Reflexões das ações de engajamento estudantil no processo de construção da avaliação de um curso

INTRODUÇÃO: A avaliação Institucional pode diagnosticar tendências e desalinhamento de seus objetivos, conhecendo e reconhecendo suas fortalezas e fraquezas. Assim, correlaciona-se com a melhoria da qualidade da formação e, portanto, do profissional egresso. A participação discente na elaboração desse processo é imprescindível, para que a avaliação se consolide como democrática e representativa. OBJETIVO: Apresentar a experiência do “Dia da Avaliação do Curso”, uma avaliação institucional realizada por discentes de uma escola médica pública. RELATO DE EXPERIÊNCIA: A construção da avaliação foi proposta pelos próprios discentes da graduação em medicina, baseado em avaliações como o SAEME e SPICES, objetivando avaliar os eixos: relação docente-discente, infraestrutura e planejamento educacional. O evento ocorreu em dois períodos, com participação de graduandos em medicina. Pela manhã, houve um espaço formativo acerca de diretrizes curriculares, metodologias de ensino, avaliações e saúde mental do estudante, seguida por preenchimento de questionário individual. Durante a tarde, ocorreram os espaços de discussão coletiva, seguidos de uma plenária acerca das principais conclusões de cada grupo e encaminhamento das reivindicações. DISCUSSÃO: Observou-se engajamento estudantil pela participação dos estudantes na política e nas atividades de tomada de decisões; na provisão e avaliação do programa educacional da escola; e quando seu feedback é levado em consideração no desenvolvimento e na revisão do currículo pela instituição. CONCLUSÃO: Essa iniciativa possibilitou acúmulo teórico sobre Educação em Saúde, aquisição de competências de organização, responsabilidade e ética; e demonstrou-se a influência discente direta na melhoria da escola, o enriquecimento da educação médica local e a potencialização do pensamento crítico discente

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO2max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO2max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

Inflammation, Diabetes, and Chronic Kidney Disease: Role of Aerobic Capacity

The persistent inflammatory state is common in diabetes and chronic kidney disease (CKD). These patients present exercise intolerance and increased arterial stiffness. Long-term aerobic exercise has been associated with better arterial compliance, antidiabetic and antiinflammatory benefits. We assessed the hypothesis that in patients with diabetes and CKD, better aerobic capacity is associated with less inflammatory state and arterial stiffness. Thirty-nine CKD patients (17 in hemodialysis) were evaluated. According to CKD etiology two patient groups were obtained: group of diabetics (GD) was formed by 11 patients and nondiabetics (GND) formed by 28 patients. Central blood pressure and arterial stiffness were evaluated by Sphygmocor device. Carotida intima-media thickness (CA-IMT) was evaluated by ultrasonography. Aerobic capacity was measured by estimated VO2max according to treadmill test by Bruce protocol. The GD showed a higher frequency of C-reactive protein above laboratory cutoff (P = 0.044), higher frequency of male gender, and a non significant higher value of VO2max (P = 0.099). The CA-IMT was similar. Only better aerobic capacity was associated with lower frequency of high C-reactive protein when adjusted to diabetes and gender in a logistic regression model. In conclusion, aerobic capacity was associated with inflammatory state, in CKD patients, independently of diabetes presence

Peritoneal Dialysis-Related Peritonitis due to Coagulase-Negative Staphylococcus: A Review of 115 Cases in a Brazilian Center

Background and objectives Coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD) related peritonitis in many centers. This study aimed to describe clinical and microbiologic characteristics of 115 CNS episodes and to determine factors influencing the outcome.Design, setting, participants, & measurements This study reviewed the records of 115 CNS peritonitis episodes that occurred in 74 patients between 1994 and 2011 at a single university center. Peritonitis incidences were calculated for three consecutive 6-year periods (P1, 1994-1999; P2,2000-2005; P3,2006-2011) and annually. The production of biofilms, enzymes, and toxins was evaluated. Oxacillin resistance was evaluated based on its minimum inhibitory concentration and the presence of the mecA gene.Results The overall incidence of CNS peritonitis was 0.15 episodes per patient per year and did not vary over time (0.12, 0.14, and 0.16 for P1, P2, and P3, respectively; P=0.21). The oxacillin resistance rate was 69.6%. Toxin and enzyme production was infrequent and 36.5% of CNS strains presented the gene encoding biofilm production. The presence of icaAD genes associated with biofilm production was predictive of relapses or repeat episodes (odds ratio [On 2.82; 95% confidence interval [95% CI], 1.11 to 7.19; P=0.03). Overall, 70 episodes (60.9%) resolved; oxacillin susceptibility (OR, 4.41; 95% CI, 1.48 to 13.17; P=0.01) and vancomycin use as the first treatment (OR, 22.27; 95% CI, 6.16 to 80.53; P<0.001) were the only independent predictors of resolution.Conclusions Oxacillin resistance and vancomycin use as the first treatment strongly influence the resolution rate in CNS peritonitis, which reinforces the validity of the International Society for Peritoneal Dialysis guidelines on monitoring bacterial resistance to define protocols for initial treatment. These results also suggest that the presence of biofilm is a potential cause of repeat peritonitis episodes.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Efeito da glicose na histomorfologia do peritônio durante a diálise peritoneal

The peritoneum alterations in patients submitted to peritoneal dialysis for long periods begin with the mesothelium modifications and latter involves alterations of the submesothelium, fibrosis and vascular system. These alterations could be explained by the high concentration of glucose in the dialysis solution, and by other things. Therefore, the aim of this study was to study the histomorfological alterations of the peritoneal membrane in rats submitted to peritoneal dialysis, with the glucose solution at the local temperature. 20 Wistar rats were used, divided into two groups: control group (CG) with eight animals that didn’t receive intraperitoneal injection and the concentrated solution group (CSG) with 12 animals that received 10ml of the dialysis fluid with 4.25% of glucose once a day for 30 days. The visceral peritoneum of the spleen and the parietal peritoneum of the abdominal wall in the animals of CSG presented epithelial alterations with cubic transformation of the mesothelium cells and the thickness of the submesothelium layer, respectively. The dialysis solution of glucose at 4.25% in local temperature, done once a day, during 30 days, altered the histomorfology of the peritoneum.As alterações peritoneais em pacientes submetidos a diálise peritoneal por longos períodos começam com as modificações mesoteliais e mais tarde envolvem alterações submesoteliais, fibrose e vasculopatias. Essas alterações podem ser decorrentes entre outras coisas da alta concentração de glicose da solução de diálise. Desta forma, o objetivo desse trabalho foi estudar as alterações histomorfológicas na membrana peritoneal de ratos submetidos a diálise peritoneal, com solução de glicose a temperatura ambiente. Foram utilizados 20 ratos Wistar divididos em dois grupos: grupo controle (GC) com oito animais que não receberam nenhuma injeção intraperitoneal e grupo solução concentrada (GSC) com 12 animais que receberam 10 ml de fluido de diálise com 4,25% de glicose uma vez por dia durante 30 dias. O peritônio visceral do baço e o peritônio parietal da parede abdominal nos animais do GSC apresentaram respectivamente alterações epiteliais com transformação cúbica das células mesoteliais e espessamento na camada submesotelial. A solução de diálise com 4,25% de glicose em temperatura ambiente realizada uma vez por dia durante 30 dias alterou a histomorfologia do peritônio

Peritonitis in recent years: clinical findings and predictors of treatment response of 170 episodes at a single Brazilian center

Peritonitis continues to be a major cause of dropout in peritoneal dialysis (PD) patients. Changes in the prevalence of peritonitis etiologies and an increase in the frequency of methicillin-resistant coagulase-negative staphylococci (CoNS) and Gram-negative species resistant to commonly used antibiotics have been reported. As a consequence, the current clinical presentation and patient outcome may differ from classical descriptions. The objectives of this study were to describe the clinical and microbiological characteristics of PD-related peritonitis episodes that occurred over a period of 6 years at a single Brazilian dialysis center and to identify predictors of outcome.A total of 170 peritonitis episodes that occurred in 92 PD patients between January 2004 and December 2009 were reviewed. Multivariate analysis was used to identify demographic, clinical, and microbiological factors predicting endpoints (resolution and peritonitis-related death). Patients' characteristics and peritonitis incidence, etiology and outcomes were compared with a series of 232 episodes that occurred in the first 6 years (1995-2000) of the PD program at the same center.The overall peritonitis rate was 0.65 episodes/patient-year. Gram-positive cocci were identified in 79 (46.5%) episodes, whereas Gram-negative bacilli were isolated from 48 (28.2%). CoNS were the main Gram-positive species identified in 48 episodes. of these, 56.3% were resistant to methicillin. Among Gram-negative species, amikacin resistance was observed in 60% of non-fermentative Gram-negative bacilli (NFGNB) and in only 3.6% of Enterobacteriaceae. The overall resolution rate was 44.1%. Oxacillin resistance and NFGNB etiology were strong predictors of non-resolution, whereas older age was the only predictor of death. Antibiotic protocols did not influence outcome. Comparison with the results obtained for the 1990-1995 period showed a lower peritonitis rate, a strong decline in the proportion of Staphylococcus aureus episodes, a significant increase in the frequency of oxacillin-resistant CoNS and amikacin-resistant NFGNB, and a significantly lower resolution and higher death rate.The current clinical characteristics and outcome suggest a greater severity of peritonitis episodes and higher risk of death, possibly due to bacterial resistance. Older age is a risk factor for death.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Markers of uremia and pericardial effusion in peritoneal dialysis

Inadequate dialysis causes accumulation of toxic residues that may lead to the development of dialysis-associated pericardial effusion, but several other factors could be associated with this abnormality. The purpose of this study was to evaluate clinical risk factors to asymptomatic pericardial effusion in peritoneal dialysis.This cross-sectional study included 34 patients aged a parts per thousand yen18 years on peritoneal dialysis for at least 3 months, who showed no symptomatic pericardial effusion, hepatic cirrhosis, neoplasias, lupus or amputations, none in minoxidil use. Asymptomatic pericardial effusion was diagnosed by echocardiography. Risk factors were evaluated by logistic regression and Roc curve. Significance level was set at P < 0.05.Patient age was 51 +/- A 15.9 years. of the 34 patients enrolled, 16 were men and 11 diabetic. Five of them presented pericardial effusion. Logistic regression identifies low hemoglobin level (RR 0.454 CI 95%: 0.225-0.913; P = 0.027), low phase angle (RR 0.236 CI 95%: 0.057-0.984; P = 0.048) and low Kt/V (RR 0.001 CI 95%: 0.0-0.492; P = 0.03) as risk factors to pericardial effusion. Roc curve showed that hemoglobin levels below 12.2 g/dL, Kt/V lower than 1.9 and phase angle lower than 4.5A degrees were the best cutoffs to predict pericardial effusion. Four patients showed these three parameters in the unfavorable range, and all these four patients presented pericardial effusion. The other patient with pericardial effusion had two of these parameters reduced.These findings corroborate the hypothesis that uremia plays a significant role in the pathogenesis of dialysis-associated pericardial effusion

Advanced glycation end-products (AGEs) accumulation in skin: relations with chronic kidney disease-mineral and bone disorder

Abstract Introduction: Chronic kidney disease (CKD) is associated with high morbidity and mortality rates, main causes related with cardiovascular disease (CVD) and bone mineral disorder (CKD-BMD). Uremic toxins, as advanced glycation end products (AGEs), are non-traditional cardiovascular risk factor and play a role on development of CKD-BMD in CKD. The measurement of skin autofluorescence (sAF) is a noninvasive method to assess the level of AGEs in tissue, validated in CKD patients. Objective: The aim of this study is analyze AGEs measured by sAF levels (AGEs-sAF) and its relations with CVD and BMD parameters in HD patients. Methods: Twenty prevalent HD patients (HD group) and healthy subjects (Control group, n = 24), performed biochemical tests and measurements of anthropometric parameters and AGEs-sAF. In addition, HD group performed measurement of intact parathormone (iPTH), transthoracic echocardiogram and radiographies of pelvis and hands for vascular calcification score. Results: AGEs-sAF levels are elevated both in HD and control subjects ranged according to the age, although higher at HD than control group. Single high-flux HD session does not affect AGEs-sAF levels. AGEs-sAF levels were not related to ventricular mass, interventricular septum or vascular calcification in HD group. AGEs-sAF levels were negatively associated with serum iPTH levels. Conclusion: Our study detected a negative correlation of AGEs-sAF with serum iPTH, suggesting a role of AGEs on the pathophysiology of bone disease in HD prevalent patients. The nature of this relation and the clinical application of this non-invasive methodology for evaluation AGEs deposition must be confirmed and clarified in future studies