RESUMO
Objetivos Relacionar históricamente las transformaciones más significativas del Instituto Materno Infantil (IMI) en su proceso de crisis, cierre y liquidación con las experiencias de sus trabajadores/as. Encontrar elementos vivenciales y teóricos que interconecten el proceso de privatización de la salud con las experiencias de resistencia y dolor/sufrimiento de trabajadores/as. Métodos Etnografía inscrita en corrientes críticas y apoyada en trabajo de campo constante y colectivo, investigación histórica (fuentes primarias y secundarias) y entrevistas semiestructuradas con cinco mujeres que trabajaron por más de quince años en el IMI. Resultados Una línea del tiempo con cuatro periodos principales: Los años de gloria (hasta 1990), Llega el neoliberalismo (1990-2000), La crisis y las resistencias (2001-2005) y Liquidación (2006-). La narrativa de las mujeres entrevistadas devela múltiples agresiones que se intensificaron desde el 2006 generando dolor/ sufrimiento, relatos que ilustran violaciones a sus derechos humanos y laborales. Discusión Proponemos analizar las conexiones entre los diferentes tipos de violencia y el dolor/sufrimiento bajo la categoría tortura, entendida como acciones violentas que causan dolor físico-emocional, las cuales son ejecutadas por actores de poder sobre otros que desafían alterarlo. Enfatizamos en las burocracias, el confinamiento, los agentes torturadores y los resquebrajamientos a la unidad mente/cuerpo para argumentar que esta relación neoliberalismo y tortura pretende eliminar los últimos trabajadores/as de la salud del país con garantías laborales para avanzar en la acumulación de capital que genera la creciente sobreexplotación del trabajo y la mercantilización de la salud.
Objectives To link, from a historical point of view, the most significant transformations of the Instituto Materno Infantil (IMI) [the oldest child and maternity hospital of the country] during its process of crisis, closure and liquidation with the experiences of the hospital workers. To find experience-based and theoretical elements that can interconnect the process of health care privatization of the country with the workers' experiences of resistance and pain/suffering. Methods Critically-oriented ethnography based on continuous collective field work, historical research (primary and secondary sources) and semi-structured interviews with 5 women who worked at the IMI for more than 15 years.Results: A time line of 4 main periods: Los años de gloria [The golden years] (up to 1990); Llega el neoliberalismo [Neoliberalism arrives] (1990-2000); La crisis y las resistencias [Crisis and resistances] (2001-2005); and Liquidación [Liquidation (2006-20??)]. The narratives of the interviewed women unveil multiple aggressions that have intensified since 2006, have caused pain and suffering and are examples of violations of human and labour rights. Discussion We suggest to analyze the links between the different kinds of violence and pain and suffering as torture. This category is defined as the set of violent actions that cause physical and emotional pain, which are performed by actors in positions of power over other people who challenge that power and are part of modern States' ideological principles around a defined moral social order. For the IMI workers' case, the ideological principle that is being challenged is health care neoliberalism. From the analyses of bureaucracy, confinement, torturing agents, and the breaking-off of the body-mind unit we conclude that this relationship between neoliberalism and torture aims to eliminate the last health care workers of the country who had job stability and full-benefits through public labour contracts. Their elimination furthers the accumulation of capital generated by increasing over-exploitation of labour and commodification of health care.
Assuntos
Feminino , Humanos , Masculino , Gravidez , Emprego/legislação & jurisprudência , Fechamento de Instituições de Saúde , Pessoal de Saúde/psicologia , Hospitais Urbanos/organização & administração , Centros de Saúde Materno-Infantil/organização & administração , Política , Política Pública/legislação & jurisprudência , Tortura , Desemprego/psicologia , Colômbia , Mercantilização , Contratos/legislação & jurisprudência , Depressão/etiologia , Depressão/psicologia , Fechamento de Instituições de Saúde/legislação & jurisprudência , Hospitais Urbanos/economia , Hospitais Urbanos/legislação & jurisprudência , Hospitais Urbanos/tendências , Satisfação no Emprego , Centros de Saúde Materno-Infantil/economia , Centros de Saúde Materno-Infantil/legislação & jurisprudência , Centros de Saúde Materno-Infantil/tendências , Redução de Pessoal/legislação & jurisprudência , Redução de Pessoal/psicologia , Política Pública/tendências , Salários e Benefícios/legislação & jurisprudência , Mudança Social , Suicídio/psicologia , Tortura/psicologiaRESUMO
CAPS is an uncommon disease, characterized by clinical evidence of multiple organ involvement and histopathological evidence of multiple vessel occlusions, in patients with either primary or secondary antiphospholipid syndrome. The present series describes the clinical manifestations and autopsy findings of 12 patients with CAPS. Neurological involvement was considered the main cause of death in all of them. CNS pathology revealed thrombotic microangiopathy as well as small and large vessel occlusions in several brain areas. Neurological involvement in CAPS is strongly associated with thrombotic microangiopathy and should be considered a potential cause of death in these patients.
Assuntos
Síndrome Antifosfolipídica/mortalidade , Doenças Arteriais Intracranianas/mortalidade , Adolescente , Adulto , Idoso , Síndrome Antifosfolipídica/complicações , Autopsia , Feminino , Humanos , Doenças Arteriais Intracranianas/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Trombose/complicações , Trombose/mortalidadeRESUMO
OBJECTIVES: To review background, pharmacological properties, mechanisms of action, and published clinical experience using omega-3 fatty acids in rheumatoid arthritis. MATERIALS AND METHODS: English language publications were identified through a computerized search (using MEDLINE) between 1979 and 1995 using the terms "omega-3 fatty acids" and "fish oil". In addition, manual search and cross references were used to obtain published articles on the subject. Papers showing evidence of pharmacological properties and mechanisms of action were analyzed. For therapeutic efficacy, only randomized clinical trials are presented in this article. All papers were reviewed by a board certified rheumatologist with training in research methodology and critical appraisal skills. He was aware of study objectives. RESULTS: Main results are summarized in the text and presented in tables. Mean change from baseline is presented only for patients treated with omega-3 fatty acids. Omega-3 fatty acids are superior with respect to placebo in improving some outcome measures, and decrease the long-term requirements for nonsteroidal antiinflammatory drugs. Some of these effects are statistically significant, but their clinical significance remain to be established. CONCLUSIONS: Treatment with omega-3 fatty acids has been associated with improvement in some outcome measures in rheumatoid arthritis. Studies are needed to determine if they might represent an alternative to nonsteroidal antiinflammatory drugs in certain circumstances.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Ácidos Graxos Ômega-3/uso terapêutico , Animais , Artrite Reumatoide/dietoterapia , Artrite Reumatoide/epidemiologia , Modelos Animais de Doenças , Ácidos Graxos Ômega-3/farmacologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
OBJECTIVE: To study the outcome of patients with idiopathic thrombocytopenic purpura (ITP) treated with splenectomy, with respect to the development of systemic lupus erythematosus (SLE). METHODS: Two independent observers reviewed data of 20 clinical, laboratory, and therapeutic variables of patients with ITP, with no clinical or laboratory indications of SLE, who were treated by splenectomy from 1952 to August 1995. 115 patients were studied, 86 female, 25 male, mean age 31.5 (SD 15.4) yrs (range 10-75), who had a mean followup of 7.2 (SD 7.5) yrs (range 0.08-32.8). RESULTS: 14 patients (12.1%) developed SLE. The most common SLE manifestations were arthritis (78.5%), lymphopenia (74.1%), mucocutaneous manifestations (64.2%), and hemolytic anemia (35.7%). Mortality was greater in the SLE group than in the ITP group (3 vs 4; odds ratio 6.61, 95% confidence interval 1.57-27.76, p = 0.037). 67% of the patients with ITP and 57.2% with SLE were in complete remission at the last visit (p = 0.54). CONCLUSION: Almost one of 8 patients with splenectomy due to ITP developed SLE. These patients require periodic followup to monitor other clinical data of SLE.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Púrpura Trombocitopênica/etiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Incidência , Lúpus Eritematoso Sistêmico/mortalidade , Lúpus Eritematoso Sistêmico/cirurgia , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica/mortalidade , Púrpura Trombocitopênica/cirurgia , Esplenectomia , Resultado do TratamentoRESUMO
OBJECTIVE: Rheumatoid arthritis (RA) is a disease that often requires multiple drug treatment for long periods of time. The purpose of this study was to assess the direct costs of medical care for RA patients seen in a tertiary care center in Mexico City. METHODS: The clinical cases of 3 patients attending our Institution were studied. These represented: (i) one with a disease easily controlled with a disease modifying anti-rheumatic drug (DMARD) (mild disease), (ii) one adequately controlled with 2 or more DMARDs (moderate disease), and (iii) one poorly controlled in spite of multiple DMARDs (severe disease). The costs of the medical visits and of all laboratory and routine examinations during the last year were estimated according to local tabulators, considering the options of highest, intermediate and lowest costs. The costs of the prescribed medications were calculated from current price lists obtained from four drugstores near the Institution. RESULTS: Medical care to an RA patient costs between US $19 and US $221.70 monthly (US $228.08 and US $2,661.40 per year) depending on the socio-economic status of the patient and on variables related to the activity and severity of the disease in our setting. The number of medical visits represented 0.1% to 12.7% of the total costs, laboratory and routine examinations 0.1% to 7.1%, and medications 81.8% to 99.8%. For reference the minimum wage in Mexico is US $90.40 per month. CONCLUSIONS: The direct costs of medical care to RA patients in our setting can be high, and greatly depends on the prescribed medications.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Custos Diretos de Serviços , Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Custos de Medicamentos , Testes Hematológicos/economia , Humanos , México , Visita a Consultório Médico/economiaRESUMO
The erythrocyte (Ca2+,Mg2+)-ATPase activity from 12 hypertensive and 14 normotensive subjects have been compared. No differences were found in the calcium-ATPase activity from both studied groups. When the calcium-ATPase assay was carried out in the presence of EGTA, we observed a partial stimulatory effect of the activity, but a blunted stimulation by calmodulin in both membrane preparations. When the EGTA was removed and a total concentration of calcium (100 uM) was kept constant in the incubation media, calmodulin stimulated the ATPase four fold over the non stimulated conditions in both studied groups. It is concluded that the use of EGTA buffers in the assay of the calcium-ATPase in the erythrocyte membrane of normotensive and hypertensive patients, must be used with caution, since a different enzyme sensitive to EGTA in the normotensive and the hypertensive membranes could give an erroneous interpretation of the results. This condition could partially explain the controversies in recent reports investigating the (Ca2+,Mg2+)-ATPase activity and calcium transport in different cell systems isolated from hypertensive patients.
Assuntos
ATPase de Ca(2+) e Mg(2+)/metabolismo , Membrana Eritrocítica/enzimologia , Hipertensão/enzimologia , Adulto , Idoso , Calmodulina/farmacologia , Ácido Egtázico/farmacologia , Ativação Enzimática/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação QuímicaRESUMO
To find out if a second dose of O. streptacantha may enhance its hypoglycemic effect, three tests were performed in fasting condition to 8 type II diabetic subjects and 6 healthy individuals. The tests were as follows: A. 500 g of broiled stems of O. streptacantha were given orally initially and two hours later. B. Only the initial dose. C. Control test with water. Serum glucose and C peptide were measured every two hours from 0 to 6 hours. In diabetic patients a significant (P < 0.01 vs control) decrease of serum glucose reaching from 41 to 46% less than initial value, was noticed in tests A and B, without differences between them. C peptide did not change. In healthy subjects serum glucose and C peptide did not significantly differ between tests. A second dose of O. streptacantha, two hours after the first one, did not improve its hypoglycemic activity.