LA TESIS DE LA ELECCIÓN DIVINA DE LO ÓPTIMO: UNA EXCEPCIÓN EN LA TEORÍA MODAL DE LEIBNIZ

La proposición "Dios elige lo mejor" constituye una verdad incuestionable para Leibniz, y una premisa fundamental en su explicación de la existencia del mundo, tanto como en su teodicea. Leibniz sintió la necesidad de clarificar su carácter modal, dada la importancia de tal cuestión en relación con la libertad divina. Sin embargo, en el abordaje de este problema, se vio conducido a infringir los criterios de su propia teoría modal, con el fin de justificar la contingencia de tal proposición. Este trabajo intenta mostrar que la posición principal sostenida por Leibniz, en torno a la modalidad de esta proposición, constituye una suerte de excepción en el marco de su doctrina modal, y que esta ambigüedad refleja las razones profundas de las oscilaciones constatables en sus escritos sobre esta temática.

Serum antigliadin antibody levels as a screening criterion before jejunal biopsy indication for celiac disease in a developing country

The objective of the present study was to determine the efficacy of detection of antigliadin immunoglobulins G and A (IgG and IgA) for the diagnosis of celiac disease in a developing country, since other enteropathies might alter the levels of these antibodies. Three groups were studied: 22 patients with celiac disease (mean age: 30.6 months), 61 patients with other enteropathies (mean age: 43.3 months), and 46 patients without enteropathies (mean age: 96.9 months). Antigliadin IgG and IgA ELISA showed sensitivity of 90.9 and 95.5%, respectively. With the hypothetical values of prevalence ranging from 1:500 to 1:2000 liveborns, the positive predictive value varied from 8.5 to 2.3% for IgG and from 4.8 to 1.1% for IgA. Considering the patients without enteropathies, specificity was 97.8 and 95.7% for IgG and IgA, respectively. In patients with other enteropathies, specificity was 82.0 and 84.1%, respectively. When patients with and without other enteropathies were considered as a whole, specificity was 88.8 and 91.6%, respectively. The specificity of positive IgG or IgA was 93.5% in children without enteropathies and 78.7% in the presence of other enteropathies. The negative predictive value for hypothetical prevalences varying from 1:500 to 1:2000 liveborns was 99.9%. Thus, even in developing countries where the prevalence of non-celiac enteropathies is high, the determination of serum antigliadin antibody levels is a useful screening test prior to the jejunal biopsy in the investigation of intestinal malabsorption.