Uso de Álcool por Estudantes de Medicina segundo Características de Cursos e Escolas Médicas: uma Revisão da Literatura / Alcohol use by Medical Students according to Course and Medical School Characteristics: a Literature Review

RESUMO Introdução O álcool é fator de risco para várias condições de saúde e responde por mais de 3 milhões de óbitos por ano no mundo. A substância contribui para o desenvolvimento de doenças crônicas, como as cardiovasculares e o câncer, e para condições agudas relacionadas ao efeito direto sobre o sistema nervoso central. Apesar disso, seu uso constituí prática comum entre estudantes, particularmente entre os alunos de Medicina. Os objetivos do presente estudo foram: (i) fazer uma revisão de literatura para identificar estudos de prevalência de uso de álcool entre estudantes de Medicina de escolas brasileiras; (ii) analisar as estimativas de prevalência de uso de álcool segundo características dos cursos e das escolas médicas. Método Trata-se de revisão da literatura efetuada para resgatar publicações nas bases bibliográficas (i) Literatura Latino-Americana em Ciências de Saúde (Lilacs), utilizando a combinação de descritores de saúde [(estudantes de medicina AND álcool)], e (ii) US National Library of Medicine of National Institute of Health (Medline/Pubmed), usando a combinação de descritores de saúde [(medical students AND alcohol AND Brazil)]. Os padrões de uso de álcool nos últimos sete dias (7D), 30 dias (30D) e último ano (ANO) foram analisados pela visualização de gráficos de ações e de dispersão, bem como pela verificação de correlação. Resultados Foram incluídos 14 estudos, dos quais oito foram desenvolvidos na Região Sudeste. A maior parte das instituições envolvidas tinha administração pública (n = 8) e estava localizada em capitais (n = 8). A prevalência de uso de álcool nos últimos sete dias variou de 23,0% a 46,5%; nos últimos 30 dias, variou de 20,2% a 87,6%; e no último ano, variou de 79,3% a 92,9%. A correlação da prevalência com a carga horária do curso e com o tempo de existência da escola mostrou intensidade fraca nos três padrões de uso analisados. No padrão de uso de sete dias, a direção da correlação foi negativa nas duas características (carga horária do curso e tempo de existência da escola). Nos últimos 30 dias, a direção da correlação foi negativa com a carga horária e positiva com o tempo de existência da escola. No último ano, a direção da correlação foi positiva com a carga horária e negativa com o tempo de existência da escola. Conclusões O uso de álcool é tema recorrente na literatura científica no Brasil, e as prevalências de uso nos últimos sete dias, 30 dias e último ano são altas entre estudantes de Medicina. A influência das características de escolas médicas e de cursos de Medicina sobre o uso de substâncias psicoativas carece de mais atenção da comunidade científica, sendo notória a necessidade do envolvimento das instituições de ensino superior no controle do problema do álcool no Brasil.

ABSTRACT Introduction Alcohol is a risk factor for several health conditions and accounts for more than three million deaths per year worldwide. The substance contributes to the development of chronic diseases such as cardiovascular and cancer, as well as for acute conditions related to direct effects on the central nervous system. Despite this, its use is common practice among university students, including medical students. Objectives The objectives were (i) to develop a literature review to identify studies into the prevalence of alcohol use among students at Brazilian medical schools; and (ii) to analyze the estimates of prevalence according to medical course and school characteristics. Method Literature review developed to search publications in the (i) Latin American and Caribbean Center in Health Sciences Information (Lilacs) database, using the word combination [(estudantes de medicina AND álcool)] and in the US National Library of Medicine of National Institute of Health (Medline/Pubmed) database, using the word combination [(medical students AND alcohol AND Brazil)]. Alcohol use patterns in the past seven days, past thirty days, and past year were analyzed by plotting and visualization of point estimates and confidence intervals, as well as correlations. Results Fourteen studies were included in this review. Eight of them were developed in the southeast region. Most institutions were under public administration (n = 8), and were in state capitals (n = 8). The prevalence of alcohol use in the past seven days ranged from 23.0% to 46.5%, in the past thirty days ranged from 20.2% to 87.6%, and in the past year ranged from 79.3% to 92.9%. The correlations between prevalence and workload, and between prevalence and age of school showed a weak intensity on the three use patterns analyzed. The correlation directions followed diversified patterns. In the past seven days, the correlation directions were negative both with workload and age of the school. In the past thirty days, the correlation direction was negative with the workload, and positive with the age of the school. In the past year, the correlation direction was positive with workload, and negative with the age of the school. Conclusions Alcohol use is a recurring theme in Brazilian scientific literature and the estimates of prevalence of its use in the past seven days, in the past thirty days and in the past year are high among medical students. The influence of medical school and the medical course characteristics on the use of psychoactive substances requires more attention from the scientific community, and the involvement of the higher education institutions in controlling the alcohol problem in Brazil is fundamental.

Transient prominent anterior QRS forces in the setting ST segment elevation coronary syndrome: Left septal fascicular block.

Numerous successive publications have shown that transient prominent anterior QRS forces (PAF) in the setting of acute coronary syndrome (ACS) is suggestive of critical proximal obstruction of left anterior descending coronary artery (LAD) before its first septal perforator branch (S1). Transient ischemia of the left septal fascicle resulting in left septal fascicular block has been proposed as the causative mechanism. We present a case of acute inferior ST-elevation myocardial infarction caused by acute proximal occlusion of the right coronary artery associated with proximal critical obstruction of the left anterior descending coronary artery.

A simple and rapid method for screening amylolytic bacteria.

A laboratory class was designed for the study of the ecology of amylolytic bacteria in soil, although other sources may be equally suitable for this purpose. Groups of three students carried out the following: (a) preparation and sterilization of medium and plates, (b) collection and preparation of soil samples, spreading the samples on the plates, (c) incubation of the plates at 37 degrees C overnight, a further 1 h incubation at 60 degrees C to observe amylolytic activity due to thermophilic bacteria, and (d) interpretation and discussion of the results. These tasks are accomplished in two periods of 4h on consecutive days. No sophisticated instruments are required for these experiments, which can be carried out in three classes of 4h each. On the first day the students prepare culture media, buffers and reagents, as well as collect and grow soil samples. The second day is spent for both taxonomic identification of colonies and the HAI determination.

Patterns of detection of Strongyloides stercoralis in stool specimens: implications for diagnosis and clinical trials.

Reported efficacies of drugs used to treat Strongyloides stercoralis infection vary widely. Because diagnostic methods are insensitive, therapeutic trials generally require multiple negative posttreatment stool specimens as evidence of drug efficacy. However, only a single positive stool specimen is usually required for study enrollment. To determine the reproducibility of detection of S. stercoralis larvae in the stool, 108 asymptomatic infected men submitted 25 g of fresh stool once a week for eight consecutive weeks for examination by the Baermann technique. During the 8-week study, 239 (27.7%) of 864 stool specimens were positive for S. stercoralis. Rates of detection of larvae in the stool specimens ranged from eight of eight specimens in 3 (2.8%) men to none of eight specimens in 36 (33.3%) men. Of 43 men for whom S. stercoralis was detected in at least two of the first four stool specimens, only 1 (2.3%) man tested negative on all of the next four specimens. In comparison, of 29 men who had detectable larvae in only one of the first four specimens, 22 (75.9%) tested negative on all of the next four samples. Thus, if these 29 men had been enrolled in a therapeutic trial between the first and second sets of four specimens, the efficacy of a drug with no activity against this parasite would have been estimated to be 76%. These data suggest that patterns of S. stercoralis detection vary widely among infected persons and that intermittent larval shedding can lead to inflated estimates of drug efficacy. Before a patient is entered in a clinical trial of drug efficacy, four consecutive stool specimens should be examined for S. stercoralis; only persons with two or more positive specimens should be enrolled.