Homeopatia, imunologia, conceito saúde-doença e causalidade

Saúde e doença não são condiçes estáveis, mas sim conceitos vitais sujeitos a constante avaliacção e mudança. As principais referências através das quais se definem o processo saúde-doença se baseiam, mais comumente, em conceitos do século XIX, onde predominava a teoria do germe, ou seja, a identificação de um agente patogênico causador de uma lesão (inflamação) relacionada aos sintomas. Contudo, a evolução dos estudos epidemiológicos demonstrou que existem muitos gaps na nossa compreensão do proceso de saúde-doença.O presente trabalho tem por objetivo ressaltar alguns aspectos da literatura médica que tratam do conceito de saúde e doença, expondo o dilema da variabilidade de manifestações ou expressões clínicas e destacar alguns pontos da doutrina homeopática sobre esses mesmos aspectos, analisando interfaces possíveis entre esses conhecimentos. Para isso, iniciamos com uma breve revisão de conceitos básicos e atuais sobre imunobiologia. Em seguida, destacamos aspectos do processo saúde-doenca na doutrina homeopática, contidos no Organon da Arte de Curar, Doencas Cronicas – sua natureza peculiar e sua cura homeopática de Samuel Hahnemann e no livro Lições de Filosofía Homeopática de James Tyler Kent. Discorremos sobre as visões de saúde-doenca e causalidade contidas nas idéias da Patologia Experimental e da hipótese higiênica e por fim vimos alguns aspectos históricos da evolução do processo saúde-doença e causalidade. Concluímos mostrando a interrelação entre as diferentes abordagens do conceito saúde-doença por nós estudadas e, sobretudo, o modo como a homeopatia se relaciona com essas abordagens, contendo os aspectos mais importantes historicamente associados ao modo de adoecer na espécie humana. (AU)

Health and disease are not stable conditions, but vital concepts subject to constant evaluation and change. The main reference through which the health-disease process are based, most commonly refers to concepts of the nineteenth century, where the predominant thoughts was related to germ theory, ie, the identification of a pathogen causing a lesion (inflammation) related to symptoms. However, the evolution of epidemiological studies has shown that there are many gaps in our understanding of the process of health and illness. This paper aims to highlight some aspects of the medical literature dealing with the concept of disease and health, exposing the dilemma of the variability of clinical manifestations or expressions and highlight some points of homeopathic doutrine on these same aspects, analyzing possible interfaces between these knowledge. For this, we start with a brief revision of basic and current concepts of immunobiology. Then, we highlight aspects of the health-disease process in homeopathic doctrine contained in the Organon da arte de curar, Doenças Crônicas – sua natureza peculiar e sua cura homeopática of Samuel Hahnemann and the book Lições de filosofía homeopática of James Tyler Kent. We discuss the visions of health-and disease causation on the themes of Experimental Pathology and hygienic hypothesis and finally saw some historical aspects of the evolution of health care and causation process. We conclude by showing the interrelationship between the different approaches of the health-disease concept studied by us, and especially how homeopathy relates to these approaches, containing the most important features historically associated with the mode of illness in humans. (AU)

The search of a genetic basis for noise-induced hearing loss (NIHL).

BACKGROUND AND AIM: Knowledge about the genetic factors responsible for noise-induced hearing loss (NIHL) is still limited. This study investigated whether genetic factors are associated or not to susceptibility to NIHL. SUBJECTS AND METHODS: The family history and genotypes were studied for candidate genes in 107 individuals with NIHL, 44 with other causes of hearing impairment and 104 controls. Mutations frequently found among deaf individuals were investigated (35delG, 167delT in GJB2, Δ(GJB6- D13S1830), Δ(GJB6- D13S1854) in GJB6 and A1555G in MT-RNR1 genes); allelic and genotypic frequencies were also determined at the SNP rs877098 in DFNB1, of deletions of GSTM1 and GSTT1 and sequence variants in both MTRNR1 and MTTS1 genes, as well as mitochondrial haplogroups. RESULTS: When those with NIHL were compared with the control group, a significant increase was detected in the number of relatives affected by hearing impairment, of the genotype corresponding to the presence of both GSTM1 and GSTT1 enzymes and of cases with mitochondrial haplogroup L1. CONCLUSION: The findings suggest effects of familial history of hearing loss, of GSTT1 and GSTM1 enzymes and of mitochondrial haplogroup L1 on the risk of NIHL. This study also described novel sequence variants of MTRNR1 and MTTS1 genes.

Transillumination-guided study of the endoscopic anatomy of the lacrimal fossa.

UNLABELLED: Dacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly. AIM: study the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus. STUDY DESIGN: experimental. MATERIALS AND METHODS: we dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 - Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position. RESULTS: the most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95% of the cases. Septoplasty was needed in 12.5%, unicifectomy in 35% and middle turbinectomy in 7.5%. CONCLUSION: Although the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability.

Estudo da anatomia endoscópica da fossa lacrimal guiado por transiluminacão / Transillumination-guided study of the endoscopic anatomy of the lacrimal fossa

A dacriocistorrinostomia é o tratamento de escolha para a obstrução do aparelho lacrimal. No final do século passado, o desenvolvimento da instrumentação endoscópica em cirurgia nasossinusal tornou viável sua realização por via endonasal. Entretanto, variações anatômicas tornam difícil a reprodutibilidade de uma técnica de abordagem endonasal. Objetivo: Estudar a anatomia endoscópica da fossa lacrimal através da transiluminação do canalículo comum. Forma de estudo: Experimental. Material e método: Foram dissecadas 40 vias lacrimais de 20 cadáveres humanos, constando três etapas: 1 - identificação e dilatação do canalículo lacrimal. 2 - introdução do feixe de fibra óptica; 3 - dissecção endoscópica do saco lacrimal, descrevendo sua posição. Resultados: A posição mais frequente do saco lacrimal foi entre a borda livre do corneto médio e sua inserção e imediatamente abaixo desta. A linha maxilar foi visualizada em 95 por cento dos casos. A septoplastia foi necessária em 12,5 por cento, uncifectomia em 35 por cento e turbinectomia média em 7,5 por cento. Conclusão: embora o saco lacrimal tenha mostrado uma localização mais frequente, sua posição variou consideravelmente. A transiluminação do canalículo comum mostrou-se útil, resolvendo o problema da variabilidade anatômica.

Dacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly. AIM: study the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus. Study design: experimental. Materials and methods: we dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 - Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position. Results: the most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95 percent of the cases. Septoplasty was needed in 12.5 percent, unicifectomy in 35 percent and middle turbinectomy in 7.5 percent. Conclusion: Although the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability.