Conhecimento e interesse em ética médica e bioética na graduação médica / Knowledge and interest in medical ethics and bioethics in medical graduation

Objetivos: Avaliar o interesse e o conhecimento sobre ética médica e bioética na graduação médica. Métodos:Estudo transversal e descritivo. Foram utilizados dois questionários auto-aplicáveis, um para docentes e outro para discentes, com questões sobre o interesse em ética médica e bioética e conhecimento sobre o Código de Ética Médica (CEM). Resultados: Foram avaliados 101 professores e 331 estudantes. O CEM brasileiro foi lido por 86,2% dos professores e 100% dos alunos. A importância dada à disciplina de ética médica, numa escala de 1 a 5, foi semelhante entre professores e estudantes (4,7 ± 0,7 vs. 4,5 ± 0,8; p =0,086), enquanto o autoconhecimento sobre o tema foi maior no primeiro grupo (3,4 ± 0,9 vs. 3,2 ± 0,7; p = 0,017). De um total de nove questões avaliadas sobre o conhecimento do CEM, a média de acertos foi de 5,0 ± 1,9 questões para os professores e de 5,9 ± 1,5 para os acadêmicos (p < 0,001), sendo os acertos correlacionados positivamente com a leitura do código. Conclusões: Este estudo fornece um panorama inédito sobre a percepção de professores e estudantes de Medicina sobre a ética médica e bioética, podendoservir para fundamentar a melhora do ensino dessa disciplina em nossas faculdades.

Objectives: To evaluate the interest and knowledge about Medical Ethics and Bioethics in medical graduation. Methods: Transversal and descriptive study. Two different questionnaires were applied with questions about the interest in Medical Ethics and Bioethics and the knowledge about the Brazilian Code of Medical Ethics (CME), one to professors and the other to students. Results: One hundred and one professors and 331 students answered the questionnaires. The Brazilian CME had been read by 86.2% of the teachers and by 100% of the students. The importance given to the discipline Medical Ethics, on a scale from 1 to 5, was similar among teachers and students (4.7 ± 0.7 vs. 4.5 ± 0.8; p = 0.086); however the self-evaluation onknowledge about this subject was higher in the first group (3.4 ± 0.9 vs. 3.2 ± 0.7; p = 0.017). In a block with 9 questions, the right answer was given by 5,0 ± 1.9 of teachers and 5.9 ± 1.5 of students (p < 0,001); the mean of correct answers were related to the reading of the CME. Conclusions: The present study presents unpublished data about the perception of medical teachers and students about medical ethics andbioethics and can be useful for improving the teaching of these disciplines in our medical schools.

Central H1 and H2 receptor participation in the control of water and salt intake in rats.

The aim of the present study was to evaluate the participation of brain H1 and H2 histaminergic receptors on water and salt intake induced by water deprivation (24 h), furosemide-induced sodium depletion and central angiotensinergic pharmacological stimulation in rats. Third ventricle injections of the H1 and H2 receptor antagonists, mepyramine (50, 100, 200 and 400 nmol) and cimetidine (100, 200 and 400 nmol), were unable to modify water intake induced by water deprivation and sodium depletion. Salt intake elicited by water deprivation and sodium depletion was reduced by the central administration of mepyramine, while intracerebroventricular administration of cimetidine had no effect. Water and salt intake evoked by central angiotensinergic stimulation (10 ng) was diminished by third ventricle injections of both mepyramine and cimetidine. Inhibition of the ingestive behaviors observed here is not a result of any illness-like effect produced by the intracerebroventricular injections of the histaminergic antagonists used, as demonstrated by an avoidance test. It was also shown that third ventricle injections of these compounds were unable to modify the hedonic behavior that leads rats to drink a tasty saccharin solution. We conclude that central histaminergic receptors participate in the control of salt intake induced by distinct physiological and pharmacological stimuli.

Histaminergic H1 and H2 receptors located within the ventromedial hypothalamus regulate food and water intake in rats.

The aim of the present study was to investigate the effect of the pharmacological blockade of histamine H1 and H2 receptors located within the ventromedial hypothalamus (VMH) on overnight food and water intake and on water intake elicited by two physiological stimuli: hyperosmolarity induced by an acute intragastric salt load and water deprivation. During the overnight period, the pharmacological blockade of both H1 and H2 VMH receptors significantly increased food intake and decreased water intake. In hyperosmotic rats, the blockade of H1 VMH receptors reduced water intake, while the blockade of H2 receptors in this same region yielded no significant effect. Additionally, in water-deprived rats, the blockade of both H1 and H2 receptors located within the VMH induced a significant decrease in water intake. The inhibitory effects on drinking behavior observed in this study do not seem to be a consequence of any "illness-inducing" effect provoked by the central administration of the antihistaminergic agents employed here, because an aversion test indicated that the injection of those compounds into the VMH does not induce any "illness-like" effect. In addition, the central administration of either mepyramine or cimetidine to dehydrated and hyperosmotic rats did not produce any reduction in locomotor activity measured in an open-field arena. Injections of the antihistaminergic agents used here into the regions that circumscribe the VMH produced no significant effects on water or food intake, indicating that the actions observed here may be specifically attributed to the set of histaminergic receptors situated within the VMH.

Academética: um novo método de estudo continuado sobre Ética Médica e Bioética / Academética: a new method of continuous study in Medical Ethics and Bioethics

A consciência de que a prática deve estar fundamentada na postura ética dos profissionais leva à crescente importância de um ensino continuado e aprofundado, que ressalte os valores morais e humanos e o comprometimento social dos estudantes. Buscando adequar-se a esse novo paradigma, estudantes de Medicina da Universidade Federal da Bahia aceitaram a sugestão de criação, em novembro de 2000, de um grupo denominado Academética - Associação de Acadêmicos para o estudo da Ética Médica e Bioética. Os objetivos traçados pela equipe são: continuar o contato com o conteúdo da disciplina Ética Médica, aprofundando e atualizando as discussões acerca de Ética Médica e Bioética, e desenvolver trabalhos ligados a este assunto. As discussões de temas são realizadas através do estudo de artigos, vídeos e estímulo à participação dos estudantes em congressos, palestras e afins. Desta forma, a Academética se constitui em mais uma ferramenta para que os alunos durante a graduação na faculdade de Medicina possam desenvolver o senso crítico e conhecimento acerca de assuntos que englobem a Ética Médica e Bioética.

Central 5-HT2B/2C and 5-HT3 receptor stimulation decreases salt intake in sodium-depleted rats.

In the present study, we investigated the participation of central 5-HT(2B/2C) and 5-HT(3) receptors in the salt intake induced by sodium depletion in Wistar male rats. Sodium depletion was produced by the administration of furosemide associated with a low salt diet. Third ventricle injections of mCPP, a 5-HT(2B/2C) agonist, at doses of 80, 160 and 240 nmol, promoted a dose-dependent reduction in salt intake in sodium-depleted rats. The inhibitory effect produced by central administration of mCPP was abolished by the central pretreatment with SDZ SER 082, a 5-HT(2B/2C) antagonist. Similar results were obtained with third ventricle injections of m-CPBG (80, 160 and 240 nmol), a selective 5-HT(3) agonist that also induced a dose-related decrease in salt intake in sodium-depleted rats. The central pretreatment with LY-278,584, a selective 5-HT(3) receptor antagonist, was able to impair the salt intake inhibition elicited by third ventricle injections of m-CPBG. Central administration of each one of the antagonists alone or a combination of both antagonists together did not significantly change salt intake after sodium depletion. On the other hand, the central administration of both mCPP and m-CPBG, in the highest dose used to test their effect on salt intake (240 nmol), was unable to modify blood pressure in sodium-depleted rats. It is concluded that: (1) pharmacological activation of central 5-HT(2B/2C) and 5-HT(3) receptors diminishes salt intake during sodium depletion, (2) an inhibitory endogenous drive exerted by central 5-HT(2B/2C) and 5-HT(3) receptors does not seem to exist and (3) the reduction in salt intake generated by the pharmacological activation of these central receptors is not produced by an acute hypertensive response.