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Medical corporations have secured their authority for professional self-regulation from the State and have responded throughout history by way of their scientifically grounded statements which confer rationality to State interventions in the field of health. During the pandemic in Brazil, there was a solid right-wing association between state governance and medical governance that supported a policy to address the pandemic based on scientific denialism, off-label use of ineffective drugs, and the disregard of certain preventive measures, which together were responsible for most of the more than 700,000 deaths that occurred in the country. This article examines the phenomenon of the interaction of these two forms of governance in a context of authoritarian neoliberalism and thus seeks to reflect on the necessary limits to medical autonomy at all its levels.

A whole series of processes lead to the decrease in the use of traditional medicine by the indigenous peoples of Mexico, including the reduction in the number of traditional healers and the direct and indirect expansion of biomedicine. This essay addresses the central role these processes play in the relations of hegemony/subalternity that occur in different fields of reality, and especially in the health-illness-care-prevention processes, given that counter-hegemonic processes are not generated, or those that do arise have been ineffective in confronting social hegemony in general and biomedical hegemony in particular.

A whole series of processes lead to the decrease in the use of traditional medicine by the indigenous peoples of Mexico, including the reduction in the number of traditional healers and the direct and indirect expansion of biomedicine. This essay addresses the central role these processes play in the relations of hegemony/subalternity that occur in different fields of reality, and especially in the health-illness-care-prevention processes, given that counter-hegemonic processes are not generated, or those that do arise have been ineffective in confronting social hegemony in general and biomedical hegemony in particular.

Background: oral diseases are a health problem. The acute dento-alveolar abscess is one them and it is defined as a localized collection of pus in a cavity newly formed by the disintegration tissues.Objective: to characterize the patients with acute dento-alveolar abscess seen at “Ormani Arenado” Dental Clinic of Pinar del Rio, from February 2015 to February 2016.Methods: a descriptive, cross-sectional study was conducted at the place and during the period herein mentioned. The sample was randomly made up of 60 patients of 19 years of age and older with a diagnosis of acute dento-alveolar abscess, according to the clinical characteristics. The variables measured were age, sex, clinical stages of the acute dento-alveolar abscess, the most frequent signs and symptoms and the most affected tooth.Results: the acute dento-alveolar abscess prevailed in the 35 to 59 age group with 38 patients; the female sex was the most affected one with 45 patients. In 30 patients the abscess was detected at phase II and in 23 patients at phase I. 100 % visited the clinic complaining of pain accompanied by increased volume in 91,6 %. The first lower molar was the most affected one with 28,3 %.Conclusions: the study described the characteristics of the patients of 19 years of age and older with a diagnosis of acute dento-alveolar abscess, a step previous to new researches related to the origin, promotion and prevention of this condition.

OBJETIVO: Descrever a frequência de rastreadores de potenciais resultados adversos em internações no Sistema Único de Saúde. MÉTODOS: Estudo retrospectivo, incluindo as internações de adultos na clínica médica (n = 3.565.811) e clínica cirúrgica (n = 2.614.048) no Brasil em 2007. O Sistema de Informações Hospitalares foi utilizado como fonte de informação. A mensuração dos resultados adversos baseou-se no rastreamento de 11 condições clínicas, definidas em estudos internacionais anteriores, registradas no campo diagnóstico secundário. Foram realizadas análises bivariada e multivariada, no intuito de associar resultado adverso, óbito (variável dependente) e outras variáveis como idade, utilização de unidade de terapia intensiva e realização de cirurgia. RESULTADOS: A frequência obtida foi 3,6 potenciais resultados adversos por 1.000 internações para ambas as clínicas, superior na clínica médica (5,3 por 1.000) em relação à clínica cirúrgica (1,3 por 1.000). Houve diferenças no perfil das internações: na clínica médica predominaram idosos, maior tempo médio de permanência, maior taxa de mortalidade e menor custo total de internação. O rastreador de resultado adverso mais frequente foi pneumonia hospitalar. Choque/parada cardíaca apresentou maior risco de óbito (OR = 5,76) em relação aos demais resultados adversos. Os maiores gastos com internações estiveram relacionados à sepse hospitalar. Os rastreadores de potencial resultado adverso apresentaram altas chances de óbito, mesmo com a introdução de variáveis como uso de terapia intensiva e realização de cirurgia. CONCLUSÕES: A alta frequência de resultados adversos em internações indica a necessidade de desenvolver estratégias de monitoramento e melhorias dirigidas para a segurança do paciente.OBJETIVO: Describir la frecuencia de sondeos de potenciales resultados adversos en internaciones en el Sistema Único de Salud. MÉTODOS: Estudio retrospectivo, incluyendo las internaciones de adultos en la clínica médica (n=3.565.811) y clínica quirúrgica (n=2.614.048) en Brasil en 2007. El Sistema de Informaciones Hospitalarias fue utilizado como fuente de información. La medición de los resultados adversos se basó en el sondeo de 11 condiciones clínicas, definidas en estudios internacionales anteriores, registradas en el campo diagnóstico secundario. Se realizaron análisis bivariado y multivariado, con el propósito de asociar resultado adverso, óbito (variable dependiente) y otras variables como edad, utilización de unidad de terapia intensiva y realización de cirugía. RESULTADOS: La frecuencia obtenida fue 3,6 potenciales resultados adversos por 1.000 internaciones para ambas clínicas, superior en la clínica médica (5,3 por 1.000) con relación a la clínica quirúrgica (1,3 por 1.000). Hubo diferencias en el perfil de las internaciones: en la clínica médica predominaron ancianos, mayor tiempo promedio de permanencia, mayor tasa de mortalidad y menor costo total de internación. El sondeo de resultado adverso más frecuente fue neumonía hospitalaria. Choque/parada cardíaca presentó mayor riesgo de óbito (OR= 5,76) con relación a los demás resultados adversos. Los mayores gastos con internaciones estuvieron relacionados con la asepsia hospitalaria. Los sondeos de potencial resultado adverso presentaron altas probabilidades de óbito aún con la introducción de variables como uso de terapia intensiva y realización de cirugía. CONCLUSIONES: La alta frecuencia de resultados adversos en internaciones muestran la necesidad de desarrollar estrategias de monitoreo y mejoras dirigidas a la seguridad del paciente.OBJECTIVE: To assess the frequency of screening for potential adverse outcomes in hospitalizations of the Brazilian Unified Health System. METHODS: A retrospective study, including all hospital admissions of adults in medical clinics (n = 3,565,811) and surgical clinics (n = 2,614,048) in Brazil in 2007. The Hospital Information System was used as a source of information. The measurement of adverse events was based on screening for eleven clinical conditions, as defined by previous international studies, recorded in the secondary diagnosis field. We performed bivariate and multivariate analysis to investigate associations between adverse events, death (dependent variable) and other variables such as age, use of the intensive care unit and performance of surgery. RESULTS: The frequency obtained for both clinic types was 3.6 potential adverse events per 1,000 admissions, with a greater frequency in medical clinics (5.3 per 1,000) than in surgery clinics (1.3 per 1,000). There were differences in the profile of hospital admissions between the two clinics: medical clinics were characterized by a predominance of older adults, longer average length of stay, higher mortality rate and lower total cost of hospitalization. The most common potential adverse outcome was hospital-acquired pneumonia. Cardiac arrest had a higher risk of death (OR= 5.76) compared to other potential adverse outcomes. Increased cost for hospitalizations was associated with sepsis. The conditions used as the screening criteria were associated with greater odds of death even after the introduction of variables such as use of intensive care and surgery. CONCLUSIONS: The high frequency of adverse outcomes in hospital admissions indicates a need to develop monitoring strategies and to improve quality of care for improved patient safety.

Introducción. La simulación con modelos de alto realismo se utiliza a menudo en la formación de los profesionales sanitarios. Sin embargo, son escasas las experiencias en el pregrado. El objetivo de este trabajo fue conocer la factibilidad y la aceptación de su aplicación con estudiantes de sexto curso de la licenciatura de Medicina. Materiales y métodos. Se diseñaron ocho escenarios que simulaban problemas clínicos frecuentes para su desarrollo con maniquíes de alto realismo. Los estudiantes se dividieron en grupos de 6-8 sujetos, cada uno de los cuales atendió dos casos durante 30 minutos. Posteriormente se llevó a cabo un análisis reflexivo durante 25-40 minutos. La actividad se repitió en dos años consecutivos. Al final se recabó la opinión de los estudiantes mediante encuestas anónimas. Resultados. La actividad fue valorada muy positivamente por los estudiantes, quienes la consideraron como "útil" (4,8 y 4,9 puntos sobre 5) e "interesante" (4,9 y 4,9 puntos). El tiempo preciso para preparar cada escenario fue de unas 3 horas. Fueron necesarias una jornada completa de un profesor, un técnico y un enfermero para que un colectivo de unos 40 estudiantes se expusiera a dos casos clínicos. Conclusiones. Esta experiencia piloto sugiere que la simulación de alto realismo es factible en el pregrado, supone un consumo razonable de recursos y tiene una elevada aceptación por parte de los estudiantes. No obstante, se necesitan otros estudios que confirmen la impresión subjetiva de que resulta útil para potenciar el aprendizaje de los alumnos y su competencia clínica.Introduction. Realistic clinical simulation is commonly used with physicians and other health professionals. However it has been rarely used with undergraduate students. The aim of this study was to explore its feasibility and acceptance with medical students. Materials and methods. Eight clinical scenarios representing common acute problems in medical practice were designed and implemented using a realistic manikin. In two consecutive years, groups of 6-8 students attended two cases during 30 min, followed by a 25-40 period for assessment and feedback. Students opinion was obtained by anonymous questionnaires. Results. Students considered the activity both "useful" (4.8 and 4.9 points in a 5-point scale) and "interesting" (4.9 and 4.9 points). Designing each scenario required about 3 hours. During a work day of a teacher, a nurse and a technician, 40 students were exposed to two scenarios. Conclusions. This pilot study suggest that realistic clinical simulations is both feasible and well-accepted by medical students, with reasonable resource requirements. Nevertheless, other studies are needed to confirm their usefulness to improve student learning and clinical performance.

Los aptámeros son ácidos nucleicos de cadena sencilla, ADN o ARN, que reconocen una gran variedad de moléculas. Cada aptámero posee una estructura tridimensional particular que le permite unirse con afinidad y especificidad altas a la molécula diana. Los aptámeros tienen propiedades de reconocimiento equiparables a las de los anticuerpos; sin embargo, por la naturaleza de su composición tienen ventajas significativas en cuanto a su tamaño, producción y modificación. Estas características los hacen excelentes candidatos para el desarrollo de nuevas plataformas biotecnológicas. Se han identificado aptámeros con propiedades terapéuticas que han sido evaluados exitosamente en modelos animales; entre ellos, algunos se encuentran en fase clínica y uno ya fue aprobado para tratamiento por la FDA (Food and Drug Administration). Todos estos avances ocurridos durante las dos últimas décadas permiten anticipar el protagonismo que tendrán los aptámeros como agentes diagnósticos y terapéuticos en un futuro cercano.

En este artículo analizo la construcción del riesgo en la medicina clínica del Sida a partir del estudio de las argumentaciones y las formas retóricas puestas en juego en la presentación de la etiología de la enfermedad, la trasmisión viral y la relación entre procesos orgánicos y procesos sociales por parte de un conjunto de profesionales comprometidos en la atención de personas viviendo con VIH (PVVIH) y entrevistados en dos momentos de la epidemia (1993-1994 y 1998-2000). En la reconstrucción de la trama narrativa que pone en relación hallazgos científicos, evidencias epidemiológicas, síntomas y signos relevados en la atención de los pacientes, clasificaciones diagnósticas, presentaciones patogénicas, etc., destaco un conjunto de desplazamientos de sentido mediante procesos de tipo metonímico que vinculan vías de trasmisión, comportamientos sociales, causa y riesgo. A partir de allí desarrollo la cuestión de la individualización del riesgo en la atención de las PVVIH especificando qué componentes o aspectos de la vida sexual, las relaciones de género, el consumo de drogas y los modos de vida de los afectados juegan roles significativos en el accionar clínico y permiten establecer criterios o indicadores para definir la posibilidad individual de contraer y/o desarrollar la enfermedad y de adoptar comportamientos de cuidado en especial en la implementación de los tratamientos antirretrovirales.In this article, the construction of risk in AIDS related clinical Medicine is analyzed. The arguments and rhetoric in the presentation of the etiology of the illness, viral transmission and the relationship between organic and social processes by a group of medical professionals engaged in the care of persons living with HIV and interviewed during two moments of the epidemic (1993-1994 and 1998-2000) are studied. The paper reconstructs the narrative plot that relates scientific findings, epidemiological evidence, signs and symptons identified in patient care, diagnostic classifications, pathogenic presentations, and so on. It further identifies metonymies that link trasmission routes, social behaviors, cause and risk. The question of risk individualization in medical attention is addressed through the identification of aspects of sexual lives, gender relationships, drug consumption and ways of living of the affected persons that play significant roles in clinical work and contribute to the establishment of the individual possibility of contracting and/or developing AIDS and of adopting care behaviors, especially regarding the application of antiretroviral therapies.

Los signos de peligro son hallazgos clínicos que indican gravedad o que tienen utilidad para el pronóstico de complicación o muerte. En el paciente con malaria, o paludismo, se presentan signos clínicos o parasitológicos que pueden reconocerse fácilmente durante la fase aguda de la enfermedad y son indicadores del inicio de una complicación. Entre los signos de peligro que puede presentar el paciente con malaria se incluyen cambios neurológicos, alteraciones del patrón respiratorio, vómito y diarrea persistentes, ictericia, sangrados, orina oscura, llenado capilar lento, palidez intensa, hiperpirexia, hiperparasitemia y esquizontemia. Su reconocimiento oportuno contribuirá a la disminución de complicaciones y muertes.

Es descriuen les funcions bàsiques de les editorials científiques comercials respecte dels articles de la revista i se’n recalquen especialment els processos de revisió i d’avaluació dels continguts i de difusió en format digital. Aquest model es contraposa al moviment d’accés lliure als articles (open acces), del qual es presenten alguns aspectes qüestionables, com ara l’existència de controls de qualitat o la presència de costos ocults.The article describes the basic functions that commercial scientific publishers perform regarding journal articles and focuses especially on the processes of revising and evaluating content and of disseminating the digital format. This model is contrasted with the open access movement, of which the author presents some questionable aspects, such as existing quality control or the presence of hidden costs.

Se describen las funciones básicas de las editoriales científicas comerciales respecto a los artículos de revista, haciendo especial hincapié en los procesos de revisión y evaluación de los contenidos y a su difusión en formato digital. Este modelo se contrapone al movimiento de libre acceso a los artículos (open access) del cual se presentan algunos aspectos cuestionables, como la existencia de controles de calidad o la presencia de costes ocultos.The article describes the basic functions that commercial scientific publishers perform regarding journal articles and focuses especially on the processes of revising and evaluating content and of disseminating the digital format. This model is contrasted with the open access movement, of which the author presents some questionable aspects, such as existing quality control or the presence of hidden costs.

En este trabajo se hace una referencia a la vida y obra del doctor matancero Armando Carnot Veunles, graduado en el año 1905 como Cirujano Dental, y en 1907 como Doctor en Medicina. Su labor médica se destacó fundamentalmente por la ayuda y atención a varios gremios de trabajadores de la ciudad de Matanzas y a la clase humilde de la sociedad. Por tal motivo fue conocido como el "Médico de los Pobres".This work refers to the life and work of the Matanzas physician Armando Carnot Veulen, graduated in 1905 as Dental Surgeon, and in 1907 as Doctor in Medicine. His medical work was mainly distinguished by helping and caring several labor unions of Matanzas and the low classes of the society. For that reason he was known as the Physician of the Poors.

Desde los años 80 se ha desarrollado el concepto de la llamada "Medicina basada en la evidencia" (MBE), que constituye un replanteamiento sobre los conceptos teórico-prácticos en la formación del médico actual, la cual no sólo toma en cuenta la mejor evidencia científica, sino también la experiencia individual de cada médico. No son estos conceptos actuales, pues desde su propio origen los médicos se han ligado a ella por su afán de conocer la información más actualizada y real. La MBE se encarga de publicar revistas seleccionadoras de investigaciones validadas científicamente, y en esta revisión se indican algunas de estas fuentes, así como los pasos para realizar la MBE, la cual se ha constituido en el brazo ejecutor del perfeccionamiento médicoThe concept of the so-called Evidence-based medicine (EBM) has been developed since the 1980's. It is a restatement of the theoretic and practical concepts in the training of the present physician that takes into account not only the best scientific evidence, but the individual experience of each physician. They are not current concepts, since from its very origin physicians have been related to it in their eagerness to have the most updated and real information. EBM publishes journals selected from scientifically validated research and in this review some of these sources are explained, as well as the steps to take to put into practice EBM, which is the performing arm of medical improvement

OBJETIVO: Descrever a frequência de rastreadores de potenciais resultados adversos em internações no Sistema Único de Saúde. MÉTODOS: Estudo retrospectivo, incluindo as internações de adultos na clínica médica (n = 3.565.811) e clínica cirúrgica (n = 2.614.048) no Brasil em 2007. O Sistema de Informações Hospitalares foi utilizado como fonte de informação. A mensuração dos resultados adversos baseou-se no rastreamento de 11 condições clínicas, definidas em estudos internacionais anteriores, registradas no campo diagnóstico secundário. Foram realizadas análises bivariada e multivariada, no intuito de associar resultado adverso, óbito (variável dependente) e outras variáveis como idade, utilização de unidade de terapia intensiva e realização de cirurgia. RESULTADOS: A frequência obtida foi 3,6 potenciais resultados adversos por 1.000 internações para ambas as clínicas, superior na clínica médica (5,3 por 1.000) em relação à clínica cirúrgica (1,3 por 1.000). Houve diferenças no perfil das internações: na clínica médica predominaram idosos, maior tempo médio de permanência, maior taxa de mortalidade e menor custo total de internação. O rastreador de resultado adverso mais frequente foi pneumonia hospitalar. Choque/parada cardíaca apresentou maior risco de óbito (OR = 5,76) em relação aos demais resultados adversos. Os maiores gastos com internações estiveram relacionados à sepse hospitalar. Os rastreadores de potencial resultado adverso apresentaram altas chances de óbito, mesmo com a introdução de variáveis como uso de terapia intensiva e realização de cirurgia. CONCLUSÕES: A alta frequência de resultados adversos em internações indica a necessidade de desenvolver estratégias de monitoramento e melhorias dirigidas para a segurança do paciente.

The systematic formulation of the research question allows the researcher to focus the study, guide the method decisions, and to put forward possible solutions. In practice, there are difficulties in the formulation of research problems. Diversity of clinical scenarios can lead to a mismatch between the structure of the research question and the classical PICO (population, intervention, control, and outcomes) format. The aim of this article is to provide guidelines that help in the proper formulation of clinical practice research questions for general practitioners, specialists, and healthcare personnel in training., (Copyright © 2016 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Clinical practice guidelines (CPG) provide recommendations on the benefits and harms of different healthcare interventions. Proper CPG development and implementation can potentially reduce variability in clinical practice while improving its quality and safety. The GRADE system is used to assess the quality of evidence and to grade the strength of recommendations in the context of the development of CPGs, systematic reviews or health technology assessments. The aim of this article is to describe the main characteristics of the GRADE system through relevant examples in the context of primary care., (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.)

Most respiratory diseases are considered complex diseases as their susceptibility and outcomes are determined by the interaction between host-dependent factors (genetic factors, comorbidities, etc.) and environmental factors (exposure to microorganisms or allergens, treatments received, etc.) The reductionist approach in the study of diseases has been of fundamental importance for the understanding of the different components of a system. Systems biology or systems medicine is a complementary approach aimed at analyzing the interactions between the different components within one organizational level (genome, transcriptome, proteome), and then between the different levels. Systems medicine is currently used for the interpretation and understanding of the pathogenesis and pathophysiology of different diseases, biomarker discovery, design of innovative therapeutic targets, and the drawing up of computational models for different biological processes. In this review we discuss the most relevant concepts of the theory underlying systems medicine, as well as its applications in the various biological processes in humans., (Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.)

In this article we present a published case study as an object of reflection. On this basis, we carried out a partial reconstruction of the process of study and diagnostic elaboration of the Uruguay syndrome, showing the circumstances of the case, the selection and interpretation of "clues," and some of the details relevant to the clinical reasoning. Our starting point is the recognition of the narrative nature of clinical knowledge and of the clinical method as an indiciary method. The manuscript of the Uruguay syndrome has a narrative structure adjusted to the conventions of a scientific article, which gives lesser importance to the clinical method. We carried out diverse methodical encounters, mainly involving in-depth interviews with the authors of the manuscript and observation in their workplace. The text seeks to recover the histories of work based on the indiciary or semiotic model of knowledge, and recognize the importance of this model in medical practice.

In recent years an increasing number of physicians want to spend part of their medical training in health facilities in developing countries. Working in these areas requires good clinical skills, particularly where diagnostic resources are limited. Trainees will attend patients with many different parasitic diseases such as malaria and soil transmitted helminthic infections. The aim of this work is to provide basic concepts of epidemiology, clinical characteristics, diagnosis and treatment of the principal parasitic diseases that could occur in a rural health post in the tropics., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

The institutionalization of clinical research in Argentina reached its point of greatest maturity with the creation, in 1957, of the Institute of Medical Investigations (Instituto de Investigaciones Médicas) of the Faculty of Medicine of the Universidad de Buenos Aires, and the drive of the man who was its director for almost 20 years, Alfredo Lanari. In this paper I analyze the ways in which he generated a style of clinical research and a referential position in local medical field that allowed him to carry out said institutional realization. This achievement was the result of a personal enterprise and at the same time part of a larger context of transformations within the medical discipline world-wide and at the Universidad de Buenos Aires. This study was carried out combining oral and documentary sources, such as interviews with physicians at the Institute of Medical Investigations, members of the journal Medicina and of the Argentine Society of Clinical Investigation (Sociedad Argentina de Investigación Clínica), as well as academic files and scientific articles.

Magnetic resonance (MR) imaging is the method of choice to evaluate the cranial nerves (CN). These nerves constitute a group of structures that have acquired during their phylogenetic development a high degree of specialization. There are 12 pairs of CN to which we use their specific name or number. The olfactory (I) and optic (II) pairs are not real nerves but tracts from the encephalon. The spinal nerve (XI) derives from superior cervical segment of the spine. The other 9 pairs of CN are related with the brain stem. Although the skull base foramina can be seen on computed tomography, the nerves themselves can only be visualized in detail on MR. That means, in order to see the different segments of nerves I to XII, the right sequences must be used. It is important to provide detailed clinical information to the radiologist so that a tailored MR study can be performed. In this review, the basic imaging anatomy of the 12 CN is discussed and illustrated briefly with an emphasis on more advanced extra-axial anatomy, illustrated with high-resolution MR images. Clinicians looking for complete anatomic descriptions and/or MR illustrations are advised to consult specialized textbooks considering it is not possible to describe all of the anatomy in one article. This manuscript is intended to be a practical review for clinicians.

We review the relations between the radiology department and the clinicians that attend emergency patients, complementing our opinions with a survey conducted in the emergency departments of hospitals in the autonomous region of Madrid. A dedicated emergency radiology section is present in 63.2% of hospitals. Radiologists are readily available to consult in the emergency department in 100%. Radiologists are involved in the initial workup in 61% of hospitals, in follow-up in 22.3%, and in both the initial workup and follow-up in 16.7%. At least one common protocol is shared by radiologists and emergency clinicians in 73.7% of hospitals. Radiologists participate in deciding which imaging tests to perform in 78.9% of hospitals. Radiologists provide a written report of the examination in 83.3% of cases. Continual assessment of the relations between the emergency department and the radiology department will enable us to understand their dynamics and to know what aspects can be improved., (Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.)