Aprendizagem baseada em equipes: da teoria à prática / Team-based learning: from theory to practice

Professores que desejam utilizar a aprendizagem baseada em equipes (ABE) do inglês team-based learning (TBL) precisam compreender os princípios fundamentais envolvidos na aplicação desta estratégia educacional e a seqüência de eventos necessária para sua implantação efetiva. O objetivo deste artigo é auxiliar o leitor na compreensão do potencial desta estratégia educacional, incluindo sua capacidade de promover a aprendizagem significativa. Existem quatro princípios fundamentais para o uso eficaz do TBL, que serão descritos, assim como o passo-a-passo para quem deseja organizar um curso inteiro ou algumas atividades (aulas), utilizando a aprendizagem baseada em equipes. Ao final, apresentamos os principais atrativos e os desafios para aqueles que desejam incorporar o TBL à sua prática de ensino/aprendizagem.

Those faculty who want to use Team-based learning in their classes need to understand the basic principles behind this educational strategy and the required steps that should be followed to achieve an effective implementation. The aim of this article is offer a comprehensive view on TBL’s potential as an educational tool, including the expected outcome of students’ meaningful learning and developmental teamwork. The four principles and a step-by-step process to design and deliver a TBL will be described in details, if one wants to use it for a whole discipline or only for isolated insertions within a course. At the end, it will be expected that the reader understand the main strengthens and weaknesses and could able to do an informed decision making about incorporating TBL or not in their teaching practices.

Antisecretory Effects of Watermelon (Citrullus lanatus) Juice in Male Albino Rats.

Aims: To evaluate the effects of the juice of Citrullus lanatus (watermelon) on gastric acid secretion and pH in Indomethacin-induced ulceration in male albino rats. Study Design: The experiment was divided into two studies. Under each study, four groups of rats were pre-treated with distilled water (control), 25% watermelon, 50% watermelon and 100% watermelon juice respectively for 30 days. Place and Duration of Study: Department of Physiology, College of Medicine, University of Ibadan, Ibadan, Nigeria, between June, 2011 and July, 2012. Methodology: Sixty-four animals in total were used for the experiment. The animals were divided into two experimental studies: Study I contained thirty-two rats which were used for the study on ulcerogenesis. Study II also contained thirty-two rats which were used for the study on gastric acid secretion. Each of the experimental studies was further divided into four groups in accordance with the study design. Results: Rats pre-treated with Citrullus lanatus juice exhibited significant dose-dependent reduction of gastric lesions formation (P<0.05). Also, ulcerogenesis in the pretreated groups was significantly lower than that observed with the control (P<0.05). Conclusion: The results suggest that Citrullus lanatus (watermelon) juice has a significant gastroprotective effect in Indomethacin-induced gastric ulceration. One of the mechanisms by which this protective effect is carried out is by its inhibition of gastric acid secretion.

Distribution of Candida Species among HIV-Positive Patients with Oropharyngeal Candidiasis in Accra; Ghana

Introduction: Oropharyngeal candidiasis is a common occurrence in the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of oropharyngeal candidiasis and type of Candida species profile may be a reflection of immunological changes in patients. The aim of this study was to undertake a baseline Candida species identification for future reference. Methodology: Oral swabs of 267 HIV-infected patients with oropharyngeal candidiasis were cultured and Candida species were identified by API 32 C. Results: A total of 201 (75.3) Candida species and 10 (3.7) non candida fungi were identified. Twenty different Candida species were isolated. Candida albicans was the most prevalent species (68.5) followed by C. tropicalis (7.4); C. krusei (6.4); C. parapsilosis (3.0) and C. sake (2.5). Other species ranged from 0.5 to 1.5.Positive culture was independent of whether patients were on anti-retroviral therapy or not. Conclusion: of all Candida isolates; 68.5 were identified as C. albicans. Since other uncommon species were also isolated; it may be necessary in this group of patients to identify Candida species causing severe infections

Influência do exercício isotônico pré-dialítico / The influence of the isotonic exercise before hemodialysis

Introdução: Uma das funções da terapia renal substitutiva é a remoção da uréia acumulada nos pacientes portadores de insuficiência renal dialítica. Parte desta uréia encontra-se no compartimento muscular, reduzindo a capacidade dialítica de remoção deste soluto. A atividade física pode ser um fator importante que possa contribuir para melhora do fluxo sanguíneo muscular e conseqüente otimização da depuração deste soluto.Este trabalho teve como objetivo analisar, utilizando-se o índice de depuração da uréia por sessão dehemodálise (Kt/V) como parâmetro de eficácia dialítica, os resultados de um programa de exercícios isotônicos pré-dialíticos na qualidade de diálise. Metodologia: Foram analisados dados de quinze pacientes com insuficiência renal crônica (IRC) de ambos os sexos, submetidos à hemodiálise três vezes por semana. Um protocolo de exercícios isotônicos de baixa intensidade precedidos por alongamentos foi aplicado por um mês, imediatamente antes da sessão de hemodiálise. Após a hemodiálise, a concentração plasmática de uréia foi mensurada, o Kt/V determinado e comparado com o do mês anterior obtido com as mesmas condições de hemodiálise quanto à duração, filtro e acesso vascular, sem a aplicação do programa de exercícios. Teste t de Student, com significância de 5%, foi utilizado para análise dos dados. Resultados: Comparando o Kt/V do mês sem exercício (1,4 ± 0,33) com os obtidos após a aplicação do programa de exercícios (1,3 ± 0.3), os valores não foram estatisticamente significativos (p > 0,05). Conclusões: Os resultados sugerem que, na amostra analisada, o programa de exercícios na intensidade, duração e freqüência executados, não resultou na melhora da eficiência dialítica.

Introduction: One of the functions of the substitutive renal therapy is to remove accumulated urea inindividuals with dialytic renal failure. Part of this urea is found in the muscular compartment reducing the dialytic capacity to remove this solute. Physical activity can be an important contributing factor to improvethe muscle blood flow and consequently the optimization of this solute depuration . The aim of this studywas to analyze the results of a program of a pre-dialytic isotonic exercise, using the standard procedure of measure (Kt/V), as a parameter of the dialysis efficacy. Methodology: Data from fifteen (15) patients from both sexes with chronic renal failure (CRF) who had undergone hemodialysis three times a week were analyzed. A protocol of low intensity isotonic exercises preceded by stretching was applied during a month, immediately before hemodialysis sessions. After hemodialysis, a urea plasmatic concentration was measured; std Kt/Vwas determined and compared with the previous month obtained through the same conditions of hemodialysis according to the length, filter and vascular access, without the exercise program. Student´s t test with 5% of significance was used for data analysis. Results: Comparing the std Kt/V during the month without exercise(1.4 ± 0.33) with the Kt/V obtained after the exercise program (1.3 ± 0.3), the values were not statistically significant (p > 0.05). Conclusions: The results of this analyzed sample have suggested that this program ofexercise carried out in the intensity, length and frequency has not resulted improvement of the dialysis efficacy

Farmácias domiciliares e sua relação com a automedicação em crianças e adolescentes / Home medicine chests and their relationship with self-medication in children and adolescents

OBJETIVO: Analisar as características das farmácias domiciliares e sua relação com a automedicação em crianças e adolescentes dos municípios de Limeira e Piracicaba (SP). MÉTODOS: Estudo descritivo tipo inquérito populacional domiciliar de uma amostra aleatória simples de ambos os municípios, constituída de 705 domicílios de setores censitários selecionados por meio de amostragem por conglomerado. Critérios de inclusão: idade ≤ 18 anos; entrevista obrigatória com um dos responsáveis; inventário da farmácia domiciliar e ter consumido pelo menos um medicamento nos 15 dias prévios à data da entrevista. Segundo o uso de medicamentos, os participantes foram divididos em dois grupos de estudo: automedicação (orientação leiga) e prescrição médica. Foram realizados testes de associação linear, análise descritiva das variáveis e regressão logística múltipla. RESULTADOS: Foram identificados 3.619 medicamentos (média = 5,1/domicílio; 79,6 por cento especialidades farmacêuticas). Os principais cômodos de estoque foram dormitórios (47,5 por cento), cozinha (29,9 por cento) e banheiros (14,6 por cento); 76,5 por cento em caixas de papelão e em locais de fácil alcance a 142 crianças com idade ≤ 6 anos. Considerando somente as especialidades farmacêuticas (n = 2.891), as mais freqüentes foram analgésicos/antipiréticos (26,8 por cento) e antibióticos sistêmicos (15,3 por cento), sendo o estoque desses medicamentos significativamente mais elevado no grupo automedicação (p < 0,01). Guardar medicamentos nos banheiros (razão de chances = 1,59) e grau de instrução dos responsáveis legais ≤ 4 anos do ensino fundamental (razão de chances = 2,40) denotaram maior risco de automedicação. CONCLUSÕES: É comum armazenar medicamentos nos domicílios, sendo importante a efetivação de campanhas visando o uso racional, a diminuição do desperdício e o estoque seguro.

OBJECTIVE: To investigate the contents of home medicine chests and their relationship with self-medication in children and adolescents in the towns of Limeira and Piracicaba, SP, Brazil. METHODS: This is a descriptive population study based on a home survey of a simple random sample from both towns, comprising 705 households from census sectors selected by means of cluster sampling. Inclusion criteria: age ≤ 18 years; an obligatory interview with at least one guardian; inventory of medicines kept at home; and having taken at least one medication during the 15 days prior to the interview. The participants were split into two groups based on medication: self-medication (lay advice) and medical prescription. Tests of linear association were performed, in addition to a descriptive analysis of the variables and multiple logistic regression. RESULTS: A total of 3,619 medicines were found (mean = 5.1/household; 79.6 percent were pharmaceutical preparations). The rooms most commonly used to store medications were bedrooms (47.5 percent), kitchens (29.9 percent), and bathrooms (14.6 percent); 76.5 percent were in cardboard boxes and within easy reach of 142 children aged ≤ 6 years. Taking the pharmaceutical preparations in isolation (n = 2,891), the most common were analgesics/antipyretics (26.8 percent) and systemic antibiotics (15.3 percent), and the self-medication group had significantly larger stocks of these medications (p < 0.01). Storing medications in the bathroom (odds ratios = 1.59) and legal guardians with ≤ 4 years of primary education (odds ratios = 2.40) indicated greater risk of self-medication. CONCLUSIONS: Keeping medicines at home is a common practice, and it is important to implement campaigns to encourage rational use, reduced waste and safe storage of medicines.

Automedicação em crianças e adolescentes / Self-medication in children and adolescents

OBJETIVO: Determinar a prevalência da automedicação em crianças e adolescentes dos municípios de Limeira e Piracicaba (SP), correlacionando-a a indicadores sociodemográficos e utilização de serviços de saúde (pública ou privada). MÉTODOS: Estudo descritivo tipo inquérito populacional domiciliar de uma amostra aleatória simples de ambos os municípios, constituída de 772 moradores procedentes de 85 setores censitários selecionados por meio de amostragem por conglomerado. Critérios de inclusão: idade < 18 anos; entrevista obrigatória com um dos responsáveis legais; ter consumido pelo menos um medicamento nos 15 dias prévios à data da entrevista. Segundo a orientação de uso de medicamentos, os participantes foram divididos em dois grupos de estudo: automedicação (orientação leiga) e prescrição médica. Foram realizados testes de associação linear, análise descritiva das variáveis e regressão logística múltipla. RESULTADOS: A prevalência da automedicação foi de 56,6 por cento. Os principais responsáveis e indutores da automedicação foram as mães (51 por cento) e funcionários de farmácia (20,1 por cento). Os principais grupos de medicamentos administrados na automedicação foram: analgésicos/antipiréticos e antiinflamatórios não-hormonais (52,9 por cento); medicações de ação nos tratos respiratório (15,4 por cento) e gastrointestinal (9,6 por cento); e antibióticos sistêmicos (8,6 por cento). As situações que mais motivaram a automedicação foram afecções respiratórias (17,2 por cento), febre (15 por cento) e cefaléia (14 por cento). Indivíduos na faixa etária de 7-18 anos (razão de chances = 2,81) e usuários de serviços públicos de saúde (razão de chances = 1,52) apresentaram risco aumentado de automedicação. CONCLUSÕES: A prevalência da automedicação em crianças e adolescentes foi alta, reforçando a necessidade de intervenção das autoridades de saúde na prevenção desses agravos.

OBJECTIVE: To determine the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of São Paulo, and to correlate results with sociodemographic indicators and with the use of health care services (public or private). METHODS: Descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. Inclusion criteria: age < 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data. RESULTS: The prevalence of self-medication was 56.6 percent. Mothers (51 percent) and drugstore employees (20.1 percent) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9 percent); drugs acting on the respiratory tract (15.4 percent) and gastrointestinal drugs (9.6 percent); and systemic antibiotics (8.6 percent). The situation that most commonly motivated self-medication were respiratory diseases (17.2 percent), fever (15 percent), and headache (14 percent). Subjects in the age group of 7-18 years (odds ratio = 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication. CONCLUSIONS: The prevalence of self-medication in children and adolescents was high, which reinforces the need for public health interventions aiming at preventing this practice.

Life history and morphology of melanostoma scalare

The homopteran Melanostoma scalare Fabre, from British Isles was studied for potential use as biological control agent of the aphids. Prey consumption and prey specificity on Drepanosiphum plantanoidin, Metapolophium urticae and Acyrthosiphum pisum was also studied. Information in the morphological changes of M. scalare is also presented

High-dose anti-snake venom versus low-dose anti-snake venom in the treatment of poisonous snake bites--a critical study.

OBJECTIVES: To asses the optimum dose of anti-snake venom to treat snake bites cases effectively. This is particulary relevant in the present scenario when the cost of anti-snake venom ( Serum Institute of India) has gone up to nearly Rs. 400 per vial and the cross-section of people usually affected belong to the poor socioeconomic class. METHODOLOGY: One hundred snake bite cases with envenomation, irrespective of whether they were bitten by viper, cobra or krait, brought within 24 hours of the bite to Jubilee Mission Hospital, Trichur, Kerala State during the 15 months from August 2001 to October 2002 were randomized into two groups of 50 cases each, irrespective of the severity of the cases. One group received a fixed dose regime of six vials of anti-snake venom and the other 12 vials of the same. RESULTS: In the low-dose group there were five deaths giving a mortality rate of 10%, nine (18%) required dialysis and three (6%) required ventilatory support. In the high-dose group there were seven deaths giving a mortality rate of 14%, 13 (26%) required dialysis and three (6%) required ventilatory support. The average hospital stay for the low-dose group was 8.42 days while that of the high-dose group was 9.02 days. CONCLUSION: While there was no additional advantage in following a high-dose regime for snake bite cases, there was considerable financial gain by following the low-dose regime, Most of the parameters showed a beneficial trend for the low-dose group though the differences were not statistically significant.

Trial of heparin in viper bites.

AIMS OF THE STUDY: Viper bites produce hematotoxicity and coagulopathy which may be either true disseminated intravascular coagulation (DIC) or DIC-like syndrome. Role of heparin is studied in the present study of viper bite cases as use of heparin provides a rational therapy for defibrination caused by viper envenomation. METHODOLOGY: One hundred and twenty two patients with viper bite and incoagulable blood were randomised into test group and control group. Test group received heparin in addition to antisnake venom (ASV). Efficacy was assessed by monitoring bleeding time (BT), clotting time (CT), prothrombin time (PT), platelets, fibrinogen, blood urea (BU), serum creatinine, development of complications and overall outcome. RESULTS: Heparin group showed favourable outcome in all parameters studied. But many of them were not statistically significant. CONCLUSION: Heparin seems to be having a beneficial role which needs to be confirmed by larger trials and longer duration of heparin administration.

A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus

No periodo de janeiro de 1984 a maio de 1994, de 239 criancas com ate 15 anos de idade, picadas por escorpioes pertencentes as especies T. bahiensis (84,9 por cento) e T. serrulatus (15,1 por cento), 17 apresentaram envenenamento grave...

Fibrosis quística: biología molecular e implicancias terapéuticas / Cystic fibrosis: molecular biology and therapeutic implications

La Fibrosis Quística (FQ) es la enfermedad autosómica recesiva más común de los caucasianos potencialmente letal, que afecta a uno de cada 2.500 recién nacidos. A partir de la reciente identificación del gen defectuoso en esta enfermedad se ha conseguido un conjunto de información acerca de la estructura genética, la base mutacional y la función de los productos proteicos. El producto del gen es un canal clorado regulado por el 3',5' monofosfato de adenosina (AMP cíclico), dependiente de la fosforilación por la proteína quinasa (PQ) y que necesita la unión del trifosfato de adenosina (ATP) para la apertura del canal. Se están realizando nuevas investigaciones en cuanto a la terapia con drogas para la FQ y se está evaluando la posibilidad de una exitosa terapia con genes mediante la transferencia del gen normal a células epiteliales de las vías respiratorias