RMMG - Revista Médica de Minas Gerais

In this paper it is discussed the segregation issue of 237 Hansen's disease patients, from 1943 to 1998, in the Casa de Saúde São Francisco de Assis, in Bambuí, Minas Gerais. The stigma attached to having or having had Hansen's disease was noted in 38,4% of the patients. The wish for social reintegration was inexistent in 51,5% cases. The segregation showed to be inoperative in relation to the cure and unable to reduce the epidemic advancement, besides creating a new social problem, due to the Hansen's disease patients social and familiar reinsertion difficulty. Hansen's disease is prone to destroy personal relationships and family structure. Public policies have not been efficient for minimizing the suffering; they have only managed to set apart from health people's eyes the Hansen's disease issue.

Keywords Leprosy/therapy; Leprosy/psychology; Prejudice; Patient Isolation.

This study analyses the clinic and epidemiologic profile of HIV infected children on This paper analyses the clinical-epidemiologic profile of HIV infected children who have needed hospital treatment. It deals of a prospective, descriptive study on children with confirmed HIV infection admitted to the Pediatrics General Center (Centro Geral de Pediatria ) of the Fundação Hospitalar de Minas Gerais (CGP-FHEMIG) in the period from March to December 2003. 47 HIV-infected children, all through vertical transmission, have been included, with a rate of 1,4 internment/children. At the admission, 40,4% presented C clinical classification (CDC, 1994). The use of prophylactic sulfametoxazol-trimetoprim has been reported for 34% patients. The BCG, Haemophilus influenzae B and pneumococus vaccinal cover has been, respectively, 87,2, 78,7 and 42,6%. The most common diagnoses have been pneumonia, bronchospasm, varicela and diarrhea. No child has died. The greatest hospitalization rate has been noted in children with advanced clinical disease and severe immunodepression. The reduced use of active and passive immunoprophylaxis against encapsulated bacteria might be related to the pneumonia major frequency. The primary prophylaxis for pneumocistose has been associated to its incidence reduction.

Keywords HIV Infection; Acquired Immunodeficiency Syndrome/epidemiology; Child Health; Public Health; Hospitalization

INTRODUCTION: among the health care 14 categories only the medical act has not been legally ruled yet. In 2001, the Medicine Federal Council (Conselho Federal de Medicina) issued a decision that defines the physician attributions, which has become the Project of Medical Act Law (Projeto de Lei do Ato Médico /PLS 25/2002), which has raised a number of reactions.
OBJECTIVE: to find out the health care area courses students' perception, according to their knowledge and position about the PLS 25/2002.
MATERIAL AND METHODOLOGY: a questionnaire has been applied to 376 students in the courses of Medicine (group A), Physiotherapy, Nurse, Pharmacy and Biochemistry, Physical Education and Psychology (group B).
RESULTS: from the groups A and B, respectively, 21,70% and 83,42% have said to be not fair the physician exclusive right to diagnose diseases; the Medicine private right to diseases treatment has been approved by 58,73% (group A) and disapproved by 91,98% (group B); 71,12% (group B) have considered that the PLS 25/2002 denigrates their course and profession.
CONCLUSIONS: the improvement of the divulgation and discussion means about the theme may contribute for the improvement of the knowledge, enlightenment and understanding of the articles that rule the PLS 25/2002.

Keywords Legislation, Medical; Ethics, Professional; Education Medical; Physician's Role

OBJECTIVE: to compare the final functional result, obtained in the treatment of traumatic knee luxation, with different treatment modalities.
PATIENTS AND METHODOLOGY: the Schenck criteria were used in the luxations classification and the cases with comorbidities that might interfere in the impaired knee functional result were excluded. The patients were reexamined and the evaluation counted with objective and subjective data: anamneses, physical exam and Lysholm Scale.
RESULTS: the age rate was 35,6 ± 14,4 years, with predominance of the male gender. The most frequent trauma mechanisms were traffic accidents. The most frequently noted luxation pattern was the KD-III. The posterior crossed (cruciate) ligament was the most damaged (86,8%), followed by the anterior crossed/cruciate (80%). Four patients (26,7%) had the common fibular nerve lesion, two with complete recovery. The surgical treatment in the acute phase was performed in 11 patients, giving priority to the posterior crossed/cruciate ligament reconstruction. Pain was the most frequent claim. The patients operated in the acute phase obtained better results than those conservatively treated or those operated in the chronic phase. There has been no significant loss of full movement, but the residual instability was noted, which didn't impose limitations to the patients' daily life.
CONCLUSION: knee luxation, with no vascular damage, has a good prognostic with the adequate treatment. A varied residual instability level is expected and well tolerated. The repair or reconstruction of the peripheral lesions and of the PCL Posterior Crossed/Cruciate Ligament (LCP - Ligamento Cruzado Posterior) have been satisfactory, considering the subjective and objective criteria.

Keywords Knee Injuries; Knee Dislocation; Medial Collateral Ligament, Knee; Joint Instability

OBJECTIVES: to analyze the physical and mental health conditions, as well as the personal and professional profile of the physicians with professional practice in the town of Barbacena-MG.
METHODOLOGY: founded on the answers given to a questionnaire handed out to 279 physicians, of which 141 (50,5%) were answered and returned. The questionnaires have been grouped according to the gender.
RESULTS: the results point to a medical population, mostly males, with the average age of 46 years, presenting good physical and mental health, although considering more stress currently. The female sex presented more psychic alterations, in relation to the male sex. It has been evidenced that these physicians are professionally fulfilled (>94%), although they think they are ill paid and claim about work overload and the high professional responsibility.
CONCLUSION: it has been noted that Barbacena doctors have an intense and stressing work journey, but they manage to keep life habits considered healthy and a good social-familiar relation.

Keywords Physicians; Physician's Role; Professional Role ; Professional Practice; Health; Mental Health; Occupational Health

This paper deals about the technological evolution, its incorporation into the cardiologic practice and seeks to adjust this evolutive process with the actual needs of care and heartwarming reception to the human being. It questions the possible repercussions of technological advances on the medicine practice, the beneficial and negative aspects arising from their utilization. It deals, still, of the humanism issues and the humanitarian sense, which are lost with the super and the hyper specialization.

Keywords Medicine; Cardiology; Technology, Medical; Biomedical Technology.

Seric proteins electrophoresis (SPE) is a simple method that allows the separation of the human plasma proteins in fractions. Its interpretation gives useful information to the physician, which makes it an important tool for several diseases investigation and diagnosis. The exam consists in applying the serum sample into a solid medium and put it under an electrical potential. The proteins run different distances, forming bands named: albumin, alpha-1-globulin, alpha-2-globulin, beta globulin and gamma globulin. These bands are then quantified. It is noted a reduction of the albumin concentration in situations that promote its lost, low protein ingestion or high catabolism. The Alpha globulin fractions present increased levels in inflammatory, infectious and immune processes. The increase of beta globulin may be noted in situations of the lipid metabolism disorder or in the iron deficiency anaemia. The absence or reduction of the band-gamma indicates congenital or acquired immunodeficiency, while the increase suggests immunoglobulin polyclonal elevation related to inflammatory , neoplasic or infectious conditions, besides the monoclonal elevation typically noted in the multiple myeloma and other linfoproliferative disorders, such as Waldenström ‘s macroglobulinemia. The knowledge of each electrophoretic band main components makes easy the clinical reasoning and helps in the identification of electrophoretic patterns that characterize given diseases.

Keywords Electrophoresis; Blood Proteins Electrophoresis; Blood Proteins /analysis.

The need for the medical education reform was first suggested by Flexner (1910), in the United States, and by Osler (1913), in The United Kingdom. The implantation of problems based learning (PBL) in the McMaster University (Universidade de McMaster), in 1969, was one of the main innovations in medical education in the last 30 years. This work purpose is to review the PBL functioning dynamics and evaluate the results noted with the implantation of this educational strategy in medical courses. PBL has been developed from a better knowledge about adult learning ways and from the understanding of human memory functioning, and has four basic purposes: a) learning motivation; b) development of the clinical reasoning; c) knowledge structuring within the clinical context; and d) development of self-learning skills. The tutorial groups, including from 7 to 10 students, are the PBL central strategy. In these groups problems structured with basis on the curriculum are analyzed, with the aim of allowing the topics contextualized discussion, helping the previous knowledge recovery and the acquisition of new knowledge. Furthermore, the tutorial groups help the development of other new skills, such as communication, team work, problems solution and development of a critical posture. The comparison between the traditional learning methods and the PBL presents methodological difficulties. There are few randomized studies comparing the two methods simultaneously. Most make historical comparison between classes in the same institution in the United States qualification tests ( NBME or USMLE) and Canada (MCC). It is possible the conclusion that the PBL is an appropriate method for the current medical learning needs.

Keywords Problem-Based Learning; Education, Medical; Review (Publication Type).

The cases of two aged people with systemic arterial hypertension (SAH) (hipertensão arterial sistêmica (HAS)) related to symptomatic orthostatic hypotension (OH) are reported to be treated with quinalapril (20mg/day), an angiotensin-converting enzyme, after fruitless use of several classes of anti-hypertensive, with satisfactory results.

Keywords Hypertension/therapy; Hypotension/therapy; Orthostatic hypotension/therapy; Elderly; Antihyfertensive Agents.

The case report is of two adult patients, living in Belo Horizonte, with a frame of severe infection, characterized by extensive and quickly progressive necrosis of the subcutaneous cellular tissue and the muscle fascia, related to the skin gangrene. Undergoing ample surgical debridement combined with antibioticotherapy, they presented favorable evolution. This description warns for the need of precocious clinical diagnosis and immediate surgical approach, essential to this severe infection treatment.

Keywords Fasciitis, Necrotizing/diagnosis; Fasciitis, Necrotizing/surgery.

Currently in Brazil, a discussion is open on the humanized and ecological childbirth, in a political forum sometimes related to modernity issues. In this view, medical practice undergoes a series of questionings, being called violent among the pregnant women, whether due to the surgical instruments overuse, or due to the caesarean alarming statistics. This article tries to bring new imported elements from the Sociology cross sight with History, in order to help the reader to understand the marks left on the social by the fight for the historical occupation of childbirth practices and its care in the XIX century . What are these marks? Will the History tend to be repeated in the current times? If yes, how will that be?

Keywords History of Medicine; Historiography; Public Health/history; Woman's Health/ history.