Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer (...) manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient’s daily life, can limit side effects and “dialysis shock”. An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient’s choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients. (shrink)

Este estudo investigou práticas educativas de pais e educadores sociais e estratégias de coping adotadas por crianças abrigadas. Participaram da pesquisa 20 crianças, entre sete e 11 anos. Elas responderam a duas entrevistas, que objetivavam identificar práticas educativas e problemas nos ambientes ..

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and (...) some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of “reverse” informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles to the donor and recipient parties. (shrink)

Paula Modersohn-Becker, widely considered to have been one of the most important independent Expressionist painters of the early twentieth century, was thirty-one years old when she gave birth to her first child. Following the then-common practice of putting women to bed rest for two-four weeks after delivery, she died of massive pulmonary embolism when she was first allowed to stand, eighteen days after giving birth. Paula had foreseen her death at a young age and was apprehensive about her pregnancy, yet (...) she painted herself as pregnant in her best known self-portrait, thus underlining the importance of the pregnancy in her life. In the light of knowledge available at the time, the authors present a brief discussion of the life and death of Paula Modersohn-Becker as a reflection on the potential dangers of blindly following conventional wisdom in the medical profession. (shrink)

Tras una breve consideración de las principales concepciones de la Psicología contemporánea acerca de la afectividad humana, se presenta a la Psicología integral de la persona como un meta-modelo capaz de iluminar y poner orden en el conocimiento actual acerca de los afectos. En concreto, se proponen seis aportes a la comprensión de la vida afectiva, a partir de la consideración de (1) la relación de los grados de vida humana con la afectividad, (2) la relación de la afectividad con (...) el resto de las potencias del alma, (3) la relación de los afectos entre sí, (4) la relación de los afectos con la realidad, (5) la relación de los afectos, en especial del amor-pondus, con el conjunto de la personalidad y (6) la relación de los afectos con la dimensión moral. (shrink)

The current study verified the association between cognitive process such as attention, executive functioning, and legal capacity in patients with bipolar disorder. The sample consisted of 72 participants, assorted to episodic patients, euthymic patients, and healthy controls. We used the following neuropsychological measures: subtests of the Wechsler Abbreviated Intelligence Scale : vocabulary and matrix reasoning; Continuous Performance Test ; Five Digit Test ; and Rey–Osterrieth Complex Figure. Euthymic patients expressed slower processing speed compared to HC. They tended to make more (...) errors with slightly worse discrimination, suggesting more impulsiveness. On the contrary, episodic patients showed worse discrimination, committed more omissions, were more inconsistent with regard to response speed, showed more difficulties in organizing their actions, and were more rigid. The results suggest that bipolar patients in episode express more cognitive impairments that can compromise the quality of legal capacity. These results highlight the need for more protective support for episodic BD patients regarding legal capacity. (shrink)

Jean Hamburger is considered the founder of the concept of medical intensive care and the first to propose the name Nephrology for the branch of medicine dealing with kidney diseases. One of the first kidney grafts in the world, in 1953, and the first dialysis session in France, in 1955, were performed under his guidance. His achievements as a writer were at least comparable: Hamburger was awarded several important literary prizes, including prix Femina, prix Balzac and the Cino del Duca (...) prize, awarded, among others, to Jorge Luis Borges and Konrad Lorenz.Here we would like to offer a selected reading of a “golden” book, “Conseils aux étudiants en medicine de mon service”, the first book dedicated to patient-physician relationship in Nephrology, written when dialysis and transplantation were becoming clinical options. The themes include: the central role of the patient, who should be known by name, profession, life style, and not by disease; the importance of the setting of the care; the need for truth-telling and for leaving hope; the role of research not only in the progression of science, but also in the daily clinical practice. (shrink)

Muhyiddîn el-Kâfiyecî (öl. 879/1474), on beşinci yüzyıl Saruhanoğulları, Osmanlı ve Memlüklü alimlerindendir. Yüzden çok eser yazmıştır. Makale Kâfiyeci’nin hayatı ve eserlerini araştırır. Yazdığı eserler, onun, Arap dili, Arap grameri, belagat, tarih metodolojisi, hadis ve usulü, tefsir ve usulü, fıkıh ve usulü, kelâm, tasavvuf, dil felsefesi, semantik, metafizik meseleler, geometri, optik ve astronomi gibi konularda uzmanlaştığını göstermektedir. Kâfiyeci en önemli eserlerini Arap dili ve mantık sahalarında yazmıştır. Eserleri içerisinde yaptığı linguistik çözümlemeler, onun yetkin bir dil alimi olduğunu göstermektedir. Kâfiyeci eserlerini yazarken (...) linguistik, mantıki, ilmi ve felsefi bir yöntem kullanmıştır. Araştırmada, Kâfiyeci’nin, hayatı boyunca en az yüz on iki eser yazdığı tespit edilmiştir. Bu eserlerden, doksan altısının adı belirlenmiştir. Kâfiyeci’nin eserleri konularına göre şöylece tasnif edilebilir: Arap Dili ve Dil Felsefesi: Şerḥu’1-i‘râb ‘an Ḳavâ‘idi’l-i‘râb, el-Unmûzec fî baḥsi’l-isti‘âre, Şerḥu’l-isti‘âre, Risâle fî Kâne Zeydun Ḳâimen, Risâle fî Zeydun Ḳâimun, Risâle fi’l-mebâḥisi’l-mute‘alliḳa bi Emmâ, Nuzhetu’l-mu‘rib fi’l-Meşrıḳ ve’l-Maġrib, Nuzhetu’l-aṣhâb fî mes’eleti’l-kuhl, Remzu’l-esrâr, en-Niseb li ehli’l-edeb, el-İşrâḳ fî meratibi’ṭ-ṭıbâk, Ḥâşiye ‘ale’l-Muṭavvel, Risâle fî “men” eş-şartiyye. Mantık: et-Terġîb fî keşfi rumûzi’t-Tehẕîb. Tarih Metodolojisi: el-Muḫtaṣaru’l-mufîd fî ‘ilmi’t-târîḫ, en-Naṣru’l-ḳâhir ve’l-fetḥu’ẓ-ẓâhir. Akâid ve Kelâm: Envâru’ṣ-Ṣa ‘âde, Şerḥu’l-‘Aḳâidi’l-‘Aḍuḍiyye, Hâşiye ‘alâ Şerḥi’l-‘Aḳâidi’l-‘Aḍuḍiyye, Şerḥu’l-Mevâḳıf, Telḫîsu Şerḥi’l-Mevâḳıf, el-Hidâye li beyâni’l-ḫalḳ ve’t-tekvîn, Risâle fî beyâni’l-mu‘cizât, Nehru’l-hayât fî ma‘rifeti’ṣ-ṣıfât, ‘İlmu’l-kumûn ve’l-burûz, Risâle fî Kavlihi Teâlâ “Lâ ye’menu mekr Allâhi ille’l-kavmu’l-hâsirûn” [A‘râf, 7/99]. Kur’ân, Kırâat ve Tefsir Bilimleri: Şerḥu’l-İsti‘âẕe ve’l-Besmele, Ḥâşiye ‘ale’l-Keşşâf, Şerḥ fî muḥâkemât beyne’l-mutekellimîn ‘ale’l-Keşşâf, Ḥâşiye ‘alâ Tefsîri’l-Beyḍâvî, eẓ-Ẓafer ve’l-ḫalâṣ, et-Teysîr fî ḳavâ‘idi ‘ilmi’t-tefsîr, Risâle fî ‘ilmi’t-tefsîr ve vucûhi’l-ḳırâat, Keşfu’n-niḳâb li’l-aṣḥâb ve’l-aḥıbbe fî ‘icâzi’l-Ḳur’ân, et-Temhîd fî şerḥi’t-taḥmîd, Ḳarâru’l-vecd fi şerḥi’l-ḥamd, el-İlmâ‘ bi ifâdeti Lev li’l-imtinâ‘ fî ḳavlihi Te‘âlâ “Lev kâne fîhimâ âlihetun illallâh le fesedetâ” [Enbiyâ, 21/22], Cevâb ‘an suâl fî ḳavlihi Te‘âlâ “Ve’n-Necmi iẕâ hevâ” [Necm, 62/1], Nuzhetu’l-iḫvân fî tefsi¬ri ḳavlihi Te‘âlâ “Yâ Lûṭu İnnâ Rusülü Rabbike” [Hûd, 11/81], Neylu’l-merâm fi tefsîri ḳavlihi Te‘âlâ “Ve Mâ Rabbuke bi Ẓallâm” [Fussilet, 41/46], el-Bişâra fî ḳavlihi Te‘âlâ “Fe’tû bi sûratin min mislih” [Bakara, 2/23], Nuzhetu’l-aṣḥâb, el-Ġurratu’l-vâḍıḥa fî tefsîri’l-Fâtiḥa, Zeḫîratu’l-ḳaṣr fî tefsiri Sûrati’l-‘Aṣr. Hadis Bilimleri: Muḫtaṣar fî ‘ulûmi’l-ḥadîs, Menbe‘u’d-durer fî ‘ilmi’l-eser, Ḫulâṣatu’l-‘aḳvâl fî ḥadîsi “İnneme’l-a‘mâlu bi’n-niyyât”. Fıkıh, Usûl ve Fetva: Risale fî mesʹeleti’l-istisnâʹ, Ḥâşiye ‘ala şerḥi’l-Hidâye, Vecîzu’n-niẓâm fî ıẓhâri mevâridi’l-aḥkâm, el-Feraḥ ve’s-surûr fî beyâni’l-meẕâhîbi’l-erba‘ati fi’l-‘uṣûr, Neşâtu’ṣ-ṣudûr fî şerḥi Kitâbi’l-Feraḥ ve’s-surûr, et-Taḥrîr lima zukira fi’d-Dureri’l-manẓûm, Muhâveratu’l-fıḳhiyye, Risâle fi’stiḳbâli’l-Ḳıble, Telḫîṣu’l-Câmi‘i’l-kebîr ve’l-Mecma‘, Kitâbu’t-Teẕkira/Risâle fi’l-vaḳf, Ravḍatu’ẓ-ẓahira en-nâfi‘a fî’d-Dünya ve’l-Âḫira, Kitâbu’l-muḫtasar fî ‘ilmi’l-istibdâl, er-Remz fî ‘ilmi'l-istibdâl, el-Kâfî fî beyâni’ṣ-ṣaffi’ṭ-ṭavîli’l-mustaḳîm, Risâle fî ṭabaḳâti’l-butûn li beyâni’l-vaḳf ‘alâ evlâdi’l-evlâd, el-İḥkâm fî ma‘rifeti’l-Eymân ve’l-aḥkâm, Ferâid baḥri’l-fevâiḍ. Siyasetname, Adap ve Ahlak: Niẓâmu ḳalâidi’l-‘ıḳyân, Seyfu’l-kuḍât ‘ale’l-buġât, Seyfu’l-mulûk ve’l-ḥukkâm el-murşid lehum ilâ sebîli’1-Haḳḳ ve’1-aḥkâm, Seyfu’l-ḥaḳḳ ve’n-nuṣra ‘alâ riḳâbı ehli’l-baġy ve’l-fitne, ed-Durratu’l-‘âliyetu’l-ġâliye. Metafizik, Tasavvuf ve Felsefe: el-Kâfî eş-şâfî, Kitâbu’r-ravḥ fî ‘ilmi’r-rûḥ, Kitabu’r-raḥme fî beyânı aḥvâli ‘alemi’l-berzâḫ, en-Nuzhe fî ravḍati’r-rûḥ ve’n-nefs, Neşâtu’l-bişâra bi’l-işâra fî kıbleti’l-ervâh, Ḳıbletu’l-ervâḥ fi’t-taṣavvuf, Nuzhetu’l-ervâḥ ve ġıbṭatu’l-eşbâḥ fi’t-taṣavvuf, Menâzilu’l-ervâḥ fi’t-taṣavvuf, ‘Ikdu’l-ferâid min baḥri’l-fevâiḍ fî şerḥi Esmâillâhi’l-husnâ, el-Unsu’1-enîs fî ma‘rifeti şeʹni’n-nefsi’n-nefîs. Siyer, İrşat ve Fazâil: Zeynu’l-feraḥ bi mîlâdi’n-Nebî (s.a.v.), Muḫtasar fî ‘ilmi’l-irşâd, Risâle fi’l-maḥabbe, Ḳalâidu’l-‘ıḳyân fî baḥri faḍâili Raceb ve Şa‘bân: Fen Bilimleri: Ḥallu’l-işkâl fî mebâhisi’l-eşkâl fi’l-hendese, Şerḥu’l-caġmînî fi’l-heyʹe, er-Remz fî ‘ilmi’l-uṣturlâb. Diğer Eserleri: Remzu’l-ḫıṭâb bi raşḥi’l-‘ıyâb, Benâtu’l-efkâr fî şeʹni’l-‘i‘tibâr, Keşfu’l-vucûhi’l-ḥasene’l-mestûra bi’n-niḳâb li faḍlillâhi’l-Cevâdi’l-Vehhâb, el-Keşf ‘an şerafi Ehli’l-Beyti’l-kirâm li efḍali’r-rusuli ve’l-enâm, ‘Iḳdu’l-ferâid min taḥrîri’l-fevâid, Risâle mustaḳılle bi ‘ilmi’n-nefs ve vucûhi’l-ḳırâa, Cevâbu’l-enẓâr, Ḥusnu’l-ḫıtâm li’l-merâmi min haẕa’l-kelâm, Ḫıtâmu’l-misk. (shrink)