimestrale dominata dal “principio di autodeterminazione”. Nello stesso tempo la Consulta non ha mai negato l’umanità del concepito e in un caso ne ha affermato chiaramente il diritto alla vita. ---------- The contribution deals with the large number of Constitutional Court’s decisions concerning the law 194/1978 that has introduced the regulation of abortion in Italy. The main impugnation deals with the principle of woman’s self-determination, but also non-prevision of the tutelary judge’s objection of conscience is argued; the subordinate and possible role of the father of new born in the procedures that lead to the authorization of the abortion; the supposed damage of the parents’ rights compared with minor who intends to abort; the different treatment of minors in comparison with adults; the lack of defence of new born compared with the tutelary judge. The Authors also examine the decisions that concern the admissibility of referenda proposed against the Law 194, because they allow to understand elements from which the Court’s thought for what concern the Law 194/1978 under the interpretative and constitutionality profile is showed. Although the several intervention calls, the Supreme Court has always avoided to pronounce a decision on the crucial point of the law, i.e. the regulation on the midtrimestrial dominated by the “self-determination principle”. At the same time the Council has never denied the humanity of the new born and in one case it has clearly affirmed the right to life.
Bioetica clinica - Kernittero neonatale da deficit di G6PD. Il rischio sanitario della fecondazione artificiale eterologa
Authors: De Luca D. , Virdis A. , Di Pietro M.L. , Zecca E.
Published: September 2016

L’articolo presenta il caso di un neonato maschio, nato da una gravidanza trigemina ottenuta mediante fecondazione artificiale (FA) in forma eterologa. Una malattia raramente letale ma molto diffusa (deficit di glucosio-6-fosfatodeidrogenasi (G6PD)), insieme con la mancanza di dati sullo status parentale (per via della segretezza e dell’anonimato del donatore di gameti) ha portato, in una rapida successione di eventi clinici, all’insorgere inevitabile del kernittero nel neonato. Gli autori discutono i problemi derivanti dalla segretezza e dell’anonimato del donatore in relazione alle possibili conseguenze per la cura dei nati da FA eterologa. ---------- The article presents the case of a male neonate, born from a triplet pregnancy obtained by heterologous assisted reproduction (AR). A rarely fatal but widespread disease (Glucose-6-phosphate dehydrogenase (G6PD) deficiency), together with the lack of knowledge about parental status (due to secrecy and anonymity of gametes donor) led, in a fast succession of clinical events, to the unavoidable insurgence of kernicterus in the newborn. The Authors discuss the problems deriving from donor secrecy and anonymity in view of their possible consequences for the cure of neonates born from heterologous AR.
Gli approcci alle valutazioni etiche nei processi di Health Technology Assessment
Authors: Sacchini Dario , Refolo Pietro , Virdis Andrea
Published: September 2016

Come emerge da uno studio, apparso nel 2007, dello European network for Health Technology Assessment (EUnetHTA), il quadro degli approcci attualmente utilizzati dalle varie agenzie per eseguire le valutazioni di tipo etico nei processi di Health Technology assessment (HTA), risulta abbastanza variegato. Oltre a quelli, per così dire “generali”, coma la Casistica, il Coerentismo, il Principalismo, il Modellamento sociale della tecnologia, l’Equilibrio riflessivo ampliato e l’Approccio interattivo-partecipativo alla valutazione delle tecnologie sanitarie, sono stati segnalati alcuni approcci locali, fra cui il Personalismo ontologicamente fondato. L’articolo intende effettuare una esplicitazione di questi approcci, cercando, al contempo, di integrarla con dei cenni sulla loro genesi, qualche spunto critico ed alcune osservazioni sulla loro applicazione nei processi di HTA. ---------- As noted by a research of the European network for Health Technology Assessment (EUnetHTA) published in 2007, the actually used approaches picture in different agencies to elaborate ethical analysis in health technology assessment (HTA) processes is enough variegated. Beyond the so-called “general” approaches, as Casuistry, Coherence analysis, Principlism, Social shaping of technology (SST), Wide reflective equilibrium (WRE) and Interactiveparticipatory HTA approach (iHTA), some local approaches have been indicated, among those there is the ontologically founded Personalism. The article intends to realize an explanation of these approaches, trying, at the same time, to integrate it with some notes on their genesis, some critical points and some observations on their application to HTA process.
Trapianti da donatore a cuore fermo: il caso del paziente pediatrico
Authors: Di Pietro Maria Luisa , Parente Paola , D’Alò Ciro
Published: September 2016

In presenza di grave insufficienza d’organo, il trapianto è la sola e unica soluzione per salvare la vita del paziente. Si stima che, attualmente, in Italia oltre 9.000 persone siano in lista d’attesa per un trapianto di organo: anche se vi è stato un incremento del numero di donazioni negli ultimi decenni, il gap tra donatori e pazienti in attesa è in continua crescita. Secondo la maggior parte delle società di trapiantologia, i donatori a cuore non battente (NHBD) possono essere una fonte di reperimento degli organi. Quanto la donazione da NHBD può ampliare il pool dei donatori? Quali sono i rischi legati al prelievo di organi da NHBD non solo per il donatore ma anche per il ricevente? Nel tentativo di chiarire almeno alcuni di tali interrogativi abbiamo condotto un’analisi della letteratura scientifica internazionale. Per valutare, poi, la possibilità di ampliamento del pool di donatori con l’introduzione di un protocollo da NHBD nella popolazione pediatrica del Policlinico “A. Gemelli” in Roma, abbiamo condotto uno studio retrospettivo sui pazienti pediatrici deceduti nel corso del triennio 2004-2007. I risultati sembrano indicare la possibilità di raddoppiare il potenziale pool di donatori; questi dati richiedono poi una valutazione attenta, innanzitutto alla luce delle percentuali di opposizione alla donazione che nell’età pediatrica sono ancora più significative che nell’adulto. I risultati ottenuti sono solo il punto di partenza per un’analisi più approfondita sui problemi relativi ai trapianti e alla donazione di organi. ---------- In case of end stage organ failure, organ transplantation is the one and only solution to save patient’s life. Currently, in Italy, more than 9.000 people are awaiting for an organ transplantation; even though the number of organ donation has been increasing during last decades, gap between organ demand and transplantation is still wide. According to ideas of most society of transplantation, non heart beating donors (NHBD) could be a solution to the shortage of organs. How much NHBD could widen donors pool? Which ones and how many risks involve NHBD, even for donors or transplantation recipients? Trying to answer these questions, we led an analysis on NHBD data in international literature. To evaluate the potential of NHBD to expand the pool of donors in pediatric population of “Policlinico Gemelli” in Rome, we studied all deceased pediatric patients in the years 2004-2007. Results showed that the potential pool of donors could be twice as much, but these data should esteem about parental opposition, in particular in pediatric age. These data represent only a starting point for a deeper analysis of transplantation and donation related problems.
Il doping biotecnologico: una proposta di lettura tra medicina, bioetica e diritto
Authors: Mele Vincenza , Vantaggiato Daniela , Chiarotti Marcello
Published: September 2016

Le point de départe dell’articolo è offrire una review della letteratura medico- scientifica sul doping biotecnologico; il secondo step è illustrare il panorama dello stato dell’arte in materia legislativa, con particolare attenzione alla situazione italiana; last but not least è argomentata l’inaccettabilità etica del doping, nella doppia prospettiva, della filosofia del diritto e della bioetica. L’argomentazione bioetica si snoda secondo i criteri dell’ethos ippocratico che impone al medico prima ancora di fare del bene, di non danneggiare la salute psico-fisica della persona (primum non nocere) e dell’ethos dell’attività sportiva, intesa come palestra educativa della persona, finalizzata alla fioritura delle capacità dell’atleta, in armonia a quanto recita il Codice Mondiale Antidoping: etica, fair play ed onestà, salute, eccellenza della prestazione, carattere ed educazione, divertimento e gioia, lavoro di gruppo, dedizione ed impegno, rispetto delle norme e delle leggi, rispetto per se stessi e per gli altri concorrenti, coraggio, unione e solidarietà. L’argomentazione filosoficogiuridica si basa sull’inaccettabilità del doping in ossequio al principio di giustizia, nel senso sia di equità che di giustizia distributiva ed al principio di autonomia, che gli Autori dimostrano – avvalendosi della teoria dei giochi e dell’interpretazione biopolitica del fenomeno – verrebbe “paradossalmente” infranto qualora l’uso delle sostanze dopanti nello sport diventasse giuridicamente lecito. ---------- Le point de départe of the article is to offer a review of the medical literature on biotechnological doping; the second step is to show the state of the art on legal aspect, with particular attention to the Italian situation; last but not least, arguing the ethical unacceptableness of doping, both in Philosophy of law and Bioethics. The bioethical reasoning unwinds itself according to the criterions of the Hippocratic ethos imposing on the physician, even before doing the good, not to damage one’s psico-physics health (primum non nocere) and that one concerning to the sport activity, intended as “educational gym” of every person, aimed to the flowering of the abilities of the athlete, according to the World Anti-Doping Code: ethics, fair play and honesty, health, performance excellence, character and education, fun and joy, team work, devotion and appointment, respect of the norms and laws, self-respect, respect for others, courage, union and solidarity. The philosophical-legal reasoning is based on unacceptableness of doping according to the principle of justice, intended as both equity and distributive justice and to the principle of autonomy, demonstrated by the Authors to be “paradoxically” broken – through the game theory and the biopolitical interpretation of the phenomenon – whereas the use of doping substances becames legally permissible within the sport.
Transumanesimo e postumano: principi teorici e implicazioni bioetiche
Authors: Postigo Solana Elena
Published: September 2016

L’articolo offre una lettura critica dei presupposti concettuali del Transumanesimo, movimento culturale, intellettuale e scientifico, che afferma il dovere morale di migliorare le capacità fisiche e cognitive della specie umana. Tale movimento, infatti, si propone di ri-progettare la condizione umana in modo da evitare l'inevitabilità del processo di invecchiamento e le limitazioni dell'intelletto umano (e artificiale), attraverso l’applicazione di future tecnologie. Dopo aver ripercorso le tappe storiche che hanno portato al sorgere del movimento transumanista, chiarendo le linee programmatiche e le modalità concrete attraverso cui si realizzerà il passaggio dall’umano al post-umano, l’Autrice propone un’ampia riflessione critica intorno ai fondamenti teorici del Transumanesimo. In particolare, si sottolineano i limiti dei presupposti concettuali da cui muove il Transumanesimo: un’antropologia riduttivista, un atteggiamento acritico nei confronti dell’uso della tecnologia, e un rifiuto ideologico della metafisica che ha portato i transumanisti a formulare un fraintendimento del concetto di persona e di dignità. ---------- The article proposes a critical reading of the conceptual presuppositions of Transhumanism, a cultural, intellectual and scientific movement that claim the moral duty to improve physical and cognitive abilities of the human species. This movement, indeed, wants to project humans again to avoid the unavoidable aging process and the limits of human (and artificial) intelligence, through the use of future technologies. After having gone along the historical stages that led to the rising of transhumanist movement again, also explaining the programmatic lines and the concrete ways through which the passing from human to post-human will be realized, the Author proposes a wide critical reflection on the theoretical foundations of Transhumanism. In particular, she underlines the limits of the conceptual presuppositions of Transhumanism: a reductive anthropology, an uncritical attitude towards the use of technology, and an ideological refusal of metaphysics that led transhumanists to formulate a misunderstanding of the concepts of person and dignity.
Chiavi di lettura per la Bioetica dell’Ambiente
Authors: Mele Vincenza
Published: September 2016

L’autrice è partita dall’analisi sulle origini storiche della Bioetica dell’ambiente, che sono state trattate nella rivista Medicina e Morale all’inizio degli anni ’90. In quel periodo le diverse prospettive dell’etica ambientale erano classificate come antropocentriche o anti-antropocentriche. Sulla base dei lavori pubblicati su Medicina e Morale durante questi anni, ella ha scelto di analizzare alcune prospettive filosofiche che possono essere definite per alcuni aspetti antropocentriche e per alcuni altri anti-antropocentriche, quali ad esempio l’etica della responsabilità di Hans Jonas, l’etica ambientale cattolica e l’ecofemminismo. ---------- The Author started from the origins of environmental bioethics, which were dealt in Medicine and Moral review at the beginning of the 90’s. In that period, environmental ethics perspectives were described just as anthropocentric or antianthropocentric. Following the publications of articles in Medicine and Moral during these years, she choose to dwell on some ecophilosophical perspectives, which can be defined for some aspects anthropocentric and for some others antiantropocentric, such as the ethics of responsibility of Hans Jonas, the catholic environmental ethics and the ecofeminism.
L’Imperativo Bioetico / The bioethical imperative
Authors: Spagnolo Antonio G.
Published: September 2016

Non disponibile / Not available
Il DNA forense e la bioetica / Forensic DNA and bioethics
Authors: Fiori Angelo
Published: September 2016

Non disponibile / Not available
La comunicazione nella consulenza genetica
Authors: Pensieri Claudio , Pennacchini Maddalena
Published: September 2016

Il seguente articolo ha lo scopo di fornire una visione alternativa alla classica concezione di comunicazione e di consulenza genetica. Infatti, il rapido incremento delle nuove possibilità di conoscenza apre importanti prospettive sul piano diagnostico, preventivo e terapeutico-assistenziale. In primo luogo, noi abbiamo cercato di comprendere il contesto, il concetto di “consulenza genetica” e la differenza tra comunicazione ed empatia, poi abbiamo messo in evidenza l’influenza costante del consulente nel rapporto comunicativo, infine abbiamo considerato la persuasione e il “vincere insieme” (convincere). Siamo giunti alla conclusione che la proclamata “non direttività” della consulenza genetica non sembra possibile poiché ogni tipo di comunicazione può influenzare il paziente nelle sue scelte. Pertanto abbiamo evidenziato la necessità di definire meglio il significato di consulenza non direttiva e di specificare in quali casi il consulente genetista deve prendere una posizione. ---------- This article aims to provide an alternative vision to the classic conception of communication and genetic counselling. In fact, the rapid growth of new possibility of knowledge has opened important diagnostic, preventive and therapeutic perspective. First of all, we tried to understand the context, the term “genetic counselling” and the difference between communication and empathy, then we emphasized the constant influence of the counsellor in communicative relationship, finally we considered the persuasion and the “win together” (to convince). We concluded that a non-directive genetic counselling is not possible because each type of communication influence the choices of the patient. Therefore, we highlighted the need to better define the meaning of non-directive counselling and specify in which cases the genetic counsellor must take a position.
Dal fronte del testamento biologico / From the front of living will
Authors: Fiori Angelo
Published: September 2016

Non disponibile / Not available
Il dibattito in bioetica - Sugli argomenti razionali e confessionali usati dal CNB e sullo statuto dell’embrione umano. Una discussione con Carlo Flamigni
Authors: Possenti Vittorio
Published: September 2016

Non disponibile / Not available
Il discernimento sulla procreazione medicalmente assistita: i concetti chiave del Magistero della Chiesa Cattolica
Authors: Carrasco de Paula Ignacio
Published: September 2016

Lo scopo di questo saggio non è quello di presentare la dottrina della Chiesa Cattolica sulla procreazione medicalmente assistita, ma di fornire alcuni concetti chiave per la corretta interpretazione delle Istruzione Donum Vitae del 1987. Tra i concetti presentati, vanno sottolineati, sul piano morale, i termini “artificiale”, “razionalità” e “dignità”, includendo anche la distinzione tra “assistenza” e “sostituzione” per quanto riguarda la funzione procreativa. Condizioni indispensabili per una procreazione medicalmente assistita eticamente corretta sarebbero la salvaguardia del nesso causale della unione coniugale e il riconoscimento della donna come luogo esclusivo degno del concepimento di un nuovo essere umano. ---------- The purpose of this essay is not to present an exposition of the teaching of the Catholic Church on the procedure for medically assisted procreation, but to provide some key concepts for the correct interpretation of the statements principally contained in the Instruction Donum Vitae published in 1987. Among the concepts presented, we should wish to underline, on moral grounds, the terms “artificial”, “rationality” and “dignity” also including the distinction between “assistance” and “substitution” as regards the procreative function. Indispensible conditions for an ethically correct medically assisted procreation would be the safeguarding of the causal role of conjugal union and the recognition of the woman as the exclusive place worthy of the conception of a new human being.
Il liberalismo degli indifferenti La biopolitica nell’epoca degli stranieri morali
Authors: Musio Alessio
Published: September 2016

Il saggio intende offrire una valutazione del rapporto che lega il pensiero liberale alle forme della biopolitica e presenta a tal fine un doppio movimento che va dal liberalismo del libero mercato al pensiero di T. H. Engelhardt, per poi ritornare da questo al primo. Si comprenderà, così, per quale motivo anche in Engelhardt sia così essenziale quella discutibile e fenomenologicamente scorretta concezione proprietaria del corpo che segna il nesso tra liberalismo e la dottrina economica del libero mercato e che, appunto, sostanzia le tesi del filosofo texano sulla “persona”. Inoltre, diventerà possibile individuare per quale ragione nel suo pensiero compaiano contestualmente due tesi differenti: quella che attesta l’impossibilità di un’assistenza sanitaria universale per tutti gli “stranieri morali” e quella che sancisce la legittimità della non-curanza pubblica verso gli “esseri umani non-persone”. A fare da sfondo resta la domanda se sia questo tipo di liberalismo a divenire una fonte di indifferenza o non sia proprio una strana forma di ethos dell’indifferenza ad alimentarlo. ---------- This paper aims to provide an assessment of the relationship between the liberal thinking and the forms of biopolitics. For this purpose, the paper presents a double movement, which goes from the liberalism of the free market to the thought of T.H. Engelhardt, to then return from the latter to the first. Hence, it will be understood why even in Engelhardt it is so essential that questionable and phenomenologically incorrect conception–owner of the body–which marks the link between liberalism and the economic doctrine of the free market and that, in fact, substantiates the thesis of the Texan philosopher about the “person”. Further, it will be discussed why in his thought two different theses simultaneously emerge: the one claiming the inability of universal health care for all “moral foreigners” and the one stating the nonpublic disregard towards “non-person human beings”. In the background the open question is whether it is this type of liberalism to become a source of indifference or it is just a strange form of ethos of indifference to feed into it.
A proposito del “modello liberale” in bioetica
Authors: Paolinelli Marco
Published: September 2016

Il “modello liberale” talora impiegato nell’affrontare questioni bioetiche è un modello metaetico definito dalla tesi che “ogni azione liberamente voluta è moralmente ammissibile (lecita) purché non leda la libertà di altri”. Di questo “modello” viene valutata la consistenza interna, mostrando che esso conserva una sua plausibile coerenza solo a prezzo di rinunciare ad applicarsi ad un soggetto che permane, e ad un soggetto che è soggetto umano. Le applicazioni e l’uso di tale principio in bioetica sono perciò contraddittori, e mascherano l’assenza di una riflessione antropologica che sola può fornire un fondamento razionale per la soluzione delle questioni bioetiche. ---------- The “liberal model” is a meta-ethical model, that is sometimes used to approach bioethical issues. Its main thesis might be expressed in this way: “any act that is “freely” chosen is morally permitted, provided that it does not harm freedom of others”. The article assesses the internal consistency of this model, showing that its coherence is kept only at the cost of renouncing to apply it to an existing subject, and to a subject that is a human subject. Therefore, application and use of this principle within Bioethics are contradictory, and they conceal the lack of an anthropological reflection that alone can provide a rational basis for resolving bioethical issues.
A training intervention on child feeding among primary healthcare workers in Ibadan Municipality
Authors: Samuel Folake O. , Olaolorun Funmilola M. , Adeniyi Joshua D.
Published: September 2016

Introduction: Health workers at the primary level are well positioned to provide health information and counselling on child feeding to mothers on antenatal visits. The study was designed to evaluate the effect of training on the knowledge, attitudes and provision of infant and young child feeding (IYCF) information and counselling among primary healthcare (PHC) workers. Methods: A two-stage cluster sample was used to select health workers for training on IYCF in Ibadan, Nigeria. Baseline, immediate and 4-week post-training surveys were conducted to assess knowledge, attitudes and practices of health workers regarding IYCF. Paired t-tests were used to measure differences (p < 0.05) before and after the training. Results: A total of 124 health workers were trained on current global IYCF recommendations. Participants included community health extension workers (59.7%), nurses (27.4%), community health officers (11.3%), and pharmacy technicians (1.6%). Mean age was 41.8 ± 8.2 years and 95.2% were women. Knowledge of health workers regarding IYCF, particularly complementary feeding, was low at baseline but improved significantly following the training intervention. Attitudes and practices regarding provision of IYCF were suboptimal among health workers at the PHC facilities, but this improved with training. Conclusion: Health workers at the PHC level need regular retraining exercises to ensure effective counselling on IYCF.
Wernicke's encephalopathy due to hyperemesis gravidarum
Authors: Ashraf VV , Prijesh J , Praveenkumar R , Saifudheen K
Published: September 2016

Hyperemesis gravidarum-induced Wernicke's encephalopathy (WE) is an underestimated condition. The purpose of this study is to improve its awareness and early diagnosis. We report five cases of WE secondary to hyperemesis gravidarum. Classic triad of encephalopathy, ataxia, and ocular signs was seen in four out of five patients. Two unusual features noted in this series were papilledema in one patient and severe sensory-motor peripheral neuropathy in one patient. Magnetic resonance imaging (MRI) was abnormal in all the five patients, and high signal in medial thalamus and surrounding the aqueduct was the most common abnormality (5/5). Involvement of caudate nucleus was seen in two patients with severe psychosis, and two patients had bilateral cerebellar peduncle involvement. Median time delay between onset of neurological symptoms and diagnosis was 7 days. All patients improved with thiamine, but minor sequelae were seen in four patients at 12 months follow-up. One patient had a fetal demise. Hyperemesis gravidarum-induced WE is a common cause of maternal morbidity. Typical MRI findings of symmetric medial thalamic and periaqueductal signal changes may permit a specific diagnosis. A delay in diagnosis, therefore treatment, leads to worse prognosis.
The mysterious Zika virus
Authors: Mishra B , Behera B
Published: September 2016

Until now, known as the demure cousin of dengue virus (DENV) inhabiting Africa, Zika virus (ZIKV) has reinvented itself to cause explosive epidemics captivating the Western hemisphere. The outbreak causing potential for ZIKV was realized when it made its way from Africa to Yap Island Micronesia in 2007, and in French Polynesia in 2013. From there, it moved on to Brazil in 2015. Now ZIKV has infected people in more than 33 countries in Central and South America and the Caribbean. Moreover the epidemiological and subsequent virological association with microcephaly cases in Brazil has prompted the World Health Organization to declare a public health emergency of International Concern. ZIKV shares not only its vector Aedes aegypti with dengue and chikungunya but also the geographic distribution and clinical features, which makes the laboratory confirmation mandatory for definitive diagnosis. The serological cross-reactivity with other Flavivirus, particularly with DENV makes laboratory confirmation challenging and will place additional burden on health systems to establish molecular diagnostic facilities. The evidence of additional nonvector modes of transmission, such as perinatal, sexual as well as transfusion has made preventative strategies more difficult. As ZIKV disease continues to mystify us with several unanswered questions, it calls for coordinated effort of global scientific community to address the ever growing arboviral threat to mankind.
A case of S-100 negative melanoma: A diagnostic pitfall in the workup of a poorly differentiated metastatic tumor of unknown origin
Authors: Biernacka Anna , Linos Konstantinos D. , DeLong Peter A. , Suriawinata Arief A. , Padmanabhan Vijayalakshmi , Liu Xiaoying
Published: September 2016

When confronted with a metastatic poorly differentiated tumor of unknown origin, the initial workup includes the standard panel of immunostains to rule out carcinoma, sarcoma, lymphoma, and the greatest mimicker in pathology – malignant melanoma. Although not specific, the S-100 protein is expressed in over 95% of malignant melanomas. Herein, we present a case of multiorgan metastatic malignancy with a dominant hilar and mediastinal mass in a current smoker; clinically, highly suggestive of widespread primary lung cancer. This case was eventually classified as malignant melanoma, despite a significant diagnostic challenge due to lack of prior history, unusual cytomorphology, and S-100 protein negativity. A battery of immunostains was performed and the addition of other melanocytic-associated markers confirmed the melanocytic lineage of the neoplasm. This case highlights the pitfalls in the differential diagnosis of a metastatic tumor of unknown origin by fine needle aspiration cytology due to the significant morphologic overlap of poorly differentiated malignancies. We emphasize that, albeit rare, malignant melanomas can be completely negative for S-100 protein and the use of additional melanocytic-associated markers in the differential workup maybe critical in arriving promptly at a proper diagnosis. We also briefly discuss other currently available immunohistochemical markers that can assist in the identification of the S-100 negative melanoma.
Magnetic Resonance Imaging Analysis of Caudal Regression Syndrome and Concomitant Anomalies in Pediatric Patients
Authors: Boruah Deb K , Dhingani Dhaval D , Achar Sashidhar , Prakash Arjun , Augustine Antony , Sanyal Shantiranjan , Gogoi Manoj , Mahanta Kangkana
Published: September 2016

Objective:

The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of caudal regression syndrome (CRS) and concomitant anomalies in pediatric patients.

Materials and Methods:

A hospital-based cross-sectional retrospective study was conducted. The study group comprised 21 pediatric patients presenting to the Departments of Radiodiagnosis and Pediatric Surgery in a tertiary care hospital from May 2011 to April 2016. All patients were initially evaluated clinically followed by MRI.

Results:

In our study, 21 pediatric patients were diagnosed with sacral agenesis/dysgenesis related to CRS. According to the Pang's classification, 2 (9.5%) patients were Type I, 5 (23.8%) patients were Type III, 7 (33.3%) patients were Type IV, and 7 (33.3%) patients were of Type V CRS. Clinically, 17 (81%) patients presented with urinary incontinence, 6 (28.6%) with fecal incontinence, 9 patients (42.9%) had poor gluteal musculatures and shallow intergluteal cleft, 7 (33.3%) patients had associated subcutaneous mass over spine, and 6 (28.6%) patients presented with distal leg muscle atrophy. MRI showed wedge-shaped conus termination in 5 (23.8%) patients and bulbous conus termination in 3 (14.3%) patients above the L1 vertebral level falling into Group 1 CRS while 7 (33.3%) patients had tethered cord and 6 (28.6%) patients had stretched conus falling into Group 2 CRS.

Conclusion:

MRI is the ideal modality for detailed evaluation of the status of the vertebra, spinal cord, intra- and extra-dural lesions and helps in early diagnosis, detailed preoperative MRI evaluation and assessing concomitant anomalies and guiding further management with early institution of treatment to maximize recovery.
Integrating Ultrasound Teaching into Preclinical Problem-based Learning
Authors: Tshibwabwa Eli Tumba , Cannon Jenifer , Rice James , Kawooya Michael G , Sanii Reza , Mallin Robert
Published: September 2016

Objectives:

The aim is to provide students in the preclinical with ultrasound image interpretation skills. Research question: Are students in smaller groups with access to a combination of lectures and hands-on patient contact most likely to have better ultrasound image interpretation skills, than students in larger groups with only interactive didactic lectures?

Methodology:

First-year students at the preclinical Program of the College of Medicine, participated in two 2-h introductory interactive ultrasound sessions. The study comprised two cohorts: 2012/2013 students, who were offered large group teaching (LGT) sessions (control group), and 2013/2014 students, who received the intervention in small group learning problem-based learning (PBL) sessions (experimental group). The overall learning objectives were identical for both groups. The success of the module was evaluated using pre- and post-tests as well as students’ feedback.

Results:

The students in the experimental group showed significantly higher scores in interpretations of images than those in the control group. The experimental group showed achievement of learning outcomes along with higher levels of satisfaction with the module compared to the latter.

Conclusion:

Posttest knowledge of the basics of ultrasound improved significantly over the pretest in the experimental group. In addition, students’ overall satisfaction of the ultrasound module was shown to be higher for the PBL compared to the LGT groups. Small groups in an interactive and PBL setting along with opportunities for hands-on practice and simultaneous visualization of findings on a high definition screen should enhance preclinical student learning of the basics of ultrasound. Despite the potential of ultrasound as a clinical, teaching and learning tool for students in the preclinical years, standardized recommendations have yet to be created regarding its integration into the curricula within academic institutions and clinical medicine. The interactive and PBL is here to stay at the college of medicine. Further research would be carried out to see if this trend persists in the upcoming vertical system-based curriculum of the college of medicine.
Pharmacovigilance of Miltefosine in Treatment of Visceral Leishmaniasis in Endemic Areas of Bihar, India
Authors: Pandey Krishna , Ravidas Vidyanand , Siddiqui Niyamat A. , Sinha Sanjay K. , Verma Rakesh B. , Singh Tripurari P. , Dhariwal A. C. , Das Gupta R. K. , Das Pradeep
Published: September 2016

Miltefosine, the only oral drug for visceral leishmaniasis (VL), is being used as the first-line drug under the VL elimination program in the Indian subcontinent. Miltefosine is an oral drug which was used as a topical application for skin metastasis of breast cancer. It was found to be effective against Leishmania donovani. The main adverse events (AE) reported previously with miltefosine use includes diarrhea, vomiting, and dehydration. Other AEs include, raised serum alanine transaminase/aspartate aminotransferase and renal parameters such as creatinine. In this study, we report AEs in a large patient cohort of VL treated with miltefosine. The purpose of this pharmacovigilance study was to assess adverse drug reactions (ADRs)/AE of miltefosine treatment under unrestricted condition in the field setup. Patients were followed up to 6 months for therapeutic effectiveness. Outcomes of a larger data set of patients treated with this regimen from April 2012 to March 2015 were recorded. In the present study, 646 patients of VL were given miltefosine. Majority of the study subjects (58%) were male. Relapse occurred in 7% during follow-up period. Main causes of death were VL–pulmonary tuberculosis coinfection, extreme diarrhea, and acute pancreatitis which were reported in 1.7% subjects. Of 553 (85.6%) patients completing full course of treatment, 463 (83.7%) showed ADR with miltefosine during the study period. About 2.3% were suffering severe ADR, 51% from moderate, and the rest had mild ADR. The initial and final cure rate was 97.4% and 85.6%, respectively.
Antibody Prophylaxis Against Dengue Virus 2 Infection in Non-Human Primates
Authors: Simmons Monika , Putnak Robert , Sun Peifang , Burgess Timothy , Marasco Wayne A.
Published: September 2016

Passive immunization with anti-dengue virus (DENV) immune serum globulin (ISG) or monoclonal antibodies (Mabs) may serve to supplement or replace vaccination for short-term dengue immune prophylaxis. In the present study, we sought to establish proof-of-concept by evaluating several DENV-neutralizing antibodies for their ability to protect rhesus macaques against viremia following live virus challenge, including human anti-dengue ISG, and a human Mab (Mab11/wt) and its genetically engineered variant (Mab11/mutFc) that is unable to bind to cells with Fc gamma receptors (FcγR) and potentiate antibody-dependent enhancement (ADE). In the first experiment, groups of animals received ISG or Mab11/wt at low doses (3–10 mg/kg) or a saline control followed by challenge with DENV-2 at day 10 or 30. After passive immunization, only low-titered circulating virus-neutralizing antibody titers were measured in both groups, which were undetectable by day 30. After challenge at day 10, a reduction in viremia duration compared with the control was seen only in the ISG group (75%). However, after a day 30 challenge, no reduction in viremia was observed in both immunized groups. In a second experiment to test the effect of higher antibody doses on short-term protection, groups received either ISG, Mab11/wt, Mab11/mutFc (each at 25 mg/kg) or saline followed by challenge with DENV-2 on day 10. Increased virus-neutralizing antibody titers were detected in all groups at day 5 postinjection, with geometric mean titers (GMTs) of 464 (ISG), 313 (Mab11/wt), and 309 (Mab11/mutFc). After challenge, there was complete protection against viremia in the group that received ISG, and a reduction in viremia duration of 89% and 83% in groups that received Mab11/wt and Mab11/mutFc, respectively. An in vitro ADE assay in Fcγ receptor-bearing K562 cells with sera collected immediately before challenge showed increased DENV-2 infection levels in the presence of both ISG and Mab11/wt, which peaked at a serum dilution of 1:90, but not in Mab11/mutFc containing sera. The results suggest that antibody prophylaxis for dengue might be beneficial in eliminating or reducing viral loads thereby minimizing disease progression. Our results also suggest that blocking FcγR interactions through Mab11 Fc engineering may further prevent ADE.
Flavivirus Infections of Bats: Potential Role in Zika Virus Ecology
Authors: Kading Rebekah C. , Schountz Tony
Published: September 2016

Understanding the vector and nonhuman vertebrate species contributing to Zika virus (ZIKAV) transmission is critical to understanding the ecology of this emerging arbovirus and its potential to establish in new geographic areas. This minireview summarizes what is known regarding the association of bats with flaviviruses (Flaviviridae: Flavivirus) with a particular emphasis on the potential role of bats in the sylvatic transmission of ZIKAV. Key research directions that remain to be addressed are also discussed.
Cannatà y Fernandes. Topografías superpuestas
Authors: Merí de la Maza Ricardo , Díaz Segura Alfonso , Serra Soriano Bartolomé
Published: September 2016

Atendiendo a la acepción de topos se realiza una lectura de las obras recientes de la pareja de arquitectos italo-portugueses Cannatà y Fernandes. Para ello, se propone un recorrido por las obras construidas en los últimos cinco años en el cual se revisa las relaciones con el lugar, el contexto y la memoria de cada uno de ellos, graduando las intensidades de cada intervención y buscando los puntos comunes existentes entre ellas. Uno de estos aspectos resulta ser la simplificación material y visual de los objetos a partir de ciertas decisiones constructivovisuales. La rotundidad formal de las propuestas coexiste con la simplicidad material para lograr una superposición a lo existente que consigue adaptarse y volver a construir una nueva capa de la memoria colectiva del espacio público.
Museo de Arraiolos en Vimieiro. Arraiolos. Portugal
Authors: Fernandes Fátima , Cannatà Michele
Published: September 2016

La realización del núcleo Museológico El Mundo Rural, antes de constituir un momento de construcción de un lugar de la memoria colectiva de los procesos de producción relacionados con el mundo rural, se propone como un momento de recalificación de un núcleo urbano, de una comunidad rural que pretende mantener viva la tradición local, no como memoria estática sino como materia de construcción evolutiva de la calidad de vida de sus habitantes.