Software Educacional: Nematelmintos de Aquisição Passiva / Educational Software: Passive Acquisition of Nemathelminthes

RESUMO Objetivo Desenvolver e avaliar um software educacional com base em imagens parasitológicas de helmintos, abordando de forma ilustrativa e interativa os nematelmintos de transmissão passiva, o que poderá ser útil a professores, profissionais e alunos de graduação das diferentes profissões da saúde na compreensão e identificação dessas verminoses, aproximando-os também da prática profissional. Metodologia O software foi construído com base em um banco de imagens do próprio autor, utilizando o multimídia Flashâ, que permite elaborar animações e simulações em linguagem vetorial, resultando em arquivos pequenos, que podem ser disponibilizados através da web ou em mídias ópticas e magnéticas. A avaliação do produto final foi feita por estudantes de Medicina. Resultados O software foi concluído e bem avaliado pelos estudantes do curso de Medicina (n=97) da Faculdade de Ciências Médicas e da Saúde (FCMS) da PUC/SP. Os pré e pós-testes do material mostraram consistente crescimento do conhecimento, seja por autoavaliação ou por questões objetivas fechadas. Conclusão Os resultados atuais permitem concluir que o software é de grande interesse educacional e poderá ser útil a estudantes, profissionais e docentes da área da saúde.

ABSTRACT Object The main objective of this project is to evaluate and develop educational software utilizing Helminth parasitological images to interactively illustrate the passive transmission of roundworms. This can be useful to teachers, professionals and graduate students from various health professions understand and identify these worms as well as for use by professionals in their practice. Methodology The software was built using Multimedia Flashâ and a database of images. This enabled the creation of animations and simulations in vector language, resulting in smaller files that can be made available through the web or provided on other storage media. The final product was evaluated by medical students. Results The software has been completed and has been favorably evaluated by medicine students (n = 97) of the PUC/SP Medical Science and Health School. Their tests compared results before use of the software with results obtained after using the software. A consistent growth of knowledge was demonstrated either by self-assessment or closed objective questions. Conclusion The results obtained allow us to conclude that the software is of great educational interest and should be useful to students, teachers and professionals in the health field.

Software interativo: ecocardiografia na avaliaçao da hipertensao arterial / Interactive software: echocardiogram in assessing high blood pressure

A hipertensao arterial é uma doença muito prevalente, evoluindo com lesoes em órgaos-alvo, alta morbidade e mortalidade. A avaliaçao das repercussoes cardíacas pela ecocardiografia tem papel importante na conduçao clínica dos indivíduos hipertensos, e suas imagens podem ser utilizadas como ferramenta para o ensino. OBJETIVOS: Desenvolver e avaliar um software, construído com base em imagens ecocardiográficas, abordando de forma ilustrativa e interativa a estrutura e funçao cardíacas normais,bem como as alteraçoes induzidas pela hipertensao arterial. MÉTODOS: Foram selecionadas imagens ecocardiográficas de indivíduos normais e com comprometimento cardíaco determinado pela hipertensao (hipertrofia ventricular esquerda, miocardiopatia dilatada e infarto do miocárdio). Com estas imagens foi construído um software no programa multimídia Flash, que foi avaliado por estudantes de Medicina (n=38) e Enfermagem (n=18), também submetidos a pré- e pós-teste. RESULTADOS: Os alunos consideraram o software útil, atraente e adequado as atuais metodologias educacionais proativas,promovendo ganho de conhecimento na compreensao do comprometimento cardíaco na hipertensao arterial. Conclusao: O software foi bem avaliado e considerado útil na aquisiçao de conhecimento numa área específica mais prevalente do comprometimento da saúde do adulto.

Hypertension is a very prevalent disease that causes lesions in target organs, high morbidity and mortality. Assessing the cardiac effects of hypertension through echocardiogram plays an important role in the clinical management of the condition and these images can be used for teaching. Objectives: To develop and evaluate a software, built from echocardiographic images, addressing illustratively and interactively normal cardiac structure and function as well as lesions induced by hypertension. Methods: Echocardiographic images from normal subjects and patients with cardiac involvement induced by hypertension (left ventricular hypertrophy, dilated cardiomyopathy and myocardial infarction) were selected. With these images a software was built in Flash multimedia that was evaluated by student doctors (n=38) and student nurses (n=18), who also underwent pre- and post-testing. Results: The students considered the software useful, attractive and appropriate to current proactive educational methodologies, promoting knowledge acquisition in the understanding of cardiac involvement in hypertension. Conclusion: The software was evaluated positively and considered useful for gaining knowledge in a specific but prevalent area of adult health impairment.

Elastic fiber assembly in the adult mouse pubic symphysis during pregnancy and postpartum.

Impairment of pelvic organ support has been described in mice with genetic modifications of the proteins involved in elastogenesis, such as lysyl oxidase-like 1 (LOXL1) and fibulin 5. During pregnancy, elastic fiber-enriched pelvic tissues are modified to allow safe delivery. In addition, the mouse pubic symphysis is remodeled in a hormone-controlled process that entails the modification of the fibrocartilage into an interpubic ligament (IpL) and the relaxation of this ligament. After first parturition, recovery occurs to ensure pelvic tissue homeostasis. Because ligaments are the main supports of the pelvic organs, this study aimed to evaluate elastogenesis in the IpL during mouse pregnancy and postpartum. Accordingly, virgin, pregnant, and postpartum C57BL/6 mice were studied using light, confocal, and transmission electron microscopy as well as Western blots and real-time PCR. Female mice exhibited the separation of the pubic bones and the formation, relaxation, and postpartum recovery of the IpL. By the time the IpL was formed, the elastic fibers had increased in profile length and diameter, and they consisted of small conglomerates of amorphous material distributed among the bundles of microfibrils. Our analyses also indicated that elastin/tropoelastin, fibrillin 1, LOXL1/Loxl1, and fibulin 5 were spatially and temporally regulated, suggesting that these molecules may contribute to the synthesis of new elastic fibers during IpL development. Overall, this work revealed that adult elastogenesis may be important to assure the elasticity of the pelvic girdle during preparation for parturition and postpartum recovery. This finding may contribute to our understanding of pathological processes involving elastogenesis in the reproductive tract.

A multimedia approach for teaching human embryology: Development and evaluation of a methodology.

Human embryology requires students to understand the simultaneous changes in embryos, but students find it difficult to grasp the concepts presented and to visualise the related processes in three dimensions. The aims of this study have been to develop and evaluate new educational materials and a teaching methodology based on multimedia approaches to improve the comprehension of human development. The materials developed at the State University of Campinas include clinical histories, movies, animations, and ultrasound, as well as autopsy images from embryos and foetuses. The series of embryology lectures were divided into two parts. The first part of the series addressed the development of the body's structures, while in the second part, clinical history and the corresponding materials were shown to the students, who were encouraged to discuss the malformations. The teaching materials were made available on software used by the students in classes. At the end of the discipline, the material and methodology were evaluated with an attitudinal instrument, interviews, and knowledge examination. The response rate to the attitudinal instrument was 95.35%, and the response rate to the interview was 46%. The students approved of the materials and the teaching methodology (reliability of the attitudinal instrument was 0.9057). The exams showed that most students scored above 6.0. A multimedia approach proved useful for solving an important problem associated with teaching methods in many medical institutions: the lack of integration between basic sciences and clinical disciplines.

Malformações congênitas de embriões de camundongas expostas ao álcool e à nicotinamida / Congenital malformations in embryos of female mice exposed to alcohol and nicotinamide

Objetivos: Comparar a incidência de malformações congênitas entre a prole de camundongas expostas ao álcool associado à nicotinamida. Utilizaram-se camundongas C57BL/6J, sendo divididas em três grupos (G1, G2 e G3). As camundongas prenhes foram sacrificadas em câmara de CO2 no 18º dia de gestação. Avaliou-se o conteúdo uterino, foram contabilizados o nº de fetos. Estes foram pesados, seu comprimento crânio-caudal medido e foram identificadas as malformações congênitas. No G1 observou-se um maior número de malformações. Quanto ao estudo comparativo do peso encontrou-se uma diferença significativa entre os grupos (p = 0,0139), sendo que os de G1 possuíam um peso abaixo da média quando comparado aos de G3 (p = 0.3133). No estudo comparativo do comprimento, foram observados os menores valores no G2 e os maiores no G3. Nesta análise foi observado o contraste entre os grupos (p= 0,0145). O etanol administrado durante a prenhez causou, teratogenia na prole de camundongas. Contudo, o comprimento dos fetos do G1, foi maior quando comparado à medida observada nos demais grupos.

XX Maleness and XX true hermaphroditism in SRY-negative monozygotic twins: additional evidence for a common origin.

CONTEXT: Differentiation of testicular tissue in 46,XX individuals is seen either in XX males, the majority of them with SRY gene, or in individuals, usually SRY(-), with ovotesticular disorder of sex development (OT-DSD). Although they are sporadic cases, there are some reports on familial recurrence, including coexistence of XX maleness and OT-DSD in the same family. OBJECTIVE: We report on a case of SRY(-) 46,XX monozygotic twins with genital ambiguity. METHODS: Hormonal evaluation included testosterone, FSH, and LH measurements. SRY gene was investigated by PCR and two-step PCR in peripheral leukocytes and gonadal tissues, respectively. Direct DNA sequencing of the DAX-1 coding sequence was performed. Real-time PCR for SOX9 region on chromosome 17 was obtained. RESULTS: Both twins had a 46,XX karyotype. Twin A had a 1-cm phallus with chordee, penoscrotal hypospadias, and palpable gonads. Serum levels of FSH (2.34 mIU/ml), LH (8.8 mIU/ml), and testosterone (1.6 ng/ml) were normal, and biopsies revealed bilateral testes. Twin B had a 0.5-cm phallus, perineal hypospadias, no palpable gonad on the right, and a left inguinal hernia. Hormonal evaluation revealed high FSH (8.2 mIU/ml) and LH (15 mIU/ml) and low testosterone (0.12 ng/ml). Upon herniotomy, a right testis (crossed ectopia) and a small left ovotestis were found. SRY gene was absent in both peripheral leukocytes and gonadal tissue samples. Neither DAX-1 mutations nor SOX9 duplication was identified. CONCLUSIONS: This case provides evidence that both XX maleness and XX OT-DSD are different manifestations of the same disorder of gonadal development.

The usefulness of autopsies as a tool for teaching human embrilogy

Embryology is often difficult to teach because of the rapid, three-dimensional changes that occur simultaneously on a microscopic scale. A knowledge of normal and abnormal human development is important for understanding the pathophysiology, clinical treatment and surgical repair of malformations. In this study, we developed a method to enhance the comprehension of human embryology and its associated malformations. The strategy used macro-and-microscopical digital documentation of embryos, fetuses and neonates undergoing autopsy in the Department of Anatomical Pathology at the State University of Campinas. The images acquired were used in the Human Morpho-Physiology, course of the university´s medical curriculum. The embryology lectures were divided into two parts. In the first part, the development of the body´s structures was explained, while in the second, macro-and-microscopic images of selected autopsies were shown to the students, who were also encouraged to find and discuss the malformations and their clinical history, diagnosis and therapeutics. At the end of the course, the teaching material and the method used were evaluated using a questionnaire, interviews, and a test of the knowledge acquired during the lectures. Most of the students approved the method, and emphasized the importance of integration between basic and clinical disciplines. Their performance in the examination was also good

Phenotypic modulation of fibroblastic cells in mice pubic symphysis during pregnancy, partum and postpartum.

In many species, the cartilaginous pubic symphysis of the pregnant female is gradually replaced by a fibrous connective tissue, forming a flexible and elastic interpubic ligament. This newly formed ligament is responsible for the separation of the pubic bones, enabling safe delivery of the young. Following labor, the ligament undergoes rapid involution. To our knowledge, no previous work has focused on the phenotypic modulation that is responsible for the changes present at the interpubic ligament throughout the relaxation and closing of the symphysis. The purpose of this study was to investigate the ultrastructural features and immunophenotype of the peculiar cell type found in the pubic symphysis of cycling, pregnant and postpartum mice. In particular, immunohistochemistry studies were conducted on the expressions of the cytoskeletal proteins desmin, vimentin and alpha-smooth muscle actin (alpha-SMA). During pregnancy, the pubic symphysis cells always expressed alpha-SMA, whereas the expression of vimentin and desmin was transient from early pregnancy to postpartum. Furthermore, the expression patterns of these three cytoskeletal proteins were distinct. Cells present in the medial region of the mouse symphysis in cycling and at D12 displayed ultrastructural features characteristic of a typical fibroblast. In contrast, during the last week of pregnancy and in postpartum these cells acquired ultrastructural features representative of a myofibroblast; for example, a fibronexus and a contractile apparatus were found to be present lying in close contact with the extracellular collagenous and elastic system fibrils. Taken together, these results strongly suggest a contractile function for these cells which might contribute to support of the varying mechanical stresses present during pubic bone movement.

Differential distribution of elastic system fibers in the pubic symphysis of mice during prefnancy, partum and post-partum

The expansion of the pubic symphysis during pregnancy in some rodet depends on the growth of the interpubic ligament, primarily through the biosynthesis of extracellular matrix. Although there is a significant metabolism of elastin in the female reproductive tract during pregnancy, little is known of the architectural and ultrastructural aspects of the elastic system fibers in the mouse pubic symphysis. In this study, the main characteristics of the elastic system of the mouse pubic symphysis during pregnancy, partum and post-partum were determined by light and electron microscopy. A distinct arrangement of microfibrils, elastin deposition and development of the extracellular matrix formed a supporting framework that uniformly distributed stress in order to provide adequate interpubic resilience during delivery. These changes support a role for elastic system fibers in symphyseal maturation and reconstruction during pregnancy and after delivery.