O ensino de habilidades e atitudes: um relato de experiências

Este artigo relata a experiência do ensino de Habilidades e Atitudes, na graduação em Medicina da Universidade Estadual de Londrina (UEL) com a metodologia de ensino da Aprendizagem Baseada em Problemas, ancorada no modelo biopsicossocial. O ensino de Habilidades e Atitudes implica a formulação diagnóstica mutiaxial, descrição contextual e padronizada da condição clínica. Utiliza como instrumento a avaliação sistemática de eixos e domínios altamente informativos e relevantes para o tratamento. Eixo I: transtornos clínicos (mentais e condições médicas gerais); Eixo II: incapacidades nos cuidados pessoais, funcionamento ocupacional e com a família, e funcionamento social mais amplo; Eixo III: fatores contextuais (problemas interpessoais e outros psicossociais e ambientais); Eixo IV: qualidade de vida (refletindo primariamente as percepções do próprio paciente). A competência clínica foi avaliada por meio da discussão de casos clínicos, portfólios reflexivos e pelo Exame Clínico Estruturado por Objetivo (Osce), método que avalia as habilidades clínicas, as habilidades de atitudes e a comunicação dos estudantes de Medicina.

Carbon sequestration and nutrient reserves under differen t land use systems

This study evaluated the contribution of agroforestry (AFS) and traditional systems to carbon sequestration and nutrient reserves in plants, litter and soil. The study was carried out in the semiarid region of Brazil in a long-term experiment on an experimental farm of the goat and sheep section of the Brazilian Agricultural Research Corporation (Embrapa). Two agroforestry systems were investigated: agrosilvopastoral (ASP) and forest-pasture areas (SP) as well as traditional agriculture management (TM), two areas left fallow after TM (six fallow years - F6 and nine fallow years - F9) and one area of preserved Caatinga vegetation (CAT). Soil, litter and plants were sampled from all areas and the contents of C, N, P, K, Ca and Mg per compartment determined. The AFS (ASP and SP) had higher nutrient stocks than the traditional and intermediate stocks compared to the preserved Caatinga. In the ASP, a relevant part of the nutrients extracted by crops is returned to the system by constant inputs of litter, weeding of herbaceous vegetation and cutting of the legume crops. After fallow periods of six and nine years, carbon and nutrient stocks in the compartments soil, litter and herbaceous plants were similar to those of the preserved Caatinga (CAT), but still lower than under natural conditions in the woody vegetation.

Tekijännimet Mikael Agricolan teosten kielessä. Henkilötarkoitteisten johdosten merkitykset, funktiot ja rakenteet

My research deals with agent nouns in the language of the works of Mikael Agricola (ca. 1510–1557). The main tasks addressed in my thesis have been to describe individual agent noun types, to provide a comprehensive picture of the category of agent nouns and to clarify the relations between different types of agent nouns. My research material consists of all the agent nouns referring to persons in the language of Agricola’s works, together with their context. The language studied is for the most part translated language. Agent nouns play an important role both in the vocabulary of natural language and in broader sentence structures, since in a text it is constantly necessary to refer to actors re-ferring to persons in the text. As a concept and a phenomenon, the agent noun is widely known in languages. It is a word formed with a certain derivational affixes, which typical-ly refers to a person. In my research the agent noun category includes both deverbal and denominal derivatives referring to persons, e.g. kirjoittaa > kirjoittaja (to write > writer), asua > asuva (to inhabit > inhabitant), imeä > imeväinen (to suck > suckling), juopua > juopunut (to drink > drunkard), pelätä > pelkuri (to fear > one who fears ‘a coward’), apu > apulainen (help/to help > helper); lammas > lampuri (sheep > shepherd). Besides original Finnish expressions, agent noun derivatives taken as such from foreign languages form a word group of central importance for the research (e.g. nikkari, porvari, ryöväri, based on the German/Swedish for carpenter, burgher, robber). Especially important for the formation of agent nouns in Finnish are the models offered by foreign languages. The starting point for my work is predominantly semantic, as both the criteria for collecting the material and the categorisation underlying the analysis of the material are based on semantic criteria. When examining derivatives, aspects relating to structure are also inevitably of central importance, as form and meaning are closely associated with each other in this type of vocabulary. The alliance of structure and meaning can be described in an illustrative manner with the help of structural schemata. The examination of agent nouns comprises on the one hand analysis of syntactic elements and on the other, study of cultural words in their most typical form. The latter aspect offers a research object in which language and the extralinguistic world, referents, their designations and cultural-historical reality are in concrete terms one and the same. Thus both the agent noun types that follow the word formation principles of the Finn-ish language and those of foreign origin borrowed as a whole into Finnish illustrate very well how an expression of a certain origin and formed according to a certain structural model is inseparably bound up with the background of its referent and in general with semantic factors. This becomes evident both on the level of the connection between cer-tain linguistic features and text genre and in relation to cultural words referring to per-sons. For example, the model for the designations of God based on agent nouns goes back thousands of years and is still closely linked in 16th century literature with certain text genres. This brings out the link between the linguistic feature and the genre in a very con-crete manner. A good example of the connection between language and the extralinguistic world is provided by the cultural vocabulary referring to persons. Originally Finnish agent noun derivatives are associated with an agrarian society, while the vocabulary relat-ing to mediaeval urbanisation, the Hansa trade and specialisation by trade or profession is borrowed and originates in its entirety from vocabulary that was originally German.

Prevalência de infecção por Chlamydia trachomatis em mulheres candidatas à fertilização in vitro em serviço público de referência do Estado de São Paulo

OBJETIVO: Avaliar a prevalência de infecção por Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG) em mulheres candidatas ao tratamento tópico e de fertilização in vitro (FIV) em serviço público de referência da Região Sudeste do Brasil. MÉTODOS: Mulheres que tiveram indicação de FIV, no período de 1º de abril de 2008 a 31 de outubro de 2009, foram admitidas sequencialmente no estudo. Foi aplicado um questionário sobre antecedentes ginecológicos e obstétricos e coletada amostra de swab endocervical para pesquisa de CT e NG através de captura híbrida e PCR. As variáveis estudadas foram: faixa etária, cor, escolaridade, tempo de infertilidade, número de gestações e filhos vivos, antecedentes de aborto, gestação ectópica, número de parceiros, Doença Inflamatória Pélvica (DIP), cirurgia pélvica, manipulação de cavidade uterina, tabagismo e uso de drogas ilícitas. As mulheres foram distribuídas segundo presença ou não de infecção por clamídia e a análise foi descritiva. RESULTADOS: Entre as 176 mulheres estudadas a prevalência de infecção por CT foi de 1,1%, não houve infecção por NG. Dois terços das mulheres tinham idade >30 anos, escolaridade >8 anos, <5 anos de infertilidade e 56,2% não tinham filhos. Os principais antecedentes foram cirurgia pélvica (77,8%), manipulação de cavidade uterina (62,5%) e DIP (27,8%). O fator tubário foi o mais prevalente, em 129 mulheres (73,3%), 37,5% com e 35,8% sem laqueadura, os demais fatores tiveram prevalência <30%. CONCLUSÕES: As infecções por CT e NG tiveram baixa prevalência na amostra estudada e são necessários estudos em outros centros do país para confirmar a prevalência de infecções nesse grupo particular de mulheres inférteis.

Anthrax in cattle in southern Brazil: 1978-2006

Ten outbreaks of anthrax occurred in cattle from 1978 to 2006 in southern Brazil, in 5 municipalities on the border with Uruguay, a country where the disease is frequent. The 10 outbreaks represented 0.2% of all bovine specimens received during the period by the Regional Diagnostic Laboratory of the Federal University of Pelotas, causing 267 deaths in a risk population of 6,605 head. The disease affected young and adult cattle mainly during summer. Only one farmer reported that sheep and horses were also affected. Clinically the peracute form was more frequent, but in some outbreaks the acute form with a clinical manifestation period of 6-48 hours was also observed. The source of infection was not established; but the reduced rainfall, associated with low, flat, flooded lands used for agriculture followed by animal grazing after harvest was probably related to the disease occurrence. Annual vaccination is an efficient way to prevent the disease.

Acute and chronic nervous signs in cattle associated with Phalaris angusta poisoning in Argentina

Phalaris angusta is a South American natural grass that produces poisoning in sheep and cattle in Argentina and Brazil. Phalaris spp. can produce unrelated forms of poisoning in ruminants, acute and chronic syndromes. The objective of this paper was to describe an outbreak of acute and chronic Phalaris nervous syndrome in 53 of 980 fattening steers and heifers in a farm of Buenos Aires province. On September of 2006 the animals developed nervous signs and died after 3-5 days. The herd was removed to a phalarisfree pasture. Three months later (on December) 15 new clinical cases developed in the herd. Necropsy performed in one affected calf showed neither grossly nor microscopic changes. Microscopically, there were no major alterations in tissues. Nervous signs had been described in some field cases where neither pigment deposition nor axonal degeneration could be detected. Clinical findings displayed by affected cattle after consumption of Phalaris angusta pastures resemble those observed by other authors in Phalaris staggers. This is the first report in Argentina where both syndromes were seen in the same herd.

Development of IgY antibodies in chickens and IgG in rabbits immunized against proteins of Pythium insidiosum isolated from horses in the state of Rio de Janeiro

Pythiosis is caused by Pythium insidiosum and the occurrence of disease in horses was described in the North and Northwest State of Rio de Janeiro, Brazil. The disease was described in cattle, sheep, humans, and horses in different states and regions across the country. This paper describes the development of IgY and IgG polyclonal antibodies, in chicken and rabbits, respectively against proteins extracted from kunkers and hyphae of P. insidiosum from affected horses. The proteins were recognized by chicken, rabbit and horse antibodies by immunodiffusion and Western blot against majority bands of 27 and 43 KDa, and titrated by ELISA. The antibodies IgY developed by the first time against Brazilian strains of P. insidiosum may represent a valuable tool in the detection of antigens of the pathogen and contribute to further studies aimed at immunotherapy and knowledge about this disease in endemic areas in Rio de Janeiro and in Brazil.

Brachiaria spp. poisoning of ruminants in Brazil

Brachiaria species are the most important grasses for cattle production in Brazil. However, a limiting factor for the use of Brachiaria spp. is their toxicity. Most outbreaks of hepatogenous photosensitization are caused by B. decumbens; however B. brizantha, B. humidicola and B. ruziziensis can also cause poisoning. The poisoning affects cattle, sheep, goats and buffalo. Sheep are more susceptible than other animal species and the young are more susceptible than adults. There are differences in susceptibility among animals of the same species and it has been suggested that this resistance is genetic. Also has been suggested that buffalo and probably some sheep are resilient, i.e. when poisoned these animals have histologic lesions and high GGT serum concentrations, but do not show clinical signs. In general, saponin concentrations are higher in growing plants, but outbreaks occur all over the year, probably due to unexplained rise in saponin concentration in the plant. A clinical syndrome of progressive weight loss and death, without photosensitization, has been reported in cattle poisoned by B. decumbens. Main preventive measures are based on the selection of resistant or resilient animals and on the development of Brachiaria species or varieties with low saponin concentration.

Effects of zearalenone in prepubertal gilts

Prepubertal gilts were fed with a diet containing zearalenone (ZEA) in a concentration of 0.75 mg/kg for 21 days. The effects of this mycotoxin on morphologic aspects of the reproductive tract as well as on complete blood count (CBC), serum biochemistry analysis (SBA) and humoral immune response against sheep red blood cells (SRBC) were evaluated. There was a significant increase (P<0.05) on the reproductive tract weight, vulvar area, height of the epithelial cells of endometrial glands and uterine mucosa. These results showed the ability of this nonsteroidal mycotoxin in mimicking actions of 17β estradiol at the concentration of 0.75mg/kg. No changes in weight gain, CBC, SBA parameters and humoral response against SRBC were observed.

Weak phenotypic reversion of ivermectin resistance in a field resistant isolate of Haemonchus contortus by verapamil

Recent advances in anthelmintic resistant phenotype reversion by Pgp modulating drugs in ruminant nematodes indicate that this can be a useful tool to helminth control. The aim of the present study was to evaluate the efficacy of ivermectin (IVM) in combination with verapamil (VRP), in oil or water-based vehicle, against an IVM-resistant field isolate of Haemonchus contortus through a larval migration assay and experimental infection trial. In the in vitro assay was observed a phenotypic reversion of H. contortus resistance to ivermectin at a high concentration of VRP, increasing IVM efficacy from 53.1% to 94.3. In the in vivo trial, IVM + VRP demonstrated 36.02% efficacy compared to the 7.75% of IVM alone. The vehicle formulation showed no influence in efficacy. These are the first results demonstrating the effect of VRP as a partial IVM-resistance phenotype reverser in a field isolate of IVM-resistant H. contortus experimentally inoculated in sheep.

Pythium insidiosum: morphological and molecular identification of Brazilian isolates

Pythium insidiosum is an oomycete belonging to the kingdom Stramenipila and it is the etiologic agent of pythiosis. Pythiosis is a life-threatening infectious disease characterized by the development of chronic lesions on cutaneous and subcutaneous, intestinal, and bone tissues in humans and many species of animals. The identification of P. insidiosum is important in order to implement a rapid and definitive diagnosis and an effective treatment. This study reports the identification of 54 isolates of P. insidiosum of horses, dogs and sheep that presented suspicious clinical lesions of pythiosis from different regions in Brazil, by using morphological and molecular assays. Throughout the PCR it was possible to confirm the identity of all Brazilian isolates as being P. insidiosum.

Perreyia flavipes larvae toxicity

Fresh or thawed Perreyia flavipes larvae were ground and mixed with water and orally ad ministered to sheep. At 5mg/kg, neither clinical nor enzymatic changes were observed. Unique do ses of 7.5 and 10mg/kg induced characteristic clinical signs of Perreyia sp. larvae poisoning, increased GGT and AST values, and decreased glycemic curves. However, doses of 5, 10, and 15mg/kg repeated at 30 or 15 days intervals caused no disease and mild disease followed by death, respectively. These fin dings indicate that these animals probably developed some degree of tolerance to the toxins in P. flavipes larvae. Ultrastru ctural examination of liver revealed proliferation of the smooth endoplasmic reticulum in the hepatocytes, which may be associated with an increased ability to metabolize toxins and could consequently lead to the tolerance observed in the present study. Further investigations may elucidate whether such tolerance effects could be applied as a control measure for P. flavipes poioning or other hepatotoxic diseases. In addition, clinicopathological findings were discussed.

Antimicrobial resistance of Staphylococcus spp. from small ruminant mastitis in Brazil

The study aimed to determine the antimicrobial resistance patterns and to identify molecular resistance markers in Staphylococcus spp. (n=210) isolated from small ruminant mastitis in Brazil. The antimicrobial resistance patterns were evaluated by the disk diffusion test and by detection of the presence of mecA, blaZ, ermA, ermB, ermC and msrA genes by PCR. The efflux pump test was performed using ethidium bromide and biofilm production was determined by Congo red agar test along with PCR for detection of the icaD gene. The isolates were most resistant to amoxicillin (50.0%), streptomycin (42.8%), tetracycline (40.4%), lincomycin (39.0%) and erythromycin (33.8%). Pan-susceptibility to all tested drugs was observed in 71 (33.8%) isolates and 41 Staphylococcus isolates were positive for the efflux pump. Although phenotypic resistance to oxacillin was observed in 12.8% of the isolates, none harbored the mecA gene. However, 45.7% of the isolates harbored blaZ indicating that beta-lactamase production was the main mechanism associated with staphylococci resistance to beta-lactams in the present study. The other determinants of resistance to antimicrobial agents ermA, ermB, ermC, and msrA were observed in 1.4%, 10.4%, 16.2%, and 0.9% of the isolates, respectively. In addition, the icaD gen was detected in 32.9% of the isolates. Seventy three isolates (54 from goats and 19 from sheep) were negative for all resistance genes tested and 69 isolates presented two or more resistance genes. Association among blaZ, ermA, ermB, ermC and efflux pump were observed in 17 isolates, 14 of which originated from goats and three from sheep. The data obtained in this study show the resistance of the isolates to beta-lactamics, which may be associated with the use of antimicrobial drugs without veterinary control.

Molecular confirmation of ovine herpesvirus 2-induced malignant catarrhal fever lesions in cattle from Rio Grande do Norte, Brazil

Molecular findings that confirmed the participation of ovine herpesvirus 2 (OVH-2) in the lesions that were consistent with those observed in malignant catarrhal fever of cattle are described. Three mixed-breed cattle from Rio Grande do Norte state demonstrated clinical manifestations that included mucopurulent nasal discharge, corneal opacity and motor incoordination. Routine necropsy examination demonstrated ulcerations and hemorrhage of the oral cavity, corneal opacity, and lymph node enlargement. Significant histopathological findings included widespread necrotizing vasculitis, non-suppurative meningoencephalitis, lymphocytic interstitial nephritis and hepatitis, and thrombosis. PCR assay performed on DNA extracted from kidney and mesenteric lymph node of one animal amplified a product of 423 base pairs corresponding to a target sequence within the ovine herpesvirus 2 (OVH-2) tegument protein gene. Direct sequencing of the PCR products, from extracted DNA of the kidney and mesenteric lymph node of one cow, amplified the partial nucleotide sequences (423 base pairs) of OVH-2 tegument protein gene. Blast analysis confirmed that these sequences have 98-100% identity with similar OVH-2 sequences deposited in GenBank. Phylogenetic analyses, based on the deduced amino acid sequences, demonstrated that the strain of OVH-2 circulating in ruminants from the Brazilian states of Rio Grande do Norte and Minas Gerais are similar to that identified in other geographical locations. These findings confirmed the active participation of OVH-2 in the classical manifestations of sheep associated malignant catarrhal fever.

Evaluation of resistance in a selected field strain of Haemonchus contortus to ivermectin and moxidectin using the Larval Migration on Agar Test

Haemonchus contortus is one of the most common and economically significant causes of disease in small ruminants worldwide, and the control programs of parasitic nematodes - including H. contortus - rely mostly on the use of anthelmintic drugs. The consequence of the use of this, as the sole sanitary strategy to avoid parasite infections, was the reduction of the efficacy of all chemotherapeutic products with a heavy selection for resistance. The widespread of anthelmintic resistance and the difficulty of its early diagnosis has been a major concern for the sustainable parasite management on farms. The objective of this research was to determine and compare the ivermectin (IVM) and moxidectin (MOX) effect in a selected field strain of H. contortus with a known resistance status, using the in vitro larval migration on agar test (LMAT). Third stage larvae of the selected isolate were obtained from faecal cultures of experimentally infected sheep and incubated in eleven increasing diluted concentrations of IVM and MOX (6, 12, 24, 48, 96, 192, 384, 768, 1536, 3072 and 6144µg/mL). The dose-response sigmoidal curves were obtained using the R² value of >0.90 and the lethal concentration (LC50) dose for the tested anthelmintic drugs using a four-parameter logistic model. The LC50 value for MOX was significantly lower than IVM (1.253µg/mL and 91.06µg/mL), identifying the H. contortus isolate as considerably less susceptible to IVM compared to MOX. Furthermore, the LMAT showed a high consistency (p<0.0001) and provided to be a useful diagnostic tool for monitoring the resistance status of IVM and MOX in H. contortus field isolate, as well as it may be used for official routine drug monitoring programs under the Ministry of Agriculture (MAPA) guidance.