Impacto da pandemia do SARS-COV-2 na educação médica: migração "compulsória" para o modelo remoto, uma visão preliminar de gestores da educação médica

INTRODUÇÃO: A pandemia por SARS-CoV-2 impactou os modelos educacionais ofertados nos cursos de Medicina. Nesse contexto, com a autorização para oferta de disciplinas remotamente, evidencia-se uma aceleração sem precedentes na migração do modelo presencial para ensino remoto, o que já vinha ocorrendo gradativamente no sistema de educação superior brasileiro. Devido ao isolamento social para enfrentamento da crise, este modelo está sendo aplicado integralmente em muitas Instituições de Ensino Superior (IES) do país, podendo repercutir em mudanças metodológicas na educação médica. OBJETIVOS: Discutir o impacto da pandemia do SARS-CoV-2 na educação médica, analisando a migração para o modelo remoto. MÉTODO: Baseado na experiência dos autores na gestão da educação médica, foi realizada uma reflexão a partir de reuniões gerenciais de duas IES privadas. RESULTADOS: O contexto de pandemia global promoveu impactos no ensino no âmbito do corpo discente, docente e IES. Os altos investimentos na migração do modelo de ensino e a alta taxa de evasão vêm repercutindo na suspensão de contratos de docentes de IES privadas. A desigualdade de acesso tecnológico, ambientes não propícios e a má qualidade da telefonia/internet no país podem impactar no desempenho acadêmico. CONCLUSÕES: É inegável que a educação médica está sendo profundamente transformada por essa crise global de saúde. Entretanto, ainda é cedo para afirmar com segurança o tamanho desse impacto. Futuramente, será necessário adaptar o conceito de Ensino Médico baseado em evidências para avaliar com clareza as repercussões práticas dessa pandemia no ensino da Medicina

Efeitos da metformina no perfil inflamatório em pacientes com tuberculose e diabetes tipo 2/ Effects of metformin on the inflammatory profile in patients with tuberculosis and type 2 diabetes

O diabetes mellitus (DM) aumenta o risco de tuberculose pulmonar (TB) e desfechos adversos ao tratamento. Sabendo que a metformina é a droga mais utilizada no controle da DM, diversos estudos sugerem um efeito pleiotrópico que aumenta a resposta imunológica contra o Mycobacterium tuberculosis (Mtb) através da modulação da resposta inflamatória em pacientes com TB. Assim, o objetivo geral do presente estudo foi investigar os efeitos da metformina na resposta imunológica e inflamatória contra o Mycobacterium tuberculosis durante o tratamento para TB em pacientes diabéticos. Trata-se de um estudo de coorte prospectivo com pacientes atendidos em centros conveniados de referência em Chennai, no Sul da Índia, no período entre 2016 a 2017. Os dados clínicos e imunológicos foram coletados em 4 diferentes períodos (avaliação inicial, segundo mês, sexto mês e decimo oitavo mês). Os pacientes com tuberculose e diabetes (TBDM) foram divididos de acordo com o uso de metformina, TBDM metformina (Met) 29 pacientes e o TBDM sem uso de metformina (NMet) 14 pacientes. Foram analisadas variáveis sociodemográficas, antropométricas e os hábitos de vida. Os pacientes TBDM Met eram mais velhos, com predominância do sexo masculino em ambos os grupos. Não houve diferença estatisticamente significativa em relação ao IMC, tabagismo e etilismo. Foram mensuradas 17 citocinas plasmáticas e fatores de crescimento. Houve uma diferença estatisticamente significativa nos níveis de 2 citocinas, a IL-17F no mês 2 e IL-5 no mês 6. A associação da HbA1c com os biomarcadores em cada tempo também foi examinada.As análises indicaram que os indivíduos com TBDM Met apresentaram uma melhor resposta a infecção pelo Mtb, produzindo citocinas pró-inflamatórias ou anti-inflamatória a depender do momento específico no tratamento, indicando assim que o uso da metformina pode ter gerado um menor estado inflamatório após o tratamento para tuberculose

Can Score Databanks Help Teaching?

Basic courses in most medical schools assess students' performance by conferring scores. The objective of this work is to use a large score databank for the early identification of students with low performance and to identify course trends based on the mean of students' grades. METHODOLOGY/PRINCIPAL FINDINGS: We studied scores from 2,398 medical students registered in courses over a period of 10 years. Students in the first semester were grouped into those whose ratings remained in the lower quartile in two or more courses (low-performance) and students who had up to one course in the lower quartile (high-performance). ROC curves were built, aimed at the identification of a cut-off average score in the first semesters that would be able to predict low performances in future semesters. Moreover, to follow the long-term pattern of each course, the mean of all scores conferred in a semester was compared to the overall course mean obtained by averaging 10 years of data. Individuals in the low-performance group had a higher risk of being in the lower quartile of at least one course in the second semester (relative risk 3.907; 95% CI: 3.378-4.519) and in the eighth semester (relative risk 2.873; 95% CI: 2.495-3.308). The prediction analysis revealed that an average score of 7.188 in the first semester could identify students that presented scores below the lower quartiles in both the second and eighth semesters (p<0.0001 for both AUC). When scores conferred by single courses were compared over time, three time-trend patterns emerged: low variation, upward trend and erratic pattern. CONCLUSION/SIGNIFICANCE: An early identification of students with low performance may be useful in promoting pedagogical strategies for these individuals. Evaluation of the time trend of scores conferred by courses may help departments monitoring changes in personnel and methodology that may affect a student's performance

Using Recombinant Proteins from Lutzomyia longipalpis Saliva to Estimate Human Vector Exposure in Visceral Leishmaniasis Endemic Areas

During the blood meal, female sand flies (insects that transmit the parasite Leishmania) inject saliva containing a large variety of molecules with different pharmacological activities that facilitate the acquisition of blood. These molecules can induce the production of anti-saliva antibodies, which can then be used as markers for insect (vector) biting or exposure. Epidemiological studies using sand fly salivary gland sonicate as antigens are hampered by the difficulty of obtaining large amounts of salivary glands. In the present study, we have investigated the use of two salivary recombinant proteins from the sand fly Lutzomyia longipalpis, considered the main vector of visceral leishmaniasis, as an alternative method for screening of exposure to the sand fly. We primarily tested the suitability of using the recombinant proteins to estimate positive anti-saliva ELISA test in small sets of serum samples. Further, we validated the assay in a large sample of 1,077 individuals from an epidemiological survey in a second area endemic for visceral leishmaniasis. Our findings indicate that these proteins represent a promising epidemiological tool that can aid in implementing control measures against leishmaniasis

High seroprevalence of Leishmania infantum is linked to immune activation in people with HIV: a two-stage cross-sectional study in Bahia, Brazil

Visceral leishmaniasis is an opportunistic disease in HIV-1 infected individuals, unrecognized as a determining factor for AIDS diagnosis. The growing geographical overlap of HIV-1 and Leishmania infections is an emerging challenge worldwide, as co-infection increases morbidity and mortality for both infections. Here, we determined the prevalence of people living with HIV (PWH) with a previous or ongoing infection by Leishmania infantum and investigated the virological and immunological factors associated with co-infection. We adopted a two-stage cross-sectional cohort (CSC) design (CSC-I, n = 5,346 and CSC-II, n = 317) of treatment-naïve HIV-1-infected individuals in Bahia, Brazil. In CSC-I, samples collected between 1998 and 2013 were used for serological screening for leishmaniasis by an in-house Enzyme-Linked Immunosorbent Assay (ELISA) with SLA (Soluble Leishmania infantum Antigen), resulting in a prevalence of previous or ongoing infection of 16.27%. Next, 317 PWH were prospectively recruited from July 2014 to December 2015 with the collection of sociodemographic and clinical data. Serological validation by two different immunoassays confirmed a prevalence of 15.46 and 8.20% by anti-SLA, and anti-HSP70 serology, respectively, whereas 4.73% were double-positive (DP). Stratification of these 317 individuals in DP and double-negative (DN) revealed a significant reduction of CD4+ counts and CD4+/CD8+ ratios and a tendency of increased viral load in the DP group, as compared to DN. No statistical differences in HIV-1 subtype distribution were observed between the two groups. However, we found a significant increase of CXCL10 (p = 0.0076) and a tendency of increased CXCL9 (p = 0.061) in individuals with DP serology, demonstrating intensified immune activation in this group. These findings were corroborated at the transcriptome level in independent Leishmania- and HIV-1-infected cohorts (Swiss HIV Cohort and Piaui Northeast Brazil Cohort), indicating that CXCL10 transcripts are shared by the IFN-dominated immune activation gene signatures of both pathogens and positively correlated to viral load in untreated PWH. This study demonstrated a high prevalence of PWH with L. infantum seropositivity in Bahia, Brazil, linked to IFN-mediated immune activation and a significant decrease in CD4+ levels. Our results highlight the urgent need to increase awareness and define public health strategies for the management and prevention of HIV-1 and L. infantum co-infection

Identification of potential immunologic determinants of severity in human malaria

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2012-06-05T21:05:38Z No. of bitstreams: 1 Bruno de Bezerril Andrade - 2010.pdf: 74164438 bytes, checksum: a1cccf3d1f924ff7710fc4a73a190f0a (MD5)Made available in DSpace on 2012-06-05T21:05:38Z (GMT). No. of bitstreams: 1 Bruno de Bezerril Andrade - 2010.pdf: 74164438 bytes, checksum: a1cccf3d1f924ff7710fc4a73a190f0a (MD5)Universidade Federal da Bahia. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, BrasilA malária é considerada uma das mais importantes doenças infecciosas do mxmdo. Esta doença é causada por diversas espécies do protozoário Plasmodium sp., principalmente o Plasmodium falciparum e o Plasmodium vivax, transmitido por mosquitos do gênero Anopheles. Apesar dos esforços governamentais e privados para o desenvolvimento de estratégias para o controle da doença, o panorama atual da malária está piorando, muito em razão do aparecimento de cepas de parasitas resistentes aos medicamentos. Os casos fatais são relatados principalmente na Áfiica e são causados pelo Plasmodium falciparum. Apesar de ser menos letal, a malária causada pelo Plasmodium vivax é mais amplamente distribuída e pode apresentar também alta morbidade e mortalidade. Na maioria das áreas endêmicas, estudos têm identificado vários fatores relacionados à imunidade clínica ou susceptibilidade aos parasitas. Assim, pelo menos quanto à malária causada pelo Plasmodium falciparum, idade, polimorfismos genéticos e exposição repetida ao parasita são considerados importantes determinantes da evolução da doença. Infelizmente, pouco tem sido feito na identificação de fatores preditores consistentes que poderiam ser usados para avaliação clínica. Este quadro é ainda pior para malária causada pelo Plasmodium vivax, provavelmente porque muitos pesquisadores consideram que é uma doença benigna. Além disso, como a maioria do conhecimento atual sobre a patogênese da malária não ajudou a reduzir a ocorrência da infecção e suas complicações, novas abordagens são necessárias para superar este cenário desfavorável. Esta Tese reúne um conjunto de seis manuscritos que visam identificar potenciais determinantes da gravidade da malária em uma área endêmica da Amazônia Ocidental Brasileira. Em primeiro lugar, um método preciso e eficaz para o diagnóstico da malária foi rastreado através da comparação de vários testes, incluindo um software baseado em redes neurais artificiais. O ensaio molecular mostrou-se o mais eficiente para o diagnóstico da malária sintomáticos e assintomáticos. Além disso, a utilização racional de um teste rápido para diagnóstico da malária pode ser promissora em áreas onde há dificuldade na formação continuada dos técnicos diagnósticos. A rede neural artificial indicou que o balanço de citocinas é um forte determinante do quadro clínico. Em outro estudo, uso de sorologia para mensuração de anticorpos IgG contra o sonicado de glândula salivar do vetor Anopheles darlingi mostrou-se útil para a avaliação da exposição ao Plasmodium vivax e também para estimar a imunidade clínica á malária. Em um terceiro estudo com foco na identificação de outros fatores relacionados à imunidade clínica, a exposição natural ao vírus da hepatite B mostrou-se associada à redução da gravidade clínica da malária causada tanto pelo Plasmodium vivax quanto pelo Plasmodium falciparum. No que diz respeito exclusivamente à malária vivax, os casos graves apresentaram uma intensa e desregulada resposta inflamatoria sistêmica. Nestes pacientes, a enzima antioxidante superóxido dismutase-1 surgiu como um excelente marcador da gravidade e mostrou-se envolvida na patogênese da doença grave, na qual há uma liberação de grandes quantidades de heme livre. Em conjunto, os manuscritos desta tese adicionam importantes informações no entendimento dos mecanismos determinantes da gravidade da malária, extremamenteMalaria is considered one of the most important infectious diseases that ever threaten the world. This disease is caused mainly by the infection with Plasmodium falciparum or Plasmodium vivax transmitted by Anopheles mosquitoes. Despite governmental and private efforts for the development of key strategies for the disease control, the actual panorama of the Plasmodium infection is getting worse due to the emergence of drug resistMt parasite strains. The lethal cases are reported mostly in Africa and are caused by Plasmodium falciparum. Albeit being less lethal, Plasmodium vivax infections are more widely distributed can cause high morbidity and eventually death. In most endemic areas, studies have indentified a number of factors related to clinical immunity or susceptibility to the parasites. Thus, at least regarding the falciparum malaria, age, genetic polymorphisms and repeated exposure to Plasmodium are considered most important determinants of the disease outcome. Unfortunately, little has been made in the screening of reliable predicting factors that could be ultimately used for clinical evaluations. This landscape is even worse for vivax malaria, probably because many researches consider it as a benign disease. Moreover, as most of the current knowledge about the malaria pathogenesis did not truly help to relieve the disease burden, new insights are necessary to overcome this unfavorable scenario. This thesis brings together a set of six manuscripts that aim to identify potential determinants of the disease severity linked to the immunopathogenesis in an endemic area from the western Brazilian Amazon. First, a precise and effective method for malaria diagnosis was screening by comparing multiple tests, including a software based of artificial neural networks. The molecular assay showed to be the most efficient for the diagnosis of symptomatic and asymptomatic malaria. In addition, the rational use of a rapid test for the diagnosis of malaria may be promising in areas where there is difficulty in continued training of technical human resources. The artificial neural network indicated that the cytokine balance is a strong determinant of the clinical presentation. In another study, the use of serology for measuring IgG antibodies against the sonicate salivary gland of Anopheles darlingi vector is a promising marker of exposure to Plasmodium vivax and can also estimate the clinical immunity. Intriguingly, the natural exposure to the hepatitis B virus appeared as an important factor associated with reduced clinical severity for both vivax and falciparum malaria. Concerning solely the vivax malaria, severe cases have an intense and unregulated inflammatory response. In these patients, the antioxidant enzyme superoxide dismutase-1 has emerged as an excellent marker of severity and was involved in the pathogenesis of the severe disease in which there is a release of large amounts of free heme. Together, the manuscripts of this thesis add important information in understanding the mechanisms that determine the severity of malaria

Nuclear Factor κB Activation Pathways During Mycobacterium tuberculosis Infection

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-09-25T17:29:05Z No. of bitstreams: 1 Amaral EP Nuclear factor....pdf: 880587 bytes, checksum: e75d1d5a02d2962d17d27b9e4db51a06 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-09-25T17:59:16Z (GMT) No. of bitstreams: 1 Amaral EP Nuclear factor....pdf: 880587 bytes, checksum: e75d1d5a02d2962d17d27b9e4db51a06 (MD5)Made available in DSpace on 2017-09-25T17:59:16Z (GMT). No. of bitstreams: 1 Amaral EP Nuclear factor....pdf: 880587 bytes, checksum: e75d1d5a02d2962d17d27b9e4db51a06 (MD5) Previous issue date: 2017National Institutes of Health. National Institute of Allergy and Infectious Diseases. Laboratory of Parasitic Diseases. Immunobiology Section. Bethesda, MD, USA / University of São Paulo. Institute of Biomedical Sciences. Laboratory of Immunology of Infectious Diseases. Department of Immunology. São Paulo, SP, BrazilFundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brazil / Fundação José Silveira. Multinational Organization Network Sponsoring Translational and Epidemiological Research Initiative. Salvador, BA, Brazil / Faculdade de Tecnologia e Ciências. Salvador, BA, BrazilThe interactions between pathogens and host cells and the way by which the immune response is modulated during this process ultimately dictate the fate of infection. Host phagocytes exposed to Mycobacterium tuberculosis (M. tuberculosis) sense microbial-associated molecular patterns and activate a series of signaling pathways. In this setting, activation of the nuclear factor κB (NF-κB) initiates transcription of several key genes involved in orchestration of antimycobacterial effector functions. This review describes these major pathways that govern the outcome of host phagocytes infected with M. tuberculosis. Furthermore, we highlight evidence of how M. tuberculosis modulates activation of NF-κB pathways to evade the host antimycobacterial defense

Tuberculosis-immune reconstitution inflammatory syndrome in HIV: from pathogenesis to prediction

Andrade, Bruno Bezerril. “Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento”.Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-13T18:19:32Z No. of bitstreams: 1 Gopalan N Tuberculosis-immmune....pdf: 571793 bytes, checksum: bacca771c0253a120ab7ce34f1b955e0 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-04-13T18:42:12Z (GMT) No. of bitstreams: 1 Gopalan N Tuberculosis-immmune....pdf: 571793 bytes, checksum: bacca771c0253a120ab7ce34f1b955e0 (MD5)Made available in DSpace on 2018-04-13T18:42:12Z (GMT). No. of bitstreams: 1 Gopalan N Tuberculosis-immmune....pdf: 571793 bytes, checksum: bacca771c0253a120ab7ce34f1b955e0 (MD5) Previous issue date: 2014National Institute for Research in Tuberculosis. Mayor Sathyamoorthy. Road. Chetpet, Chennai, IndiaNational Institutes of Health. National Institute of Allergy and Infectious Diseases. Laboratory of Parasitic Diseases. Immunology Section. Bethesda, MD, USANational Institute for Research in Tuberculosis. Mayor Sathyamoorthy. Road. Chetpet, Chennai, IndiaTuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is an exaggerated, dysregulated immune response against dead or viable antigens of Mycobacterium tuberculosis that frequently occurs after initiation of antiretroviral therapy despite an effective suppression of HIV viremia. Scientific advances in IRIS pathogenesis have led researchers and clinicians to postulate risk factors that could possibly predict this syndrome, in an attempt to reduce the incidence and the severity of IRIS, with appropriate anti-inflammatory therapy. This review is a summary of the available literature on pathogenic mechanisms involved from the macro to the micro level, the clinical spectrum, available predictors and the scope of these biomarkers to function as specific therapeutic targets, that could effectively modulate or ameliorate this syndrome in future

Analysis of theoretical knowledge and the practice of science among Brazilian otorhinolaryngologists

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-02-21T13:59:45Z No. of bitstreams: 1 Mendonça V R R Analysis of theoretical....pdf: 368621 bytes, checksum: ceefb350df3734ef6175b309e60bfc83 (MD5)Made available in DSpace on 2014-02-21T13:59:45Z (GMT). No. of bitstreams: 1 Mendonça V R R Analysis of theoretical....pdf: 368621 bytes, checksum: ceefb350df3734ef6175b309e60bfc83 (MD5) Previous issue date: 2013PHD StudentHospital Santa Izabel. Santa Casa de Misericórdia da Bahia. Salvador, BA, BrasilHospital Santa Izabel. Santa Casa de Misericórdia da Bahia. Salvador, BA, BrasilNational Institutes of Health. National Institute of Allergy and Infectious Diseases. Laboratory of Parasitic Diseases. Clinical Research Fellow.Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / Federal University of Bahia. School of Medicine. Department of Pathology. Salvador, BA, BrasilHospital Santa Izabel. Salvador, BA, Brasil / Federal University of Bahia. School of Medicine. Department of Pathology. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, BrasilPhysicians from all medical specialties are required to understand the principles of science and to interpret medical literature. Yet, the levels of theoretical and practical knowledge held by Brazilian otorhinolaryngologists has not been evaluated to date. OBJECTIVE: To assess the background and level of scientific knowledge of Brazilian otorhinolaryngologists. METHOD: Participants of two national ENT meetings were invited to answer a questionnaire to assess scientific practice and knowledge. RESULTS AND CONCLUSION: This study included 73 medical doctors (52% otorhinolaryngologists and 38% residents) aged between 18 and 65 years. About two-thirds have been involved in some form of scientific activity during undergraduate education and/or reported to have written at least one scientific paper. Physicians who took part in research projects felt better prepared to interpret scientific papers and carry out research projects (p = 0.0103 and p = 0.0240, respectively). Respondents who claimed to have participated in research or to have written papers had higher scores on theoretical scientific concepts (p = 0.0101 and p = 0.0103, respectively). However, the overall rate of right answers on questions regarding scientific knowledge was 46.1%. Therefore, a deficiency was observed in the scientific education of Brazilian otorhinolaryngologists. Such deficiency may be mitigated through participation in research