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The ratio between circulating levels of leptin and soluble leptin receptor (sOB-R), the free leptin index (FLI), is used as a marker of leptin resistance. Therefore, the aim of our study was to investigate the FLI in mild pre-eclamptic pregnancies in a nested case-control study within a prospective observational study. Circulating levels of leptin and sOB-R levels rise significantly during pregnancy in healthy (p < 0.05) (n = 46) and pre-eclamptic pregnancies (p < 0.05) (n = 20). Serum levels of leptin were significantly higher in pre-eclamptic compared to healthy pregnancies at second and third trimesters of pregnancy (p < 0.05). Additionally, serum levels of sOB-R were significantly lower in pre-eclamptic pregnancies during the second and third trimesters of pregnancy compared to healthy pregnancies (p < 0.05). Moreover, we found that FLI did not vary significantly during pregnancy in healthy women (p > 0.05), while it increases in pre-eclamptic pregnancies (p < 0.05). Indeed, FLI was significantly higher at second and third trimesters of pregnancy in pre-eclamptic compared to healthy pregnancies (p < 0.05). In addition, FLI was significantly higher in the luteal phase compared with the follicular phase of the menstrual cycle in eumenorrheic women (p < 0.05). Receiver operating characteristic (ROC) curve analysis revealed the ability of leptin (AUC = 0.72) and FLI (AUC = 0.67) as a reliable predictor for mild pre-eclampsia during the second trimester of pregnancy. In conclusion, our findings show that FLI were significantly increased in mild pre-eclamptic pregnancies and allowed us to hypothesize that this rise might alter leptin bioavailability and bioactivity which might lead to the sympathetic hyperactivity and the hypertensive disorders during pregnancy.

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Introducción. El objetivo de este artículo de reflexión es estudiar el método deliberativo para la toma de decisiones en bioética clínica expuesto por Diego Gracia, una de las voces más reconocidas en el campo de la bioética española. En este artículo se analizan los siguientes aspectos de su propuesta: la fundamentación bioética, la deliberación, el proyecto humano, el acto moral, el método de toma de decisiones, las dificultades para la deliberación y las críticas al método. Métodos. La fundamentación epistemológica de esta investigación es interpretativa, el enfoque cualitativo, el diseño analítico y la técnica de investigación utilizada es el análisis documental. Las categorías de análisis de este estudio son: fundamentación bioética, deliberación, proyecto humano, acto moral, método de toma de decisiones, dificultades para la deliberación y críticas al método. Resultados. Los aportes más importantes de esta propuesta son: la valoración de la historia clínica como el elemento básico para el estudio y el análisis del caso clínico; el reconocimiento de la deliberación prudente como el eje fundamental para el estudio de las situaciones problemas; el estudio que se hace de las dificultades intrínsecas y extrínsecas que pueden dificultar o entorpecer el proceso deliberativo; y que la metodología propuesta es clara y sencilla para la identificación y elección de los problemas morales a estudio y de los cursos de acción para su resolución. Discusión. Es de reconocer la obra de Diego Gracia como una de las contribuciones más importantes realizadas al estudio de los métodos de toma de decisiones en bioética clínica en lengua española, la cual se constituye como una herramienta útil en la construcción y enriquecimiento del conocimiento en este campo para los profesionales de la salud y los comités bioéticos clínicos.

Introduction. The objective of this reflection article is to study the deliberative method for decision making in clinical bioethics presented by Diego Gracia, one of the most recognized voices in the field of Spanish bioethics. In this article the following aspects of his proposal will be analyzed: the bioethical fundamentals, deliberation, human project, moral act, the decision-making method, the difficulties for the deliberation and criticism of this method. Methods. The epistemological foundation of this research is interpretive, the qualitative approach, the analytical design and the research technique used in the documentary analysis. The categories of analysis of this study were: bioethical foundation, deliberation, human project, moral act, method of decision making, difficulties for deliberation and criticism of this method. Results. The most important contributions of this proposal are: a) the evaluation of the clinical history as the main subject for the clinical case study and analysis; b) the recognition of prudent deliberation as the main axis for the study of problematic situations; c) the study that is made of the intrinsic and extrinsic difficulties that can make difficult or obstruct the deliberative process; and d) the proposed methodology is clear and simple to identify and select moral problems to study and courses of action for their resolution. Discussion. It is to recognize the work of Diego Gracia as one of the most important contributions made to the study of decision-making methods in clinical bioethics in Spanish, which is a useful tool in the construction and enrichment of knowledge in this field for health professionals and clinical bioethics committees.

Introdução. O objetivo deste artigo de reflexão é estudar o método deliberativo de tomada de decisão em bioética clínica exposto por Diego Gracia, uma das vozes mais reconhecidas no campo da bioética espanhola. Neste artigo serão analisados os seguintes aspectos da proposta acima referida: fundamentos bioéticos, deliberação, projeto humano, o ato moral, o método de tomada de decisão, dificuldades para a deliberação e crítica ao método. Métodos. O fundamento epistemológico desta pesquisa é interpretativo, a abordagem é qualitativa, o desenho é analítico e a técnica de pesquisa utilizada na análise é documental. As categorias de análise deste estudo foram: fundamentação bioética, deliberação, projeto humano, ato moral, método de tomada de decisão, dificuldades de deliberação e crítica a esse método. Resultados. As contribuições mais importantes desta proposta são: a) a avaliação da história clínica como elemento básico para o estudo e análise do caso clínico; b) o reconhecimento da deliberação prudente como eixo fundamental para o estudo de situações-problema; c) o estudo que é feito das dificuldades intrínsecas e extrínsecas que podem dificultar ou obstruir o processo deliberativo; d) a metodologia proposta é clara e simples para a identificação e eleição dos problemas morais a serem estudados e os cursos de ação para sua resolução. Discussão. O trabalho de Diego Gracia deve ser reconhecido como uma das contribuições mais importantes ao estudo dos métodos de tomada de decisão em bioética clínica em língua espanhola e constitui uma ferramenta útil na construção e enriquecimento de conhecimento neste campo para profissionais de saúde e comitês de bioética clínica.

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Metabolic changes have been correlated with adverse pregnancy outcomes. The aim of the present study is to determine the TyG and TG/HDL-c indices in a cohort of healthy pregnant (n = 142), preeclamptic (n = 18), and healthy nonpregnant women (n = 56). Preeclamptic women were selected from the same cohort. Pregnant women were followed during three periods of pregnancy and postpartum. The results showed a significant increase in the values of TyG and TG/HDL-c (p < 0.01) as pregnancy progresses, without significant differences between healthy and preeclamptic women. TyG and TG/HDL-c indices are significantly low in nonpregnant and three months' postpartum women when compared with each gestational period studied. TyG and TG/HDL-c indices are positively correlated with HOMA-IR in the early and middle pregnancy (p < 0.05). Multiple linear regression using the TyG and TG/HDL-c indices as dependent variables showed that TyG index was significantly associated with HOMA-IR, gestational age, HDL-c, TC, LDL, fasting insulin, and mean BP (p < 0.001); meanwhile, TG/HDL-c index was only associated with HOMA-IR (p < 0.0242) and gestational age (p < 0.001). In conclusion, the TyG and TG/HDL-c indices could be useful in monitoring insulin resistance during pregnancy.

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Resumen La deliberación es una actividad humana racional básica de reconocida importancia desde la antigüedad para la toma de decisiones en la vida cotidiana y en los campos especializados del saber como la medicina, la política y la ética. El objetivo de esta reflexión es estudiar el aporte de Aristóteles al proceso deliberativo con su obra la Ética a Nicómaco. En este trabajo se han identificado los siguientes aspectos de la deliberación para su análisis: origen, definición, características, tipos y condiciones para su desarrollo. Aspectos que la bioética reivindica, ya que encuentra en la phrónesis aristotélica el eje fundamental para guiar su acción en procura de la autorealización humana y el análisis y la toma de decisiones de los problemas bioéticos clínicos. 24 siglos han transcurrido para redescubrir la importancia de este proceso y la necesidad de educar al respecto.

Abstract Deliberation is a basic rational human activity recognized since ancient times due to its role in decision making during daily life activities and in specialized areas of knowledge such as medicine, politics and ethics. The objective of this reflection paper is to study the contribution of Aristotle to the deliberative process through his work the Nicomachean Ethics, where the following aspects of deliberation were identified for analysis: origin, definition, characteristics, and types and conditions for its development. Bioethics defend these aspects, since it finds in Aristotelian phronesis the fundamental axis to guide its actions in search of human self-realization and the analysis and decision making of the clinical bioethical problems. Twenty-four centuries have passed until the importance of this process and the need to educate about it was finally rediscovered.

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Objetivo: revisar la evidencia disponible acerca de la efectividad y seguridad del sulfato de magnesio como neuroprotector en fetos pretérmino.Materiales y métodos: se realizó una búsqueda de la literatura en las bases de datos, Medline, SciELO, Embase y ScienceDirect y Cochrane, utilizando los términos de búsqueda: "premature birth, cerebral palsy, magnesium sulfate", restringida a los siguientes tipos de estudios: metaanálisis, revisiones sistemáticas, guías de práctica clínica y ensayos clínicos controlados, entre el 2000 y el 2013.Resultados: la búsqueda en las bases de datos electrónicas arrojó 31 títulos, de los cuales se excluyeron 19 estudios debido a que no respondían a la pregunta inicial, eran artículos de revisión narrativa, doble publicación, incluían estudios observacionales o se trataba de protocolos de investigación. Finalmente, se seleccionaron 12 artículos que corresponden a 5 revisiones sistemáticas, 5 ensayos clínicos controlados y 2 guías de práctica clínica. El sulfato de magnesio disminuye el riesgo de parálisis cerebral en alrededor del 30 % y de disfunción motora gruesa en un 40 %. No tiene impacto significativo en otros desenlaces como mortalidad perinatal, leucomalacia periventricular o hemorragia intraventricular. Este efecto protector es mayor en edades gestacionales más tempranas. Los eventos adversos maternos y neonatales son generalmente leves.Conclusiones: el sulfato de magnesio utilizado en pacientes con trabajo de parto pretérmino, fase activa antes de semana 32, es un tratamiento efectivo y seguro en la prevención de la parálisis cerebral en fetos prematuros.

Objective: To review the existing evidence about the effectiveness and safety of magnesium sulphate used for neuroprotection in preterm foetuses.Materials and methods: A search of the literature was conducted in the Medline, SciELO, Embase and ScienceDirect and Cochrane databases, using the terms "premature birth, cerebral palsy, magnesium sulphate" limited to the following types of studies: meta-analyses, systematic reviews, clinical practice guidelines and controlled clinical trials, between 2000 and 2013.Results: The search in the electronic databases resulted in 31 titles. Of these, 19 studies were excluded because they did not answer the initial question, they were narrative review papers, double publication, included observational studies, or they were research protocols. Finally, 12 articles were selected, including 5 systematic reviews, 5 controlled clinical trials and 2 clinical practice guidelines. Magnesium sulphate reduces the risk of cerebral palsy by approximately 30 %, and of gross motor dysfunction by 40 %; however, it does not have significant impact on other outcomes such as perinatal mortality, periventricular leukomalacia or intraventricular haemorrhage. This protective effect is greater in earlier gestational ages. Maternal and neonatal adverse events are generally mild.Conclusions: Magnesium sulphate used in women in preterm labour or in active phase before 32 weeks is an effective and safe treatment for the prevention of cerebral palsy in premature babies.

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