Brain malformations in diprosopia observed in clinical cases, museum specimens and artistic representations.

BACKGROUND: Diprosopus is a rare malformation of still unclear aetiology. It describes a laterally double faced monocephalic and single-trunk individual and has to be distinguished from the variant Janus type diprosopus. RESULTS: We examined seven double-faced foetuses, five showing true diprosopus, and one each presenting as monocephalic Janiceps and parasitic conjoined twins. Four of the foetuses presented with (cranio)rachischisis, and two had secondary hydrocephaly. Three foetuses showed cerebral duplication with concordant holoprosencephaly, Dandy-Walker cyst and/or intracranial anterior encephalocele. In the Janiceps twins, cerebral duplication was accompanied by cerebral di-symmetry. In the parasitic twins the cyclopic facial aspects were suggestive of concordant holoprosencephaly. In one of the true diprosopus cases, pregnancy was achieved after intracytoplasmic sperm injection. Whole-exome sequencing, perfomed in one case, did not reveal any possible causative variants.The comparison of our double-faced foetuses to corresponding artistic representations from the Tlatilco culture allowed retrospective assignment of hairstyles to brain malformations. CONCLUSION: Brain malformations in patients with diprosopus may not be regarded as an independent event but rather as a sequel closely related to the duplication of the notochord and neural plate and as a consequence of the cerebral and associated craniospinal structural instabilities.

The oral anticoagulants' burden / Le fardeau des anticoagulants oraux

Background: Oral anticoagulants generate a burden of care that can affect the patient's quality of life. The concept of treatment's burden measures the impact of medical care for the patient's quality of life. Various factors can exacerbate the burden. Several studies have assessed the satisfaction of patients treated with oral anticoagulants. Objective: This study has assessed the burden of patients treated with oral anticoagulants. Methods: An analytical cross-sectional study of patients recruited from pharmacies in the Loire. A questionnaire was carried out using the anti-clot treatment scale, assessing satisfaction, and the Zarit scale, assessing the burden on carers of demented patients. Results: Anticoagulants were a burden for 41% (n = 158) of the 389 responding patients. Anticoagulants' burden was higher when oral anticoagulant was responsible for side effects, anxiety or lifestyle changes. Conclusion: The patients could be satisfied with the benefit of the treatment, satisfied with its practical modalities, and describe modifications of lifestyle habits contributing to the burden of the treatment.

Introduction: Les anticoagulants oraux génèrent une charge de soins pouvant impacter la qualité de vie des patients. Le fardeau du traitement mesure l'impact de la prise en charge médicale sur la qualité de vie. Des facteurs divers peuvent aggraver le fardeau. Plusieurs études ont évalué la satisfaction des patients traités par anticoagulants oraux. Objectif: Cette étude a évalué le fardeau des patients traités par anticoagulants oraux. Méthode: Étude transversale analytique menée auprès de patients recrutés dans des pharmacies ligériennes. Un questionnaire a été réalisé à partir de l'échelle échelle anti-clot treatment scale évaluant la satisfaction et de l'échelle Zarit évaluant le fardeau des aidants de patients déments. Résultats: Les anticoagulants étaient un fardeau pour 41 % (n = 158) des 389 répondants. Le fardeau des anticoagulants était plus important lorsque l'AO était responsable d'effets secondaires, d'angoisse ou modifiait leurs habitudes de vie. Conclusion: Les patients interrogés pouvaient être convaincus du bénéfice du traitement, satisfaits de ses modalités pratiques, et décrire un fardeau du traitement.

Personal mental health navigator: Harnessing the power of data, personal models, and health cybernetics to promote psychological well-being.

Current digital mental healthcare solutions conventionally take on a reactive approach, requiring individuals to self-monitor and document existing symptoms. These solutions are unable to provide comprehensive, wrap-around, customized treatments that capture an individual's holistic mental health model as it unfolds over time. Recognizing that each individual requires personally tailored mental health treatment, we introduce the notion of Personalized Mental Health Navigation (MHN): a cybernetic goal-based system that deploys a continuous loop of monitoring, estimation, and guidance to steer the individual towards mental flourishing. We present the core components of MHN that are premised on the importance of addressing an individual's personal mental health state. Moreover, we provide an overview of the existing physical health navigation systems and highlight the requirements and challenges of deploying the navigational approach to the mental health domain.

Discapacidad en personas mayores / Disability in Older People

Introducción: El envejecimiento en Cuba constituye un problema demográfico y, desde una perspectiva individual, generalmente se acompaña de enfermedades que deterioran la funcionalidad; esto condiciona la discapacidad en las personas mayores. Objetivo: Identificar la prevalencia de discapacidad y las enfermedades que padecen los adultos mayores. Métodos: Se realizó un estudio piloto en 40 personas mayores del área de salud José Trujillo; del municipio Mariel. Se aplicó el instrumento WHODAS 2.0 para medir la discapacidad y se identificaron las enfermedades en las historias clínicas. Se resumió la información en porcentajes. Resultados: De las personas mayores estudiadas, 75 por ciento estaban discapacitadas con niveles entre ligero y moderado (27 y 25 por ciento respectivamente), con mayor frecuencia en mujeres y en edades avanzadas. Las dimensiones más afectadas fueron la comprensión y comunicación y la participación en sociedad. Las enfermedades principales fueron las cardiovasculares y las mentales (40 por ciento y 23,3 por ciento respectivamente). Conclusiones: La magnitud de la discapacidad fue importante en las personas estudiadas, las dimensiones más afectadas fueron la comprensión y comunicación, las actividades de la vida diaria y la participación en sociedad. Las enfermedades cardiovasculares fueron las más frecuentes, pero las enfermedades mentales fueron las que se relacionaron con niveles graves de discapacidad(AU)

Introduction: Aging in Cuba is a demographic problem and, from an individual perspective, it is generally accompanied by diseases that affect functionality. This brings about disability in older people. Objective: To identify the prevalence of disability and diseases suffered by older adults. Methods: A pilot study was carried out with forty elderly people from José Trujillo health area of ​​ Mariel Municipality. The WHODAS 2.0 instrument was applied to measure disability. Their diseases were identified in the medical records. Information was summarized in percentages. Results: Of the older people studied, 75 percent were disabled with levels between light and moderate (27 percent and 25 percent, respectively), with more frequency in women and in advanced ages. The most affected dimensions were understanding and communication, as well as participation in society. The main diseases were cardiovascular and mental (40 percent and 23.3 percent, respectively). Conclusions: The disability magnitude was important in the people studied. The most affected dimensions were understanding and communication, activities of daily living and participation in society. Cardiovascular diseases were the most frequent, but mental illnesses were those associated with severe levels of disability(AU)

[Nephropathy associated with hypocomplementemic urticarial vasculitis: A case report and literature review]. / Néphropathie associée à une vascularite urticarienne hypocomplémentémique : présentation d'un cas clinique et revue de la littérature.

Hypocomplementemic urticarial vasculitis is a rare systemic vasculitis, affecting small vessels, characterised by chronicle urticaria, hypocomplementemia, and systemic manifestations. Renal involvement, whose prevalence varies between 9% and 60%, is mainly glomerular. We here report the case of a 59 years old woman presenting kidney failure, associated with chronicle urticaria and arthralgias. Laboratory investigation showed haematuria, proteinuria, hypocomplementemia and anti-SSa antibody positivity. A percutaneous kidney biopsy revealed focal and segmental glomerulonephritis associated with an acute interstitial nephritis. Hypocomplementemic urticarial vasculitis diagnosis was established after identifying anti-C1q antibodies. The lack of a dry syndrome, the negativity of a Schirmer test and the lack of sialadenitis on a salivary gland biopsy excluded an associated Gougerot-Sjögren Syndrome. The patient was treated with hydroxychloroquine and low-dose steroids, enabling a clinical and biological recovery. Of the 82 cases in the literature describing hypocomplementemic urticarial vasculitis associated nephropathies, 72 (88%) were a glomerular impairment, most frequently secondary to membranoproliferative glomerulonephritis. Only 6 (7%) tubulo-interstitial nephritis have been reported, 4 of them being associated with a glomerulonephritis. Patients were more likely to be women, aged in their third decade. The most frequent renal manifestations were haematuria (60%), and proteinuria (52%). Kidney failure was rarely observed (22%), with a fairly good renal prognosis. Hypocomplementemic urticarial vasculitis was associated with a systemic disease in 11 (13%) patients. In the absence of recommendations, the treatment strategy remains to be defined.

Caracterización de los pacientes hospitalizados por úlceras flebostáticas / Characterization of the patients hospitalized due to phlebostatic ulcers

Introducción: Las úlceras en los miembros inferiores se relacionan desde los tiempos antiguos con las venas varicosas; es aceptado que dichas úlceras son una enfermedad frecuente y un grave problema de salud pública en todo el mundo y que la gran mayoría es el resultado de una insuficiencia venosa crónica. Objetivo: Caracterizar a los a los pacientes hospitalizados por úlceras flebostáticas. Métodos: Se realizó un estudio ambispectivo en 81 pacientes ingresados con el diagnóstico de úlceras flebostáticas. Las variables de estudio fueron: edad, sexo, cantidad de ingresos y estadía hospitalaria. Resultados: Se encontró un predominio del sexo femenino y de los mayores de 60 años en los 121 ingresos realizados. El 72,8 por ciento ingresó una sola vez y el 18,2 por ciento en más de una ocasión. La estadía hospitalaria fue de más de 21 días en el 55,4 por ciento. Conclusiones: Los pacientes hospitalizados con úlceras flebostáticas son predominantemente adultos mayores del sexo femenino, presentan una baja frecuencia de reingresos y una estadía hospitalaria prolongada(AU)

Introduction: The ulcers in the lower limbs are related from the old times with the varicose veins; it is accepted that the same ones are a frequent illness and a serious problem of public health in the world, and the great majority is the result of chronic venous insufficiency. Objective: To characterize the patients hospitalized due to phlebostatic ulcers. Methods: It was carried out an ambispective study in 81 patients admitted with the diagnosis of phlebostatic ulcers. The study variables were: age, sex, quantity of hospital admissions and hospital stay. Results: It was predominant in the 121 of the hospital admission: the female sex and people older than 60 years. 72.8 percent of the patients were admitted one time and 18.2 percent in more than one occasion. The hospital demurrage was of more than 21 days in 55.4 percent of the cases. Conclusions: The patients hospitalized due to phlebostatic ulcers are predominantly female elder people. It was possible to characterize the patients hospitalized with a low frequency of hospital re-admission and hospital demurrage(AU)

Cytogenetic damage analysis in mice chronically exposed to low-dose internal tritium beta-particle radiation.

The aim of this study was to carry out a comprehensive examination of potential genotoxic effects of low doses of tritium delivered chronically to mice and to compare these effects to the ones resulting from equivalent doses of gamma-irradiation. Mice were chronically exposed for one or eight months to either tritiated water (HTO) or organically bound tritium (OBT) in drinking water at concentrations of 10 kBq/L, 1 MBq/L or 20 MBq/L. Dose rates of internal ß-particle resulting from such tritium treatments were calculated and matching external gamma-exposures were carried out. We measured cytogenetic damage in bone marrow and in peripheral blood lymphocytes (PBLs) and the cumulative tritium doses (0.009 - 181 mGy) were used to evaluate the dose-response of OBT in PBLs, as well as its relative biological effectiveness (RBE). Neither tritium, nor gamma exposures produced genotoxic effects in bone marrow. However, significant increases in chromosome damage rates in PBLs were found as a result of chronic OBT exposures at 1 and 20 M Bq/L, but not at 10 kBq/L. When compared to an external acute gamma-exposure ex vivo, the RBE of OBT for chromosome aberrations induction was evaluated to be significantly higher than 1 at cumulative tritium doses below 10 mGy. Although found non-existent at 10 kBq/L (the WHO limit), the genotoxic potential of low doses of tritium (>10 kBq/L), mainly OBT, may be higher than currently assumed.

From medico-administrative databases analysis to care trajectories analytics: an example with the French SNDS.

Medico-administrative data like SNDS (Système National de Données de Santé) are not collected initially for epidemiological purposes. Moreover, the data model and the tools proposed to SNDS users make their in-depth exploitation difficult. We propose a data model, called the ePEPS model, based on healthcare trajectories to provide a medical view of raw data. A data abstraction process enables the clinician to have an intuitive medical view of raw data and to design a study-specific view. This view is based on a generic model of care trajectory, that is a sequence of time stamped medical events for a given patient. This model is combined with tools to manipulate care trajectories efficiently.

Vasculitis fibrosante crónica de origen traumático: a propósito de un caso / Traumatic fibrosing chronic vasculitis: a case report

ResumenLa vasculitis es una patología producida por la inflamación de las paredes de los vasos sanguíneos, puede afectar cualquier tipo de vaso en cualquier órgano o tejido. Los signos y síntomas que se presentan son muy diversos y se superponen con muchas otras enfermedades, por esta razón, a menudo es en el diagnóstico diferencial tanto para un solo órgano como para las enfermedades sistémicas, especialmente si el paciente tiene evidencia de una condición inflamatoria. Existen muchos tipos las cuales se clasifican de acuerdo al calibre de los vasos sanguíneos que afectan, además su fisiopatología tiene múltiples causas que se pueden agrupar en dos grandes grupos, las de origen no infeccioso y las de origen infeccioso, a su vez dentro de las no infecciosas, hay múltiples orígenes como los son las autoinmunes, e incluso relacionadas con traumas.La vasculitis fibrosante crónica es una reacción inflamatoria de la piel que produce una vasculitis de pequeños vasos, produce una lesión cutánea solitaria, histológicamente similar al Eritema elevatum diutinum o al granuloma facial de largo tiempo de evolución. Se puede decir que es una vasculitis leucocitoclástica cutánea crónica localizada que evoluciona hacia una fibrosis concéntrica con infiltrado inflamatorio mixto.En el presente trabajo se efectúa un análisis de un paciente que cursa con vasculitis fibrosante crónica de origen traumático.

AbstractVasculitis is a condition caused by inflammation of the walls of blood vessels, can affect any type of vessel in any organ or tissue. Signs and symptoms that occur are very diverse and overlap with many other diseases, for this reason, it is often in the differential diagnosis for both a single body and for systemic diseases, especially if the patient has evidence of an inflammatory condition. There are many types which are classified according to the size of the blood vessels affecting also the pathophysiology have multiple causes can be grouped into two major groups, non-infectious origin and infectious, turn within noninfectious, there are multiple sources such as autoimmune, and even related traumas.Fibrosing vasculitis chronic inflammatory reaction is a skin that produces a small vessel vasculitis, produces a histologically similar to elevatum diutinum Erythema or facial granuloma long evolution solitary cutaneous lesion. Can be said is a localized chronic skin leukocytoclastic vasculitis that evolves into a concentric fibrosis with mixed inflammatory infiltrate.In this paper work an analysis of a patient who presents a chronic traumatic fibrosing vasculitis will be performed.

The dawn and the first twenty-five years of proteomics in Mexico: a personal chronicle / El nacimiento y los 25 primeros años de la proteómica en México: una crónica personal

Abstract: This review does not aim to be an up-to-date of proteomics in Mexico; it simply tries to trace its development, exposing the story of the researchers, laboratories and some institutions that have contributed to the establishment and development of this science in Mexico.

Resumen: Esta revisión no pretende cubrir el panorama actual de la proteómica en México, simplemente intenta describir su nacimiento y desarrollo, exponiendo la historia de algunos investigadores, laboratorios e Instituciones que han contribuido al establecimiento y crecimiento de esta ciencia en México.

The dawn and the first twenty-five years of proteomics in Mexico: a personal chronicle.

This review does not aim to be an up-to-date of proteomics in Mexico; it simply tries to trace its development, exposing the story of the researchers, laboratories and some institutions that have contributed to the establishment and development of this science in Mexico.

A mudança de modelo assistencial de cuidado ao idoso na Saúde Suplementar: identificação de seus pontos-chave e obstáculos para implementação / The change of care model to elderly care in Supplementary Health: identification of its key points and obstacles to implementation

Resumo A partir de uma análise crítica sobre os atuais modelos de atenção à saúde para idosos, este artigo apresenta uma proposta de linha do cuidado para este segmento etário, tendo como foco a promoção e a prevenção da saúde, de modo a evitar a sobrecarga do sistema de saúde. Enfatiza-se o setor suplementar, pois como um quarto da população utiliza este sistema, uma discussão mais minuciosa se faz necessária. O conhecimento científico já identificou corretamente os fatores de risco para a população idosa, mas isso não basta. É prioritário utilizar esse conhecimento para efetuar a necessária transição do modelo assistencial clínico para o preventivo. Este precisa se configurar como um fluxo de ações de educação, promoção da saúde, prevenção de doenças evitáveis, postergação de moléstias, cuidado precoce e reabilitação de agravos. Não se nega a importância das instâncias pesadas (hospital, instituições de longa permanência, entre outras), mas estamos particularmente preocupados com uma abordagem contemporânea, que cuide de forma adequada o idoso e diminua custos. Se não for deste modo, o sistema se torna inviável.

Abstract From a critical analysis of current models of health care for the elderly, this article proposes a care line for this age group, focusing on the promotion and health prevention in order to avoid overloading the health system. It emphasizes the supplementary sector, since a quarter of the population uses this system, a more thorough discussion is needed. Scientific knowledge has correctly identified the risk factors for the elderly, but this is not enough. It is a priority to use this knowledge to make the necessary transition from the clinical care to preventive model. This needs to be configured as a stream of education initiatives, health promotion, prevention of preventable diseases, postponement of diseases, early care and rehabilitation of injuries. There is no denying the importance of heavy bodies (hospital, long-term care facilities, etc.), but we are particularly concerned about an approach that improves the quality of life and decrease costs. If not so, the system becomes impractical.

Do crônico à crônica: entendimentos possíveis de casos psiquiátricos cronificados / From the Chronic to the Chronicle: Questioning Some Existing Conceptions on Psychiatric Cases / Du chronique à la chronique: réflexion sur quelques conceptions des cas psychiatriques

El presente trabajo investigativo tiene como principal objetivo problematizar los casos psiquiátricos que se caracterizan como “casos crónicos”. Buscamos, mediante tal problematización, avanzar en el sentido de comprender los impases y posibilidades que surgen por medio de la utilización de esa terminología. En tal sentido, nos servimos, en nuestra investigación, de la manera como el término se entiende en diferentes áreas del conocimiento, suponiendo que dicho trabajo tiene importantes consecuencias para el trabajo clínico psicoanalítico...

This investigative work aims to question the psychiatric cases characterized as “chronic cases”. This questioning seeks to make a progress towards the understanding of the impasses and possibilities that arise when using this terminology. Therefore, this research studies how this term is understood in different areas of knowledge and also the important consequences for the psychoanalytic clinic...

O presente trabalho investigativo tem como objetivo principal problematizar os casos psiquiátricos que são caracterizados como “casos crônicos”. Buscamos, por meio dessa problematização, avançar no sentido de se compreender a respeito dos impasses e possibilidades que surgem por meio da utilização dessa terminologia. Nesse sentido, nos valemos, em nossa investigação, da forma como o termo é entendido em diferentes áreas do saber, supondo que semelhante trabalho possui importantes consequências para o trabalho clínico psicanalítico...

Le but principal de ce travail de recherche est de réfléchir sur les cas psychiatriques dits "cas chroniques". Cette réflexion cherche à approfondir la compréhension à propos des impasses et des possibilités issues de l'utilisation de cette terminologie. Ainsi, cette recherche étudie la manière dont ce terme est conçu dans les différents domaines du savoir, et les importantes conséquences qui en résultent pour le travail clinique psychanalytique...

Kinesioterapia en la enfermedad pulmonar obstructiva crónica / Kinesiotherapia in the illness lung obstructive chronicle

Introducción: a pesar de los importantes avances que se han logrado en las últimas décadas, la enfermedad pulmonar obstructiva crónica continúa siendo un problema de salud de primera magnitud. Objetivo: evaluar la efectividad de la Kinesioterapia en el tratamiento de los pacientes con enfermedad pulmonar obstructiva crónica. Materiales y Métodos: se desarrolló un estudio cuasi-experimental, en el Hospital Militar de Matanzas "Mario Muñoz Monroy”, desde enero 2013 a junio 2014. En los pacientes se llevó a cabo un programa de entrenamiento físico individualizado y ejercicios respiratorios. Para evaluar la evolución de los mismos se aplicó la escala de disnea Medical Research Council modificada y la prueba de 6 minutos marcha. Se contó con el consentimiento informado de los pacientes estudiados y se utilizó la prueba de los signos para efectuar el procesamiento estadístico. Resultados: en la mayor parte de los pacientes tratados se logró disminuir la disnea e incrementar la tolerancia al ejercicio. El 78 % de los pacientes presentó una evolución favorable, el 22 % de los mismos tuvo una evolución regular y ningún paciente presentó evolución catalogada de mal. Conclusiones: la Kinesioterapia resultó efectiva para el tratamiento de los pacientes con enfermedad pulmonar obstructiva crónica.

Background: In spite of the important advances that they have been achieved in the last decades, the illness lung obstructive chronicle continues being a problem of health of first magnitude. Aim: To evaluate the effectiveness of the Kinesiotherapia in the treatment of the patients with illness lung obstructive chronicle. Materials and methods: A quasi-experimental study was developed, in the Military Hospital of Matanzas "Mario Muñoz Monroy", from January 2013 to June 2014. In the patients it was carried out a program of individualized physical training and breathing exercises. To evaluate the evolution of the same ones the dyspnea scale Medical Research Council it was applied modified and the test of 6 minutes march. We have the informed consent of the studied patients. The test of the signs was used to make the statistical prosecution. Outcomes: In most of the patients treaties was possible diminish dyspnea and increase the tolerance to the exercise. 78% of the patients presented a favorable evolution, 22% of the same ones had a regular evolution and no patient presented classified evolution of bad. Conclusion: The Kinesiotherapia was effective for the treatment of the patients with illness lung obstructive chronicle.

"The Gracie Legend": an analysis of Nelson Rodrigues's chronicle / "A legenda dos Gracie": uma análise da crônica de Nelson Rodrigues / "La Leyenda Gracie": un análisis de la Crónica de Nelson Rodrigues

This research aims to analyze one of the first sports chronicles written by Nelson Rodrigues and published in the newspaper Ultima Hora. The author speaks about a "challenge" between Jiu-jitsu athletes Carlson Gracie and Waldemar Santana in 1955. That chronicle ­ marked by literary aesthetics and language typical of Rodriguean theater ­ stresses a discourse on the Gracies family's tradition as creators and disseminators of Jiu-jitsu in Brazil. In order to analyze the work, we will use some concepts of literary analysis, based on Antonio Candido and Carlo Ginzburg

A presente pesquisa tem como objetivo analisar uma das primeiras crônicas esportivas de Nelson Rodrigues ­ veiculada no jornal Ultima Hora ­, na qual o autor trata de um "desafio" entre atletas da modalidade jiu-jítsu, no ano de 1955 ­ Carlson Gracie e Waldemar Santana. A crônica em questão ­ caracterizada por uma estética literária e uma linguagem típicas do teatro "rodrigueano", dramática e passional ­ reforça um discurso de tradição da família Gracie enquanto criadora e disseminadora do jiu-jítsu no Brasil. A fim de analisar tal obra, utilizaram-se, aqui, alguns conceitos/categorias preconizados por Antonio Candido e Carlo Ginzburg, no que se refere à análise literária

Esta investigación tiene como objetivo analizar una de las crónicas deportivas escrito por Nelson Rodrigues y publicado en el diario Ultima Hora. En el texto, el autor habla de un "desafío" de jiu-jitsu, en año 1955, entre Carlson Gracie y Waldemar Santana. Esta crónica refuerza un discurso de la tradición familiar de los Gracie como creador y difusor del jiu-jitsu en Brasil. Con el fin de analizarlo, fue utilizado algunos conceptos de análisis del literatura, basado en Antonio Candido y Carlo Ginzburg

Nelson Rodrigues, leitor e escritor: "diálogos", criatividade e erudição explícita nas crônicas futebolísticas / Nelson Rodrigues, reader and writer: "dialogues", creativity and erudition expressed in football chronicles

O objetivo da presente pesquisa é desvendar as interferências de outros gêneros trabalhados por Nelson Rodrigues, que teriam um vínculo menor com a verdade - especificamente o teatro -, nas construções sobre o futebol, edificadas na crônica esportiva do escritor. Atrelado a isso, intenta-se, ainda, expor o sentido com que Nelson utilizou tais recursos em seus textos futebolísticos, bem como as diversas influências a partir da leitura de clássicos da literatura nacional e mundial; ou até as nem sempre sutis referências a filósofos, sociólogos e mesmo os amigos intelectuais com quem dialogava. Para tal, contou-se com a análise de crônicas e roteiro rodrigueanos, pautada no referencial de Antonio Candido, quanto ao tratamento da literatura enquanto fonte, segundo o qual se faz necessária a intersecção entre texto (autonomia do autor e fatores de arte), bem como contexto da obra

The objective of this research is to reveal the interferences from other genres worked by Nelson Rodrigues, which have a minor relation with the truth - specifically theater - in theses about football, built in sport chronics by the writer. It also aims to expose the sense that Nelson used these resources in his texts about football, as well as the various forms of influences from the reading of classic world and national literature; or even the implicit references to philosophers, sociologists and, also, the intellectual friends, with whom he used to dialogue. To this end, it was analysed the chronic and script of Nelson Rodrigues, based on the theory of Antonio Candido, about the treatment of literature as a source, intersecting the text (author's autonomy and elements of art) and the context of the work

Cumplimiento terapéutico en pacientes con enfermedades crónicas / Adherence to treatment by patients with chronic diseases

Objetivo: determinar el cumplimiento del tratamiento farmacológico en pacientes ambulatorios con enfermedades crónicas. Métodos: estudio observacional, prospectivo, transversal en pacientes con hipertensión, diabéticos tipo II y dislipémicos a quienes se les realizó el test de Morisky Green. Resultados: el 38 por ciento de los pacientes manifestóconductas de incumplimiento del tratamiento, con prevalencia de los hipertensos; seguidos de las mujeres y de los que usan más de un fármaco en la terapéutica. Conclusión: los pacientes manifestaron como principal causa de no adherencia las socioeconómicas(AU)

Objective: to determine the compliance with the drug treatment of outpatients with chronic diseases. Methods: observational, prospective, cross-sectional patients with hypertension, type II diabetes and dyslipidemia, who underwent the Morisky Green test. Results: in this group, 38 percent of patients do not adhere to treatment, with prevalence of hypertensive patients, women, and those who use more than one drug in their therapy. Conclusions: The patients reported socio-economic reasons as the main cause of non-adherence to treatment(AU)

Dolor crónico y narrativa: experiencias cotidianas y trayectorias de atención en el padecimiento de la migraña / Chronic pain and narrative: everyday experiences and trajectories of care in suffering from migraine

Desde una perspectiva socio antropológica, este trabajo está dirigido a contribuir al conocimiento del padecimiento crónico de la migraña. Para ello se realiza una investigación cualitativa, a través de entrevistas a médicos neurólogos y personas con esta dolencia, en un hospital público del Área Metropolitana de Buenos Aires, Argentina. El objetivo principal es explorar, a través de las narrativas de quienes padecen, las experiencias, prácticas cotidianas y trayectorias de atención con este tipo de dolor de cabeza. Algunas particularidades de la migraña que la diferencian de otras dolencias crónicas, y que condicionan los modos en que los pacientes se relacionan con su entorno residen en que la migraña carece de condiciones fácticas de verificación, y no tiene una etiología precisa ni un tratamiento eficaz. A partir de esto, los sujetos dicen que, en algunos casos, se relaciona al padecimiento con excusas y falta de legitimidad. Por otro lado, a través de los relatos, se observa que la migraña pasa a formar parte de la biografía de la persona. Por último, la mayoría de los pacientes dicen acostumbrarse y resignarse a estos dolores de cabeza y a tener paciencia, algo que influye en la relación consigo mismos y con los otros.

From a socio-anthropological perspective, this paper aims to contribute to the knowledge of suffering chronic migraine. For this reason, qualitative research was conducted through interviews with neurologists and people with this condition in a hospital in the Metropolitan Area of Buenos Aires, Argentina. The main objective is to explore, through the narratives of people suffering this condition, the experiences, daily practices and trajectories of care for this type of headache. Some features of migraine, which differentiate it from other chronic pain and influence the way patients relate to their environment, is that migraine does not allow to check facts and does not have a certain etiology or effective treatment. From this, the subjects say that in some cases, the pain is associated with the excuses and lack of legitimacy. Furthermore, through the stories, it is observed that migraine becomes part of the biography of the person. Finally, most patients said to have become accustomed to these headaches and have patience, something that affects the relationship with themselves and others.

A partir de uma perspectiva sócio-antropológica, o presente trabalho visa contribuir para o conhecimento do sofrimento crônico da enxaqueca. Por esse motivo, foi realizada pesquisa qualitativa, através de entrevistas com médicos neurologistas e pessoas com esta condição em um hospital da Região Metropolitana de Buenos Aires, Argentina. O objetivo principal é explorar, através das narrativas de pessoas que sofrem esta condição, as experiências, práticas cotidianas e trajetórias de cuidado com este tipo de dor de cabeça. Algumas características da enxaqueca, que a diferenciam de outras dores crônicas e influenciam na maneira como os pacientes se relacionam com seu ambiente, são que a enxaqueca não tem condições de verificação factual e que não tem uma etiologia certa nem um tratamento eficaz. A partir disso, os sujeitos dizem que, em alguns casos, o sofrimento é associado à escusas e à falta de legitimidade. Além disso, através das histórias, observa-se que a enxaqueca se torna parte da biografia da pessoa. Finalmente, a maioria dos pacientes diz ter se acostumado a essas dores de cabeça e a ter paciência, algo que influi no relacionamento com si próprio e com os outros.

Percepções e mudanças na qualidade de vida de pacientes submetidos à hemodiálise / Perceptions and changes in the quality of life of patients submitted to hemodyalisis / Percepciones y cambios en la calidad de vida de los enfermos sometidos a hemodiálisis

A Insuficiência Renal Crônica é um importante problema de Saúde Pública. O tratamento dialítico, na espera pelo transplante renal, constitui-se numa expectativa de melhoria da qualidade de vida. Este estudo qualitativo, realizado em Rio Grande-RS, objetivou conhecer as percepções dos pacientes com Insuficiência Renal Crônica acerca das mudanças ocorridas em sua rotina de vida, decorrentes do tratamento de hemodiálise, identificando os elementos que influenciam a sua qualidade de vida. Os resultados evidenciaram que os sentimentos iniciais de indignação e negação se modificam, enquanto os pacientes se fortalecem para o enfrentamento da doença. Restrições dos hábitos alimentares e hídricos, incapacidade ou limitação das atividades físicas, profissionais e de lazer foram as principais dificuldades identificadas. O apoio dos familiares e dos profissionais da saúde pode contribuir para a superação dessas limitações e adaptação ao novo estilo de vida.

Chronicle Renal Failure is considered a major problem in Public Health. The dyalitic treatment while waiting for the renal transplant means a boost on quality of life. This qualitative study, carried out in Rio Grande-RS, aimed at knowing the perceptions of patients with Chronicle Renal Failure, identifying the elements that influence their quality of life. The results highlighted that the initial feelings of indignation and denial change as they strengthen themselves to face the disease. Restrictions of fluid and eating habits, inability to perform or limitation in activities, professional and leisure, were the main difficulties identified. The support from family members and from health professionals may help to overcome these limitations and adaptation to a new lifestyle.

La Insuficiencia Renal Crónica es un importante problema para la Salud Pública. El tratamiento dialítico, en la espera por el trasplante renal, se constituye en una expectativa de mejoría de la calidad de vida. Este estudio cualitativo, realizado en Rio Grande-RS, tuvo por objetivo conocer las percepciones de los enfermos con Insuficiencia Renal Crónica sobre los cambios ocurridos en su rutina de vida que derivan del tratamiento de hemodiálisis, identificando los elementos que influencian su calidad de vida. Los resultados evidenciaron que los primeros sentimientos de indignación y negación se modifican a la medida que se fortalecen para enfrentar a la enfermedad. Restricciones de los hábitos alimentares e hídricos, incapacidad o limitación de las actividades físicas, profesionales y de ocio fueran las principales dificultades identificadas. El apoyo de los parientes y de los profesionales de la salud puede contribuir para la superación de esas limitaciones y adaptaciones al nuevo estilo de vida.

Medicina y estrés: antecedentes históricos y evidencias científicas / Medicine and stress: historic antecedents and scientific evidence

El estrés puede alterar la capacidad inmunológica de una persona, ya sea a través de neurotransmisores o a través de hormonas. El cambio hormonal que se produce como consecuencia del estrés afectará el desarrollo de cualquier enfermedad. Esto implica que el médico no debe considerar al paciente sólo como portador de una enfermedad sino también como un ser sufriente tanto física como emocionalmente, teniendo en cuenta que esas emociones pueden modificar el curso de su enfermedad. En este trabajo pretendemos llamar la atención sobre un tema que, si bien suele estar presente en el pensamiento médico, no siempre lo está como conocimiento fundamentado. Comenzamos con una breve referencia histórica y describimos las evidencias científicas que avalan la relación que nos ocupa.

Stress can alter a person's immune capacity, eíther through neurotransmitters or through hormones. Hormonal change that occurs as a results of stress affects the development of any disease. This implies that the physician should consider the patient not only as a carrier of a disease but also a suffering being, both physically and emotionally, bearing in mind that these emotions can alter the course of the disease. In this paper, we draw attention to an issue that, while often present in medical thinking, is not always as knowledge based. We begin with a brief historical reference and describe the scientific evidence that supports the relationship in question.