Marcel Proust: el rol de su enfermedad y la Medicina en la vida y obra del autor de "A la busca del tiempo perdido", a un siglo de su creación / The role of disease and Medicine in the life and work of Marcel Proust

Marcel Proust is one of the greatest French writers of the XX century and of all times. In his supreme work 'In Search of lost Time", Proust demonstrated a great knowledge of medicine and specifically neurology. He was surrounded by doctors in his family and himself came in touch with many brilliant neurologists as Babinski and Sollier due to his asthma, wrongly considered as a manifestation of his "neurasthenia". He used as a literary tool the concept of emotional memory which is the basis of bis work. Nearly a century after Proust began the elaboration of bis masterpiece, this paper reviews important medical aspects of his life and the influence that medicine had on his work.

Asthma Control Limitations in Selected Primary Health Care Clinics

Primary health care services worldwide are currently experiencing many quality-related problems. Efforts to improve these services appear to be sporadic and unsatisfactory. Investigations have revealed (Sharma et Sharma 2007) that one of the main causes for this state of affairs can be identif ed as neglected or inadequate documentation of patient/case history. The health care provider (HCP) should be equipped to improve the quality of health care and to take the lead in assuaging the predicament. The present study was undertaken to assess the correlation between asthma control and patient-related case history notes as recorded via the HCP. The data were obtained retrospectively from the patient notes of all asthmatic patients (including children and pregnant women) who attended six selected clinics in the North West Province of South Africa (Dr Kenneth Kaunda Municipal District). The analysis of the data collected from the patient clinic books confirmed the suspicion of poor quality of documentation; although the documentation in certain categories rendered some positive results. When compared to the GINAr guidelines; none of the patients had been controlled properly and only a small number (18.4) had been controlled partly (GINA 2008). Asthma control may be enhanced when a standard template is developed for completion by the HCP. It is envisaged that this will ensure that vital information regarding asthma control is documented in order to contribute to satisfactory chronic disease control

Prevalência de asma brônquica nos estudantes de medicina da Universidade do Sul de Santa Catarina (Unisul) – Tubarão – SC / Prevalence of asthma among medical students of the Universidade do Sul de Santa Catarina (Unisul) – Tubarão – SC

Objetivos: Avaliar a prevalência de asma brônquica em alunos da primeira à décima segunda fase do curso de medicina da Universidade do Sul de Santa Catarina (Unisul), no Município de Tubarão – SC, utilizando o questionário escrito módulo asma do International Study of Asthma and Allergies in Childhood (ISAAC). Métodos: Foi realizado um estudo transversal, utilizando o questionário escrito módulo asma do ISAAC em 180 alunos do curso de medicina da Unisul, selecionadospor amostragem aleatória. Foi utilizado um ponto de corte de 5 para diferenciar asmáticos de não asmáticos. Resultados: A prevalência de asma brônquica napopulação estudada foi de 16,7%. Dos participantes, 92 (51,1%) eram do gênero masculino e 88 (48,9%) do gênero feminino. Dos 180 alunos que responderam o questionário, 167 (92,8%) eram caucasianos. A idade variou entre 18 e 38 anos, sendo a idade média de 22,2 anos (DP ± 3).Conclusões: A prevalência de asma brônquica entre os alunos do curso de medicina da Unisul foi muito próxima da média estimada nacional que é de 20%

Objectives: To estimate the prevalence os asthma among the medical students from the first to twelfth term of the Universidade do Sul de Santa Catarina (Unisul) – Tubarão – SC, using the International Study of Asthma and Allergies in Childhood (ISAAC) written questionaire of asthma. Methods: A cross-sectional study, using the ISAACwritten questionaire of asthma, evaluating 180 randomly selected medical students was performed. The cut off point to selected asthmatic students was 5. Results: The prevalence of asthma among the studied population was 16,7% of those surveyed, 92 (55,1%) were male and 88 (48,9%) were female. From the 180 students who answered the questionaire, 167 (92,8%) were caucasian. The age ranged of 18 to 38 years old, and the mean age was 22,2 years old (DP ± 3).Conclusions: The prevalence of asthma among medical students of Unisul was very similar to the national average (20%), which was also obtained by using the ISAAC written questionaire.

Milestones in Asthma Management

Background: Asthma is an old and common disorder of respiratory function whose prevalence is increasing everywhere particularly in urban centres. This situation; coupled with the problem of suboptimal management has led to an increase in the morbidity of the disease and enormous economic losses through lost productivity and absenteeism from work and schools. There is therefore a need to review the evolution of the management of this disease with a view to drawing attention to currently recommended management guidelines. This should help to improve the outlook for the asthma patient and hopefully reduce the morbidity and mortality of this rampant disease.Methods: A review of the literature regarding the history of asthma and the evolution of its management was undertaken with the aid of textbooks; journal publications and the Internet via Google Pubmed. The history of asthma and the evolution of the management of asthma was surveyed with emphasis on major and spectacular developments particularly in respect of chronic asthma.Results: Asthma management started from the naming of the disorder; a description of its pathogenesis; pathology and attempts at the therapy of the disease with a variety of agents notably adrenaline; noradrenaline and cortisone. This was followed by the invention of various drug delivery systems and the discovery of salbutamol and cromoglycate. The invention of the bronchoscope led to the development of anti- inflammatory drugs like inhaled corticosteroids and leucotriene antagonists while the discovery of the synergy between salmeterol and fluticasone (an inhaled corticosteroid); made possible the development of combination therapy. Guidelines were devised to ensure the optimal management of the disease through the proper classification of the disease according to severity as well as the efficient utilization of available effective therapies.Conclusion: Although asthma management began in the pre-christian era; the most spectacular and revolutionary developments occurred during the last 55 years and include the discovery of various drug delivery systems; salbutamol; combination therapy and the development of asthma management guidelines

Historia natural da asma em criancas: ha remissao na adolescencia? / Natural history of childhood asthma: do children outgrow asthma?

O objetivo do presente estudo foi verificar a influencia de algumas variaveis clinicas no comportamento da asma, particularmente da idade, pois a doenca parece ser mais frequente na crianca do que no adolescente e no adulto. Foram avaliados os aspectos clinicos da asma em 2948 criancas atendidas entre 1994-1997, no Servico de Alergia e Imunologia, Departamento de Pediatria, UFPR. Houve predominio de pacientes do sexo masculino (1,8:1,0) e de formas leves de asma (54 por cento). Nao houve relacao entre o sexo e a gravidade da doenca. A distribuicao da frequencia por faixa estaria, mostrou que a asma e mais frequente entre 1 e 3 anos de idade, com diminuicao progressiva em direcao a puberdade. Portanto, a asma se inicia na infancia, com tendencia a remissao proximo a puberdade

Asma alérgica

Los enfermos con asma son particularmente sensibles a factores del ambiente, entre ellos la presencia de alergenos de diversos tipos. En años recientes se ha notado incremento en la prevalencia y en la mortalidad por esta clase de enfermedades, lo cual hace imperativo para el médico no solamente conocer la fisiopatología y detalles del diagnóstico, sino los medicamentos adecuados para controlar los accesos y realizar el tratamiento más adecuado a cada caso

Estudio de la mortalidad por asma en la provincia de Córdoba entre 1980 y 1991 / Study of the mortality for asthma in the Cordoba province between 1980 y 1991

El objetivo del presente trabajo fue determinar las tasas de mortalidad en la provincia de Córdoba durante el período 1980-1991 y evaluar ciertos aspectos de los pacientes como edad, sexo y nivel educacional. Los datos se obtuvieron de los certificados de defunción a través del Ministerio de Salud Pública de la Provincia de Córdoba. Se incluyeron todas las muertes registradas con el ICD-493. Durante el período mencionado se registraron 1567 muertos por asma, lo que representa una tasa de mortalidad promedio de 5/100.000 habitantes. Durante 1985 la tasa de mortalidad por asma alcanzó su pico mayor con 6,8/100.000 habitantes y en 1989 su descenso máximo con 2,6/100.000 habitantes. Las muertes fueron divididas de acuerdo con diferentes grupos etarios, con los siguientes resultados: 0-14 años: 1,59 por ciento; 15-19 años: 1,91 por ciento; 20-59 años: 32,4 por ciento y >60 años 64 por ciento. Dentro de las características evaluadas se destaca que el mayor porcentaje de muertes ocurrieron durante julio y septiembre y el menor durante marzo. Casi el 50 por ciento de los pacientes no habian completado los estudios primarios o eran analfabetos. El 86,6 por ciento de los pacientes recibieron asistencia médica durante su último episodio de asma y el 53,2 por ciento fue hospitalizado. Las tasas de mortalidad por asma en Córdoba fueron altas y variables durante el periodo analizado y en 1985 se registró una de las mayores tasas conocidas por los autores

The house dust mite and its allergy / Os ácaros da poeira doméstica e sua alergia

Allergic reactions to house dust or street dirt have been known for ages. For a long time moulds and moistness inhomes was correlated with asthmatic diseases. In the thirties of this century the existence of mites in the environment were suspected for the development of house dust allergy. In the last hundred years the knowledge of house dust allergy has been increased enormously. In 1964 the mite Dermatophagoides pteronyssinus was discovered to be the main source for the allergic complaints dued to house dust. Recently mite paeces has been discovered as the major source of house dust mite allergy. This review describes the historical aspects of the developments in the knowledge of house dust mite allergy

Asma bronquica: revisao / Asthma review

Visto que a asma bronquica e uma doenca de grande prevalencia e que avancos na elucidacao de sua fisiopatologia ocorrem frequentemente, interessamo-nos por estudar esta doenca e incluir em um unico artigo as inumeras informacoes acerca da mesma.

Caracteristicas epidemiologicas del asma en un grupo de pacientes adultos que consultan al hospital Santa Clara de Bogota D.E., durante los meses de Octubre y Noviembre de 1987 / Epidemiological characteristics of asthma in a group of adult patients that consult to hospital Santa Clara Bogota D.E., during october to november 1980

Dada la alta prevalencia de asma en el hospital Santa Clara de Bogota, se realizo el presente estudio con el fin de conocer las caracteristicas del habitat del paciente detectando los posibles factores de riesgo para hacer un cierre de campo y proponer un programa de vigilancia epidemiologica. Con este proposito se encuestaron 38 pacientes al azar del total de personas entre 1 y 60 o mas anos, que tenian diagnostico de asma y que fueron controlados por consulta externa entre octubre de 1986 y marzo de 1987. A partir de esta encuesta, se encontro que la edad promedio mas frecuente fue 50-59 anos; el 64% es del sexo femenino en proporcion de 10:4. La mayor parte 50% de los pacientes eran residentes en Bogota. Las infecciones de la via respiratoria fue el factor desencadenante mas importante (29%) seguido de polvo (18%), frio (14%), quimicos (11%), Dentro de los factores predisponentes, cabe anotar que el habito de fumar fue relevante en el 47% de los casos; en la misma proporcion, se encontraron antecedentes de alergia a diferentes farmacos y en el 61% hiperreactividad bronquial al A.S.A. La mayor parte de los pacientes desempenaban labores de hogar y provenian de areas de la ciudad francamente contaminadas. Se sugiere desarrollar un programa de vigilancia apidemiologica basado en educacion sanitaria, visitas domiciliarias y caracteristicas epidemiologicas de la enfermedad..

Obstrucción nasal y asma bronquial / Nasal obstruction and bronchial asthma

Se bosqueja el desarrollo histórico de las vinculaciones entre trastornos obstructivos nasales y enfermedades cardiopulmonares y pulmonares, más específicamente con el asma. Se pasa después de una breve revisión fisiopatológica, a considerar sus conexiones con esta última y posteriormente, mediante el estudio de un grupo de 176 asmáticos, clasificados en grados según Kraeppelien, y según nuestra clasificación en cuanto a la severidad de la obstrucción nasal, se encuentra una asociación muy significativa en el mismo sentido entre ambos procesos; sin considerarse los factores causales que los determinan. Se demuestra de esta forma la utilidad, para estos fines, de la clasificación de obstrucción nasal que se empleó. Finalmente se comenta basado en los resultados, la pobre integración de los esfuerzos de los especialistas que tratan al niño con asma y obstrucción nasal