Training on synthetic ethylene-vinyl acetate bench model allows novice medical students to acquire suture skills

PURPOSE: To assess the acquisition of suture skills by training on ethylene-vinyl acetate bench model in novice medical students.METHODS: Sixteen medical students without previous surgery experience (novices) were randomly divided into two groups. During one hour group A trained sutures on ethylene-vinyl acetate (EVA) bench model with feedback of instructors, while group B (control) received a faculty-directed training based on books and instructional videos. All students underwent a both pre-and post-tests to perform two-and three-dimensional sutures on ox tongue. All recorded performances were evaluated by two blinded evaluators, using the Global Rating Scale.RESULTS: Although both groups have had a better performance (p<0.05) in the post-test when compared with the pre-test, the analysis of post-test showed that group A (EVA) had a better performance (p<0.05) when compared with group B (control).CONCLUSION: The ethylene vinyl acetate bench model allowed the novice students to acquire suture skills faster when compared to the traditional model of teaching.

Does bench model fidelity interfere in the acquisition of suture skills by novice medical students?

OBJETIVO: Embora vários modelos de bancada inanimados tenham sido descritos para o treinamento de habilidades de sutura, até o momento, não existe um método ideal para esse ensino e aprendizagem durante a formação médica. O objetivo foi avaliar se a fidelidade dos modelos de bancada interfere na aquisição de habilidades de sutura em estudantes de medicina iniciantes na prática cirúrgica. MÉTODOS: 36 estudantes de medicina sem exposição prévia a habilidades cirúrgicas foram randomizados em três grupos (n = 12): treinamento de suturas baseado em materiais didáticos (controle); treinamento de suturas em modelo de baixa-fidelidade (modelo de bancada de etileno vinil acetato); ou treinamento de suturas em modelo de alta-fidelidade (modelo de bancada de pele de pata de porco). Foram aplicados pré e pós-testes (realização de pontos simples e pontos subdérmicos invertidos em língua de boi). Três ferramentas (Global Rating Scale com avaliação cega, tamanho do efeito e autopercepção da confiança baseada em uma escala de Likert) foram utilizadas para mensurar todas as performances de sutura. RESULTADOS: A análise após o treinamento demonstrou que os estudantes que treinaram nos modelos tiveram um melhor (p < 0.0000) desempenho na avaliação pela Global Rating Scale, quando comparados com o controle, independente da fidelidade do modelo. A magnitude do efeito (treinamento) foi considerada grande (> 0.80) em todas as mensurações. Após o treinamento os alunos sentiram-se mais confiantes (p < 0.0000) para executarem os dois tipos de suturas. CONCLUSÃO: A aquisição de habilidades de suturas no modelo de baixa fidelidade foi semelhante à prática no modelo de alta fidelidade, sendo que a melhora no desempenho dos participantes que treinaram nesses dois modelos foi superior à aprendizagem baseada em materiais didáticos.

Associação entre classe econômica e estresse na ocorrência da disfunção temporomandibular

Objetivou-se neste estudo verificar a associação da classe econômica e do estresse com a ocorrência de disfunção temporomandibular (DTM). A população deste estudo constituiu-se de uma amostra estatisticamente significativa de 354 indivíduos de ambos os sexos, pertencentes a diferentes classes econômicas da zona urbana do município de Piacatu, São Paulo, Brasil. Para isso, utilizou-se o Critério de Classificação Econômica Brasil (CCEB) para a estratificação econômica da população. Retirou-se uma amostra de cada estrato, na qual aplicou-se o Questionário de Fonseca para verificar o grau de DTM, e a Escala de Reajustamento Social (SRRS) para verificar o grau de estresse. Os dados coletados foram tabulados por meio do programa Epi Info 2000, versão 3.2, e analisados estatisticamente por meio do Teste Qui-Quadrado, com nível de significância de 5%. Os chefes das famílias foram assim distribuídos: 4 famílias pertencentes à Classe A2, 14 à Classe B1, 25 à Classe B2, 112 à Classe C, 174 à Classe D e 25 à Classe E. Após a análise estatística não foi observada associação significativa entre classe econômica e disfunção temporomandibular (DTM); entretanto, a mesma ocorreu entre estresse e DTM (p<0,01). A classe econômica não influencia na ocorrência de DTM, mas existe associação direta entre estresse e disfunção temporomandibular.

Cerebellar Cognitive Affective Syndrome in Machado Joseph Disease: Core Clinical Features

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

Depression in patients with Parkinson's disease: Impact on functioning

Depression is a frequently observed neuropsychiatric phenomenon in Parkinson's disease (PD) and it has been lately considered as a manifestation of such disease. The aim of the study was to investigate the relationship between depression and clinical aspects of PD and to assess the impact of the co-occurrence of such condition on the burden imposed by PD. Fifty Outpatients diagnosed with idiopathic PD according to the London Brain Bank criteria were examined. PD was evaluated using Hoehn & Yahr staging (H&Y), United Parkinson's Disease Rating Scale (UPDRS) and Schwab & England (S&E) functional capacity evaluation. A semi-structured clinical interview was used. The diagnosis of PD was made by neurologist experts on movement disorders, and the diagnosis of depression was trade by a psychiatrist, according to the ICD-10 diagnostic criteria. Depressive symptoms were additionally measured using the Montgomery-Asberg Depression Scale. The analysis of quantitative data was performed using descriptive statistics, Univariate linear regression, T-Student Test and ANOVA. Seventeen (34%) patients were diagnosed as clinically depressed and, when compared to the non-depressed ones, presented the following results: H&Y: 3.2 vs. 2.8; UPDRS total: 75.7 vs. 65.3; S&E: 53.5% vs. 65.8% and PD duration: 114.4 months vs. 125.8 months. Depressed patients showed more advanced staging (H&Y), a more severe global clinical condition (UPDRS) and also a greater decrease in their functional capacity (S&E). These data reinforce the hypothesis that depression is associated to poorer functioning in patients with PD. (C) 2008 Elsevier B.V All rights reserved.

Serum homocysteine and physical exercise in patients with Parkinson's disease

Background: Hyperhomocysteinemia is a major risk factor for cerebral and peripheral vascular diseases, as well as cortical and hippocampal injury, including an increased risk of dementia and cognitive impairment. Elevated serum homocysteine (Hcy) concentrations are common in patients with Parkinson's disease (PD) who have been treated with levodopa; however, physical exercises can help reduce Hcy concentrations. The aim of the present study was to compare serum Hcy levels in patients with PD who partook in regular physical exercises, sedentary PD patients, and healthy controls.Methods: Sixty individuals were enrolled in the present study across three groups: (i) 17 patients who did not partake of any type of exercise; (ii) 24 PD patients who exercised regularly; and (iii) 19 healthy individuals who did not exercise regularly. All participants were evaluated by Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS) and Schwab and England scale (measure daily functionality). The serum levels of Hcy were analyzed by blood samples collected of each participant. An analysis of variance and a Tukey's post hoc test were applied to compare and to verify differences between groups. Pearson's correlation and stepwise multiple regression analyses were used to consider the association between several variables.Results: Mean plasma Hcy concentrations in individuals who exercised regularly were similar to those in the healthy controls and significantly lower than those in the group that did not exercise at all (P = 0.000). In addition, patients who did not exercise were receiving significantly higher doses of levodopa than those patients who exercised regularly (P = 0.001). A positive relationship between levodopa dose and Hcy concentrations (R(2) = 0.27; P = 0.03) was observed in patients who did not exercise, but not in those patients who exercised regularly (R(2) = 0.023; P = 0.15).Conclusions: The results of the present study suggest that, even with regular levodopa therapy, Hcy concentrations in PD patients who exercise regularly are significantly lower than in patients who do not exercise and are similar Hcy concentrations in healthy controls.

The Use of Etoricoxib and Celecoxib for Pain Prevention After Periodontal Surgery: A Double-Masked, Parallel-Group, Placebo-Controlled, Randomized Clinical Trial

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Effect of intraperitoneal or incisional bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs

Objective To compare the effect of intraperitoneal (IP) or incisional (INC) bupivacaine on pain and the analgesic requirement after ovariohysterectomy in dogs.Study design Prospective, randomized clinical study.Animals Thirty female dogs undergoing ovariohysterectomy (OHE).Methods Dogs admitted for elective OHE were anesthetized with acepromazine, butorphanol, thiopental and halothane. Animals were randomly assigned to one of three groups (n = 10 per group). The treatments consisted of preincisional infiltration with saline solution (NaCl 0.9%) or bupivacaine with epinephrine and/or IP administration of the same solutions, as follows: INC and IP 0.9% NaCl (control group); INC 0.9% NaCl and IP bupivacaine (5 mg kg(-1), IP group); INC bupivacaine (1 mg kg(-1)) and IP 0.9% NaCl (INC group). Postoperative pain was evaluated by a blinded observer for 24 hours after extubation by means of a visual analog scale (VAS) and a numeric rating scale (NRS). Rescue analgesia (morphine, 0.5 mg kg(-1), IM) was administered if the VAS was > 5/10 or the NRS > 10/29.Results At 1 hour after anesthesia, VAS pain scores were [medians (interquartile range)]: 6.4 (3.1-7.9), 0.3 (0.0-2.6) and 0.0 (0.0-7.0) in control, IP and INC groups, respectively. VAS pain scores were lower in the IP compared to the control group. Over the first 24 hours, rescue analgesia was administered to 7/10, 5/10 and 3/10 dogs of the control, INC and IP groups, respectively. Total number of dogs given rescue analgesia over the first 24 hours did not differ significantly among groups.Conclusions and clinical relevance Intraperitoneal bupivacaine resulted in lower pain scores during the first hour of the postoperative period and there was a trend towards a decreased need for rescue analgesia after OHE in dogs.

Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Preliminary core sets of measures for disease activity and damage assessment in juvenile systemic lupus erythematosus and juvenile dermatomyositis

Objective. To identify preliminary core sets of outcome variables for disease activity and damage assessment in juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). Methods. Two questionnaire surveys were mailed to 267 physicians from 46 different countries asking each member to select and rank the response variables used when assessing clinical response in patients with JSLE or JDM. Next, 40 paediatric rheumatologists from 34 countries met and, using the nominal group technique, selected the domains to be included in the disease activity and damage core sets for JSLE and JDM. Results. A total of 41 response variables for JSLE and 37 response variables for JDM were selected and ranked through the questionnaire surveys. In the consensus conference, domains selected for both JSLE and JDM activity or damage core sets included the physician and parent/patient subjective assessments and a global score tool. Domains specific for JSLE activity were the immunological tests and the kidney function parameters. Concerning JDM, functional ability and muscle strength assessments were indicated for both activity and damage core sets, whereas serum muscle enzymes were included only in the activity core set. A specific paediatric domain called 'growth and development' was introduced in the disease damage core set for both diseases and the evaluation of health-related quality of life was advised in order to capture the influence of the disease on the patient lifestyle. Conclusions. We developed preliminary core sets of measures for disease activity and damage assessment in JSLE and JDM. The prospective validation of the core sets is in progress.

Euclidean 4d exact solitons in a Skyrme type model

We introduce a Skyrme type, four-dimensional Euclidean field theory made of a triplet of scalar fields n→, taking values on the sphere S2, and an additional real scalar field φ, which is dynamical only on a three-dimensional surface embedded in R4. Using a special ansatz we reduce the 4d non-linear equations of motion into linear ordinary differential equations, which lead to the construction of an infinite number of exact soliton solutions with vanishing Euclidean action. The theory possesses a mass scale which fixes the size of the solitons in way which differs from Derrick's scaling arguments. The model may be relevant to the study of the low energy limit of pure SU(2) Yang-Mills theory. © 2004 Elsevier B.V. All rights reserved.

Efficacy of hormone therapy with and without methyltestosterone augmentation of venlafaxine in the treatment of postmenopausal depression: A double-blind controlled pilot study

Objective: This study evaluated the augmentation of venlafaxine with hormone therapy in the treatment of postmenopausal depression. The hormones evaluated were estrogen (0.625 mg) in combination with medroxyprogesterone acetate (2.5 mg) and methyltestosterone (2.5 mg). Design: Seventy-two menopausal women (mean age: 53.6 ± 4.27 years) diagnosed with depression (Montgomery-Åsberg Depression Rating Scale [MADRS] scores ≥ 20) were treated with venlafaxine and one of the following hormone therapy combinations, in a double-blind regimen: estrogen + medroxyprogesterone + methyltestosterone (group 1, n = 20); estrogen + medroxyprogesterone acetate (group 2, n = 20); methyltestosterone only (group 3, n = 16); and no hormone therapy (group 4, n = 16). Study duration was 24 weeks. Primary efficacy outcome was remission according to the MADRS, whereas secondary efficacy measures included the Clinical Global Impression (CGI), Blatt-Kupperman Index, and Women's Health Questionnaire (WHQ). Results: Forty-eight patients completed the study. All groups showed significant improvement from baseline. Group 3 demonstrated significant improvement on the MADRS compared with placebo (group 4) at weeks 20 (P = 0.048) and 24 (P = 0.030); effect size 8.04 (0.83; 15.26) (P = 0.029), but also had the highest dropout rate. Groups 1 and 3 had significant CGI improvement rates compared with placebo: 42.23% (P = 0.012) and 44.45% (P = 0.08), respectively. There were no differences in the WHQ or BKI scores among the groups. Conclusions: Methyltestosterone 2.5 mg had the highest effect size compared with placebo, but the high dropout rate prevented its efficacy from being determined. Estrogen plus medroxyprogesterone, combined with methyltestosterone or otherwise, demonstrated a trend toward increased efficacy of venlafaxine. Further larger-scale clinical trials are needed to elucidate the findings of this pilot study. © 2006 by The North American Menopause Society.

Assessment of health-related quality of life in children with functional defecation disorders

Objective: To evaluate the health-related quality of life in children with functional defecation disorders. Methods: One hundred children seen consecutively were enrolled and subdivided into three subsets according to the Roma II classification criteria: functional constipation (n = 57), functional fecal retention (n = 29) and nonretentive functional soiling (n = 14). The generic instrument Child Health Questionnaire - Parent Form 50 (CHQ-PF50®), was used to measure quality of life and to assess the impact of these disorders from the point of view of parents. The instrument measures physical and psychosocial wellbeing in 15 health domains, each of which is graded on a scale from 0 to 100, with higher values indicating better health and greater wellbeing. Ten of these are then used to obtain two aggregated and summary scores: the physical and psychosocial scores. Results: No statistically significant differences were detected between subsets in terms of demographic or anthropometric characteristics. In 14 domains, children with defecation disorders scored lower than healthy children. When subsets were compared, statistically significant differences were detected between children with nonretentive functional soiling (lower scores) and those with functional constipation. Physical and psychosocial scores for the entire sample were lower than those for the group of healthy children used as controls. Conclusions: The CHQ-PF50® was considered adequate for demonstrating compromised quality of life in children with functional defecation disorders, as has been reported for other diseases, being a useful tool for making treatment decisions and for patient follow-up. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Sertralina no tratamento de pacientes com depressão maior leve e moderada: Estudo multicêntrico brasileiro

Introduction: To evaluate the efficacy, safety, and tolerability of sertraline for the treatment of Brazilian patients with mild to moderate major depression. Patients and methods: Patients were 18 years old or older treated on an out-patient basis. Previous medications were stopped for a 2-week washout period. Afterwards, patients received sertraline, initial dose of 50 mg/day up to the 4 th week. The dose could then be increased up to 200 mg/day according to the efficacy and tolerability. Therapeutic efficacy was evaluated with the Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton scale for depression (HAM-D), and Clinical Global Impression (CGI). Results: 51 patients (42 women) were evaluated regarding efficacy and safety. Treatment with sertraline significantly decreased scores of MADRS, HAM-D e ICGfrom 15.7 ± 6.1; 12.2 ± 3.9 e 3.5 ± 0.6 to 6.2 ± 6.5; 5.4 ± 4.7 e 2.3 ± 1.0 (P < 0.0001), respectively. Sertraline was well tolerated. Gastro-intestinal upset (N=14; 24.6%), headache (N=7; 12.3%), sleep alterations (H-7; 12.3%), dizziness (N-4; 7.0%), and anorexia (N=4; 7.0%) were the most common adverse events. Six patients discontinued the treatment due to adverse events. Conclusion: Sertraline is efficient and presents a favorable safety and tolerability profile for the treatment of Brazilian patients with mild to moderate major depression. © Copyright Moreira Jr. Editora.

Early impairment of cognitive functions in Parkinson's disease

Background: Impairment in non-motor functions such as disturbances of some executive functions are also common events in Parkinson's disease patients. Objective: To verify the performance of Parkinson's disease patients in activities requiring visuoconstructive and visuospatial skills. Method: Thirty elderly patients with mild or moderate stages of Parkinson's disease were studied. The assessment of the clinical condition was based on the unified Parkinson's disease rating scale (56.28; SD=33.48), Hoehn and Yahr (2.2; SD=0.83), Schwab and England (78.93%), clock drawing test (7.36; SD=2.51), and mini-mental state examination (26.48; SD=10.11). Pearson's correlation and stepwise multiple regression were used for statistical analyses. Results: The patients presented deterioration in visuospatial and visuoconstructive skills. Conclusion: The clock drawing test proved to be a useful predictive tool for identifying early cognitive impairment in these individuals.