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.

Medical conditions and body pain in patients presenting orofacial pain

OBJETIVO: Verificar a frequência de problemas médicos autorrelatados e a frequência de áreas de dor no corpo em pacientes com dor orofacial, comparando-os a pacientes submetidos a tratamento odontológico de rotina. MÉTODOS: Os dados foram coletados dos arquivos da Clínica de Dor Orofacial (Grupo A, n=319) e de clínicas de tratamento odontológico rotineiro (Grupo B, n=84) da Faculdade de Odontologia de Araraquara, São Paulo, Brasil. Os indivíduos responderam a questionários e preencheram um mapa corporal indicando os locais de dor. RESULTADOS: O teste de Mann-Whitney demonstrou que o Grupo A apresentou uma média de relatos de problemas médicos superior ao Grupo B (p=0,004). Para ambos os grupos, o teste de correlação de Pearson demonstrou correlação positiva entre os problemas médicos e a frequência de áreas dolorosas (respectivamente, 0,478, p=0,001 e 0,246, p=0,000). CONCLUSÕES: O Grupo A relatou maior número de problemas médicos e houve correlação positiva entre a frequência desses problemas e a de áreas de dor para ambos os grupos.

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.

Cladophialophora saturnica sp nov., a new opportunistic species of Chaetothyriales revealed using molecular data

While many members of the black yeasts genus Cladophialophora have been reported to cause diseases in humans, understanding of their natural niche is frequently lacking. Some species can be recovered from the natural environment by means of selective isolation techniques. The present study focuses on a Cladophialophora strain that caused an interdigital tinea nigra-like lesion in a HIV-positive Brazilian child. The fungal infection was successfully treated with oxiconazole. Similar strains had been recovered from the environment in Brazil, Uruguay and the Netherlands. The strains were characterized by sequencing the Internal Transcribed Spacer (ITS) regions and the small subunit (SSU) of the nuclear ribosomal RNA gene, as well as the elongation factor 1-alpha (EF1) gene. Since no match with any known species was found, it is described as the new species, Cladophialophora saturnica.

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI), to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >= 60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.

Risk-assessment algorithm and recommendations for venous thromboembolism prophylaxis in medical patients

The risk for venous thromboembolism (VTE) in medical patients is high, but risk assessment is rarely performed because there is not yet a good method to identify candidates for prophylaxis. Purpose: To perform a systematic review about VTE risk factors (RFs) in hospitalized medical patients and generate recommendations (RECs) for prophylaxis that can be implemented into practice. Data sources: A multidisciplinary group of experts from 12 Brazilian Medical Societies searched MEDLINE, Cochrane, and LILACS. Study selection: Two experts independently classified the evidence for each RF by its scientific quality in a standardized manner. A risk-assessment algorithm was created based on the results of the review. Data synthesis: Several VTE RFs have enough evidence to support RECs for prophylaxis in hospitalized medical patients (eg, increasing age, heart failure, and stroke). Other factors are considered adjuncts of risk (eg, varices, obesity, and infections). According to the algorithm, hospitalized medical patients ≥40 years-old with decreased mobility, and ≥1 RFs should receive chemoprophylaxis with heparin, provided they don't have contraindications. High prophylactic doses of unfractionated heparin or low-molecular-weight-heparin must be administered and maintained for 6-14 days. Conclusions: A multidisciplinary group generated evidence-based RECs and an easy-to-use algorithm to facilitate VTE prophylaxis in medical patients. © 2007 Rocha et al, publisher and licensee Dove Medical Press Ltd.

A medical information system to manage a cancer database

Cancer is the second main cause of death in Brazil, and according to statistics disclosed by INCA - National Cancer Institute 466,730 new cases of the disease are forecast for 2008. The storage and analysis of tumour tissues of various types and patients' clinical data, genetic profiles, characteristics of diseases and epidemiological data may provide more precise diagnoses, providing more effective treatments with higher chances for the cure of cancer. In this paper we present a Web system with a client-server architecture, which manages a relational database containing all information relating to the tumour tissue and their location in freezers, patients, medical forms, physicians, users, and others. Furthermore, it is also discussed the software engineering used to developing the system.

Comparison of GEANT4 simulations with experimental data for thick al absorbers

Proton beams in medical applications deal with relatively thick targets like the human head or trunk. Therefore, relatively small differences in the total proton stopping power given, for example, by the different models provided by GEANT4 can lead to significant disagreements in the final proton energy spectra when integrated along lengthy proton trajectories. This work presents proton energy spectra obtained by GEANT4.8.2 simulations using ICRU49, Ziegler1985 and Ziegler2000 models for 19.68MeV protons passing through a number of Al absorbers with various thicknesses. The spectra were compared with the experimental data, with TRIM/SRIM2008 and MCNPX2.4.0 simulations, and with the Payne analytical solution for the transport equation in the Fokker-Plank approximation. It is shown that the MCNPX simulations reasonably reproduce well all experimental spectra. For the relatively thin targets all the methods give practically identical results but this is not the same for the thick absorbers. It should be noted that all the spectra were measured at the proton energies significantly above 2MeV, i.e., in the so-called Bethe-Bloch region. Therefore the observed disagreements in GEANT4 results, simulated with different models, are somewhat unexpected. Further studies are necessary for better understanding and definitive conclusions. © 2009 American Institute of Physics.

Geometric modeling from the medical images in the CAD system to support prosthesis design

This paper presents an individual designing prosthesis for surgical use and proposes a methodology for such design through mathematical extrapolation of data from digital images obtained via tomography of individual patient's bones. Individually tailored prosthesis designed to fit particular patient requirements as accurately as possible should result in more successful reconstruction, enable better planning before surgery and consequently fewer complications during surgery. Fast and accurate design and manufacture of personalized prosthesis for surgical use in bone replacement or reconstruction is potentially feasible through the application and integration of several different existing technologies, which are each at different stages of maturity. Initial case study experiments have been undertaken to validate the research concepts by making dimensional comparisons between a bone and a virtual model produced using the proposed methodology and a future research directions are discussed.

Produção de biofilme em isolados de Candida spp do Hospital das Clínicas de Botucatu, UNESP

Pós-graduação em Biologia Geral e Aplicada - IBB

A NEURAL NET FOR EXTRACTING KNOWLEDGE FROM NATURAL-LANGUAGE DATA-BASES

The present paper introduces a new model of fuzzy neuron, one which increases the computational power of the artificial neuron, turning it also into a symbolic processing device. This model proposes the synapsis to be symbolically and numerically defined, by means of the assignment of tokens to the presynaptic and postsynaptic neurons. The matching or concatenation compatibility between these tokens is used to decided about the possible connections among neurons of a given net. The strength of the compatible synapsis is made dependent on the amount of the available presynaptic and post synaptic tokens. The symbolic and numeric processing capacity of the new fuzzy neuron is used here to build a neural net (JARGON) to disclose the existing knowledge in natural language data bases such as medical files, set of interviews, and reports about engineering operations.

Serological Diagnosis of Paracoccidioidomycosis: High Rate of Inter-laboratorial Variability among Medical Mycology Reference Centers

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

Tests of fed and unfed Amblyomma cajennense ticks (Acari: Ixodidae): first morphological data

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

A flexible lab-on-a-chip for the synthesis and magnetic separation of magnetite decorated with gold nanoparticles

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

Obsessive-compulsive symptoms in medical students: prevalence, severity, and correlates

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