Building scientific knowledge based on the solution of clinical cases: A contemporary learning process

The construction of scientific knowledge based on the solution of clinical cases, also called problem-situation or case study, is a contemporary methodology, centered on the student, problematizing, teaching-learning, which allows to know the previous knowledge of the group in the face of the presented situation, as well as identifying learning needs, building new meanings and knowledge, in addition to developing specific skills for self-learning. Strategically, it is the insertion, during a course, of a social material (texts, audios, printed matter, videos), whose analysis and discussion allow to contextualize the theoretical content. This work aims to present an experience in the construction, application and evaluation of clinical cases aimed at students in the fifth period of the dentistry course at Itpac - Porto Nacional in 2020. Clinical cases were previously screened by the teacher of endodontics at the multidisciplinar clinic at Itpac - Porto Nacional and presented to students in the classroom. The students were instructed to organize themselves in groups, a time of 1 hour was established for discussion of clinical cases and websites, scientific articles and books were made available to assist in solving the proposed activity. After the end of the established time, each group presented the diagnosis of each clinical situation presented. Based on this experience, it is possible to conclude that the use of clinical cases as a pedagogical practice brings students closer to the social reality and leads them to build networks of knowledge, making them active subjects in the learning process, without renouncing the depth and specificity knowledge that a dental student needs to develop

Development and validation of exhaled breath condensate microRNAs to identify and endotype asthma in children

Detection and quantification of microRNAs (miRNAs) in exhaled breath condensate (EBC) has been poorly explored. Therefore we aimed to assess miRNAs in EBC as potential biomarkers to diagnose and endotype asthma in school aged children. In a cross sectional, nested case control study, all the asthmatic children (n = 71) and a random sample of controls (n = 115), aged 7 to 12 years, attending 71 classrooms from 20 local schools were selected and arbitrarily allocated to the development or validation set. Participants underwent skin-prick testing, spirometry with bronchodilation, had exhaled level of nitric oxide determined and EBC collected. Based on previous studies eleven miRNAs were chosen and analyzed in EBC by reverse transcription-quantitative real-time PCR. Principal component analysis was applied to identify miRNAs profiles and associations were estimated using regression models. In the development set (n = 89) two clusters of miRNAs were identified. After adjustments, cluster 1 and three of its clustered miRNAs, miR-126-3p, miR-133a-3p and miR-145-5p were positively associated with asthma. Moreover miR-21-5p was negatively associated with symptomatic asthma and positively associated with positive bronchodilation without symptoms. An association was also found between miR-126-3p, cluster 2 and one of its clustered miRNA, miR-146-5p, with higher FEF25-75 reversibility. These findings were confirmed in the validation set (n = 97) where two identical clusters of miRNAs were identified. Additional significant associations were observed between miR-155-5p with symptomatic asthma, negative bronchodilation with symptoms and positive bronchodilation without symptoms. We showed that microRNAs can be measured in EBC of children and may be used as potential biomarkers of asthma, assisting asthma endotype establishment.Authors gratefully acknowledge the funding by Fundação para a Ciência e Tecnologia through the Project NORTE-01-0145-FEDER-000010 - Health, Comfort and Energy in the Built Environment (HEBE), cofinanced by Programa Operacional Regional do Norte (NORTE2020), through Fundo Europeu de Desenvolvimento Regional (FEDER) and EXALAR 21 project financed by FEDER/FNR and by Fundação para a Ciência e Tecnologia (EXALAR 21 02/SAICT/2017 - Project nº 30193). FCM kindly acknowledges the scholarship SFRH/BD/144563/2019 granted by Fundação para a Ciência e Tecnologia, as well as the Fulbright Research Grant 2019/2020 granted by Fulbright Portugal. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Mechanisms and age estimates of continental-scale endorheic to exorheic drainage transition: Douro River, Western Iberia

In western Iberia, mechanisms that can explain the transition from endorheic to exorheic continental-scale drainage reorganization are foreland basin overspill, headwards erosion and capture by an Atlantic river, or a combination of both. To explore these, we have investigated the Portuguese sector of the Douro River, the locus of drainage reorganization. The Douro River is routed downstream through the weak sedimentary infill of the Douro Cenozoic Basin, after which the river cuts down through harder granitic and metamorphic rocks crossed by active fault zones, before reaching the Atlantic coast. We investigated the drainage reorganization using an integrated approach that combined remote sensing, field survey and geochronology, applied to Pliocene–Quaternary fluvial sediments and landforms. The older drainage record is documented by a series of high and intermediate landform levels comprising: (1) a high level (1000–500 m a.s.l.) faulted regional fluvial erosion surface, the North Iberian Meseta planation surface and the Mountains and Plateaus of Northern Portugal, recording the endorheic drainage of the Douro Cenozoic Basin; (2) a first inset level at 650–600 m a.s.l., comprising a broad fluvial surface developed onto a large ENE–WSW depression, interpreted as recording the initiation of the continental scale reorganization; and (3) an inset fluvial surface at 550–400 m a.s.l., corresponding to the establishment of the exorheic ancestral Douro valley. The younger drainage record comprises an entrenched fluvial strath terrace sequence of up to 9 levels (T9 = oldest), positioned at 246–242 m above the modern river base; T1 = youngest, positioned at +17–13 m. Levels T1 and T3 display localized fault offsets. The three lowest terrace levels (T3–T1) were dated using optically stimulated luminescence techniques with results ranging from >230–360 ka (T3), through 57 ka (T2) to 39–12 ka (T1). Fluvial incision rates of the younger terraces were quantified and temporally extrapolated to model the ages of the intermediate to high elevation levels of the early drainage record. Integration of incision data informs on the probable timing of the drainage reorganization and the initial adjustment, ~3.7–1.8 Ma. This was followed by acceleration of incision, producing the entrenched river terrace sequence developed via spatial and temporal variations in rock strength, uplift and cyclic cool-climate variability as the river adjusted to the Atlantic base level

Host genetic signatures of susceptibility to fungal disease

Our relative inability to predict the development of fungal disease and its clinical outcome raises fundamental questions about its actual pathogenesis. Several clinical risk factors are described to predispose to fungal disease, particularly in immunocompromised and severely ill patients. However, these alone do not entirely explain why, under comparable clinical conditions, only some patients develop infection. Recent clinical and epidemiological studies have reported an expanding number of monogenic defects and common polymorphisms associated with fungal disease. By directly implicating genetic variation in the functional regulation of immune mediators and interacting pathways, these studies have provided critical insights into the human immunobiology of fungal disease. Most of the common genetic defects reported were described or suggested to impair fungal recognition by the innate immune system. Here, we review common genetic variation in pattern recognition receptors and its impact on the immune response against the two major fungal pathogens Candida albicans and Aspergillus fumigatus. In addition, we discuss potential strategies and opportunities for the clinical translation of genetic information in the field of medical mycology. These approaches are expected to transfigure current clinical practice by unleashing an unprecedented ability to personalize prophylaxis, therapy and monitoring for fungal disease.This work was supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER) (NORTE-01-0145-FEDER-000013), the Fundação para a Ciência e Tecnologia (FCT) (IF/00735/2014 to AC, and SFRH/BPD/96176/2013 to CC), the Institut Mérieux (Mérieux Research Grant 2017 to CC), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID Research Grant 2017 to AC)

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil

OBJECTIVE : To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS : Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS : A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS : Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition

Search for rare quark-annihilation decays, B --> Ds(*) Phi

We report on searches for B- --> Ds- Phi and B- --> Ds*- Phi. In the context of the Standard Model, these decays are expected to be highly suppressed since they proceed through annihilation of the b and u-bar quarks in the B- meson. Our results are based on 234 million Upsilon(4S) --> B Bbar decays collected with the BABAR detector at SLAC. We find no evidence for these decays, and we set Bayesian 90% confidence level upper limits on the branching fractions BF(B- --> Ds- Phi) Ds*- Phi)<1.2x10^(-5). These results are consistent with Standard Model expectations.Comment: 8 pages, 3 postscript figues, submitted to Phys. Rev. D (Rapid Communications

Emergence of vancomycin resistant Staphylococcus aureus (VRSA) from a tertiary care hospital from northern part of India

BACKGROUND: Glycopeptides such as vancomycin are frequently the antibiotics of choice for the treatment of infections caused by methicillin resistant Staphylococcus aureus (MRSA). For the last 7 years incidence of vancomycin intermediate S. aureus and vancomycin resistant S. aureus (VISA and VRSA respectively) has been increasing in various parts of the world. The present study was carried out to find out the presence of VISA and VRSA in the northern part of India. METHODS: A total 1681 staphylococcal isolates consisting of 783 S. aureus and 898 coagulase negative staphylococci (CoNS) were isolated from different clinical specimens from various outpatient departments and wards. All S. aureus and 93 CoNS were subjected to MIC testing (against vancomycin, teicolplanin and oxacillin); Brain Heart Infusion (BHI) vancomycin screen agar test; disc diffusion testing, and PCR for mecA, vanA and vanB genes detection. RESULTS: Out of 783 S. aureus two S. aureus strains were found to be vancomycin and teicoplanin resistant (one strain with MIC 32 μg/ml and the other strain with MIC 64 μg/ml); six strains of S. aureus have shown to be vancomycin intermediate (two strains with MIC 16 μg/ml and four strains with MIC 8 μg/ml); and two strains with teicoplanin intermediate (MIC 16 μg/ml). One CoNS strain was resistant to vancomycin and teicoplanin (MIC 32 μg/ml), and two CoNS strains were intermediate to vancomycin and teicoplanin (MIC 16 μg/ml). All VRSA, VISA and vancomycin resistant CoNS had shown growth on BHI vancomycin screen agar (vancomycin 6 μg/ml) and were mecA PCR positive. None of these isolates have demonstrated vanA/vanB gene by PCR. CONCLUSION: The present study reveals for the first time emergence of VISA/VRSA from this part of world and indicates the magnitude of antibiotic resistance in and around the study area. The major cause of this may be unawareness and indiscriminate use of broad-spectrum antibiotics