Comparison of knowledge on asthma: doctors completing internal medicine residency and doctors completing medical school

CONTEXT: Asthma has been reported as a disease of increasing prevalence. OBJECTIVE: To assess the level of information and knowledge about asthma by means of a questionnaire among recent graduate physicians applying for medical residency at the Clinical Hospital of the University of Säo Paulo Medical School, Brazil. DESIGN: 14 multiple-choice questions for asthma diagnosis and management. SETTING: University of Säo Paulo Medical School (FMUSP). PARTICIPANTS: Recent graduate physicians applying for the medical residency program at FMUSP in 1999 (n = 448) and physicians that had completed 2 year of internal medicine residency (n = 92). MAIN MEASUREMENTS: We applied a questionnaire with 14 multiple-choice questions about the management of asthma based upon the Expert Panel Report 2 - Guidelines for the Diagnosis and Management of Asthma, NIH/NHLBI, 1997 (EPR-2). RESULTS: The medical residency program in Internal Medicine improved treatment skills (the ability to propose adequate therapy) when compared to medical education (a score of 57.2 percent versus 46.9 percent, P < 0.001) but not diagnosis knowledge (understanding of asthma symptoms related to medicine intake) (33.5 percent versus 33.3 percent, P = 0.94). Treatment skills were higher among physicians who received their Medical Degree (MD) from public-sponsored medical schools in comparison with those from private schools [49.7 (SE 1.17)] versus [41.8 (SE 1.63)], P < 0.001. CONCLUSION: Medical schools might consider reevaluating their programs regarding asthma in order to improve medical assistance, especially when considering the general results for residents, as they were supposed to have achieved performance after completing this in-service training

Crise hemolitica aguda seguida por insuficiencia hepatica fulminante com evolucao fatal, como primeira manifestacao clinica da doenca de Wilson / Acute hemolytic anemia followed by a fulminant hepatic failure with lethal evolution as a first clinical manifestation of Wilson's disease

Descreveremos neste trabalho o caso clinico de paciente do sexo feminino, de 21 anos, portadora de doenca de Wilson, cuja primeira manifestacao clinica da doenca ocorreu como crise hemolitica aguda seguida por insuficiencia hepatica fulminante, com evolucao para o obito apos 26 dias de internacao. O diagnostico definitivo foi obtido apenas com a medida quantitativa do cobre hepatico em material de necropsia...

Dois casos de vasculite cutânea grave com plaquetopenia associada à cirrose hepática: componente autoimune e infecto-inflamatório com lesäo endotelial e padräo restritivo pulmonar em um caso / Two cases of severe cutaneous vasculitis with thrombocytopenia associated with hepatic cirrhosis: autoimmune and infect-inflammatory component with endotelial lesion and restrictive pulmonary pattern in one case

Descritos dois casos clínicos de pacientes do sexo feminino com cirrose hepática criptogênica em um e pelo vírus C em outro, com envolvimento autoimune multissistêmicos e intercorrência infecciosa. O caso 1 apresentou endocardite infecciosa e erisipela em membro inferior esquerdo. Em sua evoluçäo clínica ocorreu vasculite cutânea em membro inferior, plaquetopenia autoimune, leucopenia e quadro retritivo pulmonar com padräo inflamatótio. Havia imunecomplexos elevados e consumo de complemento. O caso 2 apresentou erisipela em membro inferior seguido por vasculite cutânea no local e consumo de complemento. O Caso 1 recebeu antibioticoterapia por 4 semanas para endocardite infecciosa, seguido por corticoterapia (prednisona) na dose de 1mg/Kg, com revisäo da plaquetopenia e leucopenia. O caso 2 apresentou melhora apenas com antibióticos. A relaçäo entre hepatopatias crônicas e fenômenos autoimunes sistemicos é discutida com ênfase para o comprometimento cutâneo, hematológico e pulmonar

Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case

This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.

Comprometimento pulmonar letal na neurofibromatose / Compromising lethal pulmonary in neurofibromatosis

É apresentado o caso de um homem de 61 anos, internado com quadro de dispnéia, tosse com pouca expectoraçäo, associado a lesöes em pele e subcutâneo típicas de neurofibromatose tipo I. A radiografia e a tomografia computadorizada de tórax revelaram bolhas enfisematosas pulmonares. O paciente foi submetido a drenagem de hemitórax, porém evoluiu com hemorragia digestiva alta que o levou ao óbito. Embora o comprometimento pulmunar na neurofibromatose varie de 0 a 20%, é possivel que com o aumento da sobrevida dos portadores deste distúrbio a prevalência da doença pulmonar cística aumente