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ABSTRACT Context Complementary and Alternative Medicine (CAM) are unconventional care practices that, according to the World Health Organization, should be implemented in the Health System, particularly in poor regions of the country. In Brazil, they have been adopted by Care Programs and introduced into undergraduate medical education. In this study we were interested in evaluating the teaching-learning process of Integrative Practices in Brazilian medical schools. Methodology A cross-sectional study was carried out at Brazilian medical schools with a self-administered questionnaire for teachers and a secondary data survey was obtained from medical school websites and government database institutions. For the presentation of the variables, frequency distribution and the Pearson coefficient (X2) -Chi-square tests were used. The proportions were compared using the Chi-square test or the Fisher's Exact Test. When the expected value of a contingency table was equal to or greater than 5, the Chi-square test was used; in all other situations, Fisher's Exact Test was used. The difference between proportions was estimated by the Odds Ratio, calculated through simple logistic regression (95% CI). Results 57 of the 272 medical schools in Brazil address CAM, with it being proportionally higher in the South and Mid-West regions. The medical schools are highly concentrated in state capitals, and the Northeast region presents a significant concentration of medical schools with CAM in the capitals. The number of schools with active and traditional methodologies in CAM is equivalent. Homeopathy, Acupuncture and Integrative Medicine predominate, with a minority using Indigenous Practices, Chronotherapy and Anthroposophic Medicine. The new educational guidelines have not affected the number of schools with CAM. Growth in CAM has been insignificant (p <0.05) in the last ten years. Conclusion There has been no growth in teaching Complementary and Alternative Medicine in undergraduate medical training in Brazil since the introduction of the new curricular guidelines, even in view of the needs of the health system.
RESUMO Contexto Medicinas Complementares e Alternativas (MAC) são práticas de cuidados não convencionais que, segundo a Organização Mundial da Saúde, devem ser implementadas no sistema de saúde, particularmente nas regiões pobres do País. No Brasil, têm sido inseridas na saúde como Práticas Integrativas por meio de programas assistenciais e no ensino de graduação. Objetivou-se avaliar o processo de ensino-aprendizagem em Práticas Integrativas nas escolas médicas brasileiras. Metodologia Um estudo transversal foi realizado em escolas médicas brasileiras com um questionário autoaplicável para professores, e um levantamento de dados secundários foi obtido em websites de escolas médicas e instituições de bancos de dados governamentais. Na apresentação das variáveis utilizou-se a distribuição de frequências e os testes do coeficiente de Pearson (x2) - Qui-Quadrado. As proporções foram comparadas por meio do teste Qui-Quadrado ou do Teste Exato de Fisher. Quando o valor esperado de uma tabela de contingência foi igual ou superior a 5, utilizou-se o teste Qui-Quadrado; em todas as outras situações, utilizou-se o Teste Exato de Fisher. A diferença entre as proporções foi estimada pela Odds Ratio, calculada por meio de regressão logística simples (95% IC). Resultados Das 272 escolas médicas do Brasil, 57 abordam MAC, sendo essa proporção maior nas regiões Sul e Centro-Oeste. Há uma concentração de escolas médicas em capitais, e a Região Nordeste apresenta uma concentração significativa de escolas médicas com MAC nas capitais. O número de escolas com metodologias ativas e tradicionais no ensino de MAC é equivalente. A homeopatia, a acupuntura e a medicina integrativa predominam, com uma minoria usando práticas indígenas, cromoterapia e medicina antroposófica. As novas diretrizes educacionais não causaram impacto no número de escolas com MAC. O crescimento em MAC foi insignificante (p < 0, 5) nos últimos dez anos. Conclusão Não houve crescimento no ensino em Práticas Integrativas e Complementares no Brasil na graduação médica após as novas diretrizes curriculares, mesmo diante das necessidades do sistema de saúde.
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We analyzed whether ivabradine (IVA), a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker, clinically used for angina and arrhythmia, had anticonvulsant, antioxidant and neuroprotective properties against classical seizure models. Potential molecular targets to IVA anticonvulsant effects were evaluated by molecular docking. Mice were treated with IVA (1, 10 or 20 mg/kg, IP) for 3 days, and 30 min after the last administration were injected with pentylenetetrazole (PTZ - 85 mg/kg, IP), pilocarpine (PILO 400 mg/kg, SC), picrotoxin (PICRO 10 mg/kg, IP). The following measures were performed: presence of seizures, latency for the first seizure, latency for death, percentage of survival. Antioxidant activity was investigated by determination of lipid peroxidation (MDA), reduced glutathione (GSH) and nitrite levels in the prefrontal cortex (PFC), hippocampus and striatum (ST). Immunohistochemistry analysis for cleaved caspase-3, a pro-apoptotic and degenerative marker, in hippocampal subregions namely cornu ammonis (CA)1, CA3 and dentate gyrus (DG), were also performed. IVA attenuated PTZ- and PICRO-induced seizures while presented an antioxidant effect in all brain areas studied. IVA markedly reduced cleaved caspase-3 expression in the CA1 and DG region of PICRO- and PTZ-treated mice, respectively. Molecular docking demonstrated that IVA has high energetic affinity and binding compatibility for GABAA receptor without causing channel obstruction. However, no reproducibility in the binding of IVA to N-methyl-d-aspartate (NMDA) receptor was detected. In conclusion, IVA has anticonvulsant, antioxidant and neuroprotective effects against PTZ- and PICRO-induced seizures. Also, a high affinity of IVA to GABAA receptor was predicted, representing a potential underlying mechanism to these observable effects.
