Hydroxy-chloroquine to treat COVID-19 - infected patients: Some lessons from medical anthropology and history of medicine.

It is certainly too early to take stock of Professor Raoult's intuitions, and moreover, that is not the aim of this short article. Nevertheless, experience has shown that in times of unprecedented health crises, prescriptions often turn out to be adventurous, especially when it comes to a new virus. The collective imagination around a remedy often takes the place of a guarantee or, on the contrary, a safeguard. Here, the authors question the implementation of hydroxy-chloroquine treatment in the context of the COVID-19 pandemic. How was his prescription discussed in this context of crisis? What lesson can we learn from medical anthropology and the history of medicine, by witnessing other epidemics and atypical or unconventional substances or behaviors of practitioners?

Il est certainement trop tôt pour faire le point sur les intuitions du professeur Raoult, et ce n'est d'ailleurs pas le but de ce court article. Néanmoins, l'expérience a montré qu'en période de crise sanitaire sans précédent, les prescriptions se révèlent souvent aventureuses, surtout lorsqu'il s'agit d'un nouveau virus. L'imagination collective autour d'un remède se substitue souvent à une garantie ou, au contraire, à une sauvegarde. Ici, les auteurs s'interrogent sur la mise en œuvre du traitement à l'hydroxy-chloroquine dans le contexte de la pandémie de la COVID-19. Comment sa prescription a-t-elle été discutée dans ce contexte de crise ? Quelle leçon pouvons-nous tirer de l'anthropologie médicale et de l'histoire de la médecine, en étant témoins d'autres épidémies et de substances ou comportements atypiques ou non conventionnels des praticiens ?

COVID-19 NATURAL HISTORY AND ITS THERAPEUTIC RELATIONSHIPS / COVID-19 HISTORIA NATURAL Y SUS RELACIONES TERAPÉUTICAS / HISTÓRIA NATURAL DA COVID-19 E SUAS RELAÇÕES TERAPÊUTICAS

Objectives: Analyze the scientific production on COVID-19 and propose a schematic model on the natural history of COVID-19, according to its therapeutic relationships. Methods: Metasynthesis in the light of thinking about the natural history of the disease, comprising 40 research products selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes - PRISMA, through a search strategy limited to the PubMed® database, operationalized in June 2020. Results: The study demonstrated that one of the first challenges faced in this pandemic is to understand the natural history of COVID-19 to guide the implementation of efficient therapeutic activities. Although the provision of specific diagnostic tests is essential for the diagnosis of COVID-19, the lack of them would not be a barrier if the knowledge about the natural history of the disease was not incomplete, since the natural history of the disease is known to be the sovereign evidence parameter in clinical diagnosis and in the implementation of an efficient treatment protocol. Conclusions: A differentiated understanding of the presentation of the natural history of COVID-19 can help to determine the appropriate time to initiate therapeutic interventions relevant to each of the three phases of evolution of COVID-19.

Objetivos: Analice la producción científica en COVID-19 y proponga un modelo esquemático sobre la historia natural de COVID-19, de acuerdo con sus relaciones terapéuticas. Métodos: Metasíntesis a la luz de pensar en la historia natural de la enfermedad, que comprende 40 productos de investigación seleccionados de acuerdo con los Artículos de informes preferidos para revisiones sistemáticas y metaanálisis - PRISMA, a través de una estrategia de búsqueda limitada a la base de datos PubMed®, operativa en junio de 2020. Resultados: El estudio demostró que uno de los primeros desafíos que enfrenta esta pandemia es comprender la historia natural de COVID-19 para guiar la implementación de actividades terapéuticas eficientes. Aunque la provisión de pruebas de diagnóstico específicas es esencial para el diagnóstico de COVID-19, la falta de ellas no sería una barrera si el conocimiento sobre la historia natural de la enfermedad no fuera incompleto, ya que se sabe que la historia natural de la enfermedad es el parámetro de evidencia soberana en diagnóstico clínico y en la implementación de un protocolo de tratamiento eficiente. Conclusiones: Una comprensión diferenciada de la presentación de la historia natural de COVID-19 puede ayudar a determinar el momento apropiado para iniciar intervenciones terapéuticas relevantes para cada una de las tres fases de evolución de COVID-19.

Objetivos: Analisar a produção científica sobre COVID-19 e propor modelo esquemático sobre história natural da COVID-19, segundo suas relações terapêuticas. Métodos: Metassíntese à luz do pensamento sobre história natural da doença, contemplando 40 produtos de pesquisa selecionados segundo a Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA, mediante estratégia de busca circunscrita à base de dados PubMed®, operacionalizada em junho de 2020.  Resultados: O estudo demonstrou que um dos primeiros desafios enfrentados nesta pandemia é entender a história natural da COVID-19 para orientar a implementação de atividades terapêuticas eficientes. Embora o fornecimento de testes de diagnóstico específicos sejam fundamentais para diagnóstico da COVID-19, a falta deles não seria uma barreira se o conhecimento sobre história natural da doença não estivesse incompleto, pois, a história natural da doença é sabidamente o parâmetro de evidência soberano no diagnóstico clinico e na implementação de um protocolo de tratamento eficiente. Conclusões: Uma compreensão diferenciada sobre a apresentação  da história natural da COVID-19 pode ajudar a determinar o momento apropriado de iniciar as intervenções terapêuticas pertinentes a cada uma das três fases de evolução da COVID-19.

At the intersection of medical geography and disease ecology: Mirko Grmek, Jacques May and the concept of pathocenosis.

Environmental historians are not sufficiently aware of the extent to which mid twentieth-century thinkers turned to medical geography-originally a nineteenth-century area of study-in order to think through ideas of ecology, environment, and historical reasoning. This article outlines how the French-Croatian Mirko D. Grmek (Krapina, 1924-Paris, 2000), a major thinker of his generation in the history of medicine, used those ideas in his studies of historical epidemiology. During the 1960s, Grmek attempted to provide, in the context of the Annales School's research program under the leadership of Fernand Braudel, a new theoretical framework for a world history of disease. Its development was inspired by several sources, most notably the French-American Jacques M. May (Paris 1896-Tunisia, 1975), who was then pioneering an opening up of medical geography and movement towards the concept of disease ecology. The cornerstone of Grmek's "synthetic approach" to the field was the notion of "pathocenosis". The diverse uses of this notion in the course of time-from his early agenda focused on a longue durée history of diseases in Western Antiquity to his last, relating to the new epidemiological threat of (re)emerging infectious diseases, specifically HIV/aids-enables us firstly, to note how concepts of ecology sat uneasily alongside those of medical geography; secondly, to assess the reach and limits of his theoretical contribution to historical epidemiology; and thirdly, to understand better the uneven fortunes of his concept of pathocenosis at the end of the twentieth and beginning of the twenty-first centuries.

A Vida Sexual, de Egas Moniz: eugenia, psicanálise e a patologização do corpo sexuado feminino / A Vida Sexual (The Sexual Life), by Egas Moniz: eugenics, psychoanalysis, and the pathologization of the female sexed body

Resumo O artigo analisa a obra A vida sexual, do neurologista português Egas Moniz, que intencionava com ela divulgar instruções médicas sobre o corpo sexuado. Compilada nos tomos "Fisiologia" e "Patologia" em 1902, teve 19 edições até sua censura pelo Estado Novo português, em 1933. Nela, Moniz elabora um discurso de diferenciação sexual ancorado em ampla bibliografia produzida entre fins do século XIX e início do século XX, em um contexto de intensos debates acerca de papéis de gênero. Observa-se que seu autor recorreu a múltiplos dispositivos de significação da sexualidade - como a eugenia e a teoria freudiana - para difundir sua ideia de que "o homem é essencialmente sexual, a mulher é essencialmente mãe".

Abstract An analysis is presented of A vida sexual (The sexual life), by Portuguese neurologist Egas Moniz, in which the author divulged medical instructions about the sexed body. Complied in two volumes - "Physiology" and "Pathology" - in 1902, it was edited 19 times until it was censored under the Portuguese military dictatorship in 1933. In the work, Moniz devises a discourse of sexual differentiation anchored in an extensive bibliography produced between the late nineteenth and early twentieth centuries in a context of intense debate about gender roles. Moniz drew on several theories to define sexuality - including eugenics and Freudian theory - to express his idea that "man is essentially sexual, woman is essentially mother."

[Sudden death in Versailles: A review of a cardiovascular treatrise by Dionis (1710)]. / Les morts subites à Versailles : une relecture du traité de Dionis (1710).

In 1710, the surgeon Pierre Dionis publishes a Dissertation on sudden death. Echoing and expanding the work of his Roman colleague Jean Marie Lancisi, he describes and analyzes dozens of cases of sudden death observed by him. A large number of cases was followed by autopsies allowing clinicopathological confrontation. Are proposed causes of death (pulmonary embolism, myocardial infarction, hemorrhagic stroke, arterial rupture, etc.), pathophysiological mechanisms based on the ancient theory of humors, and preventive actions to avoid these unexpected deaths. In this article, we oppose these old data to those of current literature.

The Natural History of Brain Arteriovenous Malformations

Brain arteriovenous malformations (AVMs) are relatively rare lesions with irreversible consequences in the context of hemorrhage. They are characterized by direct connections between arteries and veins without an intervening capillary network. The natural history of brain AVMs is controversial in the literature, with low evidence level gathered in the papers published, and with large divergence of results among them. A detailed understanding of the natural history is critical for treatment decision. The risk of development of deleterious outcomes such as hemorrhage or brain infarction should always be considered when submitting a patient to the risks of treatment. Several factors related to the patient and to the AVMs are determinants in the natural history of this disease. The topography, size, morphology and angioarchitecture of AVMs determine the risk of rupture. Large AVMs, those located in the posterior fossa and with deep venous drainage, have higher risk of rupture. Due to divergence in the literature regarding the natural history of AVMs, the choice of treatment should also consider experiences acquired over the years from reference centers with a high number of AVMs treated per year. We determined 7 variables that should be considered during the decision to treat an AVM: 1) previous hemorrhage; 2) aneurysm associated to the AVM; 3) direct arteriovenous fistula; 4) factors related to the nidus; 5) age and habits (smoking, sedentary lifestyle, diet quality); 6) the functional performance of the patient; 7) psychological factors.

Malformações arteriovenosas (MAVs) são lesões caracterizadas por conexões diretas entre artérias e veias sem rede capilar. São relativamente raras e com consequências muitas vezes irreversíveis no contexto de hemorragia. A história natural das MAVs é controversa na literatura, com pouca evidência extraída dos artigos publicados, além de alta divergência entre resultados. Um entendimento detalhado da história natural da doença é determinante para a decisão do tratamento. O risco de desenvolver consequências deletérias como hemorragia ou isquemia deve ser sempre considerado antes de submeter pacientes ao tratamento. Vários fatores relacionados ao paciente e às MAVs são determinantes na história natural da doença. A localização, tamanho, morfologia e angioarquitetura das MAVs estimam o risco de ruptura. As MAVs grandes, de fossa posterior, com drenagem venosa profunda, têm maior risco de ruptura. A decisão de tratar deve também levar em conta a experiência do serviço, adquirida após anos de tratamento de MAVs. Nós determinamos 7 fatores que devem ser avaliados diante da decisão de tratamento das MAVs: 1) hemorragia prévia; 2) aneurismas associados à MAV; 3) fístula arteriovenosa; 4) fatores relacionados ao nidus; 5) idade e hábitos de vida; 6) performance funcional do paciente; 7) fatores psicológicos.

Oldest medical description of osteogenesis imperfecta (17th Century, France).

Osteogenesis imperfecta (OI), also known as Lobstein's syndrome or Vrolik's syndrome, comprises a heterogeneous group of rare genetic connective tissue disorders. It is characterized by increased bone fragility, low bone mass, and susceptibility to bone fractures of variable severity. Originally named "osteomalacia congenita," the condition was first medically described in a family by Ekman in 1778. Here, we report a 17th century medical account from France, which predates Eckman's doctoral dissertation by about a century. Medical analysis of this anatomical presentation indicates a precise diagnosis of Type I OI. Clin. Anat. 30:128-129, 2017. © 2016 Wiley Periodicals, Inc.

Organização da especialidade médica e controle do câncer do colo do útero no Brasil: o Instituto de Ginecologia do Rio de Janeiro em meados do século XX / Organization of medical specialization in cervical cancer and its control in Brazil: the Instituto de Ginecologia in Rio de Janeiro in the mid-twentieth century

Resumo O Instituto de Ginecologia, no Rio de Janeiro, sob chefia do médico Arnaldo de Moraes, foi pioneiro no país na introdução e difusão de técnicas médicas para controle do câncer do colo do útero, em meados do século XX. A instituição tornou-se referência nas ações sobre a doença no período, organizando um modelo específico de diagnóstico que particularizou a atuação da medicina brasileira em relação à enfermidade e foi referência no país até a década de 1970. O objetivo deste texto é discutir a organização e o funcionamento do instituto a partir de seu papel sob dois pontos de atuação: na afirmação da ginecologia como especialidade médica e na divulgação de um modelo de referência para o controle da doença.

Abstract Instituto de Ginecologia (Institute of Gynecology), in Rio de Janeiro, headed by Dr. Arnaldo de Moraes, was the first institution in Brazil to introduce and divulge medical techniques for the control of cervical cancer in the mid-1900s. It became a benchmark for actions geared towards the disease at the time, organizing a specific diagnostic procedure that set Brazilian medicine apart in the field, in which it remained a leader until the 1970s. The aim of this text is to discuss the organization and running of the institution from two perspectives: its role in enhancing the position of gynecology as a medical specialty, and its role in spreading a standard practice for the control of cervical cancer.

Organização da especialidade médica e controle do câncer do colo do útero no Brasil: o Instituto de Ginecologia do Rio de Janeiro em meados do século XX / Organization of medical specialization in cervical cancer and its control in Brazil: the Instituto de Ginecologia in Rio de Janeiro in the mid-twentieth century

O Instituto de Ginecologia, no Rio de Janeiro, sob chefia do médico Arnaldo de Moraes, foi pioneiro no país na introdução e difusão de técnicas médicas para controle do câncer do colo do útero, em meados do século XX. A instituição tornou-se referência nas ações sobre a doença no período, organizando um modelo específico de diagnóstico que particularizou a atuação da medicina brasileira em relação à enfermidade e foi referência no país até a década de 1970. O objetivo deste texto é discutir a organização e o funcionamento do instituto a partir de seu papel sob dois pontos de atuação: na afirmação da ginecologia como especialidade médica e na divulgação de um modelo de referência para o controle da doença.(AU)

Instituto de Ginecologia (Institute of Gynecology), in Rio de Janeiro, headed by Dr. Arnaldo de Moraes, was the first institution in Brazil to introduce and divulge medical techniques for the control of cervical cancer in the mid-1900s. It became a benchmark for actions geared towards the disease at the time, organizing a specific diagnostic procedure that set Brazilian medicine apart in the field, in which it remained a leader until the 1970s. The aim of this text is to discuss the organization and running of the institution from two perspectives: its role in enhancing the position of gynecology as a medical specialty, and its role in spreading a standard practice for the control of cervical cancer.(AU)

Cáncer de mama triple negativo: una enfermedad de difícil diagnóstico y tratamiento / Triple negative breast cancer: a difficult disease to diagnose and treat

El cáncer de mama triple negativo (CMTN) es una neoplasia maligna caracterizada por la ausencia de la expresión de los receptores de estrógeno, de progesterona y HER2. Estudios recientes han señalado que el CMTN es un grupo heterogéneo de distintas neoplasias, con pronósticos diferentes. Sin embargo, debido a que la realización de perfiles genéticos no es una práctica estándar para el diagnóstico convencional del cáncer de mama, se dificulta la apropiada identificación de este subtipo de cáncer de mama. El CMTN se caracteriza por tener patrones epidemiológicos de alta incidencia en poblaciones afroamericanas y latinas, y de menor incidencia en población caucásica y constituye un problema de salud pública por su elevada morbilidad y mortalidad. Ante la ausencia de blancos terapéuticos, la quimioterapia cumple un rol importante en el tratamiento, y muchos esfuerzos están destinándose a buscar otras combinaciones de quimioterapia y nuevas drogas, mientras que las actuales guías no especifican un tratamiento para este tipo de cánceres. En el presente documento se hace una revisión sobre las características epidemiológicas y clínicas, los posibles factores pronósticos y sobre algunas estrategias terapéuticas contra el CMTN.

Triple negative breast cancer (CMTN, Spanish acronym) is a malignant neoplasm characterized by the absence of expression of estrogen, progesterone and HER2 receptors. Recent studies have shown that CMTN is a heterogeneous group including different neoplasm with different prognosis. However, because genetic profiles are not a standard practice in conventional diagnosis of breast cancer, it is hard to properly identify this breast cancer subtype. CMTN is characterized by its high-incidence epidemiological patterns in African-American and Latin people, and lower incidence in Caucasian people, and constitutes a public health issue due to its high morbidity and mortality. Due to the absence of therapeutic targets, chemotherapy has a key role in treatment, and many efforts are being deployed to seek other combinations of chemotherapy and new drugs, while the current guides do not specify treatment for this type of cancer. This document reviews the epidemiological and clinical characteristics, the potential prognosis factors and some therapeutic strategies against CMTN.

Doenças infecciosas emergentes e a emergência das doenças: uma revisão conceitual e novas questões / Emerging infectious diseases and the emergence of diseases: a conceptual revision and new issues

Contrariamente às expectativas de erradicação das doenças infecciosas, constata-se a emergência, mundial, de doenças desconhecidas para a ciência ou consideradas erradicadas ou sob o controle dos serviços de vigilância epidemiológica. Neste artigo, pretende-se caracterizar o debate sobre as doenças infecciosas emergentes e analisar o conceito difundido pelas publicações dos Centros de Controle e Prevenção de Doenças (CDC) dos Estados Unidos e pelas contribuições das ciências humanas. A revisão da literatura nacional e internacional sobre a temática aponta as ambiguidades na definição das categorias "doença nova" e "doença emergente" e as diferenças entre o conceito de doenças infecciosas emergentes e o estudo da emergência das doenças. Enquanto o primeiro inclui o estudo de infecções específicas e foca a análise no organismo, no paciente e na população humana, o segundo, menos trabalhado, envolve as dimensões epistemológicas do conhecimento médico e da ecologia das doenças infecciosas emergentes, no nível sistêmico (no ecossistema e populações de parasitos e hospedeiros, quaisquer que sejam as espécies, e no comportamento sociocultural), e demanda a integração de várias disciplinas acadêmicas.

Contrary to expectations concerning the eradication of infectious diseases, it has been emerged, diseases worldwide that were unknown to science or considered to be eradicated or under control by epidemiological surveillance services. In this paper we outline the emergent infectious diseases debate and analyze the concept spread through publications from the Centers for Disease Control and Prevention (CDC) of the United States and through human science point of view. The review of national and international literature suggests some ambiguities in the definition of the categories "new disease" and "emerging disease" and the differences between the concept of emerging infectious diseases and the study of the emergence of diseases. Whilst the first concept includes the study of specific infections and focuses the analysis on the organism affected, on the patient and on the human population; the second concept - less studied - encompasses the study of the epistemological dimensions of medical knowledge and the ecology of emerging infectious diseases. This concept focuses on the systemic level - on the ecosystem and populations of parasites and hosts (whatever the species) and on the socio-cultural behavior - and demands the integration of various academic disciplines.

EVOLUTION OF SLIPPED CAPITAL FEMORAL EPIPHYSIS AFTER NONSURGICAL TREATMENT.

UNLABELLED: To evaluate the efficacy of conservative treatment of patients with slipped capital femoral epiphysis (SCFE) and the complications due to the progression of the disease. METHODS: 18 patients (26 hips) seen consecutively from December 1996 to August 2006 at the Orthopedics Service of Santa Casa de Misericórdia de São Paulo, who had been referred from other services with a diagnosis of SCFE and were treated without surgery, were retrospectively analyzed. RESULTS: Slip progression occurred in 19 hips (73%). Among the mild cases, eight remained mild, four became moderate and one became severe, according to the Southwick classification. Four out of the six originally moderate cases became severe and the two already severe cases worsened. CONCLUSION: Although today there is a consensus regarding the indication of surgical treatment for SCFE to prevent progression, some cases with confirmed diagnoses are still being treated conservatively. This is a major error, since it implies increased morbidity of the disease.

Evolução do escorregamento epifisário proximal do fêrmur após tratamento não cirúrgico / Evolution of slipped capital femoral epiphysis after nonsurgical treatment

OBJETIVO: Avaliar a eficácia do tratamento conservador em pacientes com epifisiólise proximal do fêmur (EEPF) e as complicações devidas à evolução da doença. MÉTODOS: Foram analisados, retrospectivamente, 18 pacientes (26 quadris) consecutivamente atendidos no período entre dezembro de 1996 e agosto de 2006 no Serviço de Ortopedia da Santa Casa de Misericórdia de São Paulo, encaminhados por outros serviços com diagnóstico de EEPF e tratados de forma não cirúrgica. RESULTADOS: A progressão do escorregamento aconteceu em 19 quadris (73 por cento), sendo que, dos quadris com escorregamento leve, oito permaneceram leves, quatro progrediram para moderados e um tornou-se grave pela classificação Southwick. Dos seis quadris classificados como moderados, quatro evoluíram para grave e os dois graves acentuaram-se um pouco mais. Conclusões: Apesar de a indicação cirúrgica ser hoje consenso no tratamento do EEEP para evitar a progressão do escorregamento, há ainda pacientes com diagnóstico confirmado que são tratados de forma conservadora, e isto representa um grande erro, pois implica no aumento da morbidade da doença.

OBJECTIVE: To evaluate the efficacy of conservative treatment of slipped capital femoral epiphysis (SCFE) and the complications due to the progression of the slip. METHODS: 18 patients (26 hips) seen consecutively from December 1996 to August 2006 at the Orthopedics Service of Santa Casa de Misericórdia de São Paulo, referred from other services with a SCFE diagnosis and treated without surgery were retrospectively analyzed. RESULTS: Slip progression was observed in 19 hips (73 percent). Among the mild cases, 8 remained mild, four turned moderate and one became severe according to Southwick classification. Four out of the six originally moderate cases became severe and the two already severe cases worsened. Conclusion: Despite there being a consensus regarding the use of surgical treatment to prevent SCFE progression, some cases are still being treated conservatively. This represents a grave error, since it increases the morbidity of the disease.

A gripe de longe e de perto: comparações entre as pandemias de 1918 e 2009 / The flu far and near: comparing the 1918 and 2009 pandemics

Neste debate, historiadores latino-americanos comparam a pandemia de gripe de 1918-1919 com a que varre o continente em 2009, sobretudo as experiências de México, Argentina e Brasil. Analisam as estratégias adotadas nos dois momentos, com ênfase em isolamento, vigilância em portos e aeroportos, intervenções nas cidades. Comparam a atuação dos Estados nacionais e governos locais, a posição dos médicos e dos meios de comunicação e o comportamento das populações, especialmente no tocante ao medo e à morte. Analisam o desempenho das estruturas de assistência às populações e as medidas terapêuticas e profiláticas recomendadas por órgãos públicos de saúde, por interesses privados ligados à venda de medicamentos e pelas medicinas populares e caseiras. O debate trata, ainda, da influência que a experiência de 1918 teve sobre as avaliações da crise atual, bem como do legado que deixará para o futuro.

Uropatias obstrutivas bilaterais fetais: sinais ultrassonográficos durante a gravidez e evolução pós-natal / Fetal bilateral obstructive uropathies: ultrasound findings during pregnancy and postnatal outcomes

OBJETIVO: verificar a associação entre sinais ultrassonográficos durante a gestação e evoluções pós-natais em casos de fetos com uropatias obstrutivas bilaterais, acompanhados de forma expectante. MÉTODOS: fetos com uropatias obstrutivas bilaterais apresentando oligoâmnio grave e tórax estreito foram comparados a fetos com uropatias obstrutivas bilaterais que não desenvolveram estas alterações com relação à presença ou ausência de cistos em ambos os rins e à presença ou ausência de hiperecogenicidade de parênquima em ambos os rins. Casos em que houve óbito do neonato foram comparados com aqueles em que o neonato teve alta do berçário em relação aos mesmos aspectos ecográficos renais acima citados, à presença de oligoâmnio grave e de tórax estreito. A sensibilidade, a especificidade, os valores preditivos positivo e negativo da presença de cistos renais bilaterais, hiperecogenicidade renal bilateral, oligoâmnio grave e tórax fetal estreito para óbito do neonato foram calculados. RESULTADOS: o oligoâmnio grave e o tórax estreito foram mais frequentes (p=0,03; p<0,001) nos fetos que tiveram cistos renais bilaterais quando comparados àqueles com parênquimas renais ecograficamente normais. O óbito neonatal foi mais frequente entre os casos que tiveram oligoâmnio grave (p<0,001), tórax estreito (p<0,001) e cistos renais bilaterais (p<0,002) quando respectivamente comparados aos casos sem essas alterações. Os melhores valores de sensibilidade, especificidade, valores preditivos positivo e negativo para óbito do neonato/lactente foram obtidos com o uso do aspecto ecográfico tórax estreito, tendo sido de 81,8, 100, 100 e 79,3 por cento, respectivamente. CONCLUSÕES: Em casos de fetos com uropatias obstrutivas bilaterais acompanhados de forma expectante, os sinais ultrassonográficos mais associados ao mau prognóstico são o oligoâmnio grave, o tórax fetal estreito e a presença de cistos renais bilaterais.

PURPOSE: to verify the association between ultrasonographic signs during gestation and post-delivery evolution in fetuses with bilateral obstructive uropathies, followed up in an expectant way. METHODS: fetuses with bilateral obstructive uropathies presenting severe oligoamnios and narrow thorax have been compared with fetuses with bilateral obstructive uropathies without those alterations, concerning the presence or absence of cysts in both kidneys, and the presence or absence of parenchymal hyperechogenicity in both kidneys. Cases of neonatal death were compared with cases of neonatal discharge from the nursery, regarding the same renal echographic aspects mentioned above, the presence of severe oligoamnios and narrow thorax. The sensitivity, specificity, positive and negative predictive value of the presence of bilateral renal cysts, bilateral renal hyperechogenicity, severe oligoamnios and narrow fetal thorax for the neonatal death were calculated. RESULTS: severe oligoamnios and narrow thorax were more frequent (p=0.03; p<0.001) in fetuses with bilateral renal cysts, as compared to those with echographically normal renal parenchyma. Neonatal death was more frequent among cases with severe oligoamnios (p<0.001), narrow thorax (p<0.001) and bilateral renal cysts (p<0.002), when respectively compared with cases without those alterations. The best values of sensitivity, specificity, positive and negative predictive value for the death of neonatal/breastfeeding infants were obtained using the echographic aspect of narrow thorax, and were 81.8, 100, 100 and 79.3 percent, respectively. CONCLUSIONS: in cases of fetuses with bilateral obstructive uropathies followed up in an expectant way, the ultrasonographic signs more associated to bad prognosis are severe oligoamnios, narrow fetal thorax and presence of bilateral renal cysts.

Re-hospitalizações e morte por insuficiência cardíaca: índices ainda alarmantes / Hospital readmissions and death from heart failure: rates still alarming

FUNDAMENTO: Os pacientes com insuficiência cardíaca (IC) que necessitam ser hospitalizados para compensação constituem grupo de maior gravidade, que evoluem com alta mortalidade e alta taxa de re-hospitalizações. OBJETIVO: Procuramos avaliar a atual história natural da IC por meio da taxa de mortalidade e de re-hospitalizações, nessa nova era do bloqueio neuro-hormonal. MÉTODOS: Acompanhamos a evolução de 263 pacientes com FE média de 27,1 por cento, internados para compensação, entre janeiro de 2005 e outubro de 2006. Foram hospitalizados somente os pacientes que após avaliação e medicação no PS não estavam em condições de ter alta. Os pacientes encontravam-se em CF III/IV, a idade média foi de 59,9±15,2 anos, a maioria homens e 63,1 por cento necessitaram de inotrópicos para compensação na fase aguda. RESULTADOS: O tempo médio de internação foi de 25,1±16,7 dias. Durante a internação 23 (8,8 por cento) morreram. Após a alta, no período médio de seguimento de 370 dias, dos 240 que tiveram alta, 123 (51,2 por cento) procuraram o PS de 1 a 12 vezes (total de passagens: 350), sendo 76 re-internados, sendo a média de dias da re-hospitalização de 23,5±18,0. No primeiro ano de seguimento 62 (25,8 por cento) pacientes morreram. CONCLUSÃO: A IC continua evoluindo com alta mortalidade e alta taxa de re-hospitalização. Ao final do primeiro ano 44,5 por cento desses pacientes não necessitaram passar no PS ou morreram, números que indicam que devemos continuar dando grande atenção aos portadores de IC, na tentativa de mudar a história natural dos portadores dessa síndrome, cada vez mais freqüente.

BACKGROUND: Patients who require hospitalization because of decompensated HF represent a group of the most seriously ill individuals who evolve with high mortality and hospital readmission rates. OBJECTIVES: We sought to evaluate the current natural course of HF by analyzing mortality and readmission rates in this new era of neurohormonal blockage. METHODS: We followed the progress of 263 patients with a mean EF of 27.1 percent, admitted for decompensated HF between January 2005 and October 2006. Patients readmitted were only those whose health status precluded discharge after assessment and drug treatment in the Emergency Department. Patients were classified as HF-FC III/IV, mean age was 59.9±15.2 years, most were men, and 63.1 percent required inotropic drugs for cardiac compensation in the acute phase. RESULTS: Average hospital stay was 25.1±16.7 days. During hospitalization, 23 (8.8 percent) patients died. After discharge, over an average follow-up period of 370 days, of the 240 patients who were discharged 123 (51.2 percent) returned to the Emergency Department 1 to 12 times (total number of visits: 350); 76 of them were readmitted, and the average length of readmission stay was 23.5±18.0 days. Over the first year of follow-up, 62 (25.8 percent) patients died. CONCLUSIONS: HF remains a condition associated with high mortality and high hospital readmission rates. At the end of the first year, 44.5 percent of these patients had not needed to visit the ER or had died, which indicates that we should provide HF patients with the best possible care in an attempt to change the natural course of this increasingly frequent syndrome.

People's way to fight the epidemic diseases in the early Choson period / 의사학

Epidemic diseases in the early Choson period were big problems to the people and society. However, the weapons to the epidemic diseases were very limited at that time. There were few drugs and well-trained practitioners for people. Most people could only depend on religious means and simple folklore medicine including inhalation of specific flavor. People tried to overcome or prevent the epidemics by praying, sorcery, ornaments, runaway and isolation. In most cases, the epidemic diseases came with or broke out from the famine, severe labour (especially in civil engineering) imposed by the ruling class. The epidemics of that time are thought to be typhoid fever, epidemic typhus, or similar febrile diseases.

Assessment by questionnaire of disease status of the pupils in two primary schools in Seoul

We studied the disease status by question-naire in seoul of the pupils in two primary schools on May, 1991 and carried out statistical analysis of their results. The following results were observed: 1) Total number of answered pupil was 2330; 1103 were male and 1227 were female and the ratio of male to female was 1:1.1. Average age was 9.27 years. 2) Number of the pupil with any present described was 499(21.4%) Majority was as follows: (1) Respiratory system diseases; 358(71.1%) (2) Skin & Subcutaneous tissue diseases; 36(7.2%) (3) Circulatory system diseases; 14 (2.8%) (4) Infectious diseases; 11 (2.2%) (5) Trauma; 7 (1.4%) 3) Number of the pupil with any disease on treatment was 225 (9.7%). Majority was as follows: (1) Respiratory system diseases; 108 among 358 (2) Skin & Subcutaneous diseases; 22 among 36 (3) Infectious diseases; 11 among 11 (4) Trauma; 3 among 7 (5) Mental disorders; 1 among 6 4) Number of the pupils with the past history of diseases described was 561 (24.1%). Majority was as follows: (1) Respiratory system diseases; 217 (38.7%) (2) Infectious diseases; 105 (18.7%) (3)Trauma; 74 (13.2%) (4) Nervous system & Sense organ diseases; 39 (7.0%) (5) Digestive system diseases; 27 (4.8%) 5) Number of the pupils with the past hospitalization history was 190 (8.2%). Majority was as follows: (1) Respiratory system diseases; 48 (25.3%) (2) Trauma; 41 (21.6%) (3) Infectious diseases; 18 (9.5%) (4) Genitourinary system diseases; 9 (4.7%) (5) Digestive system diseases; 6 (3.2%) 6) Number of the pupils with the past history fo sugery was 362 (15.5%). The types of surgery of the causative diseases requiring surgery were as follows: (1) Circumcision; 98 (4.2%) (2) Trauma; 73 (3.1%) (3) Tonsillectomy & Adenectomy; 46 (2.0%) (4) Inguinal herniectomy; 25 (1.1%) (5) Appendictomy; 10 (0.4%) (6) Intussusception; 10 (0.4%) 7) Number of the pupils with hearing disturbance was 498 (21.4%), with present illness of otitis media 19 (0.82%) and with the past history of otitis media 15 (0.64). 8) Number of the pupils with visual disturbance was 498 (21.4%), with myopia 233 (10%), with hyperopia 49 (2.1%), with strabismus 16 (0.7%), color blindness 7 (0.3%). 9) Number of the pupils hoping to consult with the physicians were 446 (19.1%). The contents of their consultation were as follows: (1) Dental problems; 81 (18.0%) (2) Extremity pain; 56 (13.0%)(3) Abdominal pain; 52 (12.0%) (4) Skin disease; 34 (7.6%) (5) Headache; 30 (6.7%) 10) Number of the pupil sttended to school inspite of disease was 846 (36.3%). The caustive diseases were as follows: (1) Upper respiratory infection; 217 (25,7%) (2) Abdominal pain; 27 (3.2%) (3) Fever; 24 (2.8%) (4) Trauma; 8 (0.9%) (5) Infection (Measles, Mumps, Chicken pox et.); 6 (0.7%) .