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espanolEl presente trabajo plantea que el desarrollo de la filosofia del Derecho de Fichte contradice aquello que este filosofo presento como el fundamento metafisico de su sistema, a saber: la moralidad como busqueda racional y practica del Yo de superar las trabas de la realidad e identificarse consigo mismo. Entonces se exhibe la imposibilidad de conciliar dos textos: Grundlage der gesamtenWissenschaftslehre (GWL) y Grundlage des Naturrechts (GNR). En este ultimo se expone la doctrina del Derecho y del Estado como medios para que el individuo alcance su telos, lo cual coarta la consistencia del sistema. Si bien el trabajo se inserta en una linea hermeneutica con antecedentes, resulta novedoso en cuanto demarca problematicas argumentativas fichteanas ya al interior de sus textos de Jena.Tambien se toma en consideracion la obra: Einige Vorlesungen uber die Bestimmung des Gelehrten (BG), en la cual Fichte incorpora aspectos de GWL y de GNR que ayudan a pensar el tema en cuestion. EnglishThe present article states that the development of Fichte’s philosophy of Right stands in contradiction with the way that he founded the metaphysical ground of his system: morality as I’s rational and practical search to overcome the check of reality and to unify with itself. Thus, the paper exposes the impossibility to reconcile two texts: Grundlage der gesamtenWissenschaftslehre (GWL) and Grundlage des Naturrechts (GNR). In the latter, Fichte presents the Doctrine of Right and the State as mediums for the individual to reach its telos. But this affects the consistency of his thought. Although there is a hermeneutic background for this idea, it is groundbreaking as it exhibits Fichtean argumentative problems within Jena’s works. The article also takes into consideration the text: Einige Vorlesungen uber die Bestimmung des Gelehrten (BG). Here Fichte incor-porates several aspects from GWL and GNR that help to think on those contradictions.

El presente trabajo plantea como hipótesis que la fuente de influencia más profunda en el pensamiento romántico argentino no fue el romanticismo francés sino el idealismo y el romanticismo alemán. Se trata de demostrar el influjo de la metafísica del anhelo, que Fichte expone en la Grundlage der gesamten Wissenschaftslehre (1794-1795), en dos obras: El peregrinaje de Gualpo (ca. 1825) de Esteban Echeverría y los Cantos del peregrino (1846) de José Mármol. De esta manera se muestra el modo en que uno y otro de los autores caracterizan la figura del peregrino como personaje principal y alter ego en sus textos. A su vez, se resaltan las nociones de melancolía y de hastío como enclaves que conforman el pensamiento idealista y romántico. En este sentido se muestra que tanto Fichte como los Frühromantiker y los intelectuales argentinos, forman parte de una corriente de pensamiento idealista y romántico que cabe calificar como melancólico, práctico y moral.

Over the last three years, the Coronavirus-19 disease has been a global health emergency, playing a primary role in the international scientific community. Clinical activity and scientific research have concentrated their efforts on facing the pandemic, allowing the description of novel pathologies correlated to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), such as the Multisystemic Inflammatory Syndrome in Children and Adults (MIS-C, MIS-A). Conversely, this shift of attention to COVID-19 disease and its complications could, in some cases, have delayed and underestimated the diagnosis of diseases not associated with SARS-CoV-2, including rare diseases. Here we describe the diagnostic process that led to the definition of a rare vasculitis in a young woman with a recent clinical history of SARS-CoV-2.

Resumen: El presente trabajo plantea que el desarrollo de la filosofía del Derecho de Fichte contradice aquello que este filósofo presentó como el fundamento metafísico de su sistema, a saber: la moralidad como búsqueda racional y práctica del Yo de superar las trabas de la realidad e identificarse consigo mismo. Entonces se exhibe la imposibilidad de conciliar dos textos: Grundlage der gesamten Wissenschaftslehre (GWL) y Grundlage des Naturrechts (GNR). En este último se expone la doctrina del Derecho y del Estado como medios para que el individuo alcance su telos, lo cual coarta la consistencia del sistema. Si bien el trabajo se inserta en una línea hermenéutica con antecedentes, resulta novedoso en cuanto demarca problemáticas argumentativas fichteanas ya al interior de sus textos de Jena. También se toma en consideración la obra: Einige Vorlesungen über die Bestimmung des Gelehrten (BG), en la cual Fichte incorpora aspectos de GWL y de GNR que ayudan a pensar el tema en cuestión. Abstract: The present article states that the development of Fichte’s philosophy of Right stands in contradiction with the way that he founded the metaphysical ground of his system: morality as I’s rational and practical search to overcome the check of reality and to unify with itself. Thus, the paper exposes the impossibility to reconcile two texts: Grundlage der gesamten Wissenschaftslehre (GWL) and Grundlage des Naturrechts (GNR). In the latter, Fichte presents the Doctrine of Right and the State as mediums for the individual to reach its telos. But this affects the consistency of his thought. Although there is a hermeneutic background for this idea, it is groundbreaking as it exhibits Fichtean argumentative problems within Jena’s works. The article also takes into consideration the text: Einige Vorlesungen über die Bestimmung des Gelehrten (BG). Here Fichte incor- porates several aspects from GWL and GNR that help to think on those contradictions.

La propuesta del trabajo es resaltar la necesidad de entender la filosofía idealista de Fichte a partir del rol central del concepto de yo en la Grundlage der gesamten Wissenschaftslehre (GWL) (1794-1795). Se busca subrayar que sólo en cuanto se conciba su pensamiento como una filosofía del yo se la puede comprender como un sistema coherente que da cuenta del fundamento de la subjetividad y de la relación del sujeto con el mundo. De otra manera el idealismo deviene dogmatismo y la filosofía, religión. Para presentar semejantes alternativas se analizan, en paralelo con la GWL, textos de dos filósofos coetáneos a Fichte, a saber: Fichte Studien (FS) (1795-1796) de Novalis y: Differenz des Fichteschen und Schellingschen Systems der Philosophie (Differenzschrift - DS) (1801) y Glauben und Wissen (GuW) (1802) del joven Hegel. Novalis oscila entre una comprensión del yo, o con mayor rigor, de la conciencia, como una imagen del ser o como una idea en sentido kantiano. A partir del estudio de sus fragmentos se refuerza tanto por la negativa, en el primer caso, como de manera afirmativa en el segundo, la necesidad hermenéutica que se mencionó. Esto último también se expone, aunque sólo de manera indirecta, desde la crítica hegeliana al yo como término que no presenta una unidad fundamental al interior del sistema filosófico. Además del estudio de las fuentes se toma en consideración el estado de la cuestión actual acerca del tema, buscando contribuir a la comprensión de los estudios sobre el idealismo y, en particular, sobre Fichte.

El presente libroexpone el modo en que Emil Cioran concibió el concepto de melancolía en sus múltiples textos. Para contextualizar su consideración se realiza, en primer lugar, un repaso por el modo en que a lo largo de la historia de la filosofía occidental, diversos pensadores describieron las causas y consecuencias de una constitución melancólica de la subjetividad. En segundo lugar, también con vistas a enmarcar la particular visión cioraniana sobre la cuestión, se lleva a cabo un análisis de lo que se denomina “sentido general del pensamiento de Cioran”. En este punto se estudia la manera en que él expone los conceptos de “fragmento”, “yo”, “ser”, “existencia” y “tiempo”, como nociones clave al interior de su pensamiento filosófico y a-filosófico. En lo que remite en concreto a la caracterización que Cioran lleva a cabo acerca de la melancolía, se subraya su poder transformador con respecto a la existencia subjetiva. En este sentido se expone su asociación con respecto a otros tres conceptos que delinean las ideas cioranianas, a saber: “tristeza”, “ironía” y “nostalgia”. De esta forma se resalta el carácter libre y libertario de la existencia melancólica, que adopta la figura filosóficade carácter moral y estético del “fantasma”.

Cardiorenal syndrome type 4 (CRS type 4), or chronic renocardiac syndrome, has been defined as "chronic abnormalities in renal function leading to cardiac disease" and recognizes the extreme burden of cardiovascular disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Even though the treatment for CVD has dramatically improved over the past decades, it still takes responsibility for up to 50% of deaths in CKD patients. For this reason, patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system. This review focuses on the most significant conventional and non-conventional CVD risk factors related to CKD.

IgG4 related disease is a systemic fibro-inflammatory disorder characterized by multiple organ and multiple tissue lesions. The real pathogenesis is currentlyactually unknown. For these reasons many authors compare IgG4 related disease to sarcoidosis. Lesions are often localized in the pancreas, salivary and lacrimal glands, biliary ducts, retroperitoneum and in many other organs. The diagnosisis difficult because of mild symptoms and the possibility of mimicking other severe diseases. Therefore, histopathology together with clinical and radiological typical findings are mandatory tools for diagnosis. Steroidtherapy usually enables disappearance of tumor like lesions and complete recovery. Kidney has an extensive organ involvement in the contextof IgG4-related disease. Historically, tubule - interstitial nephritis(TIN) is considered the main renal feature of renal lesions, however recent studies extend the spectrum of renal lesions also to glomerular tuft. These findings allow to introduce in the nosography the term of IgG4related kidney disease (IgG4 RKD). This review focuses on renal involvement in IgG4related disease, in order to help nephrologists to improve their clinical, diagnostic and therapeutic approach to this emerging pleiotropic clinical pattern.

Background Malfunction of the peritoneal dialysis catheter is frequently caused by dislocation. The diagnostic approach is classically based on abdomen X-ray together with detailed case history and physical examination. Despite being rarely applied in clinical practice to evaluate catheter misplacement, ultrasound is a noninvasive, radiation-free technique that is potentially useful also to explore reasons for catheter malfunction. Consequently, we aimed to evaluate the diagnostic accuracy of ultrasound to identify peritoneal catheter misplacement. Methods In a multicenter observational blinded study, we compared ultrasound to abdomen X-ray for catheter localization in 93 consecutive peritoneal dialysis patients with dialysate outflow problems enrolled in two nephrology and dialysis units. The position of the catheter was annotated on a standard scheme of nine abdominopelvic regions. The sensitivity, specificity, positive and negative predictive value and Kappa coefficient were calculated. Results Dislocation out of the inferior abdominopelvic regions was present in 19 patients (20 %) at X-ray and 23 patients (25 %) at ultrasound. Correct determination of the position of the catheter in the lower abdomen by ultrasound had a sensitivity of 93 % (95 % CI 84 – 97 %), specificity of 95 % (95 % CI 72 – 100 %), positive predictive value of 99 % (95 % CI 91 – 100 %), negative predictive value of 78 % (95 %CI 56 – 92 %) and Kappa coefficient of 0.82 (95 % CI 0.67 – 0.96). In 10 out of 93 patients (11 %), there was a position mismatch between X-ray and ultrasound in an adjacent abdominopelvic region. Conclusion Our results suggest that abdomen X-ray for the evaluation of peritoneal catheter position can be replaced by ultrasound in experienced hands. This bedside diagnostic procedure might reduce costs, the time necessary for diagnosis and lifetime radiation exposure.

Bioimpedance analysis (BIA) is reported to be useful in assessing dry weight (DW) in patients on hemodialysis (HD), but its exact role has never been clearly defined. We reviewed our experience of using the BIA measure of reactance (Xc) in pediatric patients on chronic HD. Our approach is currently based on identifying a range of patient-specific Xc values at which a child can be considered at DW according to a multidisciplinary assessment. Values lower than the patient-specific limit suggests the need for a reduction in DW, whereas values higher than the limit suggest that DW should be increased. The accuracy of our approach was retrospectively assessed by analyzing the left ventricular mass index (LVMI) and the incidence of pulmonary edema (PE) in two groups: The first consisted of 13 patients (median age 15.6 years) on dialysis in 2007, before the introduction of the BIA-based approach; the second included 18 patients (median 14.8 years) on dialysis in 2011. In 2007, three children experienced four episodes of PE, whereas no PE occurred in 2011. The median LVMI was 56.8 g/m(2.7) in 2007, and 44.5 g/m(2.7) in 2011 (P 38.5 g/m(2.7)) was 92.3% in 2007 and 61.1% in 2011 (P < 0.05). There were no between-group differences in terms of blood pressure, antihypertensive medications, percentage of symptomatic sessions, or biochemistry. In conclusion, a simple approach based on BIA may be useful in assessing DW in pediatric patients on HD, and thus improve their cardiovascular status.

Chronic hemodialysis requires an efficient vascular access which is fundamental for a good dialytic efficiency. The native arteriovenous fistula is preferred for its longer survival and lower infec...

Thyroid cancer is the most common endocrine tumor. Thyroidectomy, radioactive iodine, and TSH suppression represent the standard treatment for differentiated thyroid cancer. Since chemotherapy has been shown to be unsuccessful in case of advanced thyroid carcinomas, the research for new therapies is fundamental. In this paper, we reviewed the recent literature reports (pubmed, medline, EMBASE database, and abstracts published in meeting proceedings) on new treatments in advanced nonmedullary and medullary thyroid carcinomas. Studies of many tyrosine kinase inhibitors as well as antiangiogenic inhibitors suggest that patients with thyroid cancer could have an advantage with new target therapy. We summarized both the results obtained and the toxic effects associated with these treatments reported in clinical trials. Reported data in this paper are encouraging, but further trials are necessary to obtain a more effective result in thyroid carcinoma treatment.

In pazienti che necessitino sia di plasmaferesi (PLF) che di emodialisi (ED), l'applicazione simultanea delle due metodiche, nota come tandem PLF-ED (TPE) può costituire una soluzione vantaggiosa. Tuttavia esiste scarsa esperienza circa il suo utilizzo, in particolare in età pediatrica. Abbiamo esaminato in modo retrospettivo le sedute di TPE eseguite negli ultimi 5 anni nel nostro Centro. I trattamenti di TPE sono stati 67 in 7 pazienti, di età mediana 16.2 anni (5–34) e peso mediano di 37 kg (17.0– 59.0). Le indicazioni per TPH erano: sindrome emolitica uremica atipica da deficit di fattore H, fattore I o da mutazioni non definite, nella maggior parte delle sedute (64/67 sedute), vasculite, glomerulosclerosi focale (prima del trapianto) e iperimmunizzazione in pazienti in lista per trapianto di rene. In 66/67 trattamenti la procedura è stata completata con successo, raggiungendo i volumi di sostituzione e ultrafiltrazione desiderati. La durata della PLF è stata inferiore a quella di ED, e non ha quindi comportato un prolungamento della seduta dialitica. Un unico trattamento è stato interrotto a causa di un episodio ipotensivo, in una paziente nota per ipotensioni ricorrenti. In conclusione la TPE è una procedura sicura e ben tollerata, anche in bambini e adolescenti stabili dal punto di vista emodinamico.

A large amount of recent epidemiological studies have shown the worldwide growth on the incidence and prevalence of diabetes mellitus type II (DM2), especially in industrialized countries where DM2 is the most frequent cause of chronic kidney disease. Diabetic nephropathy progression to ESRD (End Stage Renal Disease) may be slowed down only with a tight glycemic control, since no hypoglycemic drugs have been shown to possess renoprotective effects. Treatment with oral hypoglycemic agents should be closely and regularly monitored in patients with diabetic nephropathy since the decline of renal function below 60 ml/min of glomerular filtration rate (GFR) could cause multiple pharmacokinetic alterations. It may expose the patient to serious side effects if cautious dose reduction or even withdrawal of these drugs is not considered. Pharmacological approaches to the treatment of diabetes type 2 include the traditional oral hypoglycemic drugs (insulin sensitizers, insulin secretagogues and drugs inhibiting the absorption of glucose), incretin system drugs (orally or intravenously administered) and insulin therapy, if these drugs are insufficient or are contraindicated. The objective of this review is to evaluate the evidence regarding the use of oral hypoglycemic agents (with particular attention to the DPP-4 inhibitors) in diabetes type 2 with chronic kidney disease stage III- IV and ESRD, while in case of eGFR60 ml / min no dosage adjustment is usually required.