Can Score Databanks Help Teaching?

Basic courses in most medical schools assess students' performance by conferring scores. The objective of this work is to use a large score databank for the early identification of students with low performance and to identify course trends based on the mean of students' grades. METHODOLOGY/PRINCIPAL FINDINGS: We studied scores from 2,398 medical students registered in courses over a period of 10 years. Students in the first semester were grouped into those whose ratings remained in the lower quartile in two or more courses (low-performance) and students who had up to one course in the lower quartile (high-performance). ROC curves were built, aimed at the identification of a cut-off average score in the first semesters that would be able to predict low performances in future semesters. Moreover, to follow the long-term pattern of each course, the mean of all scores conferred in a semester was compared to the overall course mean obtained by averaging 10 years of data. Individuals in the low-performance group had a higher risk of being in the lower quartile of at least one course in the second semester (relative risk 3.907; 95% CI: 3.378-4.519) and in the eighth semester (relative risk 2.873; 95% CI: 2.495-3.308). The prediction analysis revealed that an average score of 7.188 in the first semester could identify students that presented scores below the lower quartiles in both the second and eighth semesters (p<0.0001 for both AUC). When scores conferred by single courses were compared over time, three time-trend patterns emerged: low variation, upward trend and erratic pattern. CONCLUSION/SIGNIFICANCE: An early identification of students with low performance may be useful in promoting pedagogical strategies for these individuals. Evaluation of the time trend of scores conferred by courses may help departments monitoring changes in personnel and methodology that may affect a student's performance

Resistance of Leishmania (Leishmania) amazonensis and Leishmania (Viannia) braziliensis to nitric oxide correlates with disease severity in Tegumentary Leishmaniasis

BACKGROUND: Nitric oxide (NO(•)) plays a pivotal role as a leishmanicidal agent in mouse macrophages. NO(• )resistant Escherichia coli and Mycobacterium tuberculosis have been associated with a severe outcome of these diseases. METHODS: In this study we evaluated the in vitro toxicity of nitric oxide for the promastigote stages of Leishmania (Viannia) braziliensis and Leishmania (Leishmania) amazonensis parasites, and the infectivity of the amastigote stage for human macrophages. Parasites were isolated from patients with cutaneous, mucosal or disseminated leishmaniasis, and NO(• )resistance was correlated with clinical presentation. RESULTS: Seventeen isolates of L. (L.) amazonensis or L. (V.) braziliensis promastigotes were killed by up to 8 mM of more of NaNO(2 )(pH 5.0) and therefore were defined as nitric oxide-susceptible. In contrast, eleven isolates that survived exposure to 16 mM NaNO(2 )were defined as nitric oxide-resistant. Patients infected with nitric oxide-resistant Leishmania had significantly larger lesions than patients infected with nitric oxide-susceptible isolates. Furthermore, nitric oxide-resistant L. (L.) amazonensis and L. (V.) braziliensis multiplied significantly better in human macrophages than nitric oxide-susceptible isolates. CONCLUSION: These data suggest that nitric oxide-resistance of Leishmania isolates confers a survival benefit for the parasites inside the macrophage, and possibly exacerbates the clinical course of human leishmaniasis

Pediatric urolithiasis: the current surgical management

Children represent about 1% of all patients with urolithiasis, but 100% of these children are considered high risk for recurrent stone formation, and it is crucial for them to receive a therapy that will render them stone free. In addition, a metabolic workup is necessary to ensure a tailored metaphylaxis to prevent or delay recurrence. The appropriate therapy depends on localization, size, and composition of the calculus, as well as on the anatomy of the urinary tract. In specialized centers, the whole range of extracorporeal shock-wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PCNL) are available for children, with the same efficiency and safety as in adults

Conhecimento vocal e a importância da voz como recurso pedagógico na perspectiva de professores universitários

OBJETIVO: investigar o conhecimento vocal e sua importância como recurso pedagógico em professores universitários. MÉTODOS: participaram 112 docentes, média de 46,60 anos, 35,7% do sexo masculino e 64,3% do feminino, 66,1% doutores. Utilizou-se o questionário Condições de Produção Vocal-Professor, adaptado pela pesquisadora, além da inserção de novas questões abertas e fechadas de interesse para o estudo, as quais foram assinaladas em uma escala analógica de zero a dez. Foram coletadas amostras de voz dos professores e analisadas por avaliação fonoaudiológica. As questões fechadas receberam tratamento estatístico, considerando-se a média das notas autorreferidas, em cada variável pesquisada. Os resultados foram correlacionados a partir das variáveis: sexo e presença/ausência de alteração vocal. Organizaram-se as respostas das questões abertas por similaridade de conteúdo e frequência de ocorrência. RESULTADOS: constatou-se associação significante entre sexo feminino e voz fina, fadiga e perda da voz; presença de distúrbio de voz e autorreferência à voz fraca, rouquidão, voz insuficiente para o trabalho e fadiga vocal. Os professores participaram da pesquisa para colaborar e melhorar a voz na docência; mudariam suas vozes nos aspectos de intensidade, tom e modulação; os recursos vocais mais utilizados em sala de aula foram variação de tom e intensidade, modulação e pausas; e quando a voz está alterada, recorrem ao repouso vocal e à hidratação. Atribuiu-se a média de 9,42 para a voz como recurso pedagógico. CONCLUSÃO: o conhecimento vocal dos participantes foi apropriado e eles avaliaram a voz como recurso pedagógico essencial