Assessment of medical courses in Brazil using student-completed questionnaires. Is it reliable?

INTRODUCTION: Debates about the quality of medical education have become more evident in the recent past, and as a result several different assessment methods have been refined for that purpose. The use of questionnaires filled out by medical students to assess the quality of lectures is one of the most common methods employed in our milieu. However, the reliability of this investigation method has not yet been systematically tested. The authors present the reliability of a specific form applied to the fourth grade medical students during the clinical psychiatry course. METHOD: Eighty-one fourth grade medical students were instructed to complete a form immediately after each clinical psychiatry lecture. Thirty-four students (42%) failed to turn in the forms after the final lecture. These students were given an identical form to assess the lectures in a retrospective fashion. The grades given by both groups of students for each performed lecture and the number of students who have graded an unperformed lecture were compared. Statistical significance for both groups was determined by means of the chi-square test (p< 0.05). RESULTS: Eighteen out of the 34 students who filled out the forms retrospectively (53%) rated the unperformed lecture, whereas only 5 out of the 47 students who filled out the forms during the course (11%) did so. This is statistically significant (p< 0.05). There was no statistical difference for the grades given to the lectures that were actually performed. DISCUSSION: The authors concluded the low reliability rate of the retrospective evaluation warrant a continuous assessment method during the course.

Vaccines in pregnancy: a review of their importance in Brazil

Neonates and young children remain susceptible to many serious infectious diseases preventable through vaccination. In general, current vaccines strategies to prevent infectious diseases are unable to induce protective levels of antibodies in the first 6 months of life. Women vaccinated during pregnancy are capable of producing immunoglobulin antibodies that are transported actively to the fetus, and maternal immunization can benefit both the mother and the child. With few exceptions, maternal immunization is not a routine, because of the concerns related to the safety of this intervention. Ethical and cultural issues make the studies on maternal immunization difficult; however, in the last decade, the development of new vaccines, which are very immunogenic and safe has reactivated the discussions on maternal immunization. In this paper we present a review of the literature about maternal immunization based on MEDLINE data (1990 to 2002). The most important conclusions are: 1) there is no evidence of risk to the fetus by immunizing pregnant women with toxoids, polysaccharide, polysaccharide conjugated and inactive viral vaccines; 2) most viral attenuated vaccines are probably safe too, but data is still insufficient to demonstrate their safety; therefore these vaccines should be avoided in pregnant women; 3) in Brazil, there is a need for a maternal immunization program against tetanus. Many new candidate vaccines for maternal immunization are available, but studies should be conducted to evaluate their safety and efficacy, as well as regional priorities based on epidemiological data.

Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility

Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals - both natural and synthetic - that can interact with the endocrine system.

The genital atrium armature of some Brazilian sand fly females (Diptera: Phlebotominae)

Phlebotomine sand flies are insects of medical importance. Species in the Neotropical region are highly diverse. Some of these species are considered cryptic species because of their morphological similarity between adult females of different species make identification especially difficult. The aim of this study was to analyze and describe the armature in the genital atrium (AGA) of some adult female sand flies, in order to discover new taxonomic characters that make it possible to distinguish between species that would otherwise be treated as cryptic by analysis of the AGA. The AGA of 16 Phlebotomine sand fly species are described. Distinct differences were found in relation to the shape and size of the armature, the presence or absence of spines on the armature, and the shape, size, and grouping patterns of the spines. These characters made it possible to distinguish between the species studied.

Assessment of the DIXTAL DX-2710 Automated Oscillometric Device for Blood Pressure Measurement with the Validation Protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI)

OBJECTIVE: To assess the Dixtal DX2710 automated oscillometric device used for blood pressure measurement according to the protocols of the BHS and the AAMI. METHODS: Three blood pressure measurements were taken in 94 patients (53 females 15 to 80 years). The measurements were taken randomly by 2 observers trained to measure blood pressure with a mercury column device connected with an automated device. The device was classified according to the protocols of the BHS and AAMI. RESULT: The mean of blood pressure levels obtained by the observers was 148±38/93±25 mmHg and that obtained with the device was 148±37/89±26 mmHg. Considering the differences between the measurements obtained by the observer and those obtained with the automated device according to the criteria of the BHS, the following classification was adopted: "A" for systolic pressure (69% of the differences < 5; 90% < 10; and 97% < 15 mmHg); and "B" for diastolic pressure (63% of the differences < 5; 83% < 10; and 93% < 15 mmHg). The mean and standard deviation of the differences were 0±6.27 mmHg for systolic pressure and 3.82±6.21 mmHg for diastolic pressure. CONCLUSION: The Dixtal DX2710 device was approved according to the international recommendations.

Bromeliad-associated mosquitoes from Atlantic forest in Santa Catarina Island, southern Brazil (Diptera, Culicidae), with new records for the State of Santa Catarina

Bromeliad-associated mosquitoes (Diptera: Culicidae) in Atlantic Forest in Florianópolis, Santa Catarina, southern Brazil, were studied, examining plants of Vriesea philippocoburgi Wawra and Aechmea lindenii (E. Morren) Baker var. lindenii at secondary Atlantic rain forest, and A. lindenii and Vriesea friburgensis Mez var. paludosa (L. B. Smith) at "restinga" per month, during 12 months. No immature forms of mosquitoes were collected from A. lindenii in the secondary forest. Collections obtained 368 immature mosquitoes, none of them from A. lindenii from rain forest. Culex (Microculex) spp. constituted 79.8% of the total, Wyeomyia (Phoniomyia) spp. 17.93%, and Anopheles (Kerteszia) cruzii (Dyar & Knab, 1908) only 1.36%. The study shows the great predominance of species of medical importance not yet proved, and the small number of immature stages of anopheline mosquitoes. The rainfall, but not the mean temperatures, significantly influenced the quantity of mosquitoes from V. philippocoburgi. Significant differences between the quantities of immature forms of all the bromeliad species were found, and the shape of the plants could be important to the abundance of mosquitoes. All six species of Cx. (Microculex) found are recorded for the first time in the State of Santa Catarina, and all six species of Wyeomyia (Phoniomyia) are recorded for the first time in bromeliads in this state.

The snail hosts of schistosomiasis: some evolutionary and ecological perspectives in relation to control

Despite opportunities for radiation provided by spatio-temporal isolation, the basic morphological plan of pulmonate snails has remained conservative. In consequence of the resulting dearth of morphological characters and their plasticity, there is a case for using biochemical characters such as exogenous chemicals released by the snails (e.g. amino acids) and their chemoreception niche as taxonomic aids to classify snails of medical importance. As these same chemicals are used by snails to distinguish conspecifics they could also be used as "environmental antibodies" in controlled release formulations (CRF's) designed to remove target snails in a specific, cost-effective and ecologically acceptable manner. The snails, surface-living bacteria, algae and macrophytic plants are considered as co-evolved, interactive modular systems with strong mutualistic elements. Recently, anthropogenic perturbations such as deforestation, and damming of flowing waters, have benefited these modules whereas others such as river canalization, acid deposition, accumulation of pesticide residues and eutrophication have harmed them. Research is needed to elucidate the factors which limit the growth of snails in primitive habitats, uninfluenced by man, as well as in those subject to harmful anthropogenic factors. The understanding thus gained could be applied to develop cost-effective primary health care strategies to reduce or prevent transmission of schistosomiasis and other water related diseases.

Morphometric comparison of Simulium perflavum larvae (Diptera: Simuliidae) in relation to season and gender in Central Amazônia, Brazil

Number of larval instars, age structure and environmental effects on these parameters represent basic information in the study of insect population biology. When species have economic importance, this information is essential in order to choose the best period to apply different control methods and to determine the stages of the life cycle of the insect that are most susceptible to each treatment. The family Simuliidae has many species of medical/veterinary importance in the world, and some studies in the temperate region have suggested that the number of larval instars and the larval size can vary according to the season, gender and some environmental factors, such as temperature and diet. This study, with the zoophilic species Simulium perflavum Roubaud, is the first in the Neotropics observing some of these factors and will serve as a template for other species of medical importance in the region. S. perflavum larvae were collected in five streams in Central Amazônia (Manaus and Presidente Figueiredo counties, State of Amazonas), in Sept./Oct. 1996 (dry season) and Feb./Mar. 1997 (rainy season). These larvae were measured (lateral length of head capsule and width of cephalic apodema) to determine the number of larval instars (n=3985), to compare the larval size between seasons and genders (last and penultimate larval instars, n=200). Seven larval instars were determined for this species using frequency distributions, t-tests and Crosby´s growth rule. Significant differences were not detected (t-test, p>0.05) in larval size between seasons and genders. Our results differ from some found in temperate regions suggesting that in the Neotropical region the larval size in different seasons and different genders remains constant, although some environmental parameters, such as diet, change depending on the season.

In vitro and in vivo activity of meglumine antimoniate produced at Farmanguinhos-Fiocruz, Brazil, against Leishmania (Leishmania) amazonensis, L (L.) chagasi and L (Viannia) braziliensis

The leishmanicidal activity of four batches of meglumine antimoniate, produced in Farmanguinhos-Fiocruz, Brazil (TAMs), was assessed and compared to Glucantime®-Aventis Pharma Ltda. Using the amastigote-like in vitro model, the active concentrations of Sb v varied from 10µg/ml to 300 µg/ml for L. (L.) chagasi and from 50µg/ml to 300µg/ml for L. (L.) amazonensis, with no statistically significant differences among the four batches of TAMs and Glucantime®. The inhibitory concentrations (IC50) determined by the amastigote-infected macrophage model for TAM01/03 and Glucantime® were, respectively: 26.3µg/ml and 127.6µg/ml for L. chagasi, 15.4µg /ml and 22.9µg/ml for L. amazonensis, and 12.1µg/ml and 24.2µg/ml for L. (V.) braziliensis. The activities of the four batches of TAMs were confirmed in an in vivo model by assessing, during eight weeks skin lesions caused by L. braziliensis in hamster that were treated with 20mg Sb v/Kg/day for 30 consecutive days. The meglumine antimoniate produced by Farmanguinhos was as effective as the reference drug, Glucantime®-Aventis, against three species of Leishmania that are of medical importance in Brazil.

Temporal distribution of ten calyptrate dipteran species of medicolegal importance in Rio de Janeiro, Brazil

Brazilian studies involving entomological succession patterns in carcasses have been used to describe the necrophagous entomofauna of a determined municipality or region with forensic objectives. Following the same objectives, an ecological study with 10 calyptrate dipterans was carried out during the winter of 2007 and the summer of 2008 in the metropolitan region of the municipality of Rio de Janeiro. The aim of this study was to describe several aspects of the phenology of these species in three neighbouring areas. Carcasses of three domestic pigs (Sus scrofa L.) were used in each season as models for forensic and legal medicine investigations in the region. Temperature, relative humidity and rainfall were measured daily and their relations with population abundance of the colonising species and the decomposition stages were analysed. Ten fly species were recorded to be colonising the carcasses, five of which belonged to the Calliphoridae family, three to the Muscidae, one to the Fanniidae and one to the Sarcophagidae family. Data show preferences of these species for climatic season and decomposition stage, as well as for the studied area and suggest that short distances can significantly influence the abundance of some species.

Temporal variation of wing geometry in Aedes albopictus

Although native to the tropical and subtropical areas of Southeast Asia, Aedes albopictus is now found on five continents, primarily due to its great capacity to adapt to different environments. This species is considered a secondary vector of dengue virus in several countries. Wing geometric morphometrics is widely used to furnish morphological markers for the characterisation and identification of species of medical importance and for the assessment of population dynamics. In this work, we investigated the metric differentiation of the wings of Ae. albopictus samples collected over a four-year period (2007-2010) in São Paulo, Brazil. Wing size significantly decreased during this period for both sexes and the wing shape also changed over time, with the wing shapes of males showing greater differences after 2008 and those of females differing more after 2009. Given that the wings play sex-specific roles, these findings suggest that the males and females could be affected by differential evolutionary pressures. Consistent with this hypothesis, a sexually dimorphic pattern was detected and quantified: the females were larger than the males (with respect to the mean) and had a distinct wing shape, regardless of allometric effects. In conclusion, wing alterations, particularly those involving shape, are a sensitive indicator of microevolutionary processes in this species.

Insects of forensic importance from Rio Grande do Sul state in southern Brazil

The experiment was conducted throughout the year 2005, at the Universidade Federal de Pelotas campus. The objectives of the study were to analyze the decomposition of rabbit (Oryctolagus cunniculus L.) with mean weight 2.67 Kg carcass and describe the interaction of insects acting on it, as well as the insect's potential use in legal medicine. We collected 5.239 insect specimens; 1.827 of them were obtained from larvae collected from carcasses and reared. The specimens were identified and 20 species were of forensic importance. The species Lucilia eximia (Wiedemann, 1819) and Chrysomya albiceps (Wiedemann, 1819) (Diptera, Calliphoridae) were better indicators of post-mortem interval (PMI) because they occurred in all seasons and were the first to reach the carcass. Hemilucilia semidiaphana (Rondani, 1850), H. segmentaria (Fabricius, 1805) (Diptera, Calliphoridae), Muscina stabulans (Fallén, 1817) and Synthesiomyia nudiseta (Wulp, 1883) (Diptera, Muscidae) can disclose death time because they occur only in certain months of the year. Oxyletrum discicolle (Brullé, 1840) (Coleoptera, Silphidae) and Dermestes maculates De Geer, 1774 (Coleoptera, Desmestidae) were found in advanced stages of decomposition.

Diagnosis and key of the main families and species of South American Coleoptera of forensic importance

The objective of this paper is to provide diagnosis and keys of the families and species, with illustrations of the main groups. A table of all related species recorded from South America is presented, including the substrate in which they were collected and their geographical distribution. The list comprises 221 species included in 15 families, of which 70% of the species are from Brazil. Scarabaeidae is the most diverse family with 121 species, followed by Staphylinidae with 68. Also we provide one database of Coleoptera species associated with carcasses in South America.