ANÁLISE COMPARATIVA SOBRE A PERCEPÇÃO DOS ESTUDANTES DE MEDICINA ACERCA DO IMPACTO DAS DISCIPLINAS IESC E HA NO CONTEXTO DE ATIVIDADES PRÁTICAS DURANTE A GRADUAÇÃO

A metodologia ativa de ensino permite a inserção precoce do estudante de medicina em unidades básicas de saúde, sendo gradual a sua evolução nas práticas médicas. Para que esse processo seja possível o estudante necessita de respaldo conteudista e de orientação quanto aos limites do que lhe é permitido realizar de acordo com o semestre em que se encontra. Assim, dentro da graduação médica no UniCEUB, o estudante é submetido a dois eixos educacionais que tem por objetivo prepara-lo para uma melhor atuação profissional: Interação Ensino Saúde e Comunidade (IESC) e Habilidades e Atitudes profissionais (HA). As disciplinas que compõem o eixo de HA visam desenvolver a semioténica e a semiologia aplicada, incluindo capacidade de raciocínio clínico e técnicas cirúrgicas e aprimorar a qualidade do atendimento dos pacientes. Em contrapartida, no eixo de IESC o aluno desenvolve habilidades de comunicação e fortalece o vínculo com os usuários dos serviços de saúde, de forma que tende a aperfeiçoar, cada vez mais, a relação médico-paciente, por estar envolvido no planejamento de estratégias e implantação de ações de promoção de saúde. Dessa forma, é esperado um sinergismo entre as disciplinas de HA e IESC, de modo que conhecimentos e técnicas adquiridas no eixo de HA tendem a melhorar o desempenho dos alunos nas atividades práticas desenvolvidas em IESC e vice-versa. É importante salientar que em ambos os eixos, desde o primeiro semestre, os graduandos de uma mesma turma são subdivididos em grupos, o que facilita a realização das atividades práticas nos diversos cenários de saúde e melhora a condução dos grupos por parte dos docentes. Para investigar a maneira como tais eixos têm se desenvolvido no UniCEUB e verificar a relação existente entre eles, foi realizada na Instituição uma pesquisa transversal qualitativa com a técnica de grupos focais, com as turmas do terceiro ao oitavo semestre da graduação de medicina. O objetivo dos grupos focais era extrair, na perspectiva do discente, a importância de tais eixos educacionais para a formação médica. Por ser uma pesquisa a partir de um curso em que se emprega a metodologia ativa, o ponto de vista dos alunos no processo educativo é fundamental, de forma que a metodologia que melhor permite ouvir e produzir informações que possam influenciar no processo educativo e avaliativo é a qualitativa. Foi possível, após análise dos grupos focais, a partir da hermenêutica de profundidade, perceber que existem problemas estruturais relacionados aos dois eixos de ensino, principalmente relacionados à maneira como são conduzidos pelo corpo docente. Assim, os discentes consideraram como problemas centrais, de ambos os eixos, a desorganização e a despadronização dos alunos quanto ao conhecimento desenvolvido ao longo dos semestres, o que é evidenciado, em especial, quando se compara os subgrupos de uma mesma turma. Além disso, foi possível concluir que os eixos de IESC e HA, apesar das limitações que possuem na instituição, são considerados fundamentais para a formação de um médico mais humano e que preza pela boa relação com paciente e com o cenário de saúde em que está inserid

Indução de hipotensão pós-exercício como técnica terapêutica em indivíduos com hipertensão arterial sistêmica

A hipertensão arterial sistêmica é uma doença de enorme importância a nível de saúde pública nacional e internacional, fato corroborado pela expressividade da prevalência dentre a população, associado a um quadro de morbimortalidade extremamente significativo. Os principais fatores de risco associados à doença são comuns a maioria da população e o enfrentamento dos mesmos, compõem a melhor estratégia no combate a hipertensão arterial sistêmica. Nesse contexto, o combate ao sedentarismo demonstra ser medida de elevada recomendação científica, com a indução da hipotensão pós-exercício (HPE) mediante a prática de exercícios físicos sendo uma importante ferramenta não-medicamentosa no combate à doença. A atual pesquisa objetivou realizar uma revisão de literatura sobre a indução de hipotensão pós-exercício como técnica terapêutica da hipertensão arterial sistêmica. Trata-se de uma revisão de literatura realizada por meio de buscas nos bancos de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (PubMed) e Scientific Electronic Library Online (Scielo). As palavras-chave utilizadas foram “hipotensão pós-exercício”, “exercício” e “pressão sanguínea” e seus correspondentes em inglês associados ao operador booleano AND. Na literatura selecionada foram encontrados estudos que evidenciaram uma redução dos níveis de pressão arterial após a realização de exercícios físicos de modo significativo. Estudos demonstraram que a pressão arterial pode ser reduzida por até oito horas através do fenômeno da hipotensão pós-exercício, sendo um mecanismo que pode ser obtido tanto em atividades aeróbias quanto resistidas, além de exercícios mistos. Redução da pressão arterial sistólica de 6,9 mmHg a 5,6 mmHg após uma hora de exercício foi verificada, demonstrado capacidade como ente terapêutico de relevância. A hipertensão arterial sistêmica demonstrou ao longo das décadas ser uma doença de enorme importância, e o seu combate, atuando na prevenção e redução de eventos adversos se faz uma medida imperiosa pelos sistemas de saúde mundiais

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Potentially inappropriate medication use in older adults: prevalence and physician knowledge

OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians’ knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203).  Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications.</p

Using Bokashi and Cow Urine as Organic Low-Cost Amendments Can Enhance Arugula (<i>Eruca sativa</i> L.) Agronomic Traits but Not Always Total Polyphenols and Antioxidant Activity

Productive traits, total polyphenols (TPC), and antioxidant activity (DPPH) of arugula submitted to the combination (or not) of cow urine and doses of bokashi were evaluated in two experimental areas. Arugula was planted in cultivation bags with 55 dm3 of capacity in protected cultivation. The treatments were bokashi doses (0, 10, 20, and 30 g) and use (or not) of cow urine diluted 1% in water. The variables evaluated were fresh leaf biomass (FLB), dry leaf biomass (DLM), plant height (PH), chlorophyll index, TPC, and DPPH. In area 1, all agronomic variables were increased at 30 g and 20 g bokashi doses. FLB was increased by 87 and 76% with 30 g of bokashi. Cow urine only increased PH. In area 2, the use of bokashi + cow urine increased FLB, DLB, and PH with a positive quadratic response. At the maximum point, the FLB was increased by 159% with 28.92 g of bokashi. Bokashi increased FLB and DLB in the two areas in all evaluated doses. For TPC, with the use of cow urine, 10 g of bokashi increased TPC by 14%. Without the use of cow urine, increases of 17 and 33% with 10 and 30 g of bokashi were observed. The 30 g of bokashi is recommended because of increased productive traits and TPC

Unicornual Uterine Twist in Non-Pregnant Bitch

Background: Uterine twisting in bitches is an uncommon disease in which the difficulty of diagnosis is due to nonspecific clinical signs. This condition is more commonly observed in pluriparous females and is usually associated with a pregnant uterus close to birth, or associated with hemometra, pyometra and neoplasms in non-pregnant bitches. This study reports a case of an 11-year-old Poodle bitch with a rare case of uterine twisting in a non-pregnant womb.Case: A 11-year-old Poodle dog, weighing 3.2 kg, was admitted at the institution with a history of anorexia, oligodipsia and apathy during one day. There was no information on the last phase of estrus or previous pregnancies. The patient arrived at the emergency room of the veterinary hospital with cardiorespiratory arrest and was resuscitated with mechanical ventilation, cardiac massage and administration of adrenaline (0.1 mg/kg IV, 1 mg/ml concentration), tramadol hydrochloride (2 mg/kg via IV) and oxygen therapy. Clinical examination revealed a distended and tense abdomen with a palpable mass in the mesogastric region. Ultrasound examination showed a heterogeneous structure (> 10cm. in diameter), with cavitary areas filled with heterogeneous anechoic content and septations, located between the liver and urinary bladder. It was not possible to identify in which organ or structure the mass originated, and the possibility of gestation and fetal death was discarded. The female died six hours after admission. The patient was submitted to necropsy and histopathological analysis revealed a dark red and enlarged segment of the uterine horn with a 360º twist, occupying most of the abdominal cavity. The left uterine horn was about 10 cm in diameter and firm, and cystic areas were observed on a reddish-black surface containing a large amount of bloody fluid. The right uterine horn was normal in appearance, but with a small amount of fluid, slightly viscous and translucent. The histopathological examination of the structure found in the left uterine horn showed areas of partially organized hematomas with red blood cells inside the vessels, without neoplastic or inflammatory cells. The definitive diagnosis was unilateral uterine twist, unrelated to the gestational or neoplastic process. Discussion: Uterine twist is an uncommon problem in most domestic species. The occurrence of this condition is higher in the gravid uterus, usually in pluriparous females at the end of gestation or delivery, or in non-pregnant bitches secondary to hemometra or pyometra. During uterine twist, occlusion of blood vessels occurs, with subsequent engorgement and vascular rupture, leading to intraluminal hemorrhage and tissue ischemia, which may lead to extravasation of blood into uterine lumen. Thus, the main suspect for the occurrence of unicornual twisting was hemometra in the left uterine horn, associated with relaxation of the uterine ligaments due to the advanced age of the patient. These factors may have favored abnormal mobility and the twist of the organ within the abdominal cavity, even in the absence of the most common predisposing factors, such as gestation and delivery. The rarity of the case is highlighted by the absence of a gestational process associated with the condition. In addition, due to the non-specific clinical signs, the difficulty in the accurate and immediate diagnosis was demonstrated, as well as the potential to cause a rapid clinical deterioration of the patient

POTENTIALLY INAPPROPRIATE MEDICATION USE IN OLDER ADULTS: PREVALENCE AND PHYSICIAN KNOWLEDGE

OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians' knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203). Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications