Emprego de simulações no ensino e na avaliação

No mundo todo atualmente busca-se, dentro da moderna ciência educacional médica, tecnologias e métodos de ensino aprendizagem realmente eficazes ao ensino de competências, que envolvam adequadamente as esferas cognitivas, comportamentais e psico-motoras.1 Mais ainda, é desejável a esse fim que se utilize de meios que, ativamente, promovam o desenvolvimento reflexivo do estudante em medicina espelhando o mais próximo possível a prática médica real. É fundamental que se assegure que o processo educacional respeite e garanta de forma inalienável e primordial a segurança física e emocional dos pacientes, no ensino e na assistência. Também é reconhecido largamente que comportamentos não podem ser adequadamente desenvolvidos através somente de memorização e reprodução da teoria médica e ou ética isoladamente. Este artigo pretende em nível introdutório apresentar e descrever o uso da Simulação como metodologia ativa de ensino, demonstrando seu potencial e suas limitações, contextualizando-a para o ensino e avaliação em áreas de saúde

Nontelomeric TRF2-REST Interaction Modulates Neuronal Gene Silencing and Fate of Tumor and Stem Cells

SummaryRemoval of TRF2, a telomere shelterin protein, recapitulates key aspects of telomere attrition including the DNA-damage response and cell-cycle arrest [1]. Distinct from the response of proliferating cells to loss of TRF2 [2, 3], in rodent noncycling cells, TRF2 inhibition promotes differentiation and growth [4, 5]. However, the mechanism that couples telomere gene-silencing features [6–8] to differentiation programs has yet to be elucidated. Here we describe an extratelomeric function of TRF2 in the regulation of neuronal genes mediated by the interaction of TRF2 with repressor element 1-silencing transcription factor (REST), a master repressor of gene networks devoted to neuronal functions [9–12]. TRF2-REST complexes are readily detected by coimmunoprecipitation assays and are localized to aggregated PML-nuclear bodies in undifferentiated pluripotent human NTera2 stem cells. Inhibition of TRF2, either by a dominant-negative mutant or by RNA interference, dissociates TRF2-REST complexes resulting in ubiquitin-proteasomal degradation of REST. Consequentially, REST-targeted neural genes (L1CAM, β3-tubulin, synaptophysin, and others) are derepressed, resulting in acquisition of neuronal phenotypes. Notably, selective damage to telomeres without affecting TRF2 levels causes neither REST degradation nor cell differentiation. Thus, in addition to protecting telomeres, TRF2 possesses a novel role in stabilization of REST thereby controlling neural tumor and stem cell fate

Trastuzumab-Induced Myocardiotoxicity Mimicking Acute Coronary Syndrome

Trastuzumab is an important biological agent in the treatment of HER2-positive breast cancer, with effects on response rates, progression-free survival, overall survival and quality of life. Although this drug is well tolerated in terms of adverse effects, trastuzumab-associated myocardiotoxicity has been described to have an incidence of 0.6–4.5% and in rare cases, the drug can trigger severe congestive heart failure with progression to death or even mimic acute coronary syndrome with complete left bundle branch blockade. In this paper is reported a case of trastuzumab-associated myocardiotoxicity manifesting as acute coronary syndrome in a 69-year-old female. The patient is currently undergoing a conservative clinical treatment that restricts overexertion

Ultrasonic tissue characterization of vulnerable carotid plaque: correlation between videodensitometric method and histological examination

BACKGROUND: To establish the correlation between quantitative analysis based on B-mode ultrasound images of vulnerable carotid plaque and histological examination of the surgically removed plaque, on the basis of a videodensitometric digital texture characterization. METHODS: Twenty-five patients (18 males, mean age 67 ± 6.9 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (≥ 70% luminal narrowing) underwent to quantitative ultrasonic tissue characterization of carotid plaque before surgery. A computer software (Carotid Plaque Analysis Software) was developed to perform the videodensitometric analysis. The patients were divided into 2 groups according to symptomatology (group I, 15 symptomatic patients; and group II, 10 patients asymptomatic). Tissue specimens were analysed for lipid, fibromuscular tissue and calcium. RESULTS: The first order statistic parameter mean gray level was able to distinguish the groups I and II (p = 0.04). The second order parameter energy also was able to distinguish the groups (p = 0,02). A histological correlation showed a tendency of mean gray level to have progressively greater values from specimens with < 50% to >75% of fibrosis. CONCLUSION: Videodensitometric computer analysis of scan images may be used to identify vulnerable and potentially unstable lipid-rich carotid plaques, which are less echogenic in density than stable or asymptomatic, more densely fibrotic plaques

Mapeamento do fluxo de trabalho das atividades em engenharia clínica: a experiência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo

The incorporation of medical devices and other technological resources with high aggregate value increases the challenges to achieve an efficient and quality management by Health Organizations. In this context, the use of tools to support the management becomes essential for the efficient use health resources in order to achieve greater stability and sustainability of the system as a whole. Thus, this study aimed to develop a mapping workflow of activities in the Clinical Engineering sector, responsible for managing medical diagnostic equipment at HCFMRP-USP, exposed in flow chart form, aiming later incorporation and spread among other hospital departments.A incorporação de equipamentos médicos hospitalares e outros recursos tecnológicos com alto valor agregado aumentam os desafios para realizar uma gestão eficiente e de qualidade pelas Organizações de Saúde. Nesse contexto, a utilização de ferramentas de apoio a gestão se torna essencial para o aproveitamento racional dos recursos de saúde, de forma a alcançar maior estabilidade e sustentabilidade do sistema como um todo. Assim, o presente trabalho teve como finalidade elaborar um mapeamento do fluxo de trabalho das atividades desenvolvidas no setor de Engenharia Clínica, responsável pela gestão de equipamentos médico diagnósticos do HCFMRP-USP, exposto na forma de fluxograma, objetivando posteriormente, sua incorporação e propagação dentre outros setores do hospital

HbA1c as a risk factor for heart failure in persons with diabetes: the Atherosclerosis Risk in Communities (ARIC) study

Heart failure (HF) incidence in diabetes in both the presence and absence of CHD is rising. Prospective population-based studies can help describe the relationship between HbA1c, a measure of glycaemia control, and HF risk

Bilateral percutaneous mininephrolithotripsy: simultaneous or staged approach?

Introduction. Patients with bilateral nephrolithiasis are a challenge for the treating physician. Therefore, such patients traditionally are subject to phased surgery to reduce the rate of complications. At the same time, the enhancement of endoscopic technologies and anesthesia makes it possible to perform surgical treatment of bilateral nephrolithiasis simultaneously.Objective. To evaluate the effectiveness and safety of performing simultaneous bilateral percutaneous nephrolithotripsy (PCNL).Materials &amp; methods. The main group comprises 19 patients (avg age 45.0 ± 2.25 years) suffering from bilateral nephrolithiasis (13 men and 6 women). The control group include 20 patients (avg age 45.80 ± 2.29 years) suffering from bilateral nephrolithiasis. Main group patients underwent simultaneous bilateral mini-PCNL, control group patients — staged PCNL within two hospitalisations. The visual analogue scale (VAS) was used to assess the pain severity. Patients noted subjective pain sensations on post-op days 1 and 3. QoL indicators were assessed using the SF-36 general questionnaire, as well as the Russian-language validated version of the WISQoL questionnaire.Results. There were no statistically significant differences between the parameters (the difference between the hemoglobin before and after mini-PCNL was 12 g/l; between the serum creatinine was 18 µmol/l). There was a decrease in total surgery time (121.0 ± 6.1 min) for main group patients compared to (147.0 ± 7.3 min) control group patients (total surgery time during the first and second hospitalisations) and a reduction in hospital stay (4.50 ± 0.23 days) for main group patients compared to control group patients (10.0 ± 0.5 days). Complications observed by us in the two groups were comparable. The valuesobtained on the SF, RE and MH scales in main group patients were higher both on post-op day 1 (67.9 ± 3.39; 56.90 ± 2.85 and 63.80 ± 3.19, respectively) and post-op day 3 (86.80 ± 4.34; 83.70 ± 4.19 and 82.50 ± 4.13, respectively) compared to control group patients during the first and second hospitalizations. Statistically significant differences were also recorded according to the grades "Social functioning" and "Emotional influence" in main group patients (80.90 ± 0.26 and 82.6 ± 0.19, respectively).Conclusion. Simultaneous bilateral mini-PCNL is safe and effective in well-selected patients

Defining functional DNA elements in the human genome

With the completion of the human genome sequence, attention turned to identifying and annotating its functional DNA elements. As a complement to genetic and comparative genomics approaches, the Encyclopedia of DNA Elements Project was launched to contribute maps of RNA transcripts, transcriptional regulator binding sites, and chromatin states in many cell types. The resulting genome-wide data reveal sites of biochemical activity with high positional resolution and cell type specificity that facilitate studies of gene regulation and interpretation of noncoding variants associated with human disease. However, the biochemically active regions cover a much larger fraction of the genome than do evolutionarily conserved regions, raising the question of whether nonconserved but biochemically active regions are truly functional. Here, we review the strengths and limitations of biochemical, evolutionary, and genetic approaches for defining functional DNA segments, potential sources for the observed differences in estimated genomic coverage, and the biological implications of these discrepancies. We also analyze the relationship between signal intensity, genomic coverage, and evolutionary conservation. Our results reinforce the principle that each approach provides complementary information and that we need to use combinations of all three to elucidate genome function in human biology and disease

ChIP-seq guidelines and practices of the ENCODE and modENCODE consortia

Chromatin immunoprecipitation (ChIP) followed by high-throughput DNA sequencing (ChIP-seq) has become a valuable and widely used approach for mapping the genomic location of transcription-factor binding and histone modifications in living cells. Despite its widespread use, there are considerable differences in how these experiments are conducted, how the results are scored and evaluated for quality, and how the data and metadata are archived for public use. These practices affect the quality and utility of any global ChIP experiment. Through our experience in performing ChIP-seq experiments, the ENCODE and modENCODE consortia have developed a set of working standards and guidelines for ChIP experiments that are updated routinely. The current guidelines address antibody validation, experimental replication, sequencing depth, data and metadata reporting, and data quality assessment. We discuss how ChIP quality, assessed in these ways, affects different uses of ChIP-seq data. All data sets used in the analysis have been deposited for public viewing and downloading at the ENCODE (http://encodeproject.org/ENCODE/) and modENCODE (http://www.modencode.org/) portals