Trabalho de Campo Supervisionado II: uma experiência curricular de inserção na Atenção Primária à Saúde

O componente curricular Trabalho de Campo Supervisionado II (TCS II), a partir da diversificação de cenários de aprendizagem, propõe a inserção na Atenção Primária à Saúde (APS) desde os períodos iniciais do curso de Medicina da Universidade Federal Fluminense, em Niterói, Rio de Janeiro, Brasil. Este trabalho apresenta a experiência de discentes e preceptor de TCS II, em uma Unidade Básica de Saúde, nos 3º e 4º períodos. Da experiência do campo, acompanhada por meio de relatos escritos e reflexões, emergiram categorias utilizadas para descrever e analisar as contribuições da inserção sistemática na APS como dispositivo de mudança na formação médica. Conclui-se que a APS como cenário de aprendizagem é um espaço capaz de oferecer novas perspectivas de formação em saúde, com base nas necessidades de saúde da população, devendo permanecer como um espaço de prática nos períodos subsequentes do curso, o que, efetivamente, ainda não acontece

Anticardiolipin antibodies and recurrent spontaneous abortion in Brazilian women

Aims: To determine the frequency of anti-cardiolipin antibodies (aCL) in women with previous history of recurrent spontaneous abortion (RSA). Methods: Medical records from pregnant women seen from April 2005 to December 2008 at the High-Risk Pregnancy Unit at the Hospital de Base from FUNFARME (Fundação Faculdade Regional de Medicina), in São José do Rio Preto, São Paulo, Brazil, were revised. Patients older than 18 years who had at least two spontaneous abortions and who were tested for aCL were included in the study. Data on maternal age, number of miscarriages and the results of serological tests for aCL were recorded. The exact Fisher’s test was used to compare the results. A p value less than 0.05 was considered significant. Results: During the study period a total of 294 pregnant women were seen, from whom 44 consecutive women fulfilled the inclusion criteria. The overall mean age was 33.8±5.4 years (range: 22 to 44; median: 34). Eighteen (40.9%) patients were reagent for aCL and 26 (59.1%) non-reagent, and the difference between their mean age was not statistically significant (reagent: 34.6±5.8 years; non reagent: 33.2±5.2 years, p=0.4001). Fourteen (77.8%) patients presented IgM aCL and six (33.2%), IgG aCL. Two patients (11%) were reagent for both IgM and IgG aCL. In the most of cases the aCL antibody titers were compatible with low risk for pregnancy morbidity. The number of abortions ranged from two to six. The average number of abortions among those reagent for aCL was 3.5±1.1 and in those non-reagent was 2.9±1.1 (p=0.0813). Conclusions: The frequency of aCL was elevated among patients with a history of RSA, especially those having higher number of fetal losses. Among women with at least two spontaneous abortions, the mean number of abortions was not significantly different between those reagent for aCL and those non reagent

Frequency of anti- Toxoplasma gondii IgA, IgM, and IgG antibodies in high-risk pregnancies, in Brazil

Abstract: INTRODUCTION Toxoplasmosis during pregnancy can be severe; thus, it is essential to diagnose the disease via serological tests. METHODS An enzyme-linked immunosorbent assay (ELISA) was used to investigate anti-Toxoplasma gondii immunoglobulin A (IgA), M (IgM) and G (IgG) antibodies in 62 high-risk pregnant women. RESULTS Forty-three (69.4%) women were positive for IgA, 31 (50%) for IgG, and 57 (91.9%) for IgM; 4 (6,5%) were positive for IgA but negative for IgM; 10 (16.1%) were negative for IgA and IgM but positive for IgG. CONCLUSIONS Testing for these antibodies can help diagnose infection in pregnant women, thereby contributing to clinical management

Lycopene and beta-carotene induce growth inhibition and proapoptotic effects on ACTH-secreting pituitary adenoma cells.

Pituitary adenomas comprise approximately 10-15% of intracranial tumors and result in morbidity associated with altered hormonal patterns, therapy and compression of adjacent sella turcica structures. The use of functional foods containing carotenoids contributes to reduce the risk of chronic diseases such as cancer and vascular disorders. In this study, we evaluated the influence of different concentrations of beta-carotene and lycopene on cell viability, colony formation, cell cycle, apoptosis, hormone secretion, intercellular communication and expression of connexin 43, Skp2 and p27(kip1) in ACTH-secreting pituitary adenoma cells, the AtT20 cells, incubated for 48 and 96 h with these carotenoids. We observed a decrease in cell viability caused by the lycopene and beta-carotene treatments; in these conditions, the clonogenic ability of the cells was also significantly decreased. Cell cycle analysis revealed that beta-carotene induced an increase of the cells in S and G2/M phases; furthermore, lycopene increased the proportion of these cells in G0/G1 while decreasing the S and G2/M phases. Also, carotenoids induced apoptosis after 96 h. Lycopene and beta-carotene decreased the secretion of ACTH in AtT20 cells in a dose-dependent manner. Carotenoids blocked the gap junction intercellular communication. In addition, the treatments increased the expression of phosphorylated connexin43. Finally, we also demonstrate decreased expression of S-phase kinase-associated protein 2 (Skp2) and increased expression of p27(kip1) in carotenoid-treated cells. These results show that lycopene and beta-carotene were able to negatively modulate events related to the malignant phenotype of AtT-20 cells, through a mechanism that could involve changes in the expression of connexin 43, Skp2 and p27(kip1); and suggest that these compounds might provide a novel pharmacological approach to the treatment of Cushing's disease

ACTH secretion by AtT-20 cells.

<p>Cells were treated with 5 and 10 µM of beta-carotene or lycopene for a period of 24 h, and ACTH levels were determined in the supernatant by immunoassay. The treatment reduced the ACTH secretion in a dose-dependent manner. Data are expressed as mean±standard deviation pg/mL, of 3 independent experiments, each performed with at least 2 replicates. *indicates significant differences from control group. (*<i>p</i><0.05, **<i>p</i><0.01, ***<i>p</i><0.001).</p