A Mediterranean paradigm? Convergence and divergence in the Southern European Health Care Systems / Um paradigma mediterrâneo? Convergência e divergência nos Sistemas de Saúde da Europa Meridional / ¿Un paradigma mediterráneo? Convergencia y divergencia en los Sistemas de Salud de Europa Meridional

The concept of a 'Mediterranean paradigm' was raised by Josep Figueras in 1994 as a distinctive Southern European model for the health care systems of Italy, Spain and Greece based on the basis of six factors. The subsequent debate (including Portugal, too) is reconstructed on the basis of pros and cons arguments. The specific contribution of the author to the debate - consisting in the proposal of the concept of 'health macro-region' as an analytic tool to pursue a more comprehensive approach in comparative terms on the basis of a connectionist model - is then presented in details by showing the peculiar characteristics of the Southern European health macro-region. Finally, an historical perspective involving three different kinds of temporality (long, middle and short span) is proposed in order to explain both the substantial similar timing (diachronic convergence) and, at the same time, the significant differences (synchronic divergences) among Southern European health care systems in the way and levels their national health services were implemented. (AU)

O conceito de um "paradigma mediterrâneo" foi levantado por Josep Figueras em 1994, como um modelo distinto do Sul da Europa para os sistemas de saúde da Itália, Espanha e Grécia, com base em seis fatores. O debate subsequente (incluindo também Portugal) é reconstruído com base em argumentos prós e contras. A contribuição específica do autor para o debate - consistindo na proposta do conceito de 'macrorregião da saúde' como ferramenta analítica para buscar uma abordagem mais abrangente em termos comparativos a partir de um modelo conexionista - é então apresentada em detalhes. mostrando as características peculiares da macrorregião da saúde do Sul da Europa. Finalmente, uma perspectiva histórica envolvendo três diferentes tipos de temporalidade (período longo, médio e curto) é proposta para explicar tanto o tempo substancialmente semelhante (convergência diacrônica) quanto, ao mesmo tempo, as diferenças significativas (divergências sincrônicas) entre os sistemas de saúde da Europa Meridional na forma e níveis de como seus serviços nacionais de saúde foram implementados. (AU)

El concepto de un "paradigma mediterráneo" fue levantado por Josep Figueras en 1994, como un modelo distinto del Sur de Europa para los sistemas de salud de Italia, España y Grecia, con base en seis factores. El debate subsecuente (que incluyó también a Portugal) se reconstruye con base en argumentos de pro y contra. La contribución específica del autor para el debate, que consiste en la propuesta del concepto de la 'macrorregión de la salud' como herramienta analítica para buscar un abordaje más incluyente en términos comparativos a partir de un modelo conexionista, se presenta entonces en detalles, mostrando las características peculiares de la macrorregión de la salud del sur de Europa. Finalmente, se propone una perspectiva histórica envolviendo tres diferentes tipos de temporalidad (largo, medio y corto espacio) para explicar tanto el tiempo substancialmente semejante (convergencia diacrónica) como, al mismo tiempo, las diferencias significativas (divergencias sincrónicas) entre los sistemas de salud de Europa Meridional en la forma y niveles en que se implementaron sus servicios nacionales de salud. (AU)

Molecular methods for diversity assessment among xanthomonads of Bulgarian and Macedonian pepper

ABSTRACT Bacterial spot is an important disease of pepper in Bulgaria and Macedonia. For characterization of Xanthomonas species associated with bacterial spot, 161 strains were collected from various field pepper-growing regions. Among them, 131 strains were identified as Xanthomonas euvesicatoria and 30 as Xanthomonas vesicatoria using species-specific primers and polymerase chain reaction followed by restriction fragment length polymorphism analysis. To assess the genetic diversity of the strains, two methods (Random Amplified Polymorphic DNA and Repetitive Element Palindromic-Polymerase Chain Reaction) were applied. Discriminatory index was calculated and analysis of molecular variance was carried out.Combined random amplified polymorphic DNA analysis of the X. euvesicatoria strains with primers CUGEA-4 and CUGEA-6 had greater discriminative power (0.60) than repetitive element palindromic-polymerase chain reaction with ERIC and BOX A1R primers, which makes this method applicable for strain diversity evaluation. Discrimination among the X. vesicatoria strains was achieved by the use of ERIC primers and only for the Bulgarian strains. The results demonstrated that X. euvesicatoria was more diverse than X. vesicatoria and heterogeneity was observed mainly in the Bulgarian populations. According to the analysis of molecular variance, genetic variations in X. euvesicatoria were observed among and within populations from different regions, while the differences between the two countries were minor. Following the principal coordinates analysis, a relation between the climatic conditions of the regions and a genetic distance of the populations may be suggested.

Pan, Syrinx and syringomyelia / Pan, Syrinx e siringomielia

ABSTRACT Many myths and legends have had a deep influence on modern language, and on modern medical vernacular. The terms "syrinx" and "panic"are two of the most characteristic examples and their use in neurology and other specialties is well known. This article reviews the history of these words in Greek mythology and their use in modern medicine. It is known by very few that clinical symptoms or conditions, such as syringomyelia and panic attacks, have a mythological origin in their definition and naming.

RESUMO Muchos mitos y leyendas han tenido una profunda influencia sobre el lenguaje y el uso del argot médico moderno. Los términos "syrinx" y "pánico" son dos de los ejemplos más característicos y su uso en neurología y otras especialidades es bien conocido. Este artículo revisa la historia de estas palabras en la mitología griega y su uso en la medicina moderna. Es conocimiento de pocos que síntomas o condiciones como la siringomielia o los ataques de pánico, tienen un origen mitológico en su definición y denominación.

Perceptions of critical and emergency department nurses regarding changes in their professional role / Percepção dos enfermeiros dos serviços críticos e de emergência em relação a mudanças no seu papel profissional / Percepciones de enfermeros en el departamento crítico y de emergencia en lo que se refiere a cambios en su papel profesional

ABSTRACT Objective Preliminary investigation of the way Greek critical and emergency department nurses conceptualize changes in their professional role. Method A qualitative focus-group methodology was applied. Following purposeful sampling and informed consent of participants. Results Participated eight individuals. The need for enhancement of nurses' participation in decision-making in order for an actual change in their professional role to be achieved was the central theme of participants' narratives. Perceived advancements in professional role performance regarded: evidence-based practice; technology; education, knowledge; clinical skills; research; heightened nurse-physician collaboration. Perceived reasons why these advancements failed to enhance nurses' professional role were lack of meritocracy; competitive relationships; lack of support among nurses; insufficient managerial support; budget limitations. Conclusion Despite advancements in clinical practice, participants did not deem that their professional role was enhanced significantly, as participation in decision-making and control over practice remain limited. Interventions targeted to enhance nurses' participation in clinical decision-making, and overall professional autonomy are recommended.

RESUMO Objetivo Investigar preliminarmente a forma como os enfermeiros gregos de enfermagem crítica e de emergência conceituam as mudanças no seu papel profissional. Método Aplicou-se metodologia qualitativa de grupo focal. Após amostragem intencional e consentimento informado dos participantes. Resultados Participaram oito indivíduoas. A necessidade de reforçar a participação dos enfermeiros na tomada de decisões para que uma mudança real no seu papel profissional fosse alcançada foi o tema central das narrativas dos participantes. Avanços constatados no desempenho profissional: prática baseada em evidências; tecnologia; educação, conhecimento; habilidades clínicas; pesquisa; profunda colaboração enfermeiro-médico. As razões pelas quais esses avanços não conseguiram reforçar o papel profissional dos enfermeiros foram falta de meritocracia, relações competitivas, falta de apoio entre enfermeiros, apoio hierárquico insuficiente e limitações orçamentárias. Conclusão Apesar dos avanços na prática clínica, os participantes não consideraram que seu papel profissional foi aumentado significativamente, uma vez que a participação na tomada de decisões e no controle de sua prática permanece limitada. São recomendadas intervenções destinadas a reforçar a participação dos enfermeiros na tomada de decisões clínicas e a aumentar a sua autonomia profissional.

RESUMEN Objetivo Investigación preliminar acerca de la manera cómo los enfermeros griegos del departamento crítico y de emergencia conceptualizan los cambios en su papel profesional Método Una metodología de grupo focal cualitativa fue aplicada. Previo muestreo significativo y consentimiento informado de los participantes. Resultados Ocho individuos participaron. La necesidad de mejora de la participación de los enfermeros en la toma de decisiones a fin de proporcionar un cambio real en su papel profesional fue el tema central de las narrativas de los participantes. Avances percibidos en el papel estimado de desempeño profesional; prática basada en evidencias; tecnología; educación, conocimiento; habilidades clínicas; investigación; colaboración intensificada enfermero-médico. Razones percibidas por las que dichos avances fallan en mejorar en papel profesional del enfermero fueron la falta de meritocracia; relaciones competitivas; falta de apoyo entre los enfermeros; insuficiente soporte de gestión; limitaciones presupuestarias. Conclusión Pese a los avances en la práctica clínica, los participantes no consideran que su papel profesional haya mejorado significativamente, puesto que la participación en la toma de decisiones y su control sobre la práctica permanecen limitados. Se recomiendan intervenciones con vistas a incrementar la participación enfermera en la toma de decisiones clínicas e una autonomía profesional general.

Quality of life, depression, anxiety and loneliness in patients with bullous pemphigoid. A case control study

Abstract: Background: Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. Objective: The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. Methods: Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. Results: The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). Conclusion: BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity.

Improvement of health-related quality of life and adherence to treatment with calcipotriol-betamethasone dipropionate gel in patients with psoriasis vulgaris

Abstract BACKGROUND: Psoriasis is a common, chronic, recurrent, immune-mediated disorder of the skin and joints. It can have a significant negative impact on the physical, emotional and psychosocial wellbeing of affected patients. OBJECTIVES: To measure improvement in health-related QoL (HRQoL) in Greek patients with psoriasis vulgaris after a month of treatment with calcipotriol-betamethasone dipropionate gel; and evaluate adherence to treatment parameters. METHODS: The study included 394 psoriasis vulgaris patients from 16 private dermatological practices in Greece, all treated with calcipotriol-betamethasone dipropionate gel. They were evaluated at the first visit and after 4 weeks. Moreover, they completed the Dermatology Life Quality Index (DLQI), while other data such as disease severity, subjective symptoms and adherence, were collected. RESULTS: At week 4, the DLQI median was reduced by 3.5 points from the baseline (p<0.001; baseline and week 4 median: 4.5 and 1.0 respectively). Pruritus and sleep disorders also improved (p<0.001). Furthermore, 90.1% of the subjects fully adhered to treatment, with a 97.1% mean level of compliance. CONCLUSIONS: The convincing clinical results, with a distinct improvement in HRQoL, plus the high level of adherence due to its advantageous physical properties, make the calcipotriol-betamethasone dipropionate gel formulation an important, effective and well-tolerated topical therapy to treat psoriasis.

Quality of life and psychosocial aspects in Greek patients with psoriasis: a cross-sectional study

Abstract: BACKGROUND: Psoriasis is a common, long-term skin disease associated with high levels of psychological distress and a considerable adverse impact on life. The effects of psoriasis, beyond skin affliction, are seldom recognized and often undertreated. OBJECTIVE: The aim of the study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients with psoriasis. METHODS: Eighty-four patients with psoriasis were enrolled in the study. The quality of life, depression and anxiety, loneliness and self-esteem of the patient were assessed using the Dermatology Life Quality Index, Hospital Anxiety and Depression Scale, the UCLA loneliness Scale (UCLA-Version 3) and Rosenberg's Self-esteem Scale, respectively. RESULTS: The Dermatology Quality of Life Index score among psoriasis patients was 12.61 ± 4.88. They had statistically significantly higher scores according to the Hospital Anxiety and Depression Scale -anxiety subscale (p=0.032)-compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale (p=0.033) and RSES-scale (p<0.0001). Female patients presented with lower self-esteem than male patients. CONCLUSION: Psoriasis is a distressing, recurrent disorder that significantly impairs quality of life. Therefore, the recognition and future management of psoriasis may require the involvement of multi-disciplinary teams to manage the physical, psychological and social aspects of the condition, as is the case for systemic, long-term conditions.

The dialectics of new fascism in Greece / A dialética do novo fascismo na Grécia

The success of historical fascism in the particular transitional period at the beginning of the 20th century was grounded in its contribution to the successive acceptance and application of the so-called Fordist model for the organization of labor (accompanied by the correspondent social conditions and relations). Historical fascism contributed thus, with its particular way, to establishing a new class compromise between the potentials related with the productive forces and the confinements emanating from the productive relations. This contribution constitutes the "creativity" of fascism. Such a historical perspective on social processes allows us not to fall into the trap of understanding fascism only as a (barbarian) "deception". Fascism cannot be a plain deception, because a "mere deceit" cannot mobilize people. Fascism takes over, adopts real and unfulfilled needs and hopes - which as such constitute resistance to the capitalist arrogance and logic of commodification of everything - and offers its own (fascist, barbarian) solution or fulfillment. Consequently, our responsibility cannot lie in rejecting these needs and hopes (which are basically needs and hopes for security) because of their distorted or "pervert" articulations. Our responsibility lies in the careful peeling of these hopes/demands from their (fascist) enwrapment. Nationalism (from the subalterns!) does not constitute a mere irrational leftover from the past, but contains potentially mystic and romantic pre- or anti-capitalist elements and references. Nationalism obtains its dynamics and persuasion (for the subalterns!) from and for the contemporary societal processes, thus constituting an active, political and actual demand/position within the restructuring of society - which is in itself a moment in the restructuring of capitalism. Herein also the "rational kernel" of the anti-capitalist antithesis by the New Right is founded as counter position to the "neutral"...

O sucesso do fascismo histórico no período de transição, em particular no início do século 20, foi baseado em sua contribuição para a aceitação e aplicação sucessiva do chamado modelo fordista para a organização do trabalho (acompanhada das condições e relações sociais correspondentes). Fascismo histórico contribuiu assim, em sua forma particular, com a criação de um novo compromisso de classe entre os potenciais relacionados com as forças produtivas e as prisões que emanam das relações produtivas. Esta contribuição constitui a "criatividade" do fascismo. Tal perspectiva histórica sobre os processos sociais, não nos permite cair na armadilha de se compreender o fascismo apenas como um (bárbaro) "engano". O fascismo não pode ser um engano simples, porque um "mero engano" não pode mobilizar as pessoas. Fascismo assume, adota necessidades e esperanças reais e não cumpridas - que, como tal, constituem resistência à arrogância capitalista e lógica da mercantilização de tudo -, e oferece a sua própria solução (fascista, bárbara) ou sua realização. Por conseguinte, a nossa responsabilidade não pode mentir em rejeitar essas necessidades e esperanças (que são, basicamente, precisas e esperar pela segurança) por causa de suas articulações distorcidas ou "pervertido". Nossa responsabilidade exige-nos cuidadosas esperanças e demandas de seu (fascista) envolvimento. Nacionalismo (a partir dos subalternos!) não constitui uma mera sobra irracional do passado, mas contém potencialmente elementos anticapitalistas e referencias pré-místicas e românticas. Nacionalismo obtém sua dinâmica e persuasão (para os subalternos!) de e para os processos sociais contemporâneos, constituindo, assim, uma demanda/posição ativa, política e real no âmbito da reestruturação da sociedade - que é em si mesmo um momento na reestruturação do capitalismo. Aqui também o "núcleo racional" da antítese anticapitalista pela Nova Direita é fundada como posição contrária à mercantilização...

Migraine and tension-type headache triggers in a Greek population / Fatores desencadeantes de enxaqueca e de cefaleia tipo tensional em uma população grega

Migraine and tension type headache are the two most common primary headaches. The purpose of this study was to detect differences in clinical characteristics and headache triggers and in a Greek cohort of 51 migraineurs and 12 patients with tension-type headache. (TTH) Migraine patients had a significantly lower age at headache onset and frequency, higher mean visual analogue scale (VAS) and greater maximum duration of headache episodes compared to TTH patients. They did not differ from (TTH) patients in quality of headache, laterality of pain, way of headache installation and progression and temporal pattern of headaches. Nausea, vomiting and phonophobia were more frequent in migraine. Triggering of headaches by dietary factors was associated with migraine, whereas there was no difference between the two groups in any of the other headache triggers. Stress, both physical and psychological, were particularly common in both patient groups.

Enxaqueca e cefaleia tipo tensional são as duas cefaleias primárias mais frequentes. O propósito deste estudo foi avaliar as diferenças e características dos fatores desencadeantes destas cefaleias numa coorte grega de 51 pacientes com enxaqueca e 12 com cefaleia tipo tensional. Pacientes com enxaqueca tinham uma idade significativamente menor por ocasião do início da cefaleia e maior frequência, maiores valores de (VAS) e maior duração dos episódios em comparação com os pacientes com (CTT). Não houve diferença entre os pacientes com enxaqueca e (CTT) com relação à qualidade e lateralidade da dor, na forma de instalação e progressão, e no padrão temporal das cefaleias. Náuseas, vômitos e fonofobia foram mais frequentes em enxaqueca. Fatores desencadeantes na dieta estavam associados à enxaqueca, enquanto não houve diferença entre os dois grupos para outros fatores desencadeantes. Estresse físico e psicológico foram particularmente prevalentes em ambos os grupos de pacientes.

Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas

Envenoming snakebites are thought to be a particularly important threat to public health worldwide, especially in rural areas of tropical and subtropical countries. The true magnitude of the public health threat posed by snakebites is unknown, making it difficult for public health officials to optimize prevention and treatment. The objective of this work was to conduct a systematic review of the literature to gather data on snakebite epidemiology in the Amazon region and describe a case series of snakebites from epidemiological surveillance in the State of Amazonas (1974-2012). Only 11 articles regarding snakebites were found. In the State of Amazonas, information regarding incidents involving snakes is scarce. Historical trends show an increasing number of cases after the second half of the 1980s. Snakebites predominated among adults (20-39 years old; 38%), in the male gender (78.9%) and in those living in rural areas (85.6%). The predominant snake envenomation type was bothropic. The incidence reported by the epidemiological surveillance in the State of Amazonas, reaching up to 200 cases/100,000 inhabitants in some areas, is among the highest annual snakebite incidence rates of any region in the world. The majority of the cases were reported in the rainy season with a case-fatality rate of 0.6%. Snakebite envenomation is a great disease burden in the State of Amazonas, representing a challenge for future investigations, including approaches to estimating incidence under-notification and case-fatality rates as well as the factors related to severity and disabilities.

Measuring professional satisfaction and nursing workload among nursing staff at a Greek Coronary Care Unit / Avaliação da satisfação profissional e carga laboral das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas / Evaluación de la satisfacción profesional y de la carga laboral del personal de enfermería en las Unidades Griegas de Cuidados Coronarios

ABSTRACT Objective To explore potential associations between nursing workload and professional satisfaction among nursing personnel (NP) in Greek Coronary Care Units (CCUs). Method A cross-sectional study was performed involving 66 members of the NP employed in 6 randomly selected Greek CCUs. Job satisfaction was assessed by the IWS and nursing workload by NAS, CNIS and TISS-28. Results The response rate was 77.6%. The reliability of the IWS was α=0.78 and the mean score 10.7 (±2.1, scale range: 0.5-39.7). The most highly valued component of satisfaction was “Pay”, followed by “Task requirements”, “Interaction”, “Professional status”, “Organizational policies” and “Autonomy”. NAS, CNIS and TISS-28 were negatively correlated (p≤0.04) with the following work components: “Autonomy”, “Professional status”, “Interaction” and “Task requirements”. Night shift work independently predicted the score of IWS. Conclusion The findings show low levels of job satisfaction, which are related with nursing workload and influenced by rotating shifts.

RESUMO Objetivo Explorar as potenciais associações entre a carga laboral e a satisfação profissional das equipes de enfermagem nas Unidades de Cuidados Coronarianos Gregas. Método Estudo transversal com 66 membros das equipes que desenvolvem suas atividades em seis diferentes unidades, selecionadas aleatoriamente. A satisfação no trabalho foi avaliada pelo Index of Work Satisfaction (IWS) e a carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Antervention Score (CNIS) e Therapeutic Intervention Scoring System-28 (TISS-28). Resultados A taxa de resposta foi de 77.6%. A confiabilidade do IWS foi de α=0.78 e a média 10.7 (±2.1,intervalo:0.5-39.7). O componente de satisfação mais valorizado foi “Remuneração”, seguido por “Requisitos da Tarefa”, “Interação”, “Status Profissional”, “Políticas Organizacionais” e “Autonomia”. NAS, CNIS e TISS-28 foram correlacionados negativamente (p≤0.04) com os seguintes componentes de trabalho: “Autonomia”, “Status Profissional”, “Interação” e “Requisitos da Tarefa”. O trabalho no turno noturno definiu independentemente o índice de IWS. Conclusão Os resultados mostraram níveis baixos de satisfação no trabalho, que estão relacionados com a carga laboral e influenciados pelos turnos rotativos.

RESUMEN Objetivo Explorar las asociaciones potenciales entre la carga laboral y la satisfacción profesional del personal de enfermería en las Unidades Griegas de Cuidados Coronarios. Método Estudio transversal en 66 miembros das equipes, seleccionados al azar, que están empleados en 6 diferentes unidad griegas. La satisfacción en el trabajo se evaluó por el Index of Work satisfaction (IWS) y la carga laboral pelo Nursing Activities Score (NAS), Comprehensive Nursing Intervention Score (CNIS) y Therapeutic Intervention Scoring System-28 (TISS-28). Resultados La tasa de respuesta fue del 77,6%. La fiabilidad del IWS fue de α=0,78 y la media 10,7(±2,1, rango de escala:0,5-39,7). El componente de la satisfacción más valorado fue “Salario”, seguido de “Requisitos de la tarea”, “Interacción”, “Estatus Profesional”, “Políticas Organizacionales” y “Autonomía”. NAS, CNIS y TISS-28 se correlacionaron negativamente (p≤0.04) con los siguientes componentes de trabajo:”Autonomía”, “Estatus Profesional”, “Interacción” y “Requisitos de la tarea”. El trabajo en el turno nocturno definió independientemente el índice de IWS. Conclusión Los resultados muestran bajos niveles de satisfacción en el trabajo del personal de enfermería que están relacionados con la carga laboral e influenciados por los turnos rotativos.

Development of Anatomophysiologic Knowledge Regarding the Cardiovascular System: From Egyptians to Harvey / Evolução do Conhecimento Anatomofisiológico do Sistema Cardiovascular: dos Egípcios a Harvey

Our knowledge regarding the anatomophysiology of the cardiovascular system (CVS) has progressed since the fourth millennium BC. In Egypt (3500 BC), it was believed that a set of channels are interconnected to the heart, transporting air, urine, air, blood, and the soul. One thousand years later, the heart was established as the center of the CVS by the Hippocratic Corpus in the medical school of Kos, and some of the CVS anatomical characteristics were defined. The CVS was known to transport blood via the right ventricle through veins and the pneuma via the left ventricle through arteries. Two hundred years later, in Alexandria, following the development of human anatomical dissection, Herophilus discovered that arteries were 6 times thicker than veins, and Erasistratus described the semilunar valves, emphasizing that arteries were filled with blood when ventricles were empty. Further, 200 years later, Galen demonstrated that arteries contained blood and not air. With the decline of the Roman Empire, Greco-Roman medical knowledge about the CVS was preserved in Persia, and later in Islam where, Ibn Nafis inaccurately described pulmonary circulation. The resurgence of dissection of the human body in Europe in the 14th century was associated with the revival of the knowledge pertaining to the CVS. The main findings were the description of pulmonary circulation by Servetus, the anatomical discoveries of Vesalius, the demonstration of pulmonary circulation by Colombo, and the discovery of valves in veins by Fabricius. Following these developments, Harvey described blood circulation.

O conhecimento da anatomofisiologia do Sistema Cardiovascular (SCV) progride desde o quarto milênio AC. No Egito (3500 AC), acreditava-se que um conjunto de canais conectava-se ao coração, transportando ar, urina, ar, sangue e a alma. Mil anos após, o Corpo Hipocrático, na escola médica de Kós, estabeleceu o coração como o centro do SCV, definindo algumas características deste órgão. O SCV transportava sangue via ventrículo direito pelas veias, e o pneuma via ventrículo esquerdo pelas artérias. Duzentos anos depois, em Alexandria, com o aparecimento da dissecção anatômica do corpo humano, Herophilus descobriu que as artérias eram seis vezes mais espessas que as veias, enquanto que Erasistratus descreveu as válvulas semilunares, enfatizando que as artérias eram preenchidas por sangue quando o ventrículo esquerdo se esvaziava. Duzentos anos depois, Galeno demonstrou que as artérias continham sangue, não ar. Com o declínio do Império Romano, todo o conhecimento médico Greco-romano do SCV foi preservado na Pérsia, e posteriormente no Islã, onde Ibn-Nafis descreveu incompletamente a circulação pulmonar. Aqui, deve-se enfatizar a incompleta descrição da circulação pulmonar por Ibn-Nafis. A ressurgência da dissecção do corpo humano na Europa no século XIV é associada ao renascimento do conhecimento do SCV. Os principais marcos foram a descrição da circulação pulmonar por Servetus, as descobertas anatômicas de Vesalius, a demonstração da circulação pulmonar por Colombo, e a descoberta das válvulas das veias por Fabricius. Tal contexto abriu o caminho para Harvey descobrir a circulação do sangue.

Una mirada histórica: una civilización olvidada: medicina y ritos funerarios / A forgotten civilization: medicine and funeral rites

El trabajo recuerda a los Tracios, pueblos de la antigüedad desarrollados desde el tercer milenio antes de Cristo y extendidos en una amplia área que comprendía la parte oriental de la Península de los Balcanes hasta zonas costeras del Asia Menor.La herencia dorada de Homero, Hesiodo y Heródoto, nos permiten conocer el antiguo pueblo que en sentido étnico, hablaba “tracio”, una rama de la familia de las lenguas indoeuropeas. Los mitos griegos que han enriquecido la literatura universal y que colaboran con los hallazgos arqueológicos, nos permiten describir la medicina y los ritos funerarios tracios

This work reminds the people from Thrace and all the other people included under that name, that covered different regions. They developed from the third millenium before Christ. They extended from the oriental part of the Peninsula of Balkan until the costal región of Minor Asia. The golden heritage of Hesiodo, Homero and Herodoto, let us know the old popolution that, in ethnic sense used to talk of “tracio”, an old brank of the family of indoeuropean languages The greek miths that have enriched universal literatura and that used to cooperate in the archeological find. They allow us to describe the tracios medicine and the funeral rites

Rufus de éfeso (I d.C. ), médico y anatomista greco-romano / Rufus of ephesus (I a.C. ), medical doctor and greco-roman anatomist

Rufus de Éfeso (I d.C.), prominente médico-cirujano y anatomista greco-romano. Experto en anatomia, fisiología, observación clínica, cirugía y en el tratamiento de enfermedades, realizo hallazgos anatómicos y fisiológicos extraordinarios, entre otros permanecen conservados fragmentos de sus obras como: en la nomenclatura de las partes del cuerpo humano, en enfermedades del riñón y la vejiga, así como y en el interrogatorio del paciente.

Rufus of Ephesus (I a.C.), outstanding medical doctor, surgeon and greco-roman anatomist. Expert in anatomy, physiology, clinical observation, surgery and in treatment of the diseases, He realized extraordinary anatomical and physiological findings; among others remain conserved fragments of his works like: In nomenclature of the parts of the human body, In diseases of the kidney and the bladder, and In the interrogation of the patient.

Cross-cultural analysis of the motor development of Brazilian, Greek and Canadian infants assessed with the Alberta Infant Motor Scale / Análisis transcultural del desarrollo motor de niños brasileños, griegos y canadienses evaluados con la Alberta Infant Motor Scale / Análise transcultural do desenvolvimento motor de crianças brasileiras, gregas e canadenses avaliadas com a Alberta Infant Motor Scale

OBJECTIVE: To compare the motor development of infants from three population samples (Brazil, Canada and Greece), to investigate differences in the percentile curves of motor development in these samples, and to investigate the prevalence of motor delays in Brazilian children. METHODS: Observational, descriptive and cross-sectional study with 795 Brazilian infants from zero to 18 months of age, assessed by the Alberta Infant Motor Scale (AIMS) at day care centers, nurseries, basic health units and at home. The Brazilian infants' motor scores were compared to the results of two population samples from Greece (424 infants) and Canada (2,400 infants). Descriptive statistics was used, with one-sample t-test and binomial tests, being significant p≤0.05. RESULTS: 65.4% of Brazilian children showed typical motor development, although with lower mean scores. In the beginning of the second year of life, the differences in the motor development among Brazilian, Canadian and Greek infants were milder; at 15 months of age, the motor development became similar in the three groups. A non-linear motor development trend was observed. CONCLUSIONS: The lowest motor percentiles of the Brazilian sample emphasized the need for national norms in order to correctly categorize the infant motor development. The different ways of motor development may be a consequence of cultural differences in infant care. .

OBJETIVO: Comparar el desarrollo motor de niños de tres muestras poblacionales (Brasil, Canadá y Grecia), verificar las diferencias en las curvas de percentiles del desarrollo motor para esas muestras e investigar la prevalencia de retardos motores en niños brasileños. MÉTODOS: Estudio observacional, descriptivo y transversal, del que participaron 795 niños brasileños con edad entre 0 y 18 meses, evaluados con la Alberta Infant Motor Scale (AIMS) en las escuelas infantiles, maternidades, unidades de salud pública y en domicilio. Los escores motores de niños brasileños fueron comparados a los resultados de investigaciones con los grupos poblacionales de Grecia (424 niños) y de Canadá (2.400 niños). Se utilizó la estadística descriptiva, con las pruebas one-sample t-test y binominal, siendo significante p≤0,05. RESULTADOS: Se observó que el 65,4% de los niños brasileños presentaron desempeño motor normal, aunque con escores medianos más bajos que los otros grupos. En el inicio del segundo año de vida, las diferencias de desempeño entre los niños brasileños, canadienses y griegos se redujeron y, a los 15 meses, el desempeño motor se hizo semejante. Se verificó tendencia de adquisiciones motoras no lineales. CONCLUSIONES: Los percentiles más bajos de la muestra brasileña reforzaron la necesidad de usarse normas nacionales para categorizar adecuadamente el desempeño motor. Los distintos recorridos del desarrollo motor son posiblemente decurrentes de diferencias culturales en el cuidado del niño. .

OBJETIVO: Comparar o desempenho motor de crianças de três amostras populacionais (Brasil, Canadá e Grécia), verificar as diferenças nas curvas de percentis do desenvolvimento motor para essas amostras e investigar a prevalência de atrasos motores em crianças brasileiras. MÉTODOS: Estudo observacional, descritivo e transversal, do qual participaram 795 crianças brasileiras com idade entre zero e 18 meses, avaliadas com a Alberta Infant Motor Scale (AIMS) nas escolas infantis, maternidades, unidades de saúde pública e em domicílio. Os escores motores de crianças brasileiras foram comparados aos resultados de pesquisas com os grupos populacionais da Grécia (424 crianças) e do Canadá (2.400 crianças). Utilizou-se estatística descritiva, com os testes one-sample t-test e binomial, sendo significante p≤0,05. RESULTADOS: Observou-se que 65,4% das crianças brasileiras apresentaram desempenho motor normal, embora com escores médios mais baixos que os outros grupos. No início do segundo ano de vida, as diferenças de desempenho entre as crianças brasileiras, canadenses e gregas diminuíram e, aos 15 meses, o desempenho motor tornou-se semelhante. Verificou-se tendência de aquisições motoras não lineares. CONCLUSÕES: Os percentis mais baixos da amostra brasileira reforçam a necessidade de se usarem normas nacionais para categorizar adequadamente o desempenho motor. As diferentes trajetórias do desenvolvimento motor são possivelmente decorrentes de diferenças culturais no cuidado das crianças. .

The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece: results of a population survey / O impacto da acne vulgar na qualidade de vida e saúde psíquica em jovens adolescentes na Grécia: resultados de uma pesquisa populacional

BACKGROUND: Acne vulgaris can severely affect social and psychological functioning. OBJECTIVE: The aim of this study was to investigate the impact of acne vulgaris and its severity on Quality of Life of young adolescents in Greece. METHODS: We conducted a questionnaire based survey among 1560 adolescent between the ages of 11 and 19 years old and 1531 of these were completed. Adolescents with acne filled all the questions including the Children Dermatology Life Quality Index. Adolescents without acne filled the questions about age, family history of acne, stress and smoking. Data were analyzed with Pearson Chi Square test. RESULTS: Acne prevalence was 51.2% affecting both sexes equally. Self reported mild acne was present in 71.2% and moderate-severe acne in 28.8% of the study population. The mean age of the study population was 15.77y. The median score of Children Dermatology Life Quality Index was 4.02. The impact of acne on quality of life is associated with the severity of the acne (p<0.0001). Patients with moderate/severe acne experience greater psychosocial and emotional impairment (p<0.0001). Body image is modified proportionally to the severity of acne (p<0.0001). Symptoms and treatment of acne are factors that also influence their quality of life. Girls and boys are equally affected. Stress and heredity are correlated with acne and its severity (p<0.0001). We didn't find any correlation between smoking and acne. CONCLUSION: Acne affects Quality of Life of young adolescents in Greece. The impact is proportional to the severity of acne. More severe acne is associated with greater effect on quality of life with implications for self esteem, body image and relationships with others.

FUNDAMENTOS: Acne vulgar pode afetar seriamente o funcionamento social e psicológico. OBJETIVO: O objetivo deste estudo foi investigar o impacto da acne vulgar e sua gravidade na Qualidade de Vida de jovens adolescentes na Grécia. MÉTODOS: Nós conduzimos uma pesquisa baseada em questionário entre 1560 adolescentes com idades entre 11 e 19 anos e 1531 destes foram completados. Adolescentes com acne completaram todas as questões incluindo o Children Dermatology Life Quality Index (CDLQI). Adolescentes sem acne completaram as questões sobre idade, história familiar de acne, estresse e tabagismo. Os dados foram analisados pelo teste de chi-quadrado de Pearson. RESULTADOS: A prevalência de acne foi de 51.2%, afetando igualmente ambos os sexos. O auto relato de acne leve estava presente em 71.2% e de acne moderada a grave em 28.8% da população. A idade média da população em estudo foi de 15.77 anos. O escore médio do Children Dermatology Life Quality Index foi de 4.02. O impacto da acne na Qualidade de Vida está associado à gravidade da acne (p<0.0001). Pacientes com acne moderada/grave experimentam maior piora psico-social e emocional (p<0.0001). A imagem corporal é modificada proporcionalmente à gravidade da acne (p<0.0001). Sintomas e tratamento da acne são fatores que também influenciam sua qualidade de vida. Meninas e meninos são afetados igualmente. Estresse e hereditariedade estão correlacionados à acne e sua gravidade (p<0.0001). Nós não encontramos nenhuma correlação entre tabagismo e acne. CONCLUSÃO: Acne afeta a qualidade de vida de jovens adolescentes na Grécia. O impacto é proporcional à gravidade da acne. A acne mais grave está associada a um maior efeito na qualidade de vida com implicações na auto-estima, imagem corporal e relacionamento com outros.

Mediterranean fever gene mutations in greek patients with Behcet's disease / Mutacionesen el gen de la fiebre mediterránea en pacientes griegos con la enfermedadde Behçet

OBJECTIVE: It is known that clinical similarities between Behcet's disease and Familial Mediterranean Fever have led to the hypothesis of a common pathogenesis. Familial Mediterranean Fever is caused by MEFV gene mutations coding for pyrin. Therefore, we examined whether these pyrin mutations are also associated with Behcet's disease. METHODS: Molecular testing for pyrin mutations was performed in 96 unrelated Greek patients with an established diagnosis of Behcet's disease. The results were compared with an analysis for pyrin mutations in 140 unrelated healthy Greek controls. RESULTS:We found no pyrin mutations among the Behcet cases tested; this result is comparable with the control group. CONCLUSIONS: Pyrin gene mutations in Greek patients with Behcet's disease are not more common than those in the general population. This finding is not in agreement with the findings in other populations. It is suggested that screening for pyrin mutations not be included in the evaluation of Greeks suspected to have Behcet's disease.

OBJETIVO:Se sabe que las similitudes clínicas entre la enfermedad de Behçet y la fiebre mediterránea familiar han llevado a la hipótesis de una patogénesis común. La fiebre mediterránea familiar es causada por mutaciones en el gen MEFV que codifica la pirina. Por lo tanto, examinamos si estas mutaciones de la pirina se hallan también asociadas con la enfermedad de Behçet. MÉTODOS: La prueba molecular para la detección de las mutaciones de la pirina se realizó en 96 pacientes griegos no relacionados, y diagnosticados con la enfermedad de Behçet. Los resultados se compararon con un análisis de las mutaciones de la pirina en 140 controles formados por individuos griegos saludables. RESULTADOS: No se encontraron mutaciones de pirina entre los casos de Behçet sometidos a prueba. Este resultado es comparable con el grupo control. CONCLUSIONES: Las mutaciones del gen de la pirina en los pacientes griegos con la enfermedad de Behçet no son más comunes que las de la población general. Este hallazgo no concuerda con los hallazgos en otras poblaciones. Se sugiere que el tamizaje para la detección de las mutaciones de pirina no se incluya en la evaluación de pacientes griegos sospechosos de padecer la enfermedad de Behçet.

¿Qué fue la plaga de Atenas? / What was the Plague of Athens?

In the year 430 B.C., at the beginning of the second year of the Peloponessian War, a terrible epidemic fell upon Athens and the most populous cities in Attica. It would last for just over four years and it would kill 100.000 people, a quarter to a third of the population. We know about it through the masterly description made by Thucydides in his History of the Peloponnesian War. His narrative has withstood twenty five centuries due to its medical interest and, above all, its great dramatic force. The description of symptoms and signs, their evolution, and the consequences upon persons and moral and social order has captivated physicians, philologists and classical historians ever since. It has inspired literary works and hundreds of medical articles, with no agreement having been reached upon its cause or consequences, or if it is history or tragedy, or even if there is a single answer to these alternatives.

En el año 430 a.C., al iniciarse el segundo año de la guerra del Pelo-poneso, una terrible epidemia se desató en Atenas y en las ciudades más populosas de Ática. Duraría algo más de cuatro años y morirían unas 100.000 personas, un cuarto a un tercio de la población. Sabemos de ella a través de la magistral descripción que Tucídides hace en su Historia de la Guerra del Peloponeso. Su relato ha perdurado por 25 siglos por su interés médico y, sobre todo, por su gran fuerza dramática. La descripción de los síntomas y signos, su evolución y las consecuencias sobre las personas y sobre el orden social y moral ha cautivado a médicos, filólogos e historiadores. Ha inspirado obras literarias y cientos de artículos sobre la etiología de la plaga sin que hasta el momento exista acuerdo sobre qué fue, si es historia o tragedia, e incluso, si es que hay una respuesta única a estas alternativas.