Effect of a Physical Exercise Program on the Inflammatory Response, Cardiac Functions, Functional Capacity, and Quality of Life in Patients with Sickle Cell Disease.

INTRODUCTION: The beneficial effects of physical exercise on functional capacity and inflammatory response are well-known in cardiovascular diseases; however, studies on sickle cell disease (SCD) are limited. It was hypothesized that physical exercise may exert a favorable effect on the inflammatory response of SCD patients, contributing to an improved quality of life. This study aimed to evaluate the effect of a regular physical exercise program on the anti-inflammatory responses in SCD patients. METHODS: A non-randomized clinical trial was conducted in adult SCD patients. The patients were divided into two groups: 1-Exercise Group, which received a physical exercise program three times a week for 8 weeks, and; 2-Control Group, with routine physical activities. All patients underwent the following procedures initially and after eight weeks of protocol: clinical evaluation, physical evaluation, laboratory evaluation, quality of life evaluation, and echocardiographic evaluation. STATISTICAL ANALYSIS: Comparisons between groups were made using Student's t-test, Mann-Whitney test, chi-square test, or Fisher's exact test. Spearman's correlation coefficient was calculated. The significance level was set at p < 0.05. RESULTS: There was no significant difference in inflammatory response between the Control and Exercise Groups. The Exercise Group showed an improvement in peak VO2 values (p < 0.001), an increase in the distance walked (p < 0.001), an improvement in the limitation domain due to the physical aspects of the 36-Item Short Form Health Survey (SF-36) quality of life questionnaire (p = 0.022), and an increase in physical activity related to leisure (p < 0.001) and walking (p = 0.024) in the International Physical Activity Questionnaire (IPAQ). There was a negative correlation between IL-6 values and distance walked on the treadmill (correlation coefficient -0.444, p = 0.020) and the estimated peak VO2 values (correlation coefficient -0.480; p = 0.013) in SCD patients in both groups. CONCLUSIONS: The aerobic exercise program did not change the inflammatory response profile of SCD patients, nor did it show unfavorable effects on the parameters evaluated, and patients with lower functional capacity were those with the highest levels of IL-6.

Are we forgetting to carry out serum protein electrophoresis as part of diagnosis workup?

BACKGROUND: Common variable immunodeficiency (CVID) is a rare disease that affects children and adults and is often difficult to diagnose. Despite being one of the most frequent causes of immunodeficiency, involving gastrointestinal (GI), respiratory, and hematological systems, the disease onset can have heterogeneous and intermittent symptoms, frequently leading to diagnostic delay. GI symptoms are common and can include diarrhea, but the asymptomatic periods lead to overlooking the recurrent pattern. The same can occur with respiratory infections, thus delaying CVID suspicion. The starting point for CVID diagnosis is the decreased gamma globulin levels in serum protein electrophoresis (SPE), also observed through direct immunoglobulin's dosage. CASE PRESENTATION: The patient is a 38 years-old man who had intermittent diarrhea and recurrent airway infections for 19 years, but the CVID diagnosis was achieved only after SPE was carried out. At that time, he was already malnourished, and developed other complications related to CVID in a short period. CONCLUSIONS: SPE is readily available and inexpensive, but is not part of the laboratory approach in diarrhea. According to the case presented herein, it can be useful for patients with recurrent infections or other clues of the disease.

Transcranial doppler as screening method for sickling crises in children with sickle cell anemia: a latin America cohort study.

BACKGROUND: Sickle cell anemia (SCA) is the leading cause of childhood stroke. We aimed to evaluate whether altered cerebral flow velocities, as measured by transcranial Doppler (TCD), are associated with vaso-occlusive complications in addition to stroke in pediatric SCA patients. METHODS: We evaluated 37 children aged between 2 and 16 years with SCA who underwent screening for TCD between January 2012 and October 2018. Genotypic profiles and demographic data were collected, TCD examinations were performed during follow-up, and the presence of sickling crises was compared. Survival analyses were performed using simple frailty models, in which each predictor variable was analyzed separately in relation to the occurrence of a sickling crisis. RESULTS: The variables related to sickle cell crises in the univariate analysis were peak systolic velocity (PSV) in the middle cerebral artery (MCA), hazard ratio (HR) 1.01 (1.00-1.02) p = 0.04; end-diastolic velocity (EDV) in the MCA, HR 1.02 (1.01-1.04) p = 0.01; time average mean maximum velocity (TAMMV) in the basilar artery (BA), HR 1.02 (1.00-1.04) p = 0.04; hemoglobin, HR 0.49 (0.38-0.65) p < 0.001; hematocrit, HR 0.78 (0.71-0.85) p < 0.001; leukocyte counts, HR 1.1 (1.05-1.15) p < 0.001; platelets counts, HR 0.997 (0.994-0.999) p = 0.02; and reticulocyte numbers, HR 1.14 (1.06-1.23) p < 0.001. CONCLUSIONS: Our results indicate PSV and EDV in the MCA and TAMMV in the BA as markers of risk for the occurrence of sickling crises in SCA.

Consenso Abem para o ensino de comunicação nas escolas médicas brasileiras / ABEM consensus for the brazilian medical schools' communication curriculum

Resumo: Introdução: A comunicação é uma competência essencial para o(a) médico(a) e outras categorias profissionais, e deve ser desenvolvida durante sua formação profissional. A elaboração de um projeto de comunicação, incluindo um consenso brasileiro, visou subsidiar as escolas médicas a preparar os estudantes de Medicina para se comunicarem efetivamente com os(as) cidadãos/cidadãs brasileiros(as), de características plurais intra e inter-regionais, pautando-se no profissionalismo e nos princípios do Sistema Único de Saúde (SUS). Objetivo: Este manuscrito apresenta o consenso para o ensino de comunicação nas escolas médicas brasileiras. Método: O consenso foi construído colaborativamente com 276 participantes, experts em comunicação, docentes, profissionais de saúde e discentes, de 126 escolas médicas e cinco instituições de saúde, ao longo de nove encontros presenciais em congressos e de encontros virtuais quinzenais ou mensais. Nos encontros, compartilharam-se as experiências dos participantes e o material bibliográfico, incluindo os consensos internacionais, e apresentou-se o consenso em construção, com discussão em grupos para elencar novos componentes para o consenso brasileiro, seguida por debate com todos para pactuá-los. A versão final foi aprovada em reunião virtual, com convite a todos(as) os(as) participantes em julho de 2021. Após submissão, diversas alterações foram requeridas, o que demandou novos encontros para revisão da versão final do consenso. Resultado: O consenso tem como pressupostos que a comunicação deve ser centrada nas relações, pautada nos princípios do SUS, na participação social e no profissionalismo, e embasada nas Diretrizes Curriculares Nacionais do curso de graduação em Medicina, em referenciais teóricos e nas evidências científicas. São descritos objetivos específicos para desenvolver a competência em comunicação nos estudantes, abrangendo: fundamentos teóricos; busca e avaliação crítica da literatura; elaboração e redação de documentos; comunicação intrapessoal e interpessoal no ambiente acadêmico-científico, na atenção à saúde em diversos contextos clínicos e na gestão em saúde. Recomenda-se a inserção curricular da comunicação do início ao final do curso, integrada a outros conteúdos e áreas de saber. Conclusão: Espera-se que esse consenso contribua para a revisão ou implementação da comunicação nos currículos das escolas médicas brasileiras.

Abstract: Introduction: Communication is an essential competence for the physician and other professional categories, and must be developed their professional training. The creation of a communication project including a Brazilian consensus aimed to subsidize medical schools in preparing medical students to communicate effectively with Brazilian citizens, with plural intra and inter-regional characteristics, based on the professionalism and the Brazilian Unified System (SUS) principles. Objective: The objective of this manuscript is to present the consensus for the teaching of communication in Brazilian medical schools. Method: The consensus was built collaboratively with 276 participants, experts in communication, faculty, health professionals and students from 126 medical schools and five health institutions in face-to-face conference meetings and biweekly or monthly virtual meetings. In the meetings, the participants' experiences and bibliographic material were shared, including international consensuses, and the consensus under construction was presented, with group discussion to list new components for the Brazilian consensus, followed by debate with everyone, to agree on them. The final version was approved in a virtual meeting with invitation to all participants in July 2021. After the submission, several changes were required, which demanded new meetings to review the consensus final version. Result: The consensus is based on assumptions that communication should be relationship-centered, embedded on professionalism, grounded on the SUS principles and social participation, and based on the National Guidelines for the undergraduate medical course, theoretical references and scientific evidence. Specific objectives to develop communication competence in the students are described, covering: theoretical foundations; literature search and its critical evaluation; documents drafting and editing; intrapersonal and interpersonal communication in the academicscientific environment, in health care and in health management; and, communication in diverse clinical contexts. The inclusion of communication in the curriculum is recommended from the beginning to the end of the course, integrated with other contents and areas of knowledge. Conclusion: It is expected that this consensus contributes the review or implementation of communication in Brazilian medical schools' curricula.

MiR-125a-3p and MiR-320b Differentially Expressed in Patients with Chronic Myeloid Leukemia Treated with Allogeneic Hematopoietic Stem Cell Transplantation and Imatinib Mesylate.

Chronic myeloid leukemia (CML), a hematopoietic neoplasm arising from the fusion of BCR (breakpoint cluster region) gene on chromosome 22 to the ABL (Abelson leukemia virus) gene on chromosome 9 (BCR-ABL1 oncogene), originates from a small population of leukemic stem cells with extensive capacity for self-renewal and an inflammatory microenvironment. Currently, CML treatment is based on tyrosine kinase inhibitors (TKIs). However, allogeneic hematopoietic stem cell transplantation (HSCT-allo) is currently the only effective treatment of CML. The difficulty of finding a compatible donor and high rates of morbidity and mortality limit transplantation treatment. Despite the safety and efficacy of TKIs, patients can develop resistance. Thus, microRNAs (miRNAs) play a prominent role as biomarkers and post-transcriptional regulators of gene expression. The aim of this study was to analyze the miRNA profile in CML patients who achieved cytogenetic remission after treatment with both HSCT-allo and TKI. Expression analyses of the 758 miRNAs were performed using reverse transcription quantitative polymerase chain reaction (RT-qPCR). Bioinformatics tools were used for data analysis. We detected miRNA profiles using their possible target genes and target pathways. MiR-125a-3p stood out among the downregulated miRNAs, showing an interaction network with 52 target genes. MiR-320b was the only upregulated miRNA, with an interaction network of 26 genes. The results are expected to aid future studies of miRNAs, residual leukemic cells, and prognosis in CML.

Sigilo, anonimato e confidencialidade de doadores de sangue com HIV / Secrecy, anonymity and confidentiality in blood donors with HIV / Secreto, anonimato y confidencialidad de los donantes de sangre con VIH

Resumo Na ocorrência de resultado positivo para HIV em triagem sorológica para doação, o serviço de hemoterapia deve, além de descartar a bolsa de sangue, encaminhar o doador ao serviço de referência. A situação, no entanto, traz dilemas éticos implícitos, vivenciados cotidianamente pelos profissionais da área. Assim, o objetivo do presente estudo é revisar pormenorizadamente a legislação sobre o assunto, desenvolvendo reflexões necessárias. Tendo em vista que a condição de ser portador de HIV/aids está envolta em preconceitos, discriminações e repercussões sociais negativas, é fundamental que o profissional da hemoterapia responsável por comunicar a inaptidão esteja ciente do sigilo e da confidencialidade das informações e devidamente capacitado para atuar nessa situação. O artigo defende a comunicação plena da inaptidão sorológica ao doador.

Abstract A recent article published in this journal on confidentiality in the care of HIV/aids patients reports that, in the event of a positive result in the Screening Tests for the virus, the Blood Bank must, in addition to disposing of the blood bag, refer the donor to the reference service. Due to the implicit ethical dilemmas we have experienced, this led us to a detailed review of the respective brazilian legislation and critical analysis of the issue. People with HIV/aids are surrounded by prejudices, discrimination and negative social repercussions, so it is essential that the Blood Bank professional who will communicate this news is fully aware of the issues involving secrecy and confidentiality, and fully trained and capable to proceed adequately. We present and discuss the fundamental points of the current Brazilian legislation the theme and how we must communicate to the donor about the detection of HIV serodiagnosis.

Resumen En caso de resultado positivo para VIH en cribado serológico para donación, el servicio de hemoterapia debe desechar la bolsa de sangre y remeter el donante a un servicio de salud de referencia. Esta situación, sin embargo, conlleva dilemas éticos implícitos que los profesionales del ramo enfrentan cada día. Así, el objetivo de este estudio es revisar en detalle la legislación sobre la materia, desarrollando reflexiones necesarias. Tengo en cuenta que la condición de ser portador de VIH/sida conlleva prejuicios, discriminación y repercusiones sociales negativas, es fundamental que el profesional de hemoterapia encargado de comunicar la inaptitud sea consciente del secreto y de la confidencialidad de la información y también debidamente capacitado para actuar en esta situación. Este artículo defiende la plena comunicación de inaptitud serológica al donante.

Cardiovascular benefits of a home-based exercise program in patients with sickle cell disease.

BACKGROUND: Physical inactivity is an important risk factor for cardiovascular disease. The benefits of exercise in patients with chronic diseases, including cardiovascular diseases, are well established. For patients with sickle cell disease, medical recommendation was to avoid physical exercise for fear of triggering painful crises or increasing the impairment of the cardiopulmonary function. Only recently, studies have shown safety in exercise programs for this population. Despite that, there is no report that assess the effects of physical exercise on cardiac parameters in patients with sickle cell disease. OBJECTIVE: This study aimed to evaluate the impact of regular physical exercise (a home-based program) on cardiovascular function in patients with sickle cell disease. DESIGN: A quasi-randomized prospective controlled trial. SETTING: During the years 2015 and 2016, we started recruiting among adult patients treated at a Brazilian Center for Patients with Sickle Cell Disease to participate in a study involving a home exercise program. The experimental (exercise) and control groups were submitted to clinical evaluation and cardiovascular tests before and after the intervention. Analysis of variance was applied to compare groups, considering time and group factors. PARTICIPANTS: Twenty-seven adult outpatients with a sickle cell disease diagnosis. INTERVENTIONS: Exercise group (N = 14): a regular home-based aerobic exercise program, three to five times per week not exceeding give times per week, for eight weeks; no prescription for the control group (N = 13). MAIN OUTCOME MEASURES: Echocardiographic and treadmill test parameters. RESULTS: The exercise group showed significant improvement in cardiovascular tests, demonstrated by increased distance traveled on a treadmill (p<0.01), increased ejection fraction (p < 0.01) and improvement of diastolic function assessed by mitral tissue Doppler E' wave on echocardiography (p = 0.04). None of the patients presented a sickle cell crisis or worsening of symptoms during the exercise program. CONCLUSION: The selected home-based exercise program is safe, feasible, and promotes a favorable impact on functional capacity and cardiovascular function in sickle cell disease patients.

Comparison of microRNA Expression Profile in Chronic Myeloid Leukemia Patients Newly Diagnosed and Treated by Allogeneic Hematopoietic Stem Cell Transplantation.

Chronic myeloid leukemia (CML) results from a translocation between chromosomes 9 and 22, which generates the Philadelphia chromosome. This forms BCR/ABL1, an active tyrosine kinase protein that promotes cell growth and replication. Despite great progress in CML treatment in the form of tyrosine kinase inhibitors, allogeneic-hematopoietic stem cell transplantation (allo-HSCT) is currently used as an important treatment alternative for patients resistant to these inhibitors. Studies have shown that unregulated expression of microRNAs, which act as oncogenes or tumor suppressors, is associated with human cancers. This contributes to tumor formation and development by stimulating proliferation, angiogenesis, and invasion. Research has demonstrated the potential of microRNAs as biomarkers for cancer diagnosis, prognosis, and therapeutic targets. In the present study, we compared the circulating microRNA expression profiles of 14 newly diagnosed patients with chronic phase-CML and 14 Philadelphia chromosome-negative patients after allo-HSCT. For each patient, we tested 758 microRNAs by reverse transcription quantitative polymerase chain reaction (RT-qPCR) analysis. The global expression profile of microRNAs revealed 16 upregulated and 30 downregulated microRNAs. Target genes were analyzed, and key pathways were extracted and compared. Bioinformatics tools were used to analyze data. Among the downregulated miRNA target genes, some genes related to cell proliferation pathways were identified. These results reveal the comprehensive microRNA profile of CML patients and the main pathways related to the target genes of these miRNAs in cytogenetic remission after allo-HSCT. These results provide new resources for exploring stem cell transplantation-based CML treatment strategies.

"Nota de Conceito Global" na Avaliação da Performance do Interno de Medicina: uma Oportunidade Desperdiçada / "Global Rating Scale" in the Evaluation of the Academic Achievement of the Medical Student: a Wasted Opportunity

Resumo: Introdução: Possuir diploma de médico é o suficiente para o exercício profissional na maioria dos estados brasileiros. A avaliação do desempenho do aluno pelas escolas médicas é, certamente, o mais importante filtro de proficiência profissional em vigência. Assim, é fundamental a utilização de instrumentos de avaliação adequados. Competência é o conjunto de conhecimentos, habilidades e atitudes que permitem uma prática médica de excelência. Diferentemente, performance pode ser definida como o que o indivíduo realmente produz em seu cotidiano. O internato é uma inigualável oportunidade para o acompanhamento preciso dos atributos esperados de um estudante em formação. Quando avaliamos a competência, buscamos medir o quanto o aluno sabe, concebe ou realiza procedimentos em um contexto objetivo de avaliação. Performance é o que efetivamente o indivíduo utiliza de suas competências. Há, portanto, uma maior dificuldade de avaliar performance, pois motivação, disciplina, condições físicas e psíquicas, e outros aspectos vivenciais estão em jogo. Além disso, é necessária uma avaliação constante, o que implica acompanhamento e monitoramento próximos. A Nota de Conceito Global (NCG) é uma das modalidades que permitem, não obstante sua implícita subjetividade, avaliar o desempenho do aluno/estagiário. Para isso, é estratégico que seja construída por meio de nomenclatura padronizada, parâmetros definidos que possibilitem quantificação, levando em conta diferenças existentes entre os diversos projetos políticos pedagógicos. Pela heterogeneidade dos estágios, diferentes contextos da prática da medicina e grande número de sujeitos envolvidos seriam os critérios estabelecidos para a constituição da NCG devidamente padronizados e adequados para avaliar alunos no internato? Método: Neste trabalho, estudamos, por meio dos planos de ensino, como a NCG está estruturada na avaliação de internos de uma instituição e o que pode ser aperfeiçoado e contribuir para o conhecimento do assunto. Resultados: Constatamos que a NCG compõe 30% (quinto ano) e 40% (sexto ano) da Nota Global do Aluno (NGA), que corresponde a uma nota única ao final de cada ano de graduação e leva em conta o desempenho e a carga horária das disciplinas. Adicionalmente, avaliamos os termos utilizados como critérios a serem utilizados para a NCG. A análise dos planos de ensino mostrou que a NCG se mostrou irregular e sem padronização institucional entre as disciplinas; há uma ausência de uniformidade na composição da nota final ou nos critérios a serem avaliados, bem como na aplicação diferenciada dos itens em cada cenário de aprendizado. Conclusões: A falta de uma metodologia uniforme impede o acompanhamento do aluno de forma global, inclusive o quanto a cultura e os valores institucionais poderiam influenciar o desempenho estudantil. Perde-se a oportunidade de realizar uma avaliação efetivamente construtiva. Contudo, a NCG, pela sua natureza subjetiva, poderia, se adequadamente aplicada, ser instrumento fundamental para o diálogo entre professores e alunos em uma avaliação formativa. Dessa forma, pela inserção inadequada, dentro de uma avaliação somativa, perde-se uma grande oportunidade de crescimento do aluno e da própria instituição.

Abstract: Introduction: Having a medical degree is enough documentation for professional practice in most Brazilian states. In fact, the evaluation of academic achievement by medical schools is certainly the most important filter of professional proficiency. Thus, the use of appropriate assessment instruments is essential. Competence is the set of knowledge, skills and attitudes that enable a medical practice of excellence. Differently, Performance can be defined as what the individual actually produces in their daily lives. The internship is the best opportunity for the precise monitoring of the expected achievements of a student in training. When we evaluate competence, we seek to measure how much the student knows, conceives or performs procedures, in an objective evaluation context. Performance is what the individual effectively uses of their skills. There is, therefore, a greater difficulty in evaluating performance, since motivation, discipline, physical and psychic conditions, as well as other experiential aspects are involved. In addition, continuous assessment is required, which implies close monitoring. The "Global Rating Scale" (GRS) is one of the modalities that allows, despite its subjectivity, evaluating the performance of the intern student. For that purpose, it is strategic that it be constructed through standardized nomenclature, defined parameters that allow the quantification, considering the differences between several pedagogical political projects. Due to the heterogeneity of the different settings of the practice of medicine, and the large number of subjects involved, would the criteria established for the structuring of the GRS be properly standardized and adequate to evaluate medical internship students? Method: In this work, we study, through the teaching plans, how GRS is structured in the evaluation of students of an institution regarding practical activities, and what can be improved and contribute to the knowledge on the subject. Results: We find that the GRS comprises 30% (fifth year) and 40% (sixth year) of the Student Global Rating (SGR), which corresponds to a single grade at the end of each graduation year and takes into account the performance and the workload of disciplines. Additionally, we evaluate the terms used as criteria to be used for the GRS. The analysis of the Teaching Plans showed that the GRS was irregular and lacked institutional standardization among the Disciplines; there is an absence of uniformity regarding the composition of the final grade or in the criteria to be evaluated, as well as in the differentiated application of the items in each learning scenario. Conclusion: The lack of a uniform methodology precludes an overall student follow-up, including how much culture and institutional values could influence student performance. The opportunity to conduct an effectively constructive evaluation is lost. On the other hand, the GRS, considering its subjective nature, could, if properly applied, be a fundamental instrument for the dialogue between teachers and students in a formative evaluation. Thus, due to inadequate inclusion, within a summative evaluation, a great opportunity for development of the student, as well as of the institution, is wasted.

Association between Sodium Intake and Urinary Fractional Albumin and Immunoglobulin G Excretion in Chronic Nondialytic Renal Disease: A Prospective Longitudinal Study.

BACKGROUND/AIMS: Previous studies reported that fractional clearance of urinary proteins is better than total proteinuria in predicting chronic kidney disease (CKD) progression. However, the role of sodium in the fractional excretion of proteins has not been established. We aimed to evaluate the association between sodium intake and fractional albumin and immunoglobulin G (IgG) excretion in nondialytic CKD. METHODS: We did a longitudinal, observational, and prospective study that included CKD patients aged 18-80. Included patients performed basal routine laboratory evaluations, urinary sodium excretion, and fractional albumin and IgG excretion that were repeated after 6-month of follow-up. RESULTS: We evaluated 84 patients, mean age 55 ± 15.6 years, 40 women, and 74 whites. The change of estimated sodium intake had an association with the change of fractional albumin (R = 0.54; p < 0.001) and IgG (R = 0.56; p < 0.001) excretion in univariate analysis (increases in sodium intake were paralleled by increases in albumin and IgG excretion fractions). This association was maintained in a multiple generalized linear model even after adjusting for age and for changes in blood pressure, urinary potassium, protein intake, and blood glucose. CONCLUSION: In CKD patients, changes in estimated sodium intake were associated with changes in the fractional albumin and IgG excretion regardless of confounding factors. Findings of this study support the idea that reducing salt intake, and consequently, albumin and IgG fractional excretions could help to slow CKD progression. This hypothesis must be tested in long-term interventional studies.

Circulating microRNAs expression profile in newly diagnosed and imatinib treated chronic phase - chronic myeloid leukemia.

Chronic myeloid leukemia (CML) is a stem cell derived malignant disorder result of translocation t(9;22)(q34;q11) called Philadelphia chromosome (Ph+). microRNAS (miRNAs) are involved in several biological processes, altering the progression of various pathologies, including CML. This study evaluated whether circulating miRNAs display differential expression profiles in peripheral blood of CML-Chronic Phase (CML-CP) patients newly diagnosed in comparison with CML-CP treated with imatinib. We obtained peripheral blood samples from CML-CP Ph+ patients divided among group 1 (untreated newly diagnosed) and group 2 (treated with imatinib). A pool of total leukocytes from healthy donors was considered as control group. Expression analyses were performed for 768 miRNAs by RT-qPCR array. Bioinformatic tools were used to identify significant pathways and interaction networks. We found 80 deregulated miRNAs between the groups and, according to bioinformatic analysis, they are involved in different pathways, including molecular mechanisms of cancer. The study allows better understanding of disease molecular behavior, and it is useful for possible monitoring CML treatment and prognostic biomarkers identification.

Caso Motivador como Estratégia Problematizadora e Integradora no Ensino Médico em um Curso de Oncologia / The Motivational Case as an Integrative Problem-Solving Strategy in Oncology Medical Teaching

RESUMO Caso Motivador, também denominado situação-problema ou case study, é uma metodologia centrada no aluno, problematizadora, de ensino-aprendizagem, que permite conhecer os saberes prévios do grupo frente à situação apresentada, bem como identificar necessidades de aprendizagem, construir novos significados e saberes, além de desenvolver competências específicas para o autoaprendizado. Estrategicamente, é a inserção, no decorrer de um curso, de um material social (textos, áudios, impressos, vídeos), cuja análise e discussão permitem contextualizar o conteúdo teórico. É muito útil no ensino de disciplinas básicas e pré-clínicas na área de saúde, conduzindo o aprendizado por meio de situações do cotidiano e da futura prática profissional. Os caminhos percorridos pelos alunos com a reflexão e a discussão dos casos motivadores permitem um contraste entre o senso comum e o senso universitário, que cria o movimento motivacional mediante o fluxo da prática e da realidade para o conteúdo teórico a ser trabalhado e pela oportunidade de gerar dilemas, opiniões, comparações e controvérsias no desenvolvimento do trabalho, com mediação do professor. Dessa forma, permite discutir e antecipar competências e habilidades futuras, além de proporcionar novas dimensões teóricas e práticas às vezes não previstas. É, portanto, uma oportunidade de o aluno criar a perspectiva da prática no momento em que tem contato teórico com o conteúdo da disciplina. É uma metodologia problematizadora mais versátil que o Problem Based Learning (PBL), pois pode ser inserida num curso tradicional (Lecture Based Teaching), não se tornando, assim, a única estratégia didática. Objetivamos, aqui, relatar nossa experiência na construção, aplicação e avaliação de dois casos motivadores voltados aos discentes do quarto ano do curso teórico de Oncologia da Faculdade de Medicina de Botucatu (Unesp). Os casos motivadores foram construídos com base em notícias divulgadas pela mídia e aplicados a uma turma de 27 discentes, divididos em dois grupos. A primeira sessão de discussão ocorreu na abertura do curso e a segunda sessão, no encerramento, quando os alunos apresentaram o resultado final do trabalho em forma de seminário. O fechamento dos casos motivadores ocorreu no final do curso, mediante aula dialogada sobre o tema "Prognóstico do Câncer", eixo comum dos dois casos motivadores. Tendo por base esta experiência, concluímos que o uso do Caso Motivador como prática pedagógica aproxima os alunos da realidade social e os leva a construir redes de conhecimentos, tornando-os sujeitos ativos do processo de aprendizagem, sem abrir mão da profundidade e da especificidade dos conhecimentos que um aluno de Medicina precisa desenvolver.

ABSTRACT The motivational case, also called a problem situation or case study, is a student-focused learning method that involves problem solving, with the aim of assessing students' prior knowledge about a presented situation and identifying the learning needs, building new meaning and knowledge, and developing specific self-learning skills. Strategically, it involves the inclusion of social materials (text, audio, printed documents, videos) in the course for analysis and discussion, in order to provide a background context for the theoretical content being taught. It is a very useful tool for teaching basic and preclinical subjects in health care, leading the student through day-to-day situations that they will encounter in their future professional careers. The students' processes of reflection and discussion of the motivational cases enable a contrast to be made between common sense and academic judgment, which creates motivational movement through the flow of practice and reality to the theoretical content being taught, and the opportunity to generate dilemmas, opinions, comparisons and controversies during the work, mediated by the teacher. Thus, it allows future skills and abilities to be discussed and anticipated, as well as providing new theoretical and practical dimensions, sometimes unforeseen. It is, therefore, an opportunity for the student to create the perspective of practice, while the theoretical content of the subject is being learned. It is a more versatile investigative methodology than PBL (Problem Based Learning) as it can be inserted within a traditional course (Lecture Based Teaching) and is not necessarily the sole teaching strategy. Our aim in this work is to report our experience of the construction, implementation and assessment of two motivational cases designed for fourth year students of the theoretical Oncology course of Botucatu Medical School (Unesp). The motivational cases were built from news media and applied to a class of twenty-seven students, divided into two groups. The first discussion session took place at the start of the course and the second session took place at the end of the course, when the students presented their final work in the form of a seminar. The motivational cases were concluded at the end of the course, through a participatory class on "Cancer Prognosis", a theme that was common to the two motivational cases. Based on this experience, we conclude that the use of the motivational case as a pedagogical tool gives students a better understanding of the social reality, enabling them to build knowledge networks, and turning them into active subjects of the learning process, without sacrificing the depth and specificity that medical students need to develop.

"Café com Educação Médica" - Breve Relato de uma Experiência para o Desenvolvimento da Docência / "Medical Education with Coffee" - a Brief Report of an Experience for Faculty Development

RESUMO O desenvolvimento docente é uma necessidade nas escolas para adequar o ensino médico às intensas e contínuas transformações do mundo e da sociedade contemporânea. Iniciativas de desenvolvimento docente precisam avançar para além de cursos de capacitação, evoluindo para comunidades de prática. Com o intuito de incorporar princípios da educação médica ao cotidiano do professor, em diversos níveis, desde o planejamento até a avaliação dos processos de ensino, entendemos que ambientes informais também podem constituir espaços para o desenvolvimento da docência. Assim, a Faculdade de Medicina de Botucatu, da Universidade Estadual Paulista, criou o "café com educação médica", uma reunião matinal quinzenal para discussão de aportes teóricos para subsidiar as ações de pesquisa e prática do Núcleo de Apoio Pedagógico. A reunião tem configuração semelhante à dos clubes de revista tradicionais no ensino de graduação e residência médica, mas com particularidades voltadas à educação em saúde. O êxito da experiência se deve à possibilidade de ocorrer desenvolvimento docente em contexto acolhedor e informal. Tendo em vista os relatos de transformação da prática docente motivados por iniciativas semelhantes ao redor do mundo e observando como nossa experiência tem sido oportuna, encorajamos as escolas médicas brasileiras a compartilharem também seus clubes de revista em educação médica e os resultados com eles obtidos.

ABSTRACT Faculty development is needed if medical schools are to adapt to the intense and constant changes taking place in the world, and in society. Initiatives for faculty development should go beyond workshops, evolving into communities of practice. To incorporate the principles of medical education into all levels of the curriculum, from planning through to assessment, the assimilation of faculty development is needed, including in informal scenarios. To this end, Botucatu School of Medicine of the Universidade Estadual Paulista created "medical education with coffee", a morning meeting that is held twice a month to discuss theoretical approaches to medical education that supports the practices and research of the institutional center for educational support. The meetings are similar to the traditional journal clubs for undergraduate and residency programs, except that they are specially geared towards medical education. The success of these meetings lies in their capacity to develop faculty, in a cozy and informal environment. Based on reports of improvements in teaching practices around the world due to similar initiatives, we encourage other Brazilian medical schools to adopt of medical education journal clubs, and to share their results.

Should Serum Protein Electrophoresis Be a Surrogate for Liver Biopsy in Some Cases of Alpha1 Antitrypsin Deficiency?

Most patients with alpha1 antitrypsin deficiency do not receive this diagnosis until developing severe complications, in particular when respiratory symptoms are absent. This is a reason for making alpha1 antitrypsin deficiency a possible diagnosis among patients with cryptogenic cirrhosis or other conditions of liver disease without a clear etiology. In this report, a case of cryptogenic cirrhosis is presented, showing the role of serum protein electrophoresis in the diagnosis, which was made before liver biopsy. Therefore, the possibility of using a typical pattern of serum protein electrophoresis as a surrogate for liver biopsy in alpha1 antitrypsin deficiency is discussed.

Evaluation of the Temporal Acoustic Window for Transcranial Doppler in a Multi-Ethnic Population in Brazil.

The aim of this study was to relate the presence of a temporal acoustic window (TAW) to the variables sex, age and race. This observational study was conducted in patients under etiologic investigation after stroke, sickle-cell anemia and hospitalization in an intensive therapy neurologic unit. TAW presence was confirmed by bilateral assessment by two neurologists via transcranial Doppler (TCD). Multiple logistic regression was performed to explain the presence of the window as a function of sex, age and race. In 20% of the 262 patients evaluated, a TAW was not present. The incidence of TAW presence was greater in men (odds ratio [OR] = 5.4, 95% confidence interval [CI] = 2.5-11.7, p < 0.01); lower with increased age (OR = 0.9, 95% CI = 0.92-0.97, p < 0.01); and lower among those of African and Asian descent (OR = 0.32, 95% CI = 0.14-0.70, p = 0.005). On the basis of the results, more men than women had TAWs, and the decrease in TAWs was associated with increased age and African or Asian descent.

Inferferência da malária na fisiologia e na fiosiopatologia do eritrócito: parte 3: relaçäo com deficiência de G6PD, talassemias e outros aspectos hereditários do eritrócito / Malaria interference of physiologic and physiopathology of erythrocyte: part 3: relation of G6PD deficiency, thalassemis and other hereditary aspects of erythrocyte

Os autores enfocam os aspectos fisiológicos e fisiopatológicos do eritrócito que se relacionam com a malária. Esta revisäo visa compreender a açäo seletiva da malária sobre as doenças hereditárias do glóbulo vermelho (anemia falciforme e hemoglobinopatias associadas, talassemias, deficiência de glicose-6-fosfato desidrogenase, ovalocitose hereditária) e do sistema Duffy, focalizando a discussäo nos aspectos associados ao ciclo evolutivo do parasita no inseto e no homem. Descrevem a fisiopatologia da deficiência de G6PD, talassemias, hemoglobinopatias C e E ovalocitose, sistema Duffy e as inter-relações com a malária

Interferência da malária na fisiologia e na fisiopatologia do eritrócito: parte 1: eritrócito normal e vetor / Interferency of malaria in physiology and physiopathology of the erythrocyte: part 1: normal erythrocyte and vector

Os autores enfocam os aspectos fisiológicos e fisiopatológicos do eritrócito que se relacionam com a malária. Esta revisäo visa compreender a açäo seletiva da malária sobre as doenças hereditárias do glóbulo vermelho (anemia falciforme e hemoglobinopatias associadas, talassemias, deficiência de glicose-6-fostato desidrogenase, ovalocitose hereditária) e do sistema Duffy, focalizando a discussäo nos aspectos associados ao ciclo evolutivo do parasita no inseto e no homem. Os autores descrevem a estrutura e funçäo da membrana eritrocitária, a eritropoese, a estrutura e fisiologia da molécula de hemoglobina, a oxigenaçäo tecidual, o metabolismo do eritrócito e os aspectos do óxido-reduçäo e a hemocaterese, conhecimento necessário para a compreensäo das alterações induzidas pelo parasita. Além disso, analisam aspectos do ciclo evolutivo do parasita no mosquito, e as conseqüentes interrelações do vetor com o eritrócito