Worked example como método de ensino da ausculta cardíaca pediátrica para estudantes de Medicina

Resumo: Introdução: A performance e a acurácia da ausculta cardíaca de médicos recém-formados estão aquém do esperado, o que resulta em excesso de encaminhamentos para o cardiologista, solicitação de exames desnecessários e atraso diagnóstico. O desenvolvimento de metodologias de ensino eficazes é necessário para melhorar a ausculta cardíaca e a capacidade diagnóstica dos médicos recém-graduados. Objetivo: Este estudo teve como objetivo verificar a eficácia do uso da metodologia do worked example, comparada ao ensino tradicional de aulas expositivas da semiologia do aparelho cardiovascular. Método: Participaram do estudo 56 alunos do quarto ano da Universidade Federal de Minas Gerais. Trata-se de um estudo experimental que comparou a eficácia do modelo de ensino baseado na metodologia do worked example com a metodologia tradicional de aula expositiva sobre ausculta cardíaca pediátrica. Os alunos foram randomizados em grupo experimental e grupo de controle, e avaliados em fases distintas - pré-teste, pós-teste imediato e pós-teste tardio. Resultado: A partir da Análise de Variância de Medidas Repetidas, houve efeito significativo em ambos os métodos de treinamento quando se considerou a fase do estudo (p < 0,001). Os dois grupos obtiveram desempenhos semelhantes independentemente do método de treinamento (p = 0,863). Conclusão: A metodologia ativa conhecida como worked example pode ser tão eficaz quanto uma metodologia tradicional no ensino e aprendizagem da ausculta cardíaca pediátrica

The Role of Macrolides in Noncystic Fibrosis Bronchiectasis

Objective. The present study aims at reviewing the main publications on the use of macrolides as immunomodulators in patients with noncystic fibrosis bronchiectasis. Source of Data. The Medline database was our source of data for this research carried out until June 2011, using the key words: macrolides and bronchiectasis, while searching for original articles and reviews. Summary of Data. Seven clinical studies that evaluated the action of the macrolides in patients with bronchiectasis were found. There was the sputum volume, reduction in pulmonary exacerbation frequency, and in the use of antimicrobial treatment, in addition to pulmonary function improvement. Conclusions. Anti-inflammatory action and immunomodulatory effects can be attributed to macrolides when administered in low doses and on the long term. This use has been well established both in diffuse panbronchiolitis and in cystic fibrosis. Evidence indicates possible benefits in bronchiectasis. Future studies are needed, though, to establish the ideal dose and treatment duration and to understand the implications in the generation of microbial resistance

Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

ABSTRACT Objective: To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease. Methods: This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome. Results: Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO 2 in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease. Conclusions: In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter

Influenza A aviária (H5N1): a gripe do frango

Este estudo tem como objetivo rever a literatura sobre o vírus influenza A aviária (H5N1). O levantamento bibliográfico foi realizado nos bancos de dados eletrônicos Medline, MD Consult, HighWire, Medscape e Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS, Literatura Latinoamericana e do Caribe em Ciências da Saúde), e por pesquisa direta, referentes aos últimos dez anos. Foram selecionados 32 artigos originais abordando os surtos recentes de infecção por um subtipo de vírus influenza A aviária, o H5N1, em criações de aves domésticas na Ásia, que resultaram em importantes prejuízos econômicos e repercussões em saúde pública, além de casos de infecção humana de alta letalidade. A maioria dos casos está associada com a exposição direta a aves infectadas ou superfícies contaminadas com excrementos dessas aves, porém foi confirmada a transmissão entre humanos. O período de incubação foi de dois a quatro dias. As manifestações clínicas variaram de infecção assintomática e doença leve do trato respiratório superior a pneumonia grave e falência múltipla de órgãos. A radiografia de tórax pode apresentar infiltrado intersticial bilateral, colapso lobar, consolidação focal e broncograma aéreo sem derrame pleural. A presença de linfopenia indica pior prognóstico. O tratamento de suporte parece ser o único tratamento aceitável. Os fatores de risco para mau prognóstico incluem idade avançada, demora na hospitalização, envolvimento do trato respiratório inferior, baixa contagem de leucócitos totais e linfopenia à admissão. Controlar os surtos em aves domésticas e o contato entre seres humanos e tais aves deve ser a prioridade no manejo da doença em nível de saúde pública, e medidas e conhecimentos acerca da doença devem ser amplamente divulgados

Parapneumonic pleural effusion: early versus late thoracoscopy

ABSTRACT Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion