Tromboflebite séptica de seio cavernoso com espessamento meníngeo de base de crânio / Cavernous sinus septic thrombophlebitis with skull base meningitis

O seio cavernoso é um sítio frequente de ocorrência de trombose séptica, frequentemente secundária a infecções de seios da face, órbitas, tonsilas, palato, dentes, seios esfenoidal e etmoidal. Este artigo relata o caso de uma paciente de 25 anos com sinusopatia que evoluiu com complicações após um mês apresentando anisocoria, ptose palpebral incompleta à direita, paralisia do olhar horizontal, paralisia facial central, queda de véu palatino, ausência de reflexo nauseoso à direita e desvio de língua para esquerda. Realizou exame de imagem que identificou acometimento de seio cavernoso e espessamento meníngeo adjacente. A tromboflebite do seio cavernoso (TSC) comumente afeta os nervos cranianos que o cruzam, constituindo-se em uma complicação incomum de infecções de pele, órbitas ou seios da face. A singularidade deste caso esteve na dificuldade de tratamento, no acometimento contínuo das meninges da base de crânio e, consequentemente, dos nervos cranianos dessa topografia (VII, IX e XII). O tratamento com anticoagulantes não é consenso na literatura, devido a complicações hemorrágicas que podem ocorrer no sítio do trombo. A importância do tratamento adequado e precoce das infecções dos seios esfenoidal e etmoidal, além de infecções de face, nariz, tonsilas, dentes e ouvidos evita disseminação bacteriana e complicações, como as descritas neste caso

The cavernous sinus is a rare site of septic thrombosis. It is associated with significant morbidity or mortality and is often related to local infection of the paranasal sinuses, orbits, tonsils, palate and teeth. This article presents a 25-year-old woman presented to our clinic with a history of anisocoria, right incomplete ptosis, horizontal gaze palsy, central facial palsy, right absence of garg reflex and left tongue deviation. Further work up with cranial magnetic resonance imaging revealed a meningeal enhancement at the skull base and signal alteration at the cavernous sinus suggestive of septic thrombosis. Cavernous sinus thrombophlebitis is a complication of skin, orbits or sinuses infections that typically causes cranial nerve palsies. We would like to emphasize that meningeal involvement at skull base can complicate the clinical course especially when there is involvement of multiple cranial nerves. Anticoagulation theraphy is not a consensus in the literature due to the risk of hemorrhagic complications that may occur on the site of the thrombus. The adequate and early treatment of infections of the sphenoid and ethmoidal sinuses, infections of nose, tonsils, teeth and ears can avoid bacterial disseminations and prevents complications, as described in this case.

[Ethical Attitudes of Brazilian Medical Students and Graduates with Active Methodologies.] / Actitudes Éticas de los estudiantes y egresados en carrera de medicina con metodologías activas.

The objective of this study was to conduct a diagnosis of the comprehensive inclusion of ethics in Brazilian medical training with a problem-based learning methodology and to describe students' and graduates' perceptions of ethical attitudes. The methodological design was a descriptive and documental case study with a qualitative and quantitative approach. The sample consisted of 20 students per course year, totaling 120 students and 40 alumni from two graduating classes at the ESCS School of Medicine. The project was approved by the Institutional Review Board of the State Health Secretariat, Federal District, Brazil. ESCS students and graduates showed that they approach ethical conflicts and respect for patients. However, an analysis of ethical sensitivity revealed weak perceptions and inappropriate attitudes by medical students, especially in the early years of medical school, requiring more systematic discussions on ethical and bioethical aspects integrated with practical activities, in order to increase and strengthen ethical reflection by students.

Actitudes Éticas de los estudiantes y egresados en carrera de medicina con metodologías activas / Ethical attitudes of Brazilian medical students and graduates with active methodologies

El presente estudio tiene por objeto desarrollar un diagnostico de la inserción integrada de la ética en la carrera demedicina brasileña con una metodología de aprendizaje basada en problemas y describir las percepciones de actitudes éticas de los estudiantes y egresados. El diseño metodológico es un estudio de caso, descriptivo y documental, con abordaje cualitativo y cuantitativo. La muestra de esta investigación ha sido constituida por 120 estudiantes y 40 egresados de dos promociones del Curso de Medicina de la ESCS. Este proyecto fue aprobado por el Comité de Ética en Investigación - SES/DF. Los estudiantes y egresados de la ESCS demostraron un buen manejo en el abordaje de los conflictos éticos y respeto a los pacientes. Sin embargo, el análisis de sensibilidad ética mostró una fragilidad en las percepciones y aptitudes inapropiadas de los estudiantes de la carrera de medicina, identificada básicamente en los años iniciales, que necesitan más discusiones sistematizadas sobre los aspectos éticos y bioéticos integrados a las actividades prácticas para estimular y fortalecer la reflexión ética de los estudiantes.

The objective of this study was to conduct a diagnosis of the comprehensive inclusion of ethics in Brazilian medical training with a problem-based learning methodology and to describe students' and graduates' perceptions of ethical attitudes. The methodological design was a descriptive and documental case study with a qualitative and quantitative approach. The sample consisted of 20 students per course year, totaling 120 students and 40 alumni from two graduating classes at the ESCS School of Medicine. The project was approved by the Institutional Review Board of the State Health Secretariat, Federal District, Brazil. ESCS students and graduates showed that they approach ethical conflicts and respect for patients. However, an analysis of ethical sensitivity revealed weak perceptions and inappropriate attitudes bymedical students, especially in the early years of medical school, requiring more systematic discussions on ethical and bioethical aspects integrated with practical activities, in order to increase and strengthen ethical reflection by students.

O objetivo deste estudo foi desenvolver um diagnóstico da inserção integrada da ética na carreira de medicina brasileira com metodologia de aprendizagem baseado em problemas e descrever as percepções de atitudes éticas que tem os estudantes e egressos. O desenho metodológico é um estudo de caso, descritivo e documental, com abordagem qualitativa e quantitativa. A amostra desta investigação constituiu-se por 20 (vinte) estudantes/ano, totalizando de 120 estudantes e 40 egressos de duas turmas do Curso de Medicina da ESCS. Este projeto foi aprovado pelo Comitê de Ética em Pesquisa -SES/DF. Os estudantes e egressos da ESCS demonstraram abordar os conflitos éticos e o respeito aos pacientes. Contudo, a análise da sensibilidade ética denunciou fragilidade quanto às percepções e atitudes inapropriadas dos estudantes da carreira de medicina, identificada especialmente nos anos iniciais, necessitando de mais discussões sistematizadas sobre os aspectos éticos e bioéticos integrados às atividades práticas, para que haja crescimento e fortalecimento da reflexão ética dos estudantes.

Inserção dos temas de humanidades e ética em curriculo médico integrado em escola pública no distrito federal, Brasil / Ethic and humanities themes insertion in medical integrate curriculum at public school of medicine in federal district of Brazil / Inserción de temas de humanidades y ética en currículo médico integrado de escuela pública en el distrito federal, Brasil

Objetivo: Realizar uma análise da inserção da ética e humanidades no currículo do Curso de Medicina da Escola Superior em Ciências da Saúde - ESCS, escola pública do Distrito Federal, Brasil, de forma a contribuir com o processo de gestão curricular. Metodologia: O Estudo é de coorte e documental. Foram pesquisados 37 termos relacionados à ética e 36 referentes à humanização nos objetivos educacionais e conteúdo dos módulos temáticos, habilidades e atitudes e interação ensino-serviço-comunidade, de 1a a 4a série e no programa do internato no currículo (ano 2006) e no projeto pedagógico do Curso de Medicina (2001). Resultados: Maior inserção da humanização, ética e bioética na 1a e 2a série, quando comparado à inserção na 3a e 4a série e no internato, (IC95 por cento-a=0,034, pvalue=0,007). Unidade de habilidades e atitudes: freqüência das 3 temáticas no currículo da 1a a 4a séries (IC95 por cento-a=0,026, pvalue=0,013). Quando comparada a inserção entre o internato e as quatro primeiras séries, observa-se que nestas a inserção da temática humanização é superior (IC95 por cento-a=0,042, pvalue=0,029). Conclusão: O currículo desenvolvido no ano de 2006 na ESCS apresentou correlação com o projeto pedagógico do curso e contemplou a temática de forma abrangente, em todas as séries e internato.

Objetivo: Realizar un análisis de la inserción de la ética y de las humanidades en el currículo del Curso de Medicina de la Escuela Superior en Ciencias de la Salud-ESCS, escuela pública del Distrito Federal, Brasil, para contribuir con el proceso de gestión curricular. Metodología: El estudio es de cohorte y documental. Se investigaron 37 términos relacionados con la ética y 36 referidos a la humanización en los objetivos educacionales y en el contenido de los módulos temáticos, habilidades, actitudes e interacción enseñanza-servicio-comunidad, de 1a a 4a serie, en el programa del internado del currículo (año 2006) y en el proyecto pedagógico del Curso de Medicina (2001). Resultados: Mayor inserción de la humanización, ética y bioética en la 1a y 2a serie, comparada con la inserción en la 3¬ y 4¬ serie y con el internado, (IC95 por ciento-#945; =0,034, pvalue=0,007). Unidad de habilidades y actitudes: frecuencia de las 3 temáticas en el currículo de 1a a 4a series (IC95 por ciento-#945; =0,026, pvalue=0,013). Cuando se compara la inserción entre el internado y las cuatro primeras series, se observa que en éstas la inserción de la temática humanización es superior (IC95 por ciento-#945; =0,042, pvalue=0,029). Conclusión: El currículo desarrollado en 2006 en ESCS presentó correlación con el proyecto pedagógico del curso y contempló la temática de forma abarcadora, en todas las series e internado.

Objective: To establish a diagnosis of the insertion of bioethics, ethics and humanistic values and attitudes to the program of the Medical School of ESCS - Escola Superior em Ciências da Saúde, public school of medicine, Distrito Federal, Brazil, in order to contribute to the process of curricular management. Methodology: The study is cohorte and documental. Thirty-two indicators to the thematic on ethics and twenty-four related to humanization were utilized. The educational purpose and contents of activities in modules such as thematic, abilities, interaction and attitude towards the community for teaching and services, from first to senior years as well as in boarding schools programs were all analyzed in the Medical School curriculum of ESCS (2006) and about the pedagogic project of the Course (2001). Results: It was observed a greater insertion of thematic related to ethics and bioethics in the initial levels of the course, Freshman and Sophomore including boarded students, when compared to the insertion in Junior and Senior clerkship years (IC95 percent-a=0,034, pvalue=0,007). The unit on abilities and attitudes was the axle which presented greater recurrence of the thematic on humanization in programs of 1a and 4a years (IC95 percent-a=0,026, pvalue=0,013). It was observed an increase in the recurrence of the thematic on humanization developed in thematic modules and interaction community-teaching/service in the 2a year and decline in the subsequent ones. The results were very low in the 3a and 4a years. When compared with the clerkship it was observed that the first four series had greater insertion of such thematic (IC95 percent-a=0,042, pvalue=0,029). Conclusion: The academic program developed in the year of 2006 at ESCS presented improvements when compared to the pedagogical project of the course.

ANALISE DA INSERCAO DOS TEMAS DE HUMANIDADES E ETICA, COM METODOLOGIA DE APRENDIZAGEM BASEADA EM PROBLEMAS, EM CURRICULO MEDICO INTEGRADO EM ESCOLA PUBLICA NO DISTRITO FEDERAL, BRASIL.

OBJECTIVE: To establish a diagnosis of the insertion of bioethics, ethics and humanistic values and attitudes to the program of the Medical School of ESCS - Escola Superior em Ciências da Saúde, public school of medicine, Distrito Federal, Brazil, in order to contribute to the process of curricular management. METHODOLOGY: The study is cohorte and documental. Thirty-two indicators to the thematic on ethics and twenty-four related to humanization were utilized. The educational purpose and contents of activities in modules such as thematic, abilities, interaction and attitude towards the community for teaching and services, from first to senior years as well as in boarding schools programs were all analyzed in the Medical School curriculum of ESCS (2006) and about the pedagogic project of the Course (2001). RESULTS: It was observed a greater insertion of thematic related to ethics and bioethics in the initial levels of the course, Freshman and Sophomore including boarded students, when compared to the insertion in Junior and Senior clerkship years (IC95%-alpha=0,034, pvalue=0,007). The unit on abilities and attitudes was the axle which presented greater recurrence of the thematic on humanization in programs of 1 and 4 years (IC95%-alpha=0,026, pvalue=0,013). It was observed an increase in the recurrence of the thematic on humanization developed in thematic modules and interaction community-teaching/service in the 2 year and decline in the subsequent ones. The results were very low in the 3 and 4 years. When compared with the clerkship it was observed that the first four series had greater insertion of such thematic (IC95%-alpha=0,042, pvalue=0,029). CONCLUSION: The academic program developed in the year of 2006 at ESCS presented improvements when compared to the pedagogical project of the course.