Concordância no diagnóstico e principais dificuldades encontradas por estudantes de medicina ao realizar o "Teste do Olhinho" / Diagnostic concordance and the main difficulties found by medical students to perform the "Red Reflex" examination

OBJETIVOS: Avaliar a concordância diagnóstica para realizar o "Teste do Olhinho" (TO) entre acadêmicos de medicina e pediatras de uma maternidade pública de Curitiba. Definir as variáveis que influenciam na execução do exame. Estudar a curva de aprendizagem semiológica do teste. MÉTODO: Foi realizado um estudo prospectivo, observacional e analítico na maternidade do Hospital do Trabalhador (HT) em Curitiba-PR. A amostra consistiu na análise dos exames de 240 recém nascidos (RN) realizados por 4 acadêmicos de medicina (E1, E2, E3 e E4). Cada acadêmico examinou 60 crianças cada e tiveram seus resultados comparados com os diagnósticos dos médicos pediatras. Os dados coletados por cada examinador foram analisados em intervalos de 20 RN (T1, T2 e T3). RESULTADOS: foram examinados 240 crianças e 480 olhos. Não foram encontradas diferenças significativas entre a curva de aprendizagem de cada aluno e não houve diferença estatística entre os estudantes na quantidade de acertos totais (p>0,05). A dificuldade mais prevalente (70%) foi relacionada às variáveis semiológicas presentes no momento do exame físico. Alterações qualitativas para interpretar o reflexo retiniano foram detectadas em 5 casos ao todo, representando 18,5% das ocorrências. Ao todo, 27 exames (11,2%) não foram concordantes entre os estudantes e os pediatras De toda a amostra, apenas três crianças (1,25%) foram encaminhadas pelo pediatra ao acompanhamento especializado. Destes casos, houve concordância com os alunos em dois exames. CONCLUSÃO: o estudo sugere que estudantes de medicina demonstram boa concordância para avaliar o Teste do Olhinho ao comparar seus desempenhos com Pediatras. As principais dificuldades encontradas para se realizar os exames foram semiológicas, devido à irritabilidade dos neonatos no momento da avaliação. Ainda, houve uma tendência de melhorar a curva de aprendizagem com o aumento da prática

OBJECTIVE: Evaluate the diagnostic agreement to perform the "Red Reflex" (RR) exam between medical students and pediatricians of a public hospital's maternity in the city of Curitiba-Brazil, and to define the variables that influences in the execution of the exam and to study the semiological learning curve of the test. METHOD: a prospective, observational and analytical study was performed at the Hospital do Trabalhador (HT) maternity in Curitiba-Brazil. The sample consisted in he analysis of the exams from 240 newborns (NB) performed by four medical students (E1, E2, E3 and E4). Each medical student examined 60 children, and their results were then compared with the pediatrician's diagnoses. The data collected by each examiner were analyzed at intervals of 20 NBs (T1, T2 and T3) RESULTS: at the end of the study, 240 children and 480 eyes were examined. Each participating medical student evaluated 60 children. No significant differences were found between the learning curve of each student and there was no statistical difference between the students in the number of total hits (p> 0,05). The most prevalent difficulty (70%) was related to the semiological variables present at the time of physical examination. Qualitative changes to interpret the retinal reflex were detected in 5 cases, representing 18,5% of the non-concordant group of exam. In all, 27 exams (11,2%) were not concordant among students and pediatricians. Of the whole sample, only three children (1,25%) were referred by the pediatrician to the specialized attendance. In these cases, there was agreement with the students in two exams. CONCLUSION: the study suggests that medical students demonstrate good agreement to evaluate the "Red Reflex" axam when comparing their performances with pediatricians. The main difficulties found to perform the exams were essentially semiological, due to the irritability of the newborns at the time of the evaluation. Still, there was a tendency to improve the learning curve with increasing practice

Inhibition of Host Cell Lysosome Spreading by Trypanosoma cruzi Metacyclic Stage-Specific Surface Molecule gp90 Downregulates Parasite Invasion.

Successful infection by Trypanosoma cruzi, the agent of Chagas' disease, is critically dependent on host cell invasion by metacyclic trypomastigote (MT) forms. Two main metacyclic stage-specific surface molecules, gp82 and gp90, play determinant roles in target cell invasion in vitro and in oral T. cruzi infection in mice. The structure and properties of gp82, which is highly conserved among T. cruzi strains, are well known. Information on gp90 is still rather sparse. Here, we attempted to fill that gap. gp90, purified from poorly invasive G strain MT and expressing gp90 at high levels, inhibited HeLa cell lysosome spreading and the gp82-mediated internalization of a highly invasive CL strain MT expressing low levels of a diverse gp90 molecule. A recombinant protein containing the conserved C-terminal domain of gp90 exhibited the same properties as the native G strain gp90: it counteracted the host cell lysosome spreading induced by recombinant gp82 and exhibited an inhibitory effect on HeLa cell invasion by CL strain MT. Assays to identify the gp90 sequence associated with the property of downregulating MT invasion, using synthetic peptides spanning the gp90 C-terminal domain, revealed the sequence GVLYTADKEW. These data, plus the findings that lysosome spreading was induced upon HeLa cell interaction with CL strain MT, but not with G strain MT, and that in mixed infection CL strain MT internalization was inhibited by G strain MT, suggest that the inhibition of target cell lysosome spreading is the mechanism by which the gp90 molecule exerts its downregulatory role.

Retention of laparoscopic skills in naive medical students who underwent short training.

BACKGROUND: Simulators are useful tools in the development of laparoscopic skills. However, little is known about the effectiveness of short laparoscopic training sessions and how retention of skills occurs in surgical trainees who are naïve to laparoscopy. This study analyses the retention of laparoscopic surgical skills in medical students without prior surgical training. METHODS: A group of first- and second-year medical students (n = 68), without prior experience in surgery or laparoscopy, answered a demographic questionnaire and had their laparoscopic skills assessed by the Fundamentals of Laparoscopic Surgery (FLS) training protocol. Subsequently, they underwent a 150-minute training course after which they were re-tested. One year after the training, the medical students' performance in the simulator was re-evaluated in order to analyse retention. RESULTS: Of the initial 68 students, a total of 36 participated throughout the entire study, giving a final participation rate of 52 %. Thirty-six medical students with no gender predominance and an average age of 20 years were evaluated. One year after the short training programme, retention was 69.3 % in the peg transfer (p < 0.05) and 64.2 % in ligature (p < 0.05) compared with immediate post-training evaluation. There was no significant difference in suturing. The average sample score in the baseline test was 8.3, in the post-training test it was 89.7, and in the retention test it was 84.2, which corresponded to a skill retention equivalence of 93 %. CONCLUSIONS: There was a significant retention of the laparoscopic surgical skills developed. Even 1 year after a short training session, medical students without previous surgical experience showed that they have retained a great part of the skills acquired through training.