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Abstract Introduction The influx of new knowledge and scientific contributions into contemporary world psychiatry has counted on a vigorous dissemination through technology-inspired means. This process has led to the realities of Global Mental Health (GMH) inspired by "a new epistemology" of mostly positivistic roots. Objective To explore the basis of these realities and the resulting homogenization attempts of psychiatry as a medical, clinical, and research discipline. Discussion and conclusion The need for "a new architecture" of contemporary psychiatry is discussed as a reflection of a correct epistemological exercise and a renewed pact between professionals and communities, materialized in and enriched by the re-emerging Community Mental Health (CMH) movement. The essential bases of the movement are presented, and its mutually collaborative, multidisciplinary, integrated, and realistic nature, as reflected in national efforts like Peru's in Latin America, is described.

Resumen Introducción El flujo de nuevos conocimientos y contribuciones científicas surgido en la psiquiatría mundial contemporánea ha contado con una vigorosa diseminación mediada por recursos tecnológicos. Este proceso ha conducido a las realidades de la Salud Mental Global (SMG) inspiradas por una "nueva epistemología" de raíces fundamentalmente positivistas. Objetivo Explorar las bases de esta nueva realidad y los resultantes intentos de homogenización de la psiquiatría como disciplina médica, clínica y de investigación. Discusión y conclusión Se discute la necesidad de "una nueva arquitectura" de la psiquiatría contemporánea como reflejo de un correcto ejercicio epistemológico y de un pacto renovado entre profesionales y comunidades que se han materializado y enriquecido por el reemergente movimiento de la Salud Mental Comunitaria (SMC). Se presentan las bases esenciales del movimiento y su naturaleza de mutua colaboración multidisciplinaria, integrada y realista, reflejada en esfuerzos nacionales como es el caso del Perú en América Latina.

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Resumen En tanto que componente fundamental del quehacer médico a lo largo de la historia, la Ética es aún más prominente en situaciones de emergencia en salud pública. Luego de exponer los principios éticos esenciales y de enfatizar su valor en el cuidado médico de todo ser humano, se plantea la inevitable tensión que su aplicación genera en los diversos contextos de la relación médico-paciente. Se presta especial atención a las distinciones de la perspectiva ética en casos individuales y en el ámbito colectivo o de salud pública, particularmente en el curso de emergencias masivas como la desencadenada por COVID-19. A la luz de recientes documentos nacionales e internacionales, se discute el inevitable advenimiento de nuevas normas que deberán incluir aspectos socio-culturales, psicobiológicos y legales poseedores de un impacto clínico altamente significativo.

Summary As an essential component of medical work throughout history, Ethics becomes even more prominent in public health emergency situations. After presenting the fundamental ethical principles, and emphasizing their value in the medical care of every human being, the inevitable tensions that their application generates in the diverse contexts of the doctor-patient relationship, are examined. Particular attention must be paid to the distinctions between ethical perspectives of individual cases and those related to public health situations such as the massive emergency triggered by the COVID-1 pandemic. On the basis of recent national and international documents, the unavoidable upcoming of new ethical norms that must include socio-cultural, psychological and legal aspects of a highly significant clinical impact, is discussed.

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Biologics are increasingly being used to modify the course of immune-mediated inflammatory diseases. Some main agents are monoclonal antibodies and a fusion-protein that target TNF. This group includes adalimumab, infliximab, certolizumab pegol, golimumab and etanercept. Although the efficacy of anti-TNFs is supported by numerous randomized clinical trials, their pharmacokinetics depend on many factors, in particular immunogenicity, which can cause marked and rapid clearance and a consequent decrease in efficacy. Kinetics involve receptors that recognize the Fc fragment of the antibody and are responsible for various processes. Pharmacological advances permit optimizing the pharmacokinetics of anti-TNFs. In this review, we examine the kinetics of anti-TNF biologics, and consequent therapeutic implications, and overview some latest developments in the field. First draftsubmitted: 17 May 2016; Accepted for publication: 15 September2016; Published online: 14 October 2016.

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BACKGROUND: Although long-term data are available from biologic studies in North American/European populations with rheumatoid arthritis (RA), long-term findings in Latin American RA populations are limited. OBJECTIVE: To examine long-term safety/efficacy of etanercept, methotrexate, and/or other disease-modifying anti-rheumatic drugs (DMARDs) in Latin American patients with moderate-to-severe active RA. METHODS: In the first phase of this open-label study, patients were randomized to etanercept 50 mg weekly plus methotrexate or conventional DMARD (hydroxychloroquine or sulfasalazine) plus methotrexate for 24 weeks. At the start of the second phase (week 24), investigators selected a treatment regimen that included any combination/dosage of etanercept, methotrexate, hydroxychloroquine, or sulfasalazine based on previous treatment response, preference, and local product labeling, and was continued for the 104-week extension. RESULTS: In the extension, in the group previously randomized to etanercept-plus-methotrexate therapy, etanercept was continued in 259/260 patients; methotrexate continued in 260/260; and hydroxychloroquine and sulfasalazine added in 8/260 and 3/260, respectively. In the group previously randomized to conventional DMARD-plus-methotrexate therapy, conventional DMARD was discontinued in 86/126 and etanercept added in 105/126. Among etanercept-exposed patients (total exposure, 798.1 patient-year [PY]), rates of adverse events, serious adverse events, and serious infections per PY were 1.7, 0.07, and 0.02 events per PY. In both groups, after treatment modification was permitted, clinical response rates and improvements in clinical/patient-reported outcomes from baseline were sustained to week 128. CONCLUSION: After investigators were permitted to modify treatment, etanercept was part of the treatment regimen in 95% of patients. Continuation or addition of etanercept in the 2-year extension resulted in a consistently good risk:benefit profile. TRIAL REGISTRATION: Open-Label Study Comparing Etanercept to Conventional Disease Modifying Antirheumatic Drug (DMARD) Therapy; ClinicalTrials.gov, number NCT00848354; https://clinicaltrials.gov/ct2/show/NCT00848354.

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El autor formula una serie de reflexiones en torno a la trayectoria de la tercera promoción egresada de la Facultad de Medicina de la Universidad Peruana Cayetano Heredia y que celebra este año sus Bodas de Oro. Examina horizontes inspirados por maestros ilustres y principios irrevocables; solsticios que a la manera de acmés y nadires iluminaron rutas de éxitos y satisfacciones o las ensombrecieron con dudas o dificultades; y penumbras o retraimientos de soledad e impotencia frente a lo inevitable. En su actual encrucijada existencial, la Promoción Alberto Hurtado de 1965 reafirma convicciones de inmenso valor ético, de servicio auténtico, de ciencia profunda y de vocación duradera.

The author formulates a series of reflections about the trajectory of the third class graduated from the School of Medicine of the Universidad Peruana Cayetano Heredia and celebrating this year itÆs Golden Anniversary. Horizons, inspired by illustrious teachers and irrevocable principles; solstices that in the manner of acmes and nadirs illuminated routes of success and satisfactions, or darkened them with doubts and difficulties; and somber moments of retractions, solitude or impotence in the face of the inevitable, are all examined. In its current existential crossroads, the Alberto Hurtado Class of 1965 reaffirms convictions of enormous ethical value, authentic service, profound science and enduring vocation.

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Tributo in memoriam a Don Oscar Pino Galarza (1926-2014), secretario y asistente administrativo de la Revista de Neuro-Psiquiatría por espacio de más de sesenta años, colaborador cercano de los Profesores Honorio Delgado, primero, y Javier Mariátegui, después. Luego de breves anotaciones biográficas, obtenidas mediante una entrevista con la esposa e hijos de Don Oscar, se describen rasgos fundamentales de su personalidad y su trabajo. En la Revista, su labor fue multidimensional al haber estado envuelto en tareas secretariales, administrativas, logísticas y editoriales que desempeñó con singular eficiencia, devoción, lealtad y modestia. Estas cualidades y su nobleza espiritual fueron evidentes en momentos decisivos de la trayectoria académica y editorial de los dos primeros Directores de nuestra publicación. Se reconocen así la vida y la obra de un auténtico orfebre, de alguien que reflejó lo mejor y más alto de una genuina calidad humana, más allá de orígenes sociales, documentos burocráticos o formalidades institucionales.

A tribute to Don Oscar Pino Galarza (1926-2014), secretary and administrative assistant of the Revista de Neuro-Psiquiatría for over 60 years, closely working with Professors Honorio Delgado, first, and Javier Mariátegui, later. After brief biographic notes obtained from an interview with Don Oscar’s wife and children, fundamental features of his personality and his work are described. At the Revista, his activity was multidimensional as he was involved in secretarial, administrative, logistic and editorial tasks which he conducted with unique efficiency, devotion, loyalty and modesty. These qualities and his spiritual nobility were evident during decisive moments in the academic and editorial careers of the first two Directors of our journal. Thus, due recognition is given to life and the work of a genuine goldsmith, one who reflected the best and the highest of a true human quality, beyond social origins, bureaucratic documents or institutional formalities.

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