The role of problem-based learning in medical education changes in Brazil

A instituição do Sistema Único de Saúde no Brasil (SUS) acarretou mudanças no trabalho médico. Novas habilidades vêm sendo demandadas do médico atuante no SUS, gerando impacto sobre o ensino médico. Através da análise das Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina é possível identificar algumas dessas repercussões, bem como abordagens propostas para a reestruturação do ensino. A Aprendizagem Baseada em Problemas (ABP) é uma metodologia ativa de ensino que vem sendo adotada em algumas Escolas Médicas do país. Constitui-se um trabalho de pequenos grupos, onde o aprendizado é centrado no aluno e não no professor, e os conhecimentos são adquiridos a partir de problemas clínicos. Essa abordagem exige uma estrutura física e organizacional complexa, treinamento adequado dos docentes e participação ativa dos discentes. Após busca não-sistemática por artigos relevantes sobre o tema, uma análise de alguns resultados obtidos a partir da experiência de países como os Estados Unidos e o Canadá sugere alguns pontos fortes do ensino através da ABP: comunicação social, trabalho em equipe multidisciplinar e aprender a aprender. Essas habilidades são consoantes com as características almejadas para o médico do SUS. Alguns aspectos são deficitários em relação ao método tradicional, como conhecimento de ciências biológicas básicas e fisiopatologia e desempenho na tomada de decisão terapêutica. Com isso, propõe-se uma reflexão sobre a pertinência da adoção da ABP como modelo didático no Brasil, sua relação com as propostas do SUS e das Diretrizes Curriculares e a factibilidade desse processo.The creation of the Unified Health System (UHS) in Brazil caused important modifications in medical practice, as new skills have been required from the physician working for the UHS, which had an impact on medical education. Analyzing the Brazilian Curriculum Guidelines for Undergraduate Programs in Medicine, it is possible to identify some of these changes, as well as some proposals for restructuring the educational process. Problem-based learning (PBL) is an active teaching method that has been implemented in many Brazilian medical schools. The work takes place in small groups of students, where learning is centered on the student and not on the professor and knowledge is built from a specially designed clinical problem. PBL approach requires a complex physical and organizational infrastructure, professors need to be well trained and active participation of students is mandatory. Systematic reviews identified through non-systematic search of the literature show the strengths of PBL, based on the analysis of results from experiences in countries like the United States and Canada: social interaction, multidisciplinary work and continuous active learning. These skills are in line with the desired characteristics for UHS physicians. Some aspects are deficient in comparison with the traditional teaching method: knowledge on basic biological sciences and physiopathology and performance in therapeutic decision making. Therefore, this study proposes a reflection on the adequacy of the implementation of PBL as a didactic model in Brazil, its relationship with proposals from the UHS and the Curriculum Guidelines, and the feasibility of this process

Risk factors for infection with different hepatitis C virus genotypes in southern Brazil

Objectives. To investigate the proportion of different genotypes in countryside microregions in southern Brazil, and their association with risk factors. Methods. Cross-sectional study including a convenience sample of patients who tested positive for HCV-RNA and were referred to a regional health center for genotyping, from December 2003 to January 2008. Data were obtained through the National Disease Surveillance Data System, from laboratory registers and from patient charts. Identification of genotypes was carried out using the Restriction Fragment Length Polymorphism “in house” technique. Independent associations with genotypes were evaluated in multinomial logistic regression and prevalence rates of genotypes were estimated with modified Poisson regression. Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old, 56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9–48.1) of patients, genotype 2 in 19.3% (95% CI 15.0–23.6), and genotype 3 in 39.2% (95% CI 35.6–43.0). HCV genotype was significantly associated with gender and age. Dental procedures were associated with higher proportion of genotype 2 independently of age, education, and patient treatment center. Conclusions. The hepatitis C virus genotype 1 was the most frequent. Genotype 2 was associated with female gender, age, and dental procedure exposition

Risk Factors for Infection with Different Hepatitis C Virus Genotypes in Southern Brazil

Objectives. To investigate the proportion of different genotypes in countryside microregions in southern Brazil, and their association with risk factors. Methods. Cross-sectional study including a convenience sample of patients who tested positive for HCV-RNA and were referred to a regional health center for genotyping, from December 2003 to January 2008. Data were obtained through the National Disease Surveillance Data System, from laboratory registers and from patient charts. Identification of genotypes was carried out using the Restriction Fragment Length Polymorphism “in house” technique. Independent associations with genotypes were evaluated in multinomial logistic regression and prevalence rates of genotypes were estimated with modified Poisson regression. Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old, 56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9–48.1) of patients, genotype 2 in 19.3% (95% CI 15.0–23.6), and genotype 3 in 39.2% (95% CI 35.6–43.0). HCV genotype was significantly associated with gender and age. Dental procedures were associated with higher proportion of genotype 2 independently of age, education, and patient treatment center. Conclusions. The hepatitis C virus genotype 1 was the most frequent. Genotype 2 was associated with female gender, age, and dental procedure exposition

Establishment of Corbicula fluminea (O.F. M?ller, 1774) in Lake Maggiore: a spatial approach to trace the invasion dynamics

We analysed the dynamics of the invasive Asian basket clam Corbicula fluminea in Lake Maggiore (Italy), recorded for the first time in August 2010. In order to reveal the extent of its dispersal, we monitored 30 locations along the lake for presence/absence of clams. This assessment of population structure, density and biomass is based on quantitative samples collected along the southern shoreline at four sites with diverse types of habitats. In the present study, the on-going process of Corbicula invasion was analysed from a spatial and temporal perspective. We compared density and size structure of the population among the sites (spatial distribution). We attempted to trace the colonization dynamics of the clams, so the invasion dynamics were tentatively reconstructed from spatial distribution of size /age groups and the contribution of the last recruited cohort to total population density along the lake littoral zone. Results from our surveys conducted in 2010-2011 have demonstrated that the Asian clam was well-established in the lake, thus about one-third of the lake (i.e. the southern basin) was already colonized by C. fluminea in 2011. Size frequency distribution in autumn 2011 further illustrated reproduction events and new recruitments. Population densities in Lake Maggiore were among the highest ever recorded in an Italian lake. Both the rapid spread of Corbicula in the littoral area and the relatively high densities, even at the most recently invaded sites, infer the potential ecosystem impacts associated with a dominant invasive species. Data reported here are not intended to be exhaustive since they concern only two years of investigations, so more detailed studies on both the ecology and invasive habits of this new alien species in Lake Maggiore are planned. The spatial approach used in the present study may clarify the dynamics of this invasion. Future monitoring might help us to disentangle the effects of spatial variability versus temporal succession during the establishment of the invasive species

Inflammatory bowel diseases and human reproduction: A comprehensive evidence-based review

To evaluate the effects of inflammatory bowel diseases (IBDs) on human reproduction, we reviewed the current literature using a systematic search for published studies (articles and/or abstracts) without limits for English language. We searched on Medline (through PubMed), the Institute for Scientific Information, the Web of Science and the websites for the registration of controlled trials (http://controlled-trials.com/). Bibliographies of retrieved articles, books, expert opinion review articles and reviewed bibliographies from subject experts were manually searched. Titles and abstracts were screened initially, and potential relevant articles were identified and reviewed. Whenever possible, data were analyzed by comparing IBD patients vs healthy controls, and patients with active IBDs vs those with disease in remission. The effects of IBDs on female fertility, fertility in infertile couples, pregnancy and male infertility were examined separately. Patients with IBDs in remission have normal fertility. At the moment, there is no established guideline for the preservation of fertility in women with IBD undergoing surgery. Further data are needed regarding guidelines for the management of these patients. Data regarding IBDs and infertility are currently completely lacking. Considering the prevalence of intestinal pathology in young adults of childbearing age, this field is of great scientific and clinical interest, opening up important future perspectives. Another important and as yet unexplored point is the response to treatments for infertility in patients with IBDs. In particular, the question is whether the reproductive outcomes (clinical and biological) can be influenced by the IBD of one of the partners. The goals for successful reproductive outcomes in IBD population are correct counseling and disease remission. IBDs significantly affect several reproductive aspects of human (female, male, couple) reproduction. Further data are needed to develop guidelines for the clinical management of subjects of reproductive age with IBDs. © 2014 Baishideng Publishing Group Inc. All rights reserved

Effect of SARS-CoV-2 infection in pregnancy on CD147, ACE2 and HLA-G expression

Introduction: Recent studies reported a differential expression of both ACE2 and CD147 in pregnant women associated to SARS-CoV-2 placental infection. The aim of this study is to further investigate the placental SARS-CoV-2 infection and the potential effect on protein expression (ACE2, CD147, HLA-G and CD56). Methods: The study was on three subgroups: i) 18 subjects positive for SARS-CoV-2 swab at delivery; ii) 9 subjects that had a positive SARS-CoV-2 swab during pregnancy but resulted negative at delivery; iii) 11 control subjects with physiological pregnancy and with no previous or concomitant SARS-CoV-2 swab positivity. None of the subjects were vaccinated for SARS-CoV-2 infection. The placenta samples were analyzed for SARS-CoV-2 NP (Nucleocapsid protein) positivity and the expression of ACE2, CD147, HLA-G and CD56. Results: We observed a higher percentage of SARS-CoV-2 NP positive placenta samples in the group of SARS-CoV-2 PCR positive at delivery in comparison with SARS-CoV-2 PCR negative at delivery. The localization of SARS-CoV-2 NP positivity in placenta samples was mainly in syncytiotrophoblast (ST) of SARS-CoV-2 PCR positive at delivery group and in extra-villous trophoblast (EVT) of SARS-CoV-2 PCR negative at delivery group. CD147, HLA-G positivity was higher in ST of SARS-CoV-2 PCR positive at delivery group, while CD56-expressing immune cells were decreased in comparison with control subjects. Discussion: We confirmed the ability of SARS-CoV-2 to infect placenta tissues. The simultaneous SARS-CoV-2 swab positivity at delivery and the positivity of the placenta tissue for SARS-CoV-2 NP seems to create an environment that modifies the expression of specific molecules, as CD147 and HLA-G. These data suggest a possible impact of SARS-CoV-2 infection during pregnancy, that might be worthy to be monitored also in vaccinated subjects