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La relación de los profesionales de salud con sus pacientes ha cambiado sustancialmente en este inicio del siglo XXI. El presente estudio tiene el objetivo de analizar los diferentes aspectos de la relación de los odontólogos con sus pacientes, en el contexto de la práctica odontológica. Inicialmente, el texto hace un análisis de la autonomía y el consentimiento, como principios bioéticos, en una incursión que va de la teoría, a la aplicación práctica concreta. En seguida, discute la utilización del consentimiento informado, sus ventajas, dificultades y su relación con la autonomía, en el contexto de las ciencias biomédicas y de la salud, especialmente en la odontología. Para finalizar, el trabajo defiende la premisa de que la relación odontólogo-paciente realmente adecuada, y jurídicamente correcta, es la construida bilateralmente, con respeto mutuo y toma compartida de decisiones.

The relationship between health professionals and their patients has substantially changed on the early 21st century. The purpose of the present study is to analyze the different approaches in the context of the dental practice. Initially the text analyzes autonomy and consent, as bioethical principles, from and approach theory to practice. Then, it discusses the use of informed consent, its advantages, difficulties, and its relationship with the autonomy, in the context of biomedical sciences and health -especially in odontology-. Finally, the work defends the premise that an adequate and legal relationship between patients and dentists should be a bilateral one, with mutual respect and shared decision making process.

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An adult patient with chronic schistosomiasis from an endemic area, complained about a seven day fever, along with jaundice and lumbar backache on the right side. Image exams showed multiple pyogenic liver abscesses. All the classic etiologies were discarded through clinical, radiological and laboratorial criteria. Schistosomiasis can cause pylephlebitis as a complication, along with immunesuppression, granulomatous reaction with central lobular liver necrosis and a greater risk of infection. The authors suggest that schistosomiasis in its chronic form may be the predisposing cause of multiple pyogenic liver abscesses, especially in endemic areas.

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The gastrointestinal tract is comparatively resistant to food-born germs, but recent studies suggest that nosocomial infections may be triggered by this route. In a study with industrialized diets, prepared with aseptic technique and stored up to 24 hours, aerobic and anaerobic contaminants were searched. Samples were taken after 0.8 and 24 hours, whereas half of these last two analyses were carried out in material left at room temperature, and the other half in refrigerated diets. Initial examination revealed 50% of positive cultures, but part of this was due to non-pathogenic Bacillus germs. After 8 and 24 hours 90% of the samples grew organisms, again with a large proportion of Bacillus, but also with several Gram-negative bacteria, as well as rare Gram-positives. Diarrhea and fever were not registered in patients submitted to enteral nutrition during the study period, nor could any episodes of bacteremia or septic shock be attributed to contaminated feeding material. This lack of clinical consequences of the reported bacterial isolations is not unexpected, and suggests that low concentrations of microorganisms were probably present in the preparations, below a critical level. Nevertheless, attention will be required in the future for better quality control of enteral nutrition mixtures, specially when resistant strains of Gram-negative species are identified, and also in the management of debilitated or immunologically compromised hosts.

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