Oxacillin Resistance of Staphylococcus aureus Isolated from the University Hospital of Botucatu Medical School in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prevalence and Risk Factors of Chlamydia trachomatis Cervicitis in Pregnant Women at the Genital Tract Infection in Obstetrics Unit Care at Botucatu Medical School, São Paulo State University - UNESP, Brazil

Objective. To evaluate the prevalence of and risk factors for Chlamydia trachomatis cervicitis in pregnant women seen at the Genital Tract Infection in Obstetrics Unit Care in Botucatu Medical School, São Paulo State University - UNESP.Materials and Methods. Between June 2006 and February 2008, 101 pregnant women were included in this study. During the gynecologic examination, cervical secretions were collected using cytobrush Plus GT (CooperSurgical Inc) to assess C. trachomatis using polymerase chain reaction. Vaginal flora were examined by Gram stain, and socio-demographic data were extracted from medical records.Results. of the 101 patients, 26 (25.7%) were positive for C. trachomatis. The median age of the infected group was 24 years (range = 13-40 y), and 48.5% of them had abnormal vaginal flora. The presence of chlamydial infection was associated with smoking (odds ratio [OR] = 2.67, 95% confidence interval [CI] = 1.01-7.19), residing in a city with fewer than 100,000 inhabitants (OR = 2.86, 95% CI = 1.03-7.94), presence of condyloma acuminatum (p = .03), and presence of discreet inflammation on Pap smear (p = .02).Conclusions. The prevalence of C. trachomatis is high in pregnant women seen at the Genital Infection Unit Care, UNESP, and is related to many risk factors. Therefore, its screening is extremely important in reducing obstetrical and neonatal complications.

Evalution of methods for the detection of MRSA in patients of Botucatu Medical School Hospital, São Paulo, Brazil

Oxacillin is the main drug of choice for the treatment of S. aureus infections. However, S. aureus resistance to oxacillin has become a major problem in the recent decades. The study aimed assess the rates of oxacillin resistance in S. aureus samples obtained at the Botucatu Medical School Hospital, UNESP, and to compare phenotypic techniques for the detection of MRSA against the gold standard method (mecA gene detection) in these samples. A total of 102 samples, previously isolated between 2002 and 2006, and kept at the Culture Collection of the Department of Microbiology and Immunology, in the Botucatu Biosciences Institute, UNESP, were included. Oxacillin resistance was assessed by oxacillin and cefoxitin disk diffusion and agar dilution tests, screening tests using Mueller-Hinton agar with 6 mu g/mL of oxacillin and 4% NaCl, E-test, and mecA gene detection. of the samples analyzed, 46 (45.1%) were mecA-positive. Oxacillin disk sensitivity and specificity were 86.9% and 91.1%, respectively. Cefoxitin disk sensitivity and specificity were respectively 91.3% and 91.1%. The screening test with the cefoxitin disk showed almost the same level of sensitivity (91.3%) and specificity (91.1%). With E-test strips, sensitivity was higher (97.8%) and specificity was comparable to that found with the other methods (91.1%). Ninety-three percent of the samples produced beta-lactamase and five of them were mecA-negative. There was a gradual increase in the number of oxacillin-resistant S. aureus samples between 2002 and 2004. However, from 2004 to 2006, the number of resistant samples dropped from 55% of MRSA in 2004, to 45% in 2005 and 34.6% in 2006. The data obtained reveal that, among phenotypic methods, the E-test yielded the best results, with higher sensitivity levels when compared to the other methods. The decreased resistance rate observed over the most recent years may be explained by the rational use of antimicrobial agents associated with good practices in the control of hospital infection, or may be related to the diminished use of oxacillin as a treatment option.

Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program

Background: Because of ethical and medico-legal aspects involved in the training of cutaneous surgical skills on living patients, human cadavers and living animals, it is necessary the search for alternative and effective forms of training simulation. Aims: To propose and describe an alternative methodology for teaching and learning the principles of cutaneous surgery in a medical undergraduate program by using a chicken-skin bench model. Materials and Methods: One instructor for every four students, teaching materials on cutaneous surgical skills, chicken trunks, wings, or thighs, a rigid platform support, needled threads, needle holders, surgical blades with scalpel handles, rat-tooth tweezers, scissors, and marking pens were necessary for training simulation. Results: A proposal for simulation-based training on incision, suture, biopsy, and on reconstruction techniques using a chicken-skin bench model distributed in several sessions and with increasing levels of difficultywas structured. Both feedback and objective evaluations always directed to individual students were also outlined. Conclusion: The teaching of a methodology for the principles of cutaneous surgery using a chicken-skin bench model versatile, portable, easy to assemble, and inexpensive is an alternative and complementary option to the armamentarium of methods based on other bench models described. © Indian Journal of Dermatology 2013.

Molecular analysis of community-acquired methicillin-resistant Staphylococcus aureus isolated from skin and soft tissue infections, Botucatu Medical School, Brazil

Community acquired methicillin Staphylococcus aureus (CA-MRSA) was first reported in 1981, infecting people without risk factors. These strains harbor the Staphylococcal Cassette Chromosome mec (SCCmec) type IV, which contains the mecA gene codifying for methicillin resistance. CA-MRSA strains usually carry PVL (Panton-Valentine Leukocidin), a virulence factor responsible for tissue invasion, causing systemic infections and leading to serious complications. The aims of this work were to detect the mecA gene, SCCmec characterization and to detect the PVL gene of the S. aureus strains isolated from patients diagnosed with skin and soft tissue infections attending the Dermatology Service, of the Botucatu Medical School, Brazil. Among 127 collected samples, 66 (51.9%) were S. aureus and, from these, 7 (10.6%) harbored mecA gene, 3 (42%) with cassette type IV, and none of these samples carried the PVL gene, but it was detected in 10 (15.1%) samples of S. aureus methicillin sensitive (MSSA). Our study suggests the S. aureus strains that harbor PVL gene and MRSA are present in the community as important pathogens.

Undergraduate research in medical education: a descriptive study of students' views

Background: Medical students engage in curricular and extracurricular activities, including undergraduate research (UR). The advantages, difficulties and motivations for medical students pursuing research activities during their studies have rarely been addressed. In Brazil, some medical schools have included undergraduate research into their curriculum. The present study aimed to understand the reality of scientific practice among medical students at a well-established Brazilian medical school, analyzing this context from the students' viewpoint.Methods: A cross-sectional survey based on a questionnaire applied to students from years one to six enrolled in an established Brazilian medical school that currently has no curricular UR program.Results: The questionnaire was answered by 415 students, 47.2% of whom were involved in research activities, with greater participation in UR in the second half of the course. Independent of student involvement in research activities, time constraints were cited as the main obstacle to participation. Among students not involved in UR, 91.1% said they favored its inclusion in the curriculum, since this would facilitate the development of such activity. This approach could signify an approximation between the axes of teaching and research. Among students who had completed at least one UR project, 87.7% said they would recommend the activity to students entering the course.Conclusion: Even without an undergraduate research program, students of this medical school report strong involvement in research activities, but discussion of the difficulties inherent in its practice is important to future developments.

Efeitos de um programa de orientação para adultos com lombalgia

OBJETIVO: Implantar um programa de Escola da Postura para pacientes com lombalgia crônica. MÉTODOS: Foram avaliados 41 sujeitos (46,81 ± 13,35 anos), de ambos os gêneros, com idade entre 25-65 anos que possuíam dor lombar há mais de 6 meses. Inicialmente, foi realizado a avaliação da qualidade de vida (Medical Outcomes Study 36- Item Short-Form Health Survey- SF-36) e capacidade funcional (Oswestry Low Back Pain Disability Questionnaire - ODQ). em seguida, todos os sujeitos participaram de cinco encontros semanais de 60 minutos, nos quais foram desenvolvidos as capacitações teórico-práticas. Após uma semana, os sujeitos foram reavaliados. Os dados obtidos nas avaliações foram analisados utilizando o teste estatístico não-paramétrico de Wilcoxon, com nível de significância de 5% (p<0,05). RESULTADOS: Foi observada melhora significativa na capacidade funcional (ODQ, p<0,0001). em relação à qualidade de vida observou-se melhora significativa nos domínios capacidade funcional (p=0,0016), dor (p=0,0035), estado geral de saúde (p<0,0001), vitalidade (p<0,0001), aspectos sociais (p<0,0001) e saúde mental (p=0,0007). Nos itens aspectos físicos e aspectos emocionais não foi observada diferença significativa. CONCLUSÃO: O programa Escola da Postura elaborado foi capaz de melhorar a qualidade de vida e capacidade funcional dos participantes.

Medical students' personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

Background: The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students.Methods: A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice.Results: A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student's own or a partner's pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03-8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS.Conclusions: A higher number of sixth year students preferred a CS for their own pregnancy (or their partner's) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students' preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.

Uso de álcool e drogas por estudantes de medicina da Unesp

INTRODUÇÃO: O objetivo deste trabalho foi analisar a prevalência do uso de drogas por estudantes da Faculdade de Medicina de Botucatu - Unesp, comparada com outras oito escolas médicas paulistas (uso na vida, nos últimos 12 meses e nos últimos 30 dias). A pesquisa foi realizada entre 1994 e 1995, com 5.227 estudantes do 1o ao 6o ano de graduação. MATERIAL E MÉTODO: Foi usado um questionário de auto-respostas, anônimo, incluindo o questionário da Organização Mundial da Saúde para levantamento de uso de drogas e álcool. Setenta e um por cento (3.725) dos alunos responderam ao mesmo, e destes, 421 eram de Botucatu. RESULTADOS: Não houve diferenças estatisticamente significantes entre escolas e, nos 30 dias anteriores ao preenchimento do questionário, a prevalência do uso de drogas para os estudantes de Botucatu foi a seguinte, com a variação entre outras escolas mostrada entre parênteses: álcool 50% (42-50%); tabaco 7% (7-13%); solventes 8% (7-12%); maconha 6% (6-16%); benzodiazepínicos (BZD) 3% (2-9%); cocaína 0,5% (0,2-4%); anfetaminas 1 % (0-1%). Embora tenha se encontrado um uso crescente de todas as drogas do 1o ao 6o ano, e em especial os BZD, os estudantes não aprovam este uso. A análise de regressão logística indicou que o uso de álcool e drogas foi favorecido por: a) ser homem; b) perder aulas sem razão e referir ou ter muito tempo livre nos finais de semana; e c) ter uma atitude favorável em relação ao uso de álcool e drogas. Diferentemente de outras escolas, na Unesp não houve diferenças estatisticamente significantes de gênero em relação ao uso de tranqüilizantes. No entanto, as mulheres iniciam uso mais precocemente e o fazem mais freqüentemente. Também as mulheres já faziam uso de maconha antes de entrar para a faculdade (30% mulheres X 10% homens), o contrário ocorrendo com solventes (50% homens X 2% mulheres), sendo essas diferenças estatisticamente significantes. CONCLUSÕES: Embora a pesquisa tenha focalizado o uso (não abuso ou dependência), os resultados sugerem a necessidade de as universidades estabelecerem uma política clara de orientação sobre uso de drogas e álcool para os estudantes, incluindo mudanças curriculares e programas de prevenção.

Programa de apoio a cuidadores: uma ação terapêutica e preventiva na atenção à saúde dos idosos

Dans le cadre du service de gériatrie du Centre de Santé-école de la faculté de médecine de Botucatu (Université de São Paulo), a été établi un programme d'appui à ces soignants avec les objectifs suivants: préserver leur qualité de vie et favoriser de meilleures conditions familiales aux patients. Le programme comprend de 10 à 12 réunions par semaine, de deux heures de durée, coordonnées par deux psychologues. on utilise des techniques de psychodrame centrées sur le rôle du soignant et leurs conséquences sociales et émotionnelles. Les informations théoriques sont transmises au moyen de discussions de groupe et de moyens audiovisuels. Les thèmes suivants sont abordés : signification et motivation du soin donné, signaux d'alertes de fatigue physique et mentale du soignant, les possibilités de se traiter et de demander de l'aide, une méthode d'amélioration de la communication face à une déficience visuelle, auditive et cognitive, une méthode pour favoriser l'indépendance et l'autonomie et surmonter les problèmes relatifs à l'hygiène, la mobilité, l'agression, l'irritation, les hallucinations et les idées délirantes de la personne âgée. Au cours de la première réunion de chaque groupe (qui comprend de 10 à 20 participants) on applique une échelle d'évaluation de l'impact émotionnel sur les soignants (Zarit et al., 1980) et le SRQ (Self Report Questionnaire - Mari and Williams, 1986) qui identifient des désordres psychiatriques. Ces échelles sont reproduites à la fin du programme, pour observer d'éventuelles modifications. Les données obtenues indiquent des changements favorables dans l'expression d'émotions, l'établissement de limites et de retour à des activités de loisirs.

Avaliação do estudante: no exercício de avaliação da prática profissional

Este estudo aborda a avaliação do exercício da prática profissional (EAPP) no curso de enfermagem da Faculdade de Medicina de Marília (Famema); tem como objetivo analisar a concepção de avaliação do professor que realizou o EAPP com estudantes de primeira a quarta séries do curso. Trata-se de um estudo qualitativo, modalidade análise de conteúdo e identificação da seguinte temática: as ambigüidades do processo de avaliação. Constata-se que a concepção do professor na avaliação no EAPP aproxima-se muito da abordagem de competência dialógica, que articula e integra resultados, atributos e contexto em situações distintas, com diferentes formas de realizar tarefas essenciais para a formação do enfermeiro. Contradições no processo avaliativo entre os professores, porém, estão presentes e necessitam ser constantemente trabalhadas.

Comparison of exfoliative pap stain and AgNOR counts of the tongue in smokers and nonsmokers

Objective To compare exfoliative cytology from the oral mucosa of smokers and nonsmokers, with emphasis on proliferative activity. Methods Exfoliative cytology specimens were obtained from clinical normal mucosa from the lateral border of the tongue in 30 nonsmokers and 30 smokers ranging in age from 40 to 70 years of age, who were seen at the Heart Institute's Patient Center and the Smoking Cessation Program of the University Hospital, University of São Paulo Medical School (InCor-HCFMUSP). The cytologic specimens were evaluated by Papanicolaou staining and AgNOR quantification in order to evaluate the presence of cytological alterations suggestive of inflammation, dysplasia, keratinization, and proliferative activity of epithelial cells. Results Only Papanicolaou Class I and Class II smears were observed. Inflammatory alterations were found in 90% of smokers and in 87% of nonsmokers. The number of AgNORs/nucleus differed significantly between smokers and nonsmokers (3.372 ± 0.375 versus 2.732 ± 0.236). Conclusions Within the limitations of this research, the results indicate higher proliferative activity in smoking patients compared to nonsmoking patients, even in the absence of clinical lesions. © The Author(s) 2008.

Grupo interdisciplinar: Construção de unidade educacional sistematizada em aprendizagem baseada em problemas

In 2003 the construction team of the 1st grade of the medical and nursing courses from a medical school began a work aiming at curriculum reconstruction, and restructured cognitive contents and the integration of basic and clinical aspects, in order to adapt to the incentive program for Curriculum Changes (PROMED) which allows for the continuity of curricular innovations. This team worked considering the group dynamics, a method already used in tutorial sessions which teachers have some familiarity with. For a good group performance the team participants were divided into two subgroups: one for constructing educational problems and the other for doing cognitive assessment exercises. The team and the subgroups met weekly, and every 15 days the group met for socialization of information, identifying the strengths and weaknesses of the process and/or products. A good adhesion, an active involvement of participants and satisfaction expressed by each participant with their inclusion in the group were reflected in the final product and contributed to the subjects' commitment to the proposal. This way, in the process the individual transformations and relations in a situation requiring the collaboration of professionals were essential in the process of permanent curricular reconstruction.

Moral judgment competence of medical students: a transcultural study

The authors conducted a cross-sectional short-term study using Lind's Moral Judgment Test (MJT) to compare moral judgment competence (C-score) among students from a medical school in the Northeast region of Brazil and a medical school in the Northern region of Portugal. This study compares the C-scores of groups in the first and eighth semesters of study within each medical school and groups from corresponding semesters between the two medical schools. This study also evaluates the influence of such factors as age and gender on moral competence. A regression of moral judgment competence among the students in their eighth semester versus the students in the first semester of Brazilian medical school (p < 0.001) and a stagnation of moral competence among students in their eighth semester versus the first semester students in the Portuguese medical school (p = 0.06) were observed. For both the first semester and eighth semester groups, the students in the Portuguese medical school had higher C-scores than the students in the Brazilian medical school. In the analysis of the students' performances in terms of MJT dilemmas, the phenomenon of moral segmentation was observed in all of the groups, and the students performed better on the worker's dilemma than on the doctor's dilemma. Among students in the same semester of study, older students had lower C-scores. There was generally no significant difference between men's and women's C-scores. © 2013 Springer Science+Business Media Dordrecht.