Oscar Castro Zúñiga: el poeta vencido por la tuberculosis / Oscar Castro Zúñiga, the poet who succumbed to tuberculosis

The life of the renowned Chilean writer, Oscar Castro Zúñiga, was interrupted early, when he was 37 years old. He acquired tuberculosis during the epidemic in our country between the second half of the nineteenth century and the first half of the twentieth century. He developed the disease during a crucial stage in terms of diagnosis and treatment, coinciding with the end of the sanatorium stage and the first chemotherapeutic attempts. The symptoms and treatments of the disease in that age are described analyzing the letters, both written by himself and by people close to him and the biographies published during the historical and personal context of the artist.

[Oscar Castro Zúñiga, the poet who succumbed to tuberculosis]. / Oscar Castro Zúñiga: el poeta vencido por la tuberculosis.

The life of the renowned Chilean writer, Oscar Castro Zúñiga, was interrupted early, when he was 37 years old. He acquired tuberculosis during the epidemic in our country between the second half of the nineteenth century and the first half of the twentieth century. He developed the disease during a crucial stage in terms of diagnosis and treatment, coinciding with the end of the sanatorium stage and the first chemotherapeutic attempts. The symptoms and treatments of the disease in that age are described analyzing the letters, both written by himself and by people close to him and the biographies published during the historical and personal context of the artist.

Vida y obra de Abel Cetrángolo (1916 - 1977) / Life and work of Abel Cetrángolo (1916-1977)

Desde 1947 se inició el tratamiento específico de la tuberculosis que adquirió un valor inusitado, dado que el mismo modificó en el mundo entero el curso de la enfermedad tuberculosa. Roentgen desde 1895 nos mostró su ubicación en el pulmón, pero fue el laboratorio que permitió su diagnóstico y tratamiento, sucesivamente modificado con el transcurrir de los años. Abel Cetrángolo, como quien fuera su maestro y padrino de tesis, Andrés Arena entre nosotros, logró caracterizar al bacilo de Koch y en esa misma tesis nos enseñó el valor diagnóstico del contenido gástrico. Se distinguió por la seriedad de sus trabajos científicos tanto en Córdoba en la escuela de Gumersindo Sayago como en la Cátedra de Patología y Clínica de la Tuberculosis con la conducción de Raúl F Vaccarezza; fue un verdadero maestro para sus discípulos sentando bases valederas en sus conclusiones. Todo jefe de servicio debe trascender por lo que dejacientíficamente, pero también en la formación de médicos que puedan continuar en la profesión desde el punto de vista asistencial y docente con el ejemplo que él les legó.

Since 1947 the specific treatment of tuberculosis acquired an unused value, since it changed over the world the course of tuberculosis. Roentgen from 1895 showed us its location in the lung, but it was the laboratory that allowed its diagnosis and treatment, successively modified with the passing of the years. Abel Cetrángolo, and his former teacher and thesis godfather Andrés Arena among us, characterized the Koch bacillus and in that same thesis reinforced the value of gastric content. It was distinguished by the seriousness of his scientific works, both in Córdoba in Gumersido Sayago school and in the Department of Pathology and Clinical Tuberculosis headed by Raul F Vaccarezza, was a true master for his disciples sitting valid bases of conclusions. All service manager must transcend so scientifically leaves, but also in the training of doctors that can continue in the profession from the point of view clinical and teaching by example that he bequeathed them.

[Tuberculosis 110 years after the Nobel Prize awarded to Koch]. / La tuberculosis a 110 años del Premio Nobel de Koch.

The Nobel Prize in Physiology or Medicine was awarded in 1905 to Robert Koch "for his investigations and discoveries in relation to tuberculosis (TB)". He discovered the causal agent of TB, described the four principles that since then have guided research in communicable diseases and also prepared the old tuberculin, a bacillary extract that failed as a healing element but allowed the early diagnosis of TB infection and promoted the understanding of cellular immunity. After his death, the most conspicuous achievements against TB were the BCG vaccine, and the discovery of streptomycin, the antibiotic that launched the era of the effective treatment of TB. Drug-resistance soon appeared. In Argentina, studies on drug resistance began in the 60s. In the 70s, shortened anti-TB drug schemes were introduced consisting in two-month treatment with four drugs, followed by four months with two drugs. The incidence of TB decreased worldwide, but the immune depression associated with awarded together with the misuse of anti-TB drugs allowed the emergence of multidrug resistance and extensive resistance, with the emergence of nosocomial outbreaks worldwide, including Argentina. New rapid diagnostic methods based on molecular biology were developed and also new drugs, but the treatment of multidrug resistant and extensively resistant TB is still difficult and expensive. TB research has marked several milestones in medical sciences, including the monumental Koch postulates, the tuberculin skin test that laid the basis for understanding cell-mediated immunity, the first design of randomized clinical trials and the use of combined multi-drug treatments.

Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000-2012.

BACKGROUND: Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years. OBJECTIVE: To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM. MATERIALS AND METHODS: We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution. RESULTS: In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p<0.001) in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p<0.001). Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11-1.61) p<0.002) compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes. CONCLUSION: Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure.

[Frederic Chopin (1810-1849), and his disease]. / Federico Chopin (1810-1849) y su enfermedad.

Frédéric Chopin - a great Polish composer and pianist-suffered from a chronic disease. Both during his life and after his death, physicians disagreed on Chopin's diagnosis. His contemporaries accepted the diagnosis of tuberculosis, a common disease in the 18th century. Description of new clinical entities provoked new dilemmas in the 21th century. Although other alternative diagnoses to tuberculosis have emerged, such as cystic fibrosis or alpha-1 antitrypsin deficiency, we still sustain that the first diagnosis is the most probable. In this paper we report F. Chopin's case history and discuss cons and pros for different diseases as the cause of F. Chopin's suffering and death.

[The assistance of the Portuguese Colony of Brazil, 1918-1973]. / A assistência da Colónia Portuguesa do Brasil, 1918-1973.

This article seeks to redeem the historical memory of a health institution in Portugal which reconfigured itself and adapted to the social and medical needs and concerns during the twentieth century. The trajectory of this institution contributes to the history of Portuguese medicine and to the history of the philanthropy of the Portuguese colony resident in Brazil and the so called "Brazilians" that returned to Portugal, whose remittances provided the means to set up a benchmark health institution in the twenty-first century. The methodology was based on archival research in Portugal (Coimbra, Bissaya Barreto Foundation) and in Brazil (Rio de Janeiro, Real Gabinete Português de Leitura) and the cross-checking of these primary sources with due historical and social contextualization.

A Assistência da Colónia Portuguesa do Brasil, 1918-1973 / The Assistance of the Portuguese Colony of Brazil, 1918-1973

Este artigo pretende resgatar a memória histórica de uma instituição de saúde em Portugal que se reconfigurou e adaptou às necessidades e preocupações sociais e médicas no decorrer do século XX. Traçar o percurso desta instituição contribui para a história da medicina portuguesa e, ao mesmo tempo, para a história da filantropia da colónia portuguesa radicada no Brasil e dos “brasileiros de torna viagem” que, pelas suas remessas financeiras, tornaram possível uma instituição de saúde de referência no século XXI. A metodologia seguida nesta investigação assentou na pesquisa de arquivo em Portugal (Coimbra, Fundação Bissaya Barreto) e no Brasil (Rio de Janeiro, Real Gabinete Português de Leitura) e no cruzamento destas fontes primárias com a devida contextualização histórica e social.

This article seeks to redeem the historical memory of a health institution in Portugal which reconfigured itself and adapted to the social and medical needs and concerns during the twentieth century. The trajectory of this institution contributes to the history of Portuguese medicine and to the history of the philanthropy of the Portuguese colony resident in Brazil and the so called “Brazilians” that returned to Portugal, whose remittances provided the means to set up a benchmark health institution in the twenty-first century. The methodology was based on archival research in Portugal (Coimbra, Bissaya Barreto Foundation) and in Brazil (Rio de Janeiro, Real Gabinete Português de Leitura) and the cross-checking of these primary sources with due historical and social contextualization.

Federico Chopin (1810-1849) y su enfermedad / Frederic Chopin (1810-1849), and his disease

Frédéric Chopin - a great Polish composer and pianist-suffered from a chronic disease. Both during his life and after his death, physicians disagreed on Chopin's diagnosis. His contemporaries accepted the diagnosis of tuberculosis, a common disease in the 18th century. Description of new clinical entities provoked new dilemmas in the 21th century. Although other alternative diagnoses to tuberculosis have emerged, such as cystic fibrosis or alpha-1 antitrypsin deficiency, we still sustain that the first diagnosis is the most probable. In this paper we report F. Chopin's case history and discuss cons and pros for different diseases as the cause of F. Chopin's suffering and death.

Cenário atual da tuberculose / Current scenario of tuberculosis

Mesmo após 133 anos desde a descoberta do Mycobacterium tuberculosis, a tuberculose continua ser uma das principais causas de morte por doenças infecciosas no mundo, principalmente em países em desenvolvimento.O objetivo deste estudo foi mostrar aspectos relevantes da doença visando uma atualização literária e a busca de um olhar mais atento à problemática da tuberculose no contexto atual. Foram utilizados 130 artigos advindos das bases LILACS, MEDLINE/PUBMED, SCielo, Paho, Biblioteca Cochrane, WHOLIS, IBECS e Scopus, com as principais palavras-chaves selecionadas em terminologia em saúde encontradas no DECS. As espécies pertencentes ao Complexo M. tuberculosis compartilham cerca de 99% de identidade do DNA,com sequências altamente conservadas, mas diferem na distribuição geográfica, patogenicidade e hospedeiros. O mecanismo de resistência clinicamente significativo para rifampicina é uma mutação do gene rpoB, que codifica o alvo desse antibiótico. Há grandes avanços no diagnóstico da TB, com novos instrumentos de biologia molecular e testes rápidos, mas ainda não substituem os métodos clássicos bacteriológicos, apesar de suas conhecidas limitações. Atualmente, a associação de métodos moleculares, principalmente aqueles baseados em reações da PCR tem proporcionado grande impulso nos estudos da epidemiologia molecular do MT. Embora haja uma diminuição do número de casos no mundo, dentre os desafios da doença estão a necessidade de pesquisas na área, envolvimento político para solucionar as questões sociais atribuídas à TB, treinamento permanente dos profissionais e monitoramento de vigilância dos casos para eliminar a doença no cenário mundial.

Even 133 years after the discovery of Mycobacterium tuberculosis, tuberculosis continues to be one of the main causes of death due to infectious diseases worldwide, especially in developing countries. The objective of this study was, after a survey of recent publications, to show issues relevant to the disease and to takea closer look at the tuberculosis problem in the current context. A total of 130 articles were found in the LILACS, MEDLINE/PubMed, SciELO, Paho, Cochrane Library, WHOLIS, IBECS and Scopus databases using the main keywords selected from health terminology of MeSH. Species belonging to the M. tuberculosis complex have highly conserved sequences and share about 99% DNA identity, but differ in their geographic distribution, pathogenicityand host. The clinically significant mechanismof rifampicin resistance is due to a mutation of the rpoB gene which encodes the target of the antibiotic. Great advances in the diagnosis of tuberculosis have occurred, with new molecular biology tools and rapid tests, but without replacing classical bacteriological methods, despite their known limitations. Recently, the association of molecular methods, especially based on PCR, has provided great impetus in molecular epidemiology studies of M. tuberculosis. Although the number of cases in the world has decreased, among the challenges are the need for further research, political involvement to solve social issues linked to tuberculosis, permanent training and the surveillance of cases in order to eliminate the disease on the world stage.

Tuberculosis pulmonar: apuntes y aspectos actualizados / Pulmonary Tuberculosis: notes and updated aspects

El incremento de casos de tuberculosis diagnosticados en nuestra provincia Guantánamo, al igual que a nivel mundial y nacional, con el consiguiente incremento de incidencia de casos de tuberculosis en el adulto mayor se ha logrado revertir gracias a la recuperación gradual del Programa Nacional de control de la tuberculosis en el contexto de las limitaciones económicas. Se realiza una revisión que contribuye al enriquecimiento de conocimientos sobre la tuberculosis pulmonar, historia, inmunología y otros aspectos de interés (AU)

The increase in cases of tuberculosis diagnosed in our Guantanamo province, as well as global and national levels, with a consequent increase in incidence of tuberculosis in the elderly has been reversed due to the gradual recovery of the National Control tuberculosis in the context of economic constraints. A bibliographical review is done that contributes to the enrichment of knowledge on pulmonary tuberculosis, history, immunology and other areas of interest (AU)

La experiencia de ser un 'niño débil y enfermo' lejos de su hogar: el caso del Asilo Marítimo, Mar del Plata (1893-1920) / The experience of a 'weak and sick child' far from home: the experience of the Maritime Asylum, Mar del Plata (1893-1920)

Este trabajo tiene como objetivo analizar la vida cotidiana de los 'niños tuberculosos', provenientes de la ciudad de Buenos Aires, que fueron internados en el Hospital Marítimo, ubicado a 400km de la metrópolis, en la localidad marítima de Mar del Plata. En 1893, surgió la idea en la Sociedad de Beneficencia de la Capital Federal de fundar un hospital y el Asilo Marítimo destinado a niños enfermos de tuberculosis ósea en general, a niños débiles y convalecientes y también al tratamiento de pacientes con tuberculosis extra-pulmonar. En este artículo, se pretende avanzar en la comprensión de dos problemáticas vinculadas entre sí: por un lado las características de la ingerencia institucionalizada de la Sociedad de Beneficencia y por el otro, la experiencia que estos niños tuberculosos vivieron en ese ámbito.

O Boletim Médico: prescrição dos tisiólogos para a cura da cidade de São José dos Campos (1930-1935) / The Boletim Médico: the tuberculosis specialists' prescription for curing the city of São José dos Campos (1930-1935)

Analisa a transformação da cidade de São José dos Campos em Estância Climatérica para o tratamento da tuberculose pulmonar, condição oficialmente instituída em 1935. Por meio de análise do periódico editado pelos tisiologistas da cidade, Boletim Médico, e de fontes correlatas, são analisadas a motivação e as estratégias desse grupo profissional na conversão da pacata cidade de São José dos Campos em centro de referência para a cura da tuberculose. A investigação dos argumentos técnicos que ampararam esse projeto reforça a constatação de que a condição de estância era, simultaneamente, ameaça à população da cidade e motriz da economia local, baseada, até a década de 1950, quase que exclusivamente na exploração da doença.

A colônia Juliano Moreira e seu pavilhão de tisiologia para mulheres (1940-1959) / The colônia Juliano Moreira and its pavillion of phthisiology for women (1940-1959)

Este trabalho tem como objetivo apresentar e discutir a história do atendimento à tuberculose para as doentes mentais internadas na Colônia Juliano Moreira entre os anos de 1940 e 1959. Busca destacar, neste sentido, como a história desta instituição e de seu Pavilhão de Tisiologia esteve articulada às proposições do governo brasileiro, tanto no que diz respeito à área psiquiátrica, quanto no que se refere às políticas públicas de saúde para o combate à tuberculose.

A enfermeira diplomada e a luta contra tuberculose no Brasil: 1961-1966 / La enfermera diplomada y la lucha contra la tuberculosis en Brasil: 1961-1966 / The registered nurse and the battle against tuberculosis in Brazil: 1961-1966

O objeto desse estudo é a reconfiguração do Serviço de Enfermagem do Hospital Estadual Santa Maria, frente a uma nova política contra a tuberculose no Brasil. Objetivos: descrever as circunstâncias que ensejaram a implantação do novo Programa de Ação na Luta contra a Tuberculose no Brasil, e discutir as estratégias utilizadas pelas enfermeiras diplomadas do Hospital Estadual Santa Maria, no Estado da Guanabara, para adequar a assistência de enfermagem ao novo programa de combate à tuberculose. Estudo histórico-social. Para sua elaboração, foi realizada pesquisa documental, entrevistas e depoimentos de enfermeiras da época. A análise do corpus documental, apoiada pelos conceitos de habitus, campo e poder simbólico de Pierre Bourdieu, se fez com base em documentos escritos, orais e fontes secundárias. Resultados: a reconfiguração do serviço de enfermagem se deu sob a liderança de uma enfermeira cujo capital simbólico lhe conferia poder e prestígio para implementar as mudanças necessárias. Pode-se concluir que a atuação dessa enfermeira possibilitou a implantação do novo programa, e contribuiu para demarcar o espaço e a importância da enfermeira diplomada na assistência aos acometidos de tuberculose, tanto nos aspectos de prevenção quanto nos de cura.

The objective of this study was to describe the circumstances that promoted the implementation of the new Program for Action Against Tuberculosis in Brazil (Programa de Ação na Luta contra a Tuberculose no Brasil) and discuss the strategies used by registered nurses from the Santa Maria State Hospital, Guanabara State, to adjust nursing care to the new program against tuberculosis. This was performed through document research, interviews, and statements from nurses working at the time of the reorganization. Documents were analyzed based on the concepts of habitus, field, and symbolic power by Pierre Bourdieu, and included written and oral documents as well as secondary sources. The reorganization of the nursing service was performed under the leadership of a nurse whose symbolic capital assigned power and prestige to implement the necessary changes. It is concluded that the work of that nurse made it possible to implement the new program and contributed to establishing the position and importance of the registered nurse in providing care to individuals with tuberculosis, for prevention and cure.

El objeto de este estudio fue la reconfiguración del Servicio de Enfermería del Hospital Estatal Santa Maria, frente a una nueva política contra la tuberculosis en Brasil. Objetivos: describir las circunstancias que permitieron la implantación del nuevo Programa de Acción en la Lucha contra la Tuberculosis en Brasil, y discutir las estrategias utilizadas por las enfermeras diplomadas del Hospital Estatal Santa Maria, en el Estado de la Guanabara, para adecuar la asistencia de enfermería al nuevo programa de combate a la tuberculosis. Estudio histórico social. Para su elaboración, fueron realizadas una investigación documental y entrevistas/declaraciones de enfermeras de la época. El análisis del corpus documental, apoyado por los conceptos de habitus, campo y poder simbólico de Pierre Bourdieu, se hizo con base en documentos escritos, orales y fuentes secundarias. Resultados: la reconfiguración del servicio de enfermería sucedió bajo el liderazgo de una enfermera cuyo capital simbólico le confería poder y prestigio para implementar los cambios necesarios. Se puede concluir que la actuación de esa enfermera posibilitó la implantación del nuevo programa, y contribuyó para delimitar el espacio y la importancia de la enfermera diplomada en la asistencia a los acometidos de tuberculosis, tanto en los aspectos de prevención como en los de cura.

[The importance of rest in sanatoria for tuberculous patients]. / Importancia del reposo en los sanatorios para tuberculosos.

Since ancient times the main indication for the treatment of pulmonary phthisis consisted in prescribing trips to better climates, horseback riding or walking outdoors. In the second half of the XIXth century, the concept of sanatoria for TB therapy was developed in Europe, in order to confine patients in premises where abundant food, exposition to pure air and graded exercises were provided. In those places, rest progressively acquired more importance, becoming a thoroughly established ritual. In the XXth century, the regulations for the recently founded Chilean sanatoriums incorporated European schedules. In the case of Hospital Sanatorio El Peral, the rules became progressively stricter until 1952, when permanent rest in bed was determined as the regime required. This rule could be explained by the policy of using this sanatorium for the treatment of more serious forms of the disease.

Importancia del reposo en los sanatorios para tuberculosos / The importance of rest in sanatoria for tuberculous patients

Since ancient times the main indication for the treatment of pulmonary phthisis consisted in prescribing trips to better climates, horseback riding or walking outdoors. In the second half of the XIXth century, the concept of sanatoria for TB therapy was developed in Europe, in order to confine patients in premises where abundant food, exposition to puré air and graded exercises were provided. In those places, rest progressively acquired more importance, becoming a thoroughly established ritual. In the XXth century, the regulations for the recently founded Chilean sanatoriums incorporated European schedules. In the case of Hospital Sanatorio El Peral, the rules became progressively stricter until 1952, when permanent rest in bed was determined as the regime required. This rule could be explained by the policy of using this sanatorium for the treatment of more serious forms of the disease.

Desde la antigüedad, la indicación principal para el tratamiento de la tisis pulmonar consistía en prescribir viajes hacia climas más benignos, cabalgar o caminar al aire libre. En la segunda mitad del siglo XIX se desarrolló en Europa en concepto de sanatorios para la terapia de la tuberculosis (TBC), con el objeto de confinar a los pacientes en un establecimiento que les proporcionaba alimentación abundante, aire puro y ejercicios físicos graduales. En esos lugares adquirió progresivamente mayor importancia el reposo, que se convirtió en un ritual minuciosamente establecido. En el siglo XX los reglamentos de los sanatorios chilenos, recientemente fundados, incorporaron las disposiciones europeas. En el caso del Hospital Sanatorio El Peral, el reglamento se hizo progresivamente más estricto hasta determinar en 1952 que el régimen habitual era la permanencia de los pacientes en cama. Esta norma podría explicarse por la política de destinar dicho establecimiento al tratamiento de formas graves de la enfermedad.