[Assisting diabetics in Portugal: the structuring role of the Association to Protect Poor Diabetics, 1926-1946]. / A assistência aos diabéticos em Portugal: o papel estruturante da Associação Protetora dos Diabéticos Pobres, 1926-1946.

Assistance to diabetics in Portugal was quintessentially linked to the 1926 foundation of the Association to Protect Poor Diabetics (Associação Protetora dos Diabéticos Pobres) which was decisive in structuring diabetology in Portugal. This article shows how during the first half of the twentieth century, this association helped create a model of assistance for diabetics in this country based on the principles of modern diabetology. First, we examine its functional and clinical organization to comply with assistance policy during the New State period in Portugal. Next, we depict the organization of the assistance model, which included treatment and education of poor patients with diabetes.

A assistência aos diabéticos em Portugal esteve umbilicalmente ligada à fundação da Associação Protetora dos Diabéticos Pobres em 1926, a qual teve um papel determinante na estruturação da diabetologia portuguesa. O objetivo do artigo é demonstrar de que forma a associação contribuiu para a estruturação de um modelo de assistência aos diabéticos em Portugal, escorada nos princípios da diabetologia moderna na primeira metade do século XX. Primeiro explicaremos como a instituição se organizou em termos funcionais e clínicos atendendo às políticas assistenciais do período do Estado Novo em Portugal. Posteriormente mostraremos como estava organizado o modelo de assistência, que incluía o tratamento e a educação dos diabéticos pobres.

Investigação científica e uso clínico da quina em Portugal na transição do século XVIII para o século XIX / Scientific research and clinical use of quinine in Portugal in the transition from the 18th to the 19th century

A quina, uma casca de árvores nativas da América do Sul do género Cinchona com propriedades antimaláricas, tem um importante lugar na história da medicina e da farmácia. Possivelmente já conhecida pelos espanhóis no século XVI, foi usada na terapêutica pela sua atividade febrífuga, estabelecendo-se como tratamento para as febres intermitentes nos séculos XVIII e XIX. Este artigo pretende avaliar a receção da quina em Portugal no último quartel do século XVIII e no primeiro quartel do século XIX através do estudo de obras portuguesas que descrevem pormenorizadamente as aplicações terapêuticas da quina, do estudo de uma publicação periódica médica, o Jornal de Coimbra e do estudo de receituário médico. Em Portugal, a quina foi também utilizada pela sua ação febrífuga, tendo sido publicadas várias obras descritivas da sua atividade terapêutica quer nas febres intermitentes, quer em doenças como a gota ou na gangrena. No periódico científico português Jornal de Coimbra (1812-1820) foram publicados, por indicação governamental, relatos de médicos de todo o país sobre as doenças existentes nas localidades em que exerciam e respetivo tratamento utilizado. Através da leitura desta publicação, verifica-se que a quina era um tratamento generalizado e normalmente eficaz para as febres intermitentes. No tratamento das febres intermitentes, a quina era geralmente associada a outros medicamentos como os eméticos. A quina foi também a droga mais prescrita num estudo de caso compreendendo 1954 receitas médicas. Foi prescrita por 434 vezes, entre 1779 e 1825, em receitas preparadas pelo Dispensatório Farmacêutico do Hospital da Universidade de Coimbra. Os relatos publicados no Jornal de Coimbra sobre a aplicação clínica da quina, e a percentagem elevada de receitas em que esta foi prescrita comprovam a sua importância na terapêutica em Portugal. (AU)

Quinine, a tree bark native to South America of the genus Cinchona, has antimalarial properties and occupies an important place in the history of medicine and pharmacy. Possibly already known to the Spanish in the 16th century, it was used in therapeutics for its febrifugal activity, becoming established as a treatment for intermittent fevers in the 18th and 19th centuries. This article aims to evaluate the reception of quinine in Portugal in the last quarter of the 18th century and the first quarter of the 19th century by studying Portuguese works that describe the therapeutic applications of quinine in detail, by studying a medical publication, the Jornal de Coimbra, and by examining medical prescriptions. In Portugal, quinine was also used for its febrifugal action, and several works were published describing its therapeutic activity in both intermittent fevers and diseases such as gout and gangrene. Acting on governmental instructions, the Portuguese scientific periodical Jornal de Coimbra (1812-1820) published reports by doctors throughout the country on diseases observed in the places where they practiced and on the treatments they applied. Reading this publication shows that quinine was a widespread and usually effective treatment for intermittent fevers, commonly combined with other drugs such as emetics. Quinine was also the most prescribed drug in a case study comprising 1,954 prescriptions. It was prescribed 434 times between 1779 and 1825 in prescriptions prepared by the Pharmaceutical Dispensatory of the Coimbra University Hospital. The reports in the Jornal de Coimbra on the clinical application of quinine and the high frequency of its prescription demonstrates its important therapeutic role in Portugal. (AU)

Classification of Pharmaceutical Policy Measures During the Portuguese Financial Crisis.

BACKGROUND: A rise in pharmaceutical expenses in Portugal led to the introduction of policy measures aimed at controlling outpatient public costs. This research examines and categorizes the most common pharmaceutical measures implemented during the Troika intervention, as well as comparing this period of time to prior ones. METHODS: A hierarchical structure of descriptors was built to classify and group measures over a 20-year period, including whether they might be deemed austerity measures. The nature, relative weight, and frequency of measures, along with the evolution of public drug expenditure, were assessed. RESULTS: Although there were fluctuations, frequency tended to increase. The highest number of policy changes per year was in 2010, a year before the financial assistance. The Troika intervention was characterized by a strong emphasis on pricing and prescription-related initiatives. Generic medicines played a significant role in the effort to reduce public drug expenditure. CONCLUSIONS: During the Troika intervention, outpatient public drug expenditure was consistently reduced through a comprehensive "package of measures" aimed at both the demand and supply sides. The effectiveness of some previous independent measures, if any, was temporary.

Medicamentos órfãos em Portugal no contexto internacional (séculos XX-XXI) / Orphan drugs in Portugal in the international context (XX-XXI centuries)

A consciência científica, clínica e pública da existência das doenças raras tem aumentado nos últimos anos. Os medicamentos denominados de “medicamentos órfãos” são aqueles que são apropriados para o tratamento de doenças raras. As doenças raras, comparadas com outras doenças, apresentam uma baixa incidência demográfica. Por esta razão, e em virtude das condições vigentes de comercialização, as indústrias farmacêuticas não apostam fortemente nos medicamentos órfãos. Os produtores não teriam oportunidade de recuperar o capital investido na investigação e desenvolvimento do medicamento. Neste estudo os autores fazem um historial dos medicamentos órfãos em Portugal tendo como fontes a legislação e regulamentação portuguesas no quadro da legislação e diretivas europeias, o papel das indústrias farmacêuticas em Portugal, a regulamentação e fiscalização realizada pelo INFARMED, IP, bem como o acesso dos doentes aos medicamentos órfãos e o papel fulcral das associações de doentes (AU)

Development of medicines consumption in Portugal before and during the financial crisis.

BACKGROUND: In May 2011, the Portuguese Government signed a Memorandum of Understanding with the European Commission, the European Central Bank and the International Monetary Fund, including detailed measures to control health costs, allowing Portugal to receive a financial rescue package. This study aims to investigate medicines utilization in the outpatient sector during Troika's financial rescue. METHODS: Using Defined Daily Dose per million inhabitants per year as a measurement unit, we compared medicines utilization with other relevant indicators over 5-year intervals for a total period of 20 years, based on a built-in inventory of national outpatient drug use using the Intercontinental Medical Statistics Health and Anatomical Therapeutic Chemical index of the World Health Organization databases. The calculation was made on the basis of both compound and year-on-year growth rates. RESULTS: With the exception of the interval 2009-11, an absolute rise in consumption was observed over the 20-year period. The downturn occurred prior to financial rescue, when expenditure management mechanisms were already in place, and coincided with an increase in out-of-pocket spending. With the decline of cost for patients, the access trend returned to being positive, but at a slower pace. CONCLUSION: The rise in out-of-pocket and austerity measures may have led to decreased access to medicines. The findings of this study suggest that this impact was influenced by public cost-saving policies implemented even before the financial rescue. The results show that price reduction attenuated the repercussion of the measures.

Quinine in Otology and Neurotology: Ototoxicity and Historic Role in Therapy.

OBJECTIVES/HYPOTHESIS: Quinine, a cinchona bark-derived antimalarial alkaloid, is a known ototoxic. Isolated and named in 1820 by the French scientists Pierre-Joseph Pelletier and Joseph-Bienaimé Caventou, it has since been employed in the treatment of different maladies. Quinine was also recommended as a local anesthetic in surgical procedures in the early 20th century. This article aims to identify early ototoxicity reports regarding quinine and to investigate if quinine was previously used in otology as an anesthetic agent or as an actual therapy. METHOD: Historical review of medical and pharmaceutical literature from the 19th and 20th centuries in databases (PubMed; Web of Science), as well as medical books on ototoxic drugs, quinine, and therapies in otology. RESULTS: The first identified reference of quinine ototoxicity was from 1824. Quinine also had a therapeutic role in otology and neurotology and was employed for its analgesic properties. It was used in Menière's disease, vertigo, otalgia, purulent otitis media, neuralgia of the plexus tympani, furuncles in the auditory canal, and herpes zoster in the auricle. CONCLUSION: Quinine was acknowledged as an ototoxic drug in the 19th century. Quinine was used in several otologic disorders, both as an analgesic (for herpes zoster, otalgia) and as a therapeutic agent (Menière's disease, vertigo, purulent otitis media, furuncles in the auditory canal). This research demonstrates that, analogously to gentamicin, quinine was used in Menière's disease specifically due to its ototoxic effects.

[The history of Pharmacy in Portugal (1900-1950) : pharmaceutical industry and community pharmacy ].

The aim of this article is to present the history of pharmacy in Portugal during the first half of the twentieth century, considering two contemporary issues : the industrialization of medicines in Portugal, with regard to law and regulation of medicines and professional activity (emphasizing community pharmacy) and other relevant issues concerning pharmacy and public health.

[Laboratory of Pharmacognosy of Faculty of Pharmacy, University of Coimbra (Portugal): teaching and et research (1902-1980)]. / Le laboratoire de pharmacognosie de la Faculté de pharmacie de l'Université de Coimbra (Portugal): enseignement et recherche (1902-1980).

In this article the authors present a brief history of the Laboratory of Pharmacognosy, Faculty of Pharmacy, University of Coimbra, Portugal (1902-1980). The authors refer the importance of pharmacognosy in the study plans, the scientific research and the scientific collection of pharmacognosy, Faculty of Pharmacy, University of Coimbra. This heritage consists of collection of drugs prepared in the laboratory of pharmacognosy, a collection Drogen-Lehrsammlung purchased to E. Merck and a collection of botanic-didactic models of the XIXth century of the famous German manufacturer R. Brendel. The authors study the relationship between research and teaching, highlighting the importance of the collections of drugs.

A introduçao da penicilina nos hospitais da universidade de Coimbra, Portugal (1944-1946) / The introduction of penicilin in Coimbra university hospitals, Portugal (1944-1946)

A importação regular de penicilina para Portugal iniciou-se em Setembro de 1944 através da Cruz Vermelha Portuguesa. Até Junho de 1945 a importação e distribuição do medicamento foram controladas por esta instituição humanitária mas a partir desta data, com o aumento da produção mundial, a penicilina começou a ser importada por intermédio da indústria farmacêutica. No Arquivo da Universidade de Coimbra consultamos papeletas (processos individuais) de doentes internados nos Hospitais da Universidade de Coimbra desde Setembro de 1944 até Agosto de 1946. A investigação realizada permitiu-nos recolher informações sobre a introdução da penicilina e sobre os primeiros tratamentos efetuados com o medicamento nestes hospitais. Com base nos dados recolhidos pretendemos, pelo presente artigo, mostrar como foi feita a receção da penicilina num hospital central de grande dimensão, um dos principais hospitais portugueses, saber a frequência com que era prescrita, as patologias mais comuns em que era empregue, as doses administradas, a posologia e o tempo de tratamento assim como os clínicos responsáveis pela sua prescrição (AU)

The Portuguese Red Cross began to import of penicillin regularly following September 1944. Until June 1945, the humanitarian institution controlled the distribution of the antibiotic, subsequently, due to the increase in world production penicillin began to be imported by means of the pharmaceutical industry. We consulted and analyzed files of patients admitted to Coimbra University Hospitals between September 1944 and August 1946. These files, located in Coimbra University Archive, enabled us to collect information on the introduction of penicillin and on the first cases treated with the antibiotic at these hospitals. In the present paper, we aim to shed some light upon how penicillin was received in one of the main Portuguese central hospitals, the frequency with which it was prescribed, the most common diseases in which the antibiotic was utilized, the dosage administrated, the length of the treatment and the physicians responsible for prescribing the antibiotic (AU)

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O médico brasileiro José Pinto de Azeredo (1766?-1810) e o exame químico da atmosfera do Rio de Janeiro / Brazilian physician José Pinto de Azeredo (1766?-1810) and the chemical examination of Rio de Janeiro's atmosphere

José Pinto de Azeredo, do Rio de Janeiro, foi aluno de medicina em Edimburgo (1786-1788), aí realizando notável trabalho experimental. Apresentou em Leiden a dissertação de formatura, sobre a gota. Regressado ao Rio em 1789, já nomeado físico-mor de Angola, praticou no Brasil. Em 1790 foi para Luanda onde exerceu no Hospital Real e onde fundou uma "Escolla de Medicina" que não sobreviveu à sua saída para Portugal, em 1797. Em Lisboa trabalhou no principal hospital militar e como médico particular, até falecer. A sua obra escrita (uns 10 manuscritos e 5 publicações) merece ser tratada do ponto de vista da história da medicina. Em artigo publicado em 1790 sobre a qualidade do ar do Rio de Janeiro, evidencia capacidades de químico analista, interesse pelos efeitos dos diversos componentes do ar nos organismos e preocupações sobre a qualidade do ar do Brasil e da Europa.

O médico brasileiro José Pinto de Azeredo (1766?-1810) e o exame químico da atmosfera do Rio de Janeiro / Brazilian physician José Pinto de Azeredo (1766?-1810) and the chemical examination of Rio de Janeiro's atmosphere

José Pinto de Azeredo, do Rio de Janeiro, foi aluno de medicina em Edimburgo (1786-1788), aí realizando notável trabalho experimental. Apresentou em Leiden a dissertacao de formatura, sobre a gota. Regressado ao Rio em 1789, já nomeado físico-mor de Angola, praticou no Brasil. Em 1790 foi para Luanda onde exerceu no Hospital Real e onde fundou uma "Escolla de Medicina" que nao sobreviveu à sua saída para Portugal, em 1797. Em Lisboa trabalhou no principal hospital militar e como médico particular, até falecer. A sua obra escrita (uns 10 manuscritos e 5 publicacoes) merece ser tratada do ponto de vista da história da medicina. Em artigo publicado em 1790 sobre a qualidade do ar do Rio de Janeiro, evidencia capacidades de químico analista, interesse pelos efeitos dos diversos componentes do ar nos organismos e preocupacoes sobre a qualidade do ar do Brasil e da Europa. (AU)

[The French influence on the reception of the homoeopathy in Portugal]. / L'influence française sur la réception de l'homéopathie au Portugal.

The authors show how France has influenced in a decisive manner the reception of the homoeopathy in Portugal. They have studied the acclamation the Hahnemann by the Medical Sciences Society of Lisbon (1839) and the controversy originated by that event for the homoeopathy institutionalization in Portugal.

[Brazilian physician José Pinto de Azeredo (1766?-1810) and the chemical examination of Rio de Janeiro's atmosphere]. / O médico brasileiro José Pinto de Azeredo (1766?-1810) e o exame químico da atmosfera do Rio de Janeiro.

José Pinto de Azeredo, of Rio de Janeiro, studied medicine and conducted notable experimental research in Edinburgh (1786-88), presenting his graduate thesis on gout in Leiden. Already appointed surgeon-general of Angola, he returned to Rio in 1789 and practiced medicine in Brazil. In 1790 he moved to Luanda, where he practiced at the Hospital Real and founded a medical school that did not survive his departure for Portugal in 1797. He worked at Lisbon's main military hospital and as a private physician until his death. His written works (some ten manuscripts and five publications) warrant an examination from the perspective of the history of medicine. In an article published in 1790 on Rio de Janeiro's air quality, he reveals the skills of an analytical chemist, his interest in the effects of different air components on organisms, and his concern with air quality in Brazil and Europe.

Paleopatologia e medicina pré-técnica: a medicina pré-técnica de civilizaçöes antigas, continente americano / Paleopathology and pre-technical medicine: the pre-technical medicine of old civilizations - the American continent

Aborda algumas das mais significativas civilizaçöes americanas - inca, maia e azteca - e alguns dos aspectos mais relevantes das suas práticas médico-farmacêuticas. (AU)