RESUMO
Resumen La clorosis fue una enfermedad muy frecuente en la literatura médica de los siglos XVI hasta el inicio del siglo XX; por más de cuatro siglos esta enfermedad también conocida como la "enfermedad verde" (green sickness) o "enfermedad de las vírgenes" (morbus virgineus) ocupó un lugar preponderante en la consulta médica y llegó a alcanzar proporciones "epidémicas" en los siglos XVIII y XIX. Era la hemopatía más frecuente en este siglo, trascendiendo al propio campo de la medicina, con implicaciones sociales importantes, con influencia en la pintura y la literatura europea de esos años. Durante varios siglos no existió acuerdo respecto a su etiología, y hubo que esperar al desarrollo de la hematología, para llegar a ser considerada como una anemia microcítica-hipocrómica, patología frecuente en mujeres jóvenes. Cuando el misterio de su etiología quedó aclarado, sucedió un nuevo "misterio": su desaparición súbita de la nosología y literatura médicas en las primeras décadas del siglo pasado. En el presente trabajo revisamos la evolución histórica de una enfermedad y la construcción social de un concepto de enfermedad.
Abastract Chlorosis was a very frequent disease in medical literature from the 16th century to the beginning of the 20th century; For more than four centuries, this disease, also known as "green sickness" or "virgin disease" (morbus virgineus), occupied a predominant place in medical consultation and reached "epidemic" proportions in the eighteenth century and XIX (it was the most frequent blood disease in this century), transcending the field of medicine itself, with important social implications and influence on European painting and literature of those years. For several centuries there was no agreement regarding its etiology, and it was not until the development of hematology that it was considered a frequent microcytic-hypochromic anemia in young women. When the mystery of its etiology was clarified, a new "mystery" occurred: its sudden disappearance from medical nosology and literature in the first decades of the last century. In this paper we review the historical evolution of a disease and the social construction of a concept of disease.
RESUMO
Diabetes mellitus is a problem of health worldwide being vascular complications the main causes of morbidity and mortality in this population. Diabetics have a fast atherothrombotic evolution which is worse than that observed for other clinical entities; however, hyperglycemia itself may not totally explain the ischemic complications observed in these patients. Most ischemic arterial events are precipitated by plaque rupture, platelet activation, and thrombosis. Several abnormalities in the blood coagulation system have been described associated to diabetes mellitus, all of them predisposing to thrombosis: endothelial cell dysfunction, platelet hyperreactivity, thrombin generation and hypofibrinolysis. Platelets play a key role in diabetic atherothrombosis due to platelet hypersensitivity to physiological agonists, low response to therapeutical antiplatelet agents, platelet hyperreactivity in sites of endothelial cell damage, hyperaggregability, resistance to the inhibitory effects of the insulin, and low endothelial production of prostacyclin and nitric oxide. All these phenomena have been associated to either a toxic microenvironment due to hyperglycemia or to intrinsic platelet abnormalities. Based on all these facts, it is proposed that platelets may be another target for the negative effects of insulin-resistance state. Because platelets are crucial in the atherosclerotic process and in the genesis of the vascular complications of diabetes mellitus, this review analyses the platelet abnormalities observed in this metabolic disease.