Therapeutic drug monitoring in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a problem that directly affects the quality of life of patients suffering from this condition. Monitoring the serum level of infliximab (IFX) (TDM) is an important tool for guiding therapeutic decisions in IBD patients. The purpose of this study was to determine the significance of quantitatively measuring the serum level of IFX (TDM) and antibody to IFX (ATI). Methods and materials: Prospective observational study involving 40 IBD patients on IFX therapy, including 14 Proactive (week 06 of the induction phase) and 26 Reactive (maintenance phase). Immediately prior to the infusion, blood samples were drawn and measured using a Bulhlmann rapid test instrument. Serum concentrations of IFX were categorized as supratherapeutic (>7.0 micrograms/ml), therapeutic (between 3.0 and 7.0 micrograms/ml), and subtherapeutic (3.0 micrograms/ml). When the serum concentration of IFX was 3 mcg/ml (subtherapeutic), the ATI was measured. 25 patients with CD and 15 patients with UC were evaluated. Only three of the twenty patients with subtherapeutic serum levels had a positive ATI, and both were reactive; two had CD and one had UC. There was a statistically significant difference between reactive and proactive patients with respect to levels of CRP (p = 0.042), with proactive DNS patients suffering greater alterations in CRP and albumin. (AU)

Virtual Case-Based Learning: Nova Estratégia de Ensino e de Treinamento Médico Digital Humanizado em Cardiologia / Learning: New Strategy for Humanized Digital Medical Education and Training in Cardiology

Resumo Fundamento A consolidação de novos paradigmas educacionais exige a implantação de estratégias inovadoras com potencial de transformar estudantes em profissionais competentes. Objetivos Analisar o conhecimento e a satisfação de estudantes antes e após a utilização de uma nova metodologia ativa de ensino médico de modelo digital humanizado chamada Virtual Case-Based Learning (VCBL). Métodos Estudo descritivo com análise documental sobre o processo de ensino-aprendizagem de estudantes de medicina. Dados obtidos da avaliação de conhecimento teórico e do instrumento de satisfação dos alunos nos anos de 2018 e 2019 foram analisados, e a nova metodologia proposta VCBL foi comparada com a metodologia ativa de ensino tradicional, o Problem-Based Learning (PBL). As análises descritivas e de associação foram realizadas utilizando o programa Statistical Package for the Social Sciences. Resultados Foram analisados 167 documentos aplicados a estudantes de medicina. Em relação à avaliação do conhecimento teórico, os alunos avaliados em 2018 obtiveram média 41,7%, comparados aos alunos de 2019 que alcançaram 73,3% (p<0,001). Entre os estudantes submetidos à avaliação da satisfação com a metodologia de aprendizagem proposta, 76,0% pontuaram o valor máximo para a questão um, e 83,0% para a questão número dois. Cerca de 70,0% dos estudantes classificaram positivamente o aprendizado adquirido após utilização da plataforma Paciente 360; 78,0% responderam que se sentem preparados para o atendimento ambulatorial; e 94,0% pontuaram de forma positiva a metodologia empregada. Conclusão Neste estudo inicial, os resultados indicaram que a nova ferramenta em metodologia ativa de ensino médico digital humanizado, o VCBL, pode auxiliar no aprimoramento do processo de ensino-aprendizagem, proporcionando conhecimento e satisfação dos estudantes.

Abstract Background The consolidation of new educational paradigms requires the implementation of innovative strategies to transform students into competent professionals. Objectives To assess knowledge and satisfaction of medical students before and after the use of a new humanized digital model of active learning, called virtual case-based learning (VCBL). Methods This was a descriptive, documentary analysis of the teaching-learning process of medical students. Data obtained from theoretical knowledge assessment and satisfaction evaluation questionnaires applied in 2018 and 2019 were analyzed, and the new VCBL was compared with the traditional active methodology PBL (problem-based learning). Descriptive and association analyses were made using the Statistical Package for the Social Sciences. Results A total of 167 evaluation forms administered to medical students were analyzed. In the evaluation of theoretical knowledge, the 2018 and the 2019 student groups had a mean of 41.7% and 73.3%, respectively (p<0.001). Among the students who responded to the satisfaction evaluation form, 76.0% gave the highest rating to question one, and 83.0% to question two. Nearly 70.0% of students positively evaluated knowledge acquisition with the Paciente 360 platform; 78.0% reported to feel prepared for working in outpatient care; and 94.0% positively evaluated the new method. Conclusion In this initial study, the results indicate that the new active method for humanized digital medical education, the VCBL, can help in the betterment of the teaching-learning process, promoting knowledge and satisfaction by the students.

Accuracy of mandibular measurements of sexual dimorphism using stabilizer equipment

Abstract The objective of this investigation was to compare the accuracy of mandibular measurements using a stabilizer (MS) with gold standard computed tomography (GS) images. Sixty mandibles were studied. Werth TomoScope HV Compact® was used to obtain CT images (GS), and the MS was also used. Analysis of the CT scans was performed using the VG Studio Max software® (Volume Graphics GmbH, Heidelberg, Germany), and MS was used after the proper positioning of the mandible. Descriptive and paired t test measures were used, and a ROC curve was calculated, as well as sensibility and specificity. MedCalc and STATA 13.0® were used (95% level of significance). Bicondylar breadth, bicoronoid breadth and minimum ramus breadth reached the highest concordance correlation coefficients at 0.99 (0.99-1.00), 0.99 (0.99–1.00) and 1.00 (0.99–1.00), respectively. Comparing observers with GS, the lowest accuracy was noted for the maximum mandibular length [0.59 (0.45–0.69), 0.64 (0.51–0.74)], the breadth of the right (0.14 (0.04–0.23), 0.14 (0.004–0.24)) and left mandibular body [0.14 (0.03–0.24), 0.16 (0.05-0.26)], and the right [0.58 (0.45–0.69), 0.63 (0.51–0.73) and left (0.59 (0.45–0.70), 0.59 (0.46–0.69)] mandibular angle. Various measurements exhibited good sensibility for males using MS: maximum mandibular length (78.12), bicondylar breadth (78.12), left mandibular notch breadth (84.37), and the left height of the mandibular body at the mental foramen (75.00). High specificity in discriminating females was observed for the left maximal ramus height (85.19), mandibular length (85.71), bicoronoid breadth (96.43), right height of the mandibular body at the mental foramen (82.19), bimental breadth (78.57), breadth right (92.86) and left (96.43) mandibular body, minimum ramus breadth (89.29), and left mandibular angle (85.71). MS was able to discriminate sexual dimorphism.

Luto: uma perspectiva da terapia analíticocomportamental / Grief: a perspective from behavioral analytic therapy

O luto é um fenômeno universal decorrente de perdas e envolve diversas reações voltadas para a adaptação à nova realidade com que o enlutado se depara. O objetivo do presente trabalho é propor uma releitura das tarefas do luto propostas por Worden sob a ótica da Análise do Comportamento e gerar um conjunto de regras para orientar a atuação terapêutica nesse tipo de tratamento, indicando novos estímulos discriminativos para que analistas do comportamento possam guiar o cliente em uma adaptação saudável ao luto. Para isso, foi utilizada a abordagem dos fatores comuns, parte do movimento de integração em psicoterapia, que busca identificar os pontos congruentes entre diferentes abordagens, a despeito de suas limitações e diferenças epistemológicas. Pautando-se nas produções de analistas do comportamento, o luto foi entendido como o processo decorrente da relação que existe entre o organismo e o seu ambiente, e isso foi analisado a partir das influências dos três níveis de seleção de comportamento (filogenético, ontogenético e cultural) a forma como o indivíduo encara esse evento e possíveis consequências comportamentais, operantes e respondentes, que acompanham o processo de luto. Depois foram apresentadas as quatro tarefas postuladas por Worden e uma releitura de como elas se ajustariam em um processo de Terapia Analítico-Comportamental. Em conclusão, é demonstrado que a perspectiva behaviorista radical é adequada para acompanhamento de enlutados, diferente do que ditam algumas posições contrárias a essa forma de terapia.

Mourning is a universal phenomenon that stems from loss, and involves diverse reactions aimed at adapting to the new reality which the mourner faces. The objective of the following work is to propose a reinterpretation of Worden’s mourning tasks using the behavioral analysis perspective, and create an assortment of rules in order to guide therapeutic action, indicating new discriminative stimuli so that behavior analysts may guide their clients towards a healthy adaptation during their mourning process. To this end the common factors model was used, part of the integration movement in psychotherapy, which seeks to identify the congruent points between different perspectives in spite of their limitations and epistemological differences. Based on the productions by behavior analysts mourning was defined as a processes which stems from the relationship between and organism and its environment, and this was analyzed based on the influence of the three levels of selection (phylogeny, ontogeny, and culture), the way which the individual deals with these events, and the possible behavioral consequences, operant and respondent, that accompany the morning process. Afterwards, Worden’s four mourning tasks where presented, and a reinterpretation of how they adapt in a behavioral analysis therapeutic process. In conclusion, it is demonstrated that the radical behavioral perspective is adequate for treating mourners, unlike what opposing viewpoints might say.

Physical activity and depressive symptoms in community-dwelling elders from southern Brazil / Atividade física e sintomas depressivos em idosos sul-brasileiros da comunidade

OBJECTIVE: To determine the existence of a relationship between physical activity and depressive symptoms in community-dwelling elders. METHOD: This is a cross-sectional, population-based study, which included 379 community-dwelling elders from Novo Hamburgo, state of RS, Brazil. The level of physical activity was estimated using the International Physical Activity Questionnaire and depressive symptoms were diagnosed according to the Yesavage Geriatric Depression Scale. The association between the level of physical activity and depressive symptoms was analyzed by logistic regression. RESULTS: A tendency towards a lower prevalence of depressive symptoms was observed in individuals with higher levels of physical activity, both in the sample as a whole as well as among men, but not among women (p for linear trend 0.04, 0.03 and 0.36, respectively). The odds ratio of the presence of depressive symptoms in the very active group as compared against that of the insufficiently active group was 0.32 (95 percent CI: 0.12-0.86) for men and 0.76 (95 percent CI: 0.39-1.46) for women. CONCLUSION: In this population of aged individuals, more intense physical activity is related to a lower prevalence of depressive symptoms. As shown by gender stratification, physical activity is inversely related to depressive symptoms in men, albeit not in women.

OBJETIVO: Avaliar a relação entre atividade física e sintomas depressivos em idosos da comunidade. MÉTODO: Estudo transversal de base populacional que incluiu 379 idosos da comunidade da cidade de Novo Hamburgo-RS, Brasil. O nível de atividade física foi estimado pelo Questionário Internacional de Atividade Física e os sintomas depressivos foram diagnosticados por meio da Escala de Depressão Geriátrica de Yesavage. A associação entre nível de atividade física e sintomas depressivos foi analisada por regressão logística. RESULTADOS: Foi observada uma tendência a menor prevalência de sintomas depressivos em indivíduos com níveis mais altos de atividade física na amostra como um todo e entre os homens, mas não entre as mulheres (p = 0,04, 0,03 e 0,36, respectivamente). O odds ratio para a presença de sintomas depressivos no grupo muito ativo, quando comparado com o grupo insuficientemente ativo, foi de 0,32 (IC 95 por cento: 0,12-0,86) para homens e 0,76 (IC 95 por cento: 0,39-1,46) para mulheres. CONCLUSÃO: Nesta população de idosos, a atividade física mais intensa está relacionada com uma menor prevalência de sintomas depressivos. Como demonstrado pela estratificação por gênero, a atividade física está inversamente relacionada com sintomas depressivos em homens, mas não em mulheres.

Cognitive deficit and depressive symptoms in a community group of elderly people: a preliminary study

Com o objetivo de avaliar déficit cognitivo e presença de sinais e sintomas depressivos, 62 idosos registrados numa Unidade de Saúde Comunitária em Porto Alegre/RS foram entrevistados em suas casas. Foram avaliados pelo Mini Exame do Estado Mental (Mini Mental state), pela escala de Montgomery-Asberg, e por um questionário sobre condiçöes de saúde, moradia e outras variáveis de vínculos sociais. Níveis mais altos de sintomas depressivos foram observados entre os idosos expostos a fatores de risco maiores para doença cérebro-vascular (diabete e doença coronariana), enquanto que pior desempenho cognitivo foi encontrado nos sujeitos que näo contavam com um confidente (variável da rede social). Os resultados sugeriam que a identificaçäo precoce dos grupos idosos de risco pode auxiliar na prevençäo de problemas sociais e de saúde, mantendo os indivíduos na comunidade