Knowledge and interest in medical ethics and bioethics in medical graduation

OBJECTIVES: To evaluate the interest and knowledge about Medical Ethics and Bioethics in medical graduation. METHODS: Transversal and descriptive study. Two different questionnaires were applied with questions about the interest in Medical Ethics and Bioethics and the knowledge about the Brazilian Code of Medical Ethics (CME), one to professors and the other to students. RESULTS: One hundred and one professors and 331 students answered the questionnaires. The Brazilian CME had been read by 86.2% of the teachers and by 100% of the students. The importance given to the discipline Medical Ethics, on a scale from 1 to 5, was similar among teachers and students (4.7 ± 0.7 vs. 4.5 ± 0.8; p = 0.086); however the self-evaluation on knowledge about this subject was higher in the first group (3.4 ± 0.9 vs. 3.2 ± 0.7; p = 0.017). In a block with 9 questions, the right answer was given by 5,0 ± 1.9 of teachers and 5.9 ± 1.5 of students (p < 0,001); the mean of correct answers were related to the reading of the CME. CONCLUSIONS: The present study presents unpublished data about the perception of medical teachers and students about medical ethics and bioethics and can be useful for improving the teaching of these disciplines in our medical schools.OBJETIVOS: Avaliar o interesse e o conhecimento sobre ética médica e bioética na graduação médica. MÉTODOS: Estudo transversal e descritivo. Foram utilizados dois questionários auto-aplicáveis, um para docentes e outro para discentes, com questões sobre o interesse em ética médica e bioética e conhecimento sobre o Código de Ética Médica (CEM). RESULTADOS: Foram avaliados 101 professores e 331 estudantes. O CEM brasileiro foi lido por 86,2% dos professores e 100% dos alunos. A importância dada à disciplina de ética médica, numa escala de 1 a 5, foi semelhante entre professores e estudantes (4,7 ± 0,7 vs. 4,5 ± 0,8; p = 0,086), enquanto o autoconhecimento sobre o tema foi maior no primeiro grupo (3,4 ± 0,9 vs. 3,2 ± 0,7; p = 0,017). De um total de nove questões avaliadas sobre o conhecimento do CEM, a média de acertos foi de 5,0 ± 1,9 questões para os professores e de 5,9 ± 1,5 para os acadêmicos (p < 0,001), sendo os acertos correlacionados positivamente com a leitura do código. CONCLUSÕES: Este estudo fornece um panorama inédito sobre a percepção de professores e estudantes de Medicina sobre a ética médica e bioética, podendo servir para fundamentar a melhora do ensino dessa disciplina em nossas faculdades.Universidade Federal da BahiaEscola Bahiana de Medicina e Saúde PúblicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Hospital São PauloInstituto do coração da Bahia Hospital Ana NeryUniversidade Federal da Bahia Hospital Universitário Professor Edgar SantosUNIFESP, EPM, Hospital São PauloSciEL

Burden of Uncontrolled Severe Asthma With and Without Elevated Type-2 Inflammatory Biomarkers

Background: Many patients with asthma have type-2 airway inflammation, identified by the presence of biomarkers, including history of allergy, high blood eosinophil (EOS) count, and high fractional exhaled nitric oxide levels. Objective: To assess disease burden in relation to type-2 inflammatory biomarker status (history of allergy, blood EOS count, and fractional exhaled nitric oxide level) in patients with uncontrolled and controlled severe asthma in the NOVEL observational longiTudinal studY (NOVELTY) (NCT02760329). Methods: Asthma diagnosis and severity were physician-reported. Control was defined using Asthma Control Test score (uncontrolled = 20) and/or 1 or more severe physician-reported exacerbation in the previous year. Biomarker distribution (history of allergy, blood EOS count, and fractional exhaled nitric oxide level), symptom burden (Asthma Control Test score, modified Medical Research Council dyspnea scale), health status (St George's Respiratory Questionnaire score), exacerbations, and health care resource utilization were assessed. Results: Of 647 patients with severe asthma, 446 had uncontrolled and 123 had controlled asthma. Among those with uncontrolled asthma, 196 (44%) had 2 or more positive biomarkers, 187 (42%) had 1 positive biomarker, 325 (73%) had low blood EOS, and 63 (14%) were triple-negative. Disease burden was similarly high across uncontrolled subgroups, irrespective of biomarker status, with poor symptom control (Asthma Control Test score 14.9-16.6), impaired health status (St George's Respiratory Questionnaire total score 46.7-49.4), clinically important breathlessness (modified Medical Research Council grade >= 2 in 47.3%-57.1%), and 1 or more severe exacerbation (70.6%-76.2%). Conclusions: Type-2 inflammatory biomarkers did not differentiate disease burden in patients with severe asthma. Patients with low type-2 inflammatory biomarker levels have few biologic therapy options; their needs should be addressed

Physiology & Behavior

Trabalho completo: acesso restrito, p. 233–243The aim of the present study was to evaluate the participation of brain H1 and H2 histaminergic receptors on water and salt intake induced by water deprivation (24 h), furosemide-induced sodium depletion and central angiotensinergic pharmacological stimulation in rats. Third ventricle injections of the H1 and H2 receptor antagonists, mepyramine (50, 100, 200 and 400 nmol) and cimetidine (100, 200 and 400 nmol), were unable to modify water intake induced by water deprivation and sodium depletion. Salt intake elicited by water deprivation and sodium depletion was reduced by the central administration of mepyramine, while intracerebroventricular administration of cimetidine had no effect. Water and salt intake evoked by central angiotensinergic stimulation (10 ng) was diminished by third ventricle injections of both mepyramine and cimetidine. Inhibition of the ingestive behaviors observed here is not a result of any illness-like effect produced by the intracerebroventricular injections of the histaminergic antagonists used, as demonstrated by an avoidance test. It was also shown that third ventricle injections of these compounds were unable to modify the hedonic behavior that leads rats to drink a tasty saccharin solution. We conclude that central histaminergic receptors participate in the control of salt intake induced by distinct physiological and pharmacological stimuli

Pharmacology Biochemistry and Behavior

Texto completo: acesso restrito. p. 891-898In the present study, we investigated in rats the effect of third ventricle injections of 1-(3-chlorophenyl)piperazine (mCPP), a 5-HT2 receptor agonist, on water intake induced by three different physiological stimuli: fluid deprivation, acute salt load and hypovolemia. Injections of mCPP in the doses of 80 and 160 nmol/rat were able to decrease water intake in all three conditions studied. Third ventricle injections of mCPP (160 nmol/rat) were no longer able to diminish water intake in the groups of rats pretreated with central injections of an equimolar amount of (+)-cis-4,5,7a,8,9,10,11,11a-octahydro-7H-10 methylindolo[1,7-bc][2,6]-naphthyridine (SDZ SER 082), a selective 5-HT2B/2C antagonist. The central administration of mCPP (160 nmol/rat) was not able to modify the intake of a 0.1% saccharin solution. It is suggested that the central activation of a 5-HT2B/2C component is able to impair the drive for water intake induced by the physiological stimuli represented by fluid deprivation, acute salt load and hypovolemia. This effect seems not to be consequent on a general nonspecific central nervous system depression or on a locomotor deficit, because saccharin intake is not affected by third ventricle injections of mCPP

Brain Research

Texto completo: acesso restrito. p. 151–159In the present study, we investigated the participation of central 5-HT2B/2C and 5-HT3 receptors in the salt intake induced by sodium depletion in Wistar male rats. Sodium depletion was produced by the administration of furosemide associated with a low salt diet. Third ventricle injections of mCPP, a 5-HT2B/2C agonist, at doses of 80, 160 and 240 nmol, promoted a dose-dependent reduction in salt intake in sodium-depleted rats. The inhibitory effect produced by central administration of mCPP was abolished by the central pretreatment with SDZ SER 082, a 5-HT2B/2C antagonist. Similar results were obtained with third ventricle injections of m-CPBG (80, 160 and 240 nmol), a selective 5-HT3 agonist that also induced a dose-related decrease in salt intake in sodium-depleted rats. The central pretreatment with LY-278,584, a selective 5-HT3 receptor antagonist, was able to impair the salt intake inhibition elicited by third ventricle injections of m-CPBG. Central administration of each one of the antagonists alone or a combination of both antagonists together did not significantly change salt intake after sodium depletion. On the other hand, the central administration of both mCPP and m-CPBG, in the highest dose used to test their effect on salt intake (240 nmol), was unable to modify blood pressure in sodium-depleted rats. It is concluded that: (1) pharmacological activation of central 5-HT2B/2C and 5-HT3 receptors diminishes salt intake during sodium depletion, (2) an inhibitory endogenous drive exerted by central 5-HT2B/2C and 5-HT3 receptors does not seem to exist and (3) the reduction in salt intake generated by the pharmacological activation of these central receptors is not produced by an acute hypertensive response

Pharmacology Biochemistry and Behavior

p. 189-198The aim of the present study was to investigate the effect of the pharmacological blockade of histamine H1 and H2 receptors located within the ventromedial hypothalamus (VMH) on overnight food and water intake and on water intake elicited by two physiological stimuli: hyperosmolarity induced by an acute intragastric salt load and water deprivation. During the overnight period, the pharmacological blockade of both H1 and H2 VMH receptors significantly increased food intake and decreased water intake. In hyperosmotic rats, the blockade of H1 VMH receptors reduced water intake, while the blockade of H2 receptors in this same region yielded no significant effect. Additionally, in water-deprived rats, the blockade of both H1 and H2 receptors located within the VMH induced a significant decrease in water intake. The inhibitory effects on drinking behavior observed in this study do not seem to be a consequence of any billness-inducingQ effect provoked by the central administration of the antihistaminergic agents employed here, because an aversion test indicated that the injection of those compounds into the VMH does not induce any billness-likeQ effect. In addition, the central administration of either mepyramine or cimetidine to dehydrated and hyperosmotic rats did not produce any reduction in locomotor activity measured in an openfield arena. Injections of the antihistaminergic agents used here into the regions that circumscribe the VMH produced no significant effects on water or food intake, indicating that the actions observed here may be specifically attributed to the set of histaminergic receptors situated within the VMH