ABSTRACT
BACKGROUND: Brazilian medical schools equitably divide their medical education assessments into five content areas: internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. However, this division does not follow international patterns and may threaten the examinations' reliability and validity. OBJECTIVE: To assess the reliability indices of the content areas of serial, cross-institutional progress test examinations. DESIGN AND SETTINGS: This was an analytical, observational, and cross-sectional study conducted at nine public medical schools (mainly from the state of São Paulo) with progress test examinations conducted between 2017 and 2023. METHODS: The examinations covered the areas of basic sciences, internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. We calculated reliability indices using Cronbach's α, which indicates the internal consistency of a test. We used simple linear regressions to analyze temporal trends. RESULTS: The results showed that the Cronbach's α for basic sciences and internal medicine presented lower values, whereas gynecology, obstetrics, and public health presented higher values. After changes in the number of items and the exclusion of basic sciences as a separate content area, internal medicine ranked highest in 2023. Individually, all content areas except pediatrics remained stable over time. CONCLUSIONS: Maintaining an equitable division in assessment content may lead to suboptimal results in terms of assessment reliability, especially for internal medicine. Therefore, content sampling of medical knowledge for general assessments should be reappraised.
Subject(s)
Educational Measurement , Cross-Sectional Studies , Brazil , Reproducibility of Results , Humans , Educational Measurement/methods , Education, Medical , Schools, Medical/standards , Clinical Competence/standardsABSTRACT
This study aimed to evaluate the levels of pro- and anti-inflammatory cytokines in umbilical cord blood of preterm neonates who developed focal early-onset infection (EOI) after preterm premature rupture of membranes (PPROM). This is a prospective study conducted on 46 preterm infants from mothers with PPROM. The cytokines were measure by flow cytometry. Newborns were classified into two groups as focal EOI (n=19) and non-infected (n=27). Interleukin (IL)-6 and IL-8 levels were higher, whereas IL-10 and IL-12 p70 levels were lower in the EOI when compared to the non-infected group. The best combination of cytokines was IL-6+IL-8, with a diagnostic accuracy of 0.97. Focal EOI after PPROM is associated with increased levels of IL-6 and IL-8 and diminished IL-10 and IL-12 in the cord blood of preterm infants. Combined assessment of IL-6 and IL-8 in cord blood may provide an additional tool for identifying preterm infants who develop EOI after PPROM.
Subject(s)
Cytokines/metabolism , Fetal Blood/metabolism , Fetal Membranes, Premature Rupture/blood , Immunity, Innate , Infant, Premature, Diseases/blood , Sepsis/blood , Biomarkers/blood , Enzyme-Linked Immunosorbent Assay , Female , Fetal Membranes, Premature Rupture/immunology , Flow Cytometry , Follow-Up Studies , Humans , Infant, Premature , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/immunology , Pregnancy , Prospective Studies , Sepsis/diagnosis , Time FactorsABSTRACT
Tendo como princípios orientadores a integralidade e a humanização do cuidado, a Faculdade de Medicina de Botucatu (FMB) - Unesp busca reorientar a formação dos profissionais de saúde com o desenvolvimento de pesquisas e educação permanente na Estratégia de Saúde da Família. Este artigo analisa o primeiro ano do PET-Saúde desenvolvido na FMB e Secretaria Municipal de Saúde de Botucatu (SP). Foram selecionados como temas de investigação: saúde bucal de gestante, criança e idoso; imunização do adolescente; saúde do adulto e do idoso; e saúde e meio ambiente. Realizaram-se oficinas com a metodologia da problematização, produzindo-se modelos de intervenção nos quais alunos, docentes e profissionais de saúde dos serviços locais de saúde são protagonistas. O programa é um desdobramento da disciplina Interação Universidade, Serviço e Comunidade, ministrada de modo integrado aos cursos de Medicina e Enfermagem. Há resistências no interior da universidade, reconhecendo-se a desvalorização da prática clínica extra-hospitalar e na Atenção Básica. Nesse processo, o PET-Saúde vem fortalecer a prática acadêmica que interliga a universidade, em suas atividades de ensino, pesquisa, serviço e extensão, com demandas da sociedade, de forma partilhada.
Comprehensive and humanized care provides the underlying principles for the Botucatu School of Medicine (FMB/UNESP) in reorienting health professionals' training with the development of research and continuing education in the Family Health Strategy. This article analyzed the first year in the Educational Program for Health Work (PET-Saúde) developed by the School of Medicine and the Botucatu Municipal Health Department. The following research themes were selected: oral health in pregnant women, children, and the elderly; immunization in adolescents; health of adults and the elderly; and health and the environment. Workshops were held on the problem-solving methodology, producing intervention models in which students, faculty, and health professionals from local health services were the protagonists. The program is a spin-off of the course on Interaction between the University, Health Services, and the Community, given jointly to the courses in medicine and nursing. There is resistance inside the university, recognizing the devaluation of outpatient clinical practice and primary care. In this process, the PET-Saúde program is intended to strengthen academic practice that links the university with its teaching, research, services, and extension activities to demands from society, in a shared approach.
ABSTRACT
INTRODUCTION: In 1956, Africanized honeybees (AHB) migrated from Brazil to other regions of the Western Hemisphere, including South, Central, and North America, except for Canada. Despite being productive, they are highly aggressive and cause fatal accidents. This study aimed to evaluate patients at the Clinical Hospital of Botucatu Medical School (HC-FMB) and to propose treatment guidelines. METHODS: From 2005 to 2006, the clinical and laboratorial aspects of 11 patients (7 male and 4 female) and the anatomopathological aspects of one patient who had died in 2003 were analyzed. RESULTS: The age of the surviving patients varied from 5 to 87 years, with a mean of 42.5 years. The majority of accidents occurred in the afternoon, and the number of stings ranged from 20 to 500. The principal signs and symptoms were pain and local inflammatory signs, nausea, tachycardia, and vomiting. Biochemical findings presented increased levels of creatine phosphokinase, lactate dehydrogenase, and aspartate/alanine aminotransferase. An 11-year-old male patient died upon entering the attic of a two-storey building where he was attacked by a swarm, receiving more than 1,000 stings. He was sent to HC-FMB where he was treated, but he died 24h later. Observed at the autopsy were erythematous-purpuric skin lesions besides necrosis at the sting locations, rhabdomyolysis, focal myocardial necrosis, tubular hydropic degeneration and focal tubular acute necrosis of the kidneys, myoglobinuria, and centrolobular necrosis in the liver. CONCLUSIONS: Accidents caused by multiple AHB stings always constitute a medical emergency. As there is no specific antivenom, we have developed guidelines, including first aid, drugs, and the proper removal of stingers.
INTRODUÇÃO: As abelhas africanizadas (AHBs) migraram do Brasil em 1956 para todo o continente Americano. Apesar de produtivas, são agressivas causando acidentes fatais. O objetivo foi avaliar pacientes atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu (HC-FMB) e propor um roteiro de tratamento. MÉTODOS: Entre 2005 e 2006, foram analisados os aspectos clínicos e laboratoriais de 11 pacientes e anatomopatológicos de um que foi a óbito em 2003. RESULTADOS: A idade dos pacientes variou entre 5 e 87 com média de 42,5 anos. Sete eram do sexo masculino e quatro do feminino. O número de picadas variou entre 20 e 500. Nove deles receberam mais de 50 picadas. Os principais sinais e sintomas foram dor local, náuseas, taquicardia e vômitos. Os exames hematológicos mostraram leucocitose, neutrofilia, anemia e desvio à esquerda escalonado. Os exames bioquímicos revelaram níveis elevados de creatinofosfoquinase, desidrogenase lática e aspartato/alanina aminotransferase. O paciente que foi a óbito 24h após o atendimento tinha 11 anos, era do sexo masculino e foi atacado ao adentrar um edifício de dois andares recebendo mais de 1.000 picadas. O exame anatomopatológico mostrou lesões eritemato-purpúricas, além de necrose nos locais das picadas. Apresentou também rabdomiólise, necroses focais do miocárdio, degeneração hidrópica acompanhada de necrose tubular renal aguda, mioglobinúria e necrose centrolobular no fígado. CONCLUSÕES: Os pacientes acometidos por múltiplas picadas necessitam de tratamento imediato e por não dispormos de um soro específico desenvolvemos um roteiro que inclui os primeiros socorros, as drogas a serem empregadas e a retirada dos ferrões corretamente.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Animals , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Bees , Bee Venoms/poisoning , Insect Bites and Stings/therapy , Brazil , Bees/classification , Clinical Protocols , Insect Bites and Stings/complications , Insect Bites and Stings/pathology , Retrospective Studies , Severity of Illness IndexABSTRACT
INTRODUCTION: In 1956, Africanized honeybees (AHB) migrated from Brazil to other regions of the Western Hemisphere, including South, Central, and North America, except for Canada. Despite being productive, they are highly aggressive and cause fatal accidents. This study aimed to evaluate patients at the Clinical Hospital of Botucatu Medical School (HC-FMB) and to propose treatment guidelines. METHODS: From 2005 to 2006, the clinical and laboratorial aspects of 11 patients (7 male and 4 female) and the anatomopathological aspects of one patient who had died in 2003 were analyzed. RESULTS: The age of the surviving patients varied from 5 to 87 years, with a mean of 42.5 years. The majority of accidents occurred in the afternoon, and the number of stings ranged from 20 to 500. The principal signs and symptoms were pain and local inflammatory signs, nausea, tachycardia, and vomiting. Biochemical findings presented increased levels of creatine phosphokinase, lactate dehydrogenase, and aspartate/alanine aminotransferase. An 11-year-old male patient died upon entering the attic of a two-story building where he was attacked by a swarm, receiving more than 1,000 stings. He was sent to HC-FMB where he was treated, but he died 24h later. Observed at the autopsy were erythematous-purpuric skin lesions besides necrosis at the sting locations, rhabdomyolysis, focal myocardial necrosis, tubular hydropic degeneration and focal tubular acute necrosis of the kidneys, myoglobinuria, and centrolobular necrosis in the liver. CONCLUSIONS: Accidents caused by multiple AHB stings always constitute a medical emergency. As there is no specific antivenom, we have developed guidelines, including first aid, drugs, and the proper removal of stingers.
Subject(s)
Bee Venoms/poisoning , Bees , Insect Bites and Stings/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Animals , Bees/classification , Brazil , Child , Child, Preschool , Clinical Protocols , Female , Humans , Insect Bites and Stings/complications , Insect Bites and Stings/pathology , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Young AdultABSTRACT
Introdução: A rotura prematura de membranas pré-termo (RPM-PT) é uma das principais causas de morbimortalidade perinatal e fator de risco para infecção neonatal precoce. As citocinas pró-inflamatórias TNF-alfa, IL-8 e a antiiflamatória IL-10 são importantes mediadores da resposta imune, e na situação de risco infeccioso podem ser adjuvantes úteis no diagnóstico de infecção neonatal. Objetivo: Investigar se os níveis de TNF-alfa, IL-8 e IL-10 em sangue de cordão umbilical são marcadores de infecção precoce em prematuros advindos de gestações com RPM-PT. Método: Estudo clínico, prospectivo e do tipo teste diagnóstico, realizado no Serviço de Obstetrícia e Neonatologia da Faculdade de Medicina de Botucatu, envolvendo prematuros de gestantes com rotura de membranas maior ou igual 12 horas. As citocinas TNF-alfa, IL-8 e IL-10 foram dosadas em sangue de cordão umbilical pelo método ELISA. Conforme a evolução clínica e laboratorial dos recém-nascidos foram constituídos dois grupos: Infectado e Não infectado, os quais foram comparados quanto às variáveis perinatais e neonatais por análise estatística univariada; com significância em 5. A acurácia do teste diagnóstico foi obtida pela curva ROC, sendo calculados: sensibilidade, especificidade, valor preditivo positivo (VPP) e negativo (VPN). Resultados: Foram estudados 55 prematuros: 27 infectados e 28 não infectados. O tempo de rotura não diferiu entre os grupos (54 x 29 hs; p igual 0,102) mas, no grupo infectado corioamnionite clínica e histológica foi mais frequente; a idade gestacional (31 x 33 semanas; p menor que 0,001) e o peso de nascimento (1707 x 2109g; p igual 0,003) foram menores; a morbidade foi maior desde o nascimento com necessidade de assistência mais intensiva e o óbito ocorreu somente nesse grupo...
Subject(s)
Humans , Male , Female , Infant, Newborn , Bacterial Infections , Fetal Membranes, Premature Rupture , Infant, Premature , Tumor Necrosis Factor-alphaABSTRACT
The present study is aimed to determine serum and urine interleukin-8 (IL-8) levels in premature infants with late onset sepsis (LOS) and to evaluate if urine IL-8 is a useful test for LOS diagnosis. Fifty-six premature infants admitted to the NICU over 1 year had serum and urine IL-8 determined by ELISA. They were divided into three groups: I definite sepsis, II probable sepsis and III non-infected. Results were expressed as mean or median. Differences between groups were assessed by ANOVA, Kruskal-Wallis ANOVA and Dunn's Method. Sensitivity, specificity and positive and negative predictive values were calculated and a receiver operator characteristic curve was constructed to determine serum and urine IL-8 accuracy. There were no differences between groups for birth weight, and gestational and post-natal age. Median serum and urine IL-8 levels were significantly higher in GI and GII: 929 x 906 x 625 pg/ml; P = 0.024, and 249 x 189 x 42 pg/mgCr; P < 0.001. Optimal cut-off point was 625 pg/ml for serum IL-8 with 69% sensitivity and 75 pg/mgCr for urine IL-8 with 92% sensitivity. IL-8 can be determined in urine from premature infants with LOS and is an accurate and feasible diagnosis method.
