Uso de máquinas 3D e cortadores a laser em simulação aplicada à educação médica / Use of 3D printers and laser cutters for simulation in medical education

Introdução: As impressões tridimensionais (3D) têm obtido relevância em diversas áreas do conhecimento, especialmente na medicina. Com o advento da tecnologia, cada vez mais escolas médicas têm adotado o uso de prototipagem de estruturas humanas para aprimorar o treinamento dos estudantes, uma vez que a simulação produz um ambiente livre de riscos, no qual os alunos podem dominar com sucesso as habilidades relevantes para a prática clínica.Métodos: O projeto foi estruturado a partir da pesquisa dos softwares de impressão; seleção dos segmentos anatômicos a serem impressos; análise de materiais para a confecção; estudo aprofundado das caixas de simulação usadas no treinamento em videocirurgia e, por fim, realização de um treinamento dos estudantes interessados no desenvolvimento das habilidades cirúrgicas.Resultados: Por meio da impressão 3D,foram confeccionadas peças anatômicas para o ensino em anatomia, além de peças de silicone para treinamento de suturas manuais e videolaparoscópicas. O cortador a laser foi utilizado para fabricar caixas pretas, principalmente para simulações de cirurgia laparoscópica.Conclusão: A utilização de materiais 3D no ensino médico tem se mostrado altamente promissora, com aumento da curva de aprendizado dos alunos envolvidos e ótima relação custo-benefício. Contudo, o acesso a essa tecnologia ainda é restrito no Brasil, o que dificulta a expansão do método para todas as escolas médicas nacionais.

Introduction: Three-dimensional (3D) printing has become relevant in several areas of knowledge, especially Medicine. With the advent of technology, medical schools started using prototypes of human structures to improve student training, given that simulation provides a risk-free environment where students can successfully master relevant skills for clinical practice.Methods: The present study consisted of research about printing software, selection of anatomical segments for printing, analysis of printing materials, study of simulation boxes used in video-assisted surgery training, and training of students interested in developing surgical skills.Results: 3D printing was used to fabricate anatomical models for teaching anatomy and silicone models for manual and video-assisted laparoscopic suture training. Laser cutters were used to manufacture black boxes, mainly for laparoscopy simulation. Conclusion: The use of 3D printing in medical education is highly promising, with an improved learning curve among students and an excellent benefit-cost ratio. However, access to this technology is still limited in Brazil, which makes it difficult to expand the method to all national medical schools.

Concordance of Congenital Heart Defect in Monozygotic Twins in Brazil

Abstract Tetralogy of Fallot (TOF) consists of four cardiac changes: interventricular communication, pulmonary stenosis, aortic dextroposition and right ventricular hypertrophy. The prevalence is 0.1 per 1,000 live births. A primiparous mother with gestational age of 38 weeks came to the emergency. At the time, it was verified in her twin pregnancy that one fetus had TOF, thus a pregnancy interruption was scheduled for the following day. In the neonatal physical examination of both, localized acrocyanosis, regular heart rhythm with the presence of a heart murmur, and good peripheral perfusion were found. The echocardiogram of twin 1 revealed: patent foramen ovale; a wide perimembranous interventricular communication of misalignment, with the aorta riding the septum by 50%; hypertrophied and long infundibulum with pulmonary infundibulo-valvular stenosis, with a maximum systolic gradient of 66 mm Hg; both pulmonary arteries presented dimensions of 0.35 mm; pulmonary valve annulus: 0.56 mm; and patent ductus arteriosus measuring 0.19 mm. The echocardiogram of twin 2 showed: patent foramen ovale; a wide perimembranous interventricular communication of misalignment, with the aorta riding the septum by 50%; hypertrophied infundibulum with stenosis pulmonary infundibulo-valve, with a maximum systolic gradient of 33 mm Hg; reduced confluent pulmonary arteries; right pulmonary artery measuring 0.40 mm and left pulmonary artery measuring 0.55 mm; pulmonary valve annulus measuring 0.72 mm; a closed arterial canal, and mild aortic regurgitation. Tetralogy of Fallot is a multifaceted syndrome with a high prevalence in pediatrics. This case is the first case of congenital heart defect concordance for TOF in monozygotic twins in Brazil.

Rare diagnostics of Ebstein anomaly in an adult patient in Northern Rio de Janeiro / Diagnóstico raro da anomalia de Ebstein no norte do Rio de Janeiro em um paciente adulto

Ebstein anomaly is the fourth most frequent cyanotic heart disease in the neonatal period, and its clinical course is slow compared to other diseases, which in turn results in late diagnosis of this condition. We present a case of a 37-year-old man who complained of palpitation for about 5 years, twice a week, at rest, with prolonged duration and low systemic output. Auscultation revealed irregular heart rhythm characterized by extrasystoles with a tricuspid systolic murmur grade 5+/6 and worsening on inspiration. Clinical spectrum is variable and depends on the severity of defects and associated anatomical changes. In patients who have reached adulthood, symptoms usually present as progressive cyanosis, exercise intolerance, right heart failure, and arrhythmias. In Brazil, identification of this congenital disease usually occurs in a more adult phase, affecting the prognosis and survival of patients. (AU)

Anomalia de Ebstein é a quarta cardiopatia cianótica com maior frequência no período neonatal, cuja evolução clínica é lenta em comparação com outros tipos de doenças, o que, por sua vez, resulta no diagnóstico tardio. Apresentamos o caso de um homem de 37 anos, com queixa de palpitações por cerca de cinco anos, duas vezes por semana, em repouso, com duração prolongada e com baixo débito sistêmico. A ausculta revelou ritmo cardíaco irregular por extra-sístoles com sopro sistólico na tricúspide, 5 + / 6 piora na inspiração. O espectro clínico é variável e ocorre de acordo com a gravidade dos defeitos e alterações anatômicas associadas. Pacientes que atingiram a idade adulta, os sintomas geralmente se apresentam como cianose progressiva, intolerância ao exercício, insuficiência cardíaca direita e arritmias. A realidade brasileira é que a identificação dessa doença congênita persiste em uma fase adulta, afetando o prognóstico e a sobrevida desses pacientes. (AU)

Epidemiological profile of pregnant women with syphilis in the city of Macaé, Rio de Janeiro

Introduction: Gestational and congenital syphilis are diseases that can be prevented. Practices routinely carried out in prenatal care are effective for the prevention of cases. The prevalence of syphilis in pregnant women is considered an indicator of prenatal care quality. The objective is to define the epidemiological profile of pregnant women diagnosed with syphilis in the city of Macaé ­ Rio de Janeiro from 2010 to 2018. Methods: A cross-sectional retrospective study covering from 2010 to 2018 was conducted to assess the general prevalence in the period and annual incidence rates in records and database from the Care Center of Women and Children and from the Macaé Public Hospital. Results: A total of 535 cases of syphilis were reported in pregnant women. The highest number of reported cases was observed in 2018 (n = 151), with a detection rate of 38.4% per 1000 live births, meaning an increase of 37% compared to 2010. Most cases were diagnosed in the third trimester of pregnancy (n = 194 cases). The majority of women were aged 20-29 years (n = 322) and were housewives (n = 248). The predominant skin color was brown, accounting for 32.4% (n = 180) of the cases, followed by black skin (16.9%; n = 124). The majority of patients (n = 124) had incomplete elementary school education. The annual incidence rate of congenital syphilis increased from 1.4 to 17.2 cases per 1,000 live births between 2010 and 2018. Conclusions: There was an increased prevalence of syphilis in the city of Macaé, especially after 2015, with a peak of cases in 2018. (AU)

Microcefalia por toxoplasmose congênita em tempos de epidemia por Zika vírus no Brasil / Microcephaly due to congenital toxoplasmosis in times of Zika virus epidemic in Brazil

Descreve-se um caso de toxoplasmose congênita com microcefalia, ocorrido durante a epidemia de Zika vírus no Brasil e somente diagnosticado como toxoplasmose aos sete meses de idade. Este caso ilustra a pertinência e urgência para a implementação de políticas públicas específicas para prevenção, diagnóstico e tratamento para a toxoplasmose adquirida durante a gestação, e demonstra que quando o assunto é microcefalia por infecções congênitas no Brasil, precisamos estar atentos a outras possibilidades além da infecção por Zika vírus; em especial à toxoplasmose congênita, que é altamente prevalente em nosso país, e se for diagnosticada e tratada no devido tempo, danos neurológicos e oculares irreversíveis poderão ser evitados. Apoiamos integralmente a portaria do Ministério da Saúde que torna obrigatória a notificação de casos de toxoplasmose gestacional e congênita no Brasil. As ações que venham a ser implementadas deverão resultar em um programa nacional específico para toxoplasmose gestacional e congênita, que possa beneficiar crianças em todo o país por meio de medidas de educação preventiva em saúde, da triagem e do tratamento para gestantes e recém nascidos.

A case of congenital toxoplasmosis with microcephaly, occurred during the epidemic of Zika virus in Brazil, and only diagnosed as toxoplasmosis at seven months of age, is described. This case illustrates the pertinence and urgency for the implementation of specific public policies for prevention, diagnosis and treatment for toxoplasmosis acquired during pregnancy, and shows that when the subject is microcephaly due to congenital infections in Brazil, one must be attentive to other possibilities besides Zika virus infection; in particular to congenital toxoplasmosis, which is highly prevalent in our country, and if diagnosed and treated in due course, irreversible neurological and ocular damage may be avoided. We fully support the Ministry of Health ordinance that makes it compulsory to notify cases of gestational and congenital toxoplasmosis in Brazil. The actions that will be implemented should result in a specific national program for gestational and congenital toxoplasmosis, which will benefit children throughout the country through preventive health education, screening and treatment for pregnant women and newborns.