Students' perception of animal or virtual laboratory in physiology practical classes in PBL medical hybrid curriculum.

Over the years, much criticism against animal use for physiology teaching has been made. Hence, replacement by suitable alternatives has increased in several pedagogical approaches. This study examined students' perceptions of animal versus virtual (video/computer) laboratory classes in physiological sciences associated with the effectiveness of the problem-based learning (PBL) hybrid curriculum. Three cohorts of medical students from the University of Ribeirão Preto, who participated in animal or virtual physiology classes or both, were asked to fill out a 5-point Likert questionnaire about knowledge acquisition/motivation, importance to PBL learning goals, skills acquired, need for animal use, academic formation, learning impairment, and alternative methods. We also assessed their grades in the final exam. A total of 350 students were included, in which 108 participated only in virtual classes, 120 only in practical animal laboratory classes, and 122 in both approaches. The majority agreed that the two methods improved their knowledge acquisition/motivation and helped to reinforce tutorial goals and to acquire skills. However, the cohort who experienced both approaches favored animal laboratory. Students believe animal use is needed and did not impair their learning. Conversely, their opinion about academic formation without animal laboratory classes was divided, as was whether this approach inspired them to seek alternative methods. Despite the different perceptions, there was no difference among the groups' final grades (7.3 ± 1 vs. 7.2 ± 1 vs. 7.2 ± 2 for virtual or practical animal laboratory classes or both, respectively). Therefore, virtual activities are not as effective as animal use in the opinions of the students, but they are successful strategies in physiology learning that can be used in practical classes in a hybrid PBL curriculum.

Abnormalities in electrocardiographic ventricular repolarization in patients with dengue virus infection.

INTRODUCTION: Dengue virus infection (DENV) is an arboviral disease that affects millions of people in many countries throughout the world every year. The disease is caused by the bite of a mosquito (Aedes aegypti and / or Aedes albopictus). The symptoms/signs observed in this arboviral disease are unspecific, and the blood count usually shows leukopenia and thrombocytopenia. Although ECG changes may be observed in DENV, little is known about parameters of ventricular repolarization in patients with this condition. Accordingly, the aim of this study was to evaluate the QTc and QT interval dispersion to detect ventricular repolarization changes in patients with DENV. METHODOLOGY: Ninety-three consecutive patients seen during DENV epidemics in a small town with non-complicated DENV were included; 93 normal individuals served as controls. Clinical data, blood count and the 12-lead ECG were obtained from each individual. RESULTS: The QTc duration was higher in patients with DENV in comparison to controls. Furthermore, 5% of DENV patients had abnormal lengthening of the QTc interval. No difference regarding QT interval dispersion was observed between DENV patients and controls. No DENV patient had increased lengthening of the QT interval dispersion. CONCLUSIONS: Myocardial repolarization changes do occur in patients with DENV. Having into account the potential impact of these changes on patients' outcome, and because 12-lead ECG is not routinely recommended in the setting of DENV in our country, we recommend that a 12-lead ECG be taken from each patient with this condition during DENV epidemics.

Nitric Oxide and Related Aspects Underlying Angina.

Increased number of patients affected by metabolic syndrome (MS) has prompted the necessity of better understanding what is involved in such syndrome. Nevertheless, the establishment of promising therapies depends on the knowledge about the interaction of molecules within MS. In such context, Nitric Oxide (NO) emerges from a bulk of works relating its roles on aspects of MS, including cardiovascular diseases, their symptoms and comorbidities, which are thought to be triggered by similar sources. NO, nitric oxide synthase and enzymatic chains are keys for those disease and symptoms processes. NO has been separately described as part of hypertensive, ischemic and pain signaling. Although there are similar pathways likely shared for generating cardiovascular symptoms such angina, they are barely associated to NO in literature. The present review aims to clarify the patterns of NO alteration in metabolic syndrome directly concerned to cardiovascular symptoms, especially angina.

Resveratrol improves vasoprotective effects of captopril on aortic remodeling and fibrosis triggered by renovascular hypertension.

BACKGROUND: Renin-angiotensin system triggers vascular remodeling and fibrosis during the renovascular hypertensive two-kidney, one-clip (2K1C) model by oxidative-stress-mediated mechanisms. Thus, we hypothesized that the chronic treatment with the polyphenolic antioxidant resveratrol would improve the vasoprotective effects promoted by the chronic treatment with the angiotensin-converting enzyme inhibitor (ACEi) captopril in 2K1C hypertensive rats. Our main objective was to evaluate the effects of the combined treatment with resveratrol and captopril on vascular remodeling and fibrosis in 2K1C rats. METHODS: Male Wistar rats underwent to unilateral renal stenosis by 2K1C Goldblatt model. Six weeks after surgery, rat systolic blood pressure (SBP) was measured by indirect tail-cuff plethysmography. 2K1C rats were considered hypertensive when presenting SBP higher than 160 mmHg and underwent resveratrol (20 mg/kg), captopril (6 or 12 mg/kg), or resveratrol (20 mg/kg) combined with captopril (6 or 12 mg/kg) treatment for 3 weeks. Nine weeks after surgery, rat SBP was measured, and rat thoracic aorta was isolated for histological assays with hematoxylin/eosin or Picrosirius Red to evaluate aortic remodeling and fibrosis, respectively. RESULTS: Oral treatment of 2K1C hypertensive rats with resveratrol (20 mg/kg) combined with the dose-dependent ACEi captopril (6 and 12 mg/kg) resulted in lesser aortic thickening and reduced aortic fibrosis. Resveratrol (20 mg/kg) promoted a more expressive hypotensive effect with captopril (12 mg/kg) in 2K1C rats than the treatment with isolated captopril (12 mg/kg). CONCLUSION: Resveratrol improves the vasoprotective effects promoted by captopril on aortic remodeling and fibrosis during renovascular hypertension probably by synergic mechanisms involving antioxidant actions and nitric oxide generation.

Estratégias para resolutividade assertiva da campanha de diagnóstico e prevenção do câncer bucal / Strategies for assertive resolution of the oral cancer diagnosis and prevention campaign

Objetivo: Avaliar a efetividade das Campanhas de Prevenção do Câncer Bucal na cidade de Ribeirão Preto nos anos de 2010-2014, inseridas durante as Campanhas de Vacinação contra a Gripe em idosos. Métodos: A partir do banco de dados da Secretaria Municipal de Ribeirão Preto, do Centro de Atendimento Especializado em Diagnóstico Oral (Faculdade de Odontologia de Ribeirão Preto, USP) e da Universidade de Ribeirão Preto, foram reunidas as informações para avaliação da resolutividade desta ação. Resultados: De 57.682 pacientes examinados, 1.121 foram encaminhados aos centros de referência para elucidação diagnóstica. Houve consistência na proporção de pacientes examinados e encaminhados. Foram diagnosticados 2,89% de pacientes com lesões malignas, 9,15% com lesões pré-malignas e 62,92% com lesões benignas. Análises específicas indicaram 74,96% de resolutividade. Conclusão: As estratégias usadas durante as campanhas de prevenção do câncer bucal apresentam resolutividade e recomendamos que passem a ser incluídas em Campanhas como a de vacinação contra gripe em idosos.(AU)

Objective: To evaluate the effectiveness of Oral Cancer Prevention Campaigns in the city of Ribeirão Preto, SP, Brazil, from 2010 to 2014, set during the campaigns of vaccination against influenza in the elderly. Material and Methods: Information was gathered from the City of Ribeirão Preto's database from the Center for Specialized Care in Oral Diagnoses (Ribeirão Preto School of Dentistry, USP) and the University of Ribeirão Preto. Results: Of the 57,682 patients examined, 1,121 were referred to reference centers for a laboratory diagnosis of oral cancer. A consistent proportion of patients were screened and forwarded; 2.89% were patients diagnosed with malignant lesions; 9.15% with pre-malignant lesions and 62.92% with benign lesions. Specific analysis indicated that 74.96% were successful in their resolutions. Conclusion: The strategies used during the oral cancer prevention campaigns are effective and should be included in campaigns such as influenza vaccination in the elderly.(AU)

A Novel Vasoactive Proline-Rich Oligopeptide from the Skin Secretion of the Frog Brachycephalus ephippium.

Proline-rich oligopeptides (PROs) are a large family which comprises the bradykinin-potentiating peptides (BPPs). They inhibit the activity of the angiotensin I-converting enzyme (ACE) and have a typical pyroglutamyl (Pyr)/proline-rich structure at the N- and C-terminus, respectively. Furthermore, PROs decrease blood pressure in animals. In the present study, the isolation and biological characterization of a novel vasoactive BPP isolated from the skin secretion of the frog Brachycephalus ephippium is described. This new PRO, termed BPP-Brachy, has the primary structure WPPPKVSP and the amidated form termed BPP-BrachyNH2 inhibits efficiently ACE in rat serum. In silico molecular modeling and docking studies suggest that BPP-BrachyNH2 is capable of forming a hydrogen bond network as well as multiple van der Waals interactions with the rat ACE, which blocks the access of the substrate to the C-domain active site. Moreover, in rat thoracic aorta BPP-BrachyNH2 induces potent endothelium-dependent vasodilatation with similar magnitude as captopril. In DAF-FM DA-loaded aortic cross sections examined by confocal microscopy, BPP-BrachyNH2 was found to increase the release of nitric oxide (NO). Moreover, BPP-BrachyNH2 was devoid of toxicity in endothelial and smooth muscle cell cultures. In conclusion, the peptide BPP-BrachyNH2 has a novel sequence being the first BPP isolated from the skin secretion of the Brachycephalidae family. This opens for exploring amphibians as a source of new biomolecules. The BPP-BrachyNH2 is devoid of cytotoxicity and elicits endothelium-dependent vasodilatation mediated by NO. These findings open for the possibility of potential application of these peptides in the treatment of endothelial dysfunction and cardiovascular diseases.

MAS-mediated antioxidant effects restore the functionality of angiotensin converting enzyme 2-angiotensin-(1-7)-MAS axis in diabetic rat carotid.

We hypothesized that endothelial AT1-activated NAD(P)H oxidase-driven generation of reactive oxygen species during type I-diabetes impairs carotid ACE2-angiotensin-(1-7)-Mas axis functionality, which accounts for the impaired carotid flow in diabetic rats. We also hypothesized that angiotensin-(1-7) chronic treatment of diabetic rats restores carotid ACE2-angiotensin-(1-7)-Mas axis functionality and carotid flow. Relaxant curves for angiotensin II or angiotensin-(1-7) were obtained in carotid from streptozotocin-induced diabetic rats. Superoxide or hydrogen peroxide levels were measured by flow cytometry in carotid endothelial cells. Carotid flow was also determined. We found that endothelial AT1-activated NAD(P)H oxidase-driven generation of superoxide and hydrogen peroxide in diabetic rat carotid impairs ACE2-angiotensin-(1-7)-Mas axis functionality, which reduces carotid flow. In this mechanism, hydrogen peroxide derived from superoxide dismutation inhibits ACE2 activity in generating angiotensin-(1-7) seemingly by activating I(Cl,SWELL0, while superoxide inhibits the nitrergic Mas-mediated vasorelaxation evoked by angiotensin-(1-7). Angiotensin-(1-7) treatment of diabetic rats restored carotid ACE2-angiotensin-(1-7)-Mas axis functionality by triggering a positive feedback played by endothelial Mas receptors, that blunts endothelial AT1-activated NAD(P)H oxidase-driven generation of reactive oxygen species. Mas-mediated antioxidant effects also restored diabetic rat carotid flow, pointing to the contribution of ACE2-angiotensin-(1-7)-Mas axis in maintaining carotid flow.

Cross-talk with ß2 -adrenoceptors enhances ligand affinity properties from endothelial alpha1 D -adrenoceptors that mediates carotid relaxation.

OBJECTIVES: Our main objectives were to investigate the affinity properties of endothelial and muscular α1D -adrenoceptors and to characterize the cross-talk between endothelial α1D -adrenoceptors and ß2 -adrenoceptors in rat carotid. METHODS: Relaxation and contraction concentration-response curves for phenylephrine (α1 -adrenergic agonist) were obtained in carotid rings in absence or presence of increasing concentrations of BMY7378 (α1D -adrenergic antagonist), combined or not with increasing concentration of ICI-118,551 (ß2 -adrenergic antagonist). Schild analysis was used to estimate the affinity constant from pA2 values of BMY7378. KEY FINDINGS: BMY7378 produced an unsurmountable antagonism on phenylephrine-induced relaxation but a surmountable antagonism on phenylephrine-induced contraction. BMY7378 potency was higher in inhibiting the relaxation than the contraction induced by phenylephrine because the rightward shifts induced by BMY7378 were greater in the relaxation. The apparent pA2 value for BMY7378 in phenylephrine-induced relaxation was greater than in contraction. When combined with ICI-118,551, BMY7378 yielded a surmountable antagonism on phenylephrine-induced relaxation and presented a pA2 value similar to that obtained in phenylephrine-induced contraction. CONCLUSIONS: Endothelial α1D -adrenoceptors, which mediates rat carotid relaxation, present high ligand affinity because of the cross-talk with ß2 -adrenoceptors, which explains the higher potency of phenylephrine in inducing relaxation than contraction and the atypical unsurmountable antagonism produced by BMY7378 on phenylephrine-induced relaxation.

Potenciais interações medicamentosas identificadas em prescrições a pacientes hipertensos / Potential drug interactions identified in prescriptions to hypertensive patients

JUSTIFICATIVA E OBJETIVOS: A hipertensão arterial (HA) é uma disfunção crônica com alta prevalência entre a população brasileira e mundial. A resposta terapêutica depende, na maioria dos casos, de politerapia o que propicia interações que podem impedir os benefícios do tratamento ou ainda causar sérios riscos à saúde dos pacientes. O objetivo deste estudo foi apresentar dados epidemiológicos descritivos acerca das interações medicamentosas presentes em prescrições, no sentido de apontar os potenciais riscos à saúde dos pacientes atendidos em centro médico público em uma cidade do interior do Estado de São Paulo. MÉTODO: Foi avaliada a população (600 pacientes de ambos os gêneros) que recebeu prescrições com, no mínimo, um medicamento anti-hipertensivo, tendo sido adquiridos na farmácia comunitária do Centro Médico "Januário Theodoro de Souza", Pradópolis, SP, entre fevereiro e março de 2009. RESULTADOS: Do total das prescrições, apenas 16,30% se baseou na monoterapia. Ao todo, foram prescritos 1855 medicamentos, ou seja, três medicamentos/paciente, não necessariamente fármacos anti-hipertensivos. Verificou-se 1440 interações, sendo 192 tipos diferentes, com média de 2,4 interações/paciente. Dos fármacos não anti-hipertensivos, os mais prescritos foram ácido acetilsalicílico (24,5%) e dipirona (14,0%). A maioria dos hipertensos foi submetida à politerapia e, portanto, frequentemente expostos às interações, principalmente com anti-inflamatórios não esteroides, o que, dentre outros efeitos adversos, corroboram para o aumento da pressão arterial. CONCLUSÃO: A politerapia anti-hipertensiva, inerente à prescrição, tem potencial para acarretar prejuízos à eficácia e segurança terapêutica (incluindo falta de adesão ao tratamento), devido às elevadas possibilidades de interações negativas.

BACKGROUND AND OBJECTIVES: Hypertension is a chronic disorder with high prevalence among the Brazilian and worldwide population. The therapeutic response depends, in most cases, on the polytherapy, which provides interactions that may avoid the benefits of treatment or cause serious health risks to patients. The aim of this study was to present descriptive epidemiological data about drug interactions in the prescriptions, in order to point out potential risks to the health of patients treated in a Public Medical Center in a cityin the São Paulo state. METHOD: It was evaluated the population (600 patients of both genders) who received prescriptions containing, at least one, antihypertensive medication, which were acquired in the community pharmacy of the Medical Center "Januário Theodoro de Souza," Pradópolis, SP, between February and March/2009. RESULTS: Of the total prescriptions, only 16.3% were based on monotherapy. A total of 1855 drug prescriptions were recorded considering antihypertensive and other drugs, an average of three drugs per patient. There were 1440 drug interactions of 192 different types, with an average of 2.4 interactions per patient. Considering the non-antihypertensive drugs the most prescribed were acetylsalicylic acid (24.5%) and dipyrone (14.0%). Most hypertensive patients underwent polytherapy and therefore were frequently exposed to interactions, particularlyof antihypertensive with steroidal anti-inflammatory drugs, which, amongst other adverse effects, corroborate to increase blood pressure. CONCLUSION: The antihypertensive polytherapy, inherent in the prescription for treating this disorder, is potentially harmful to the efficacy and safety (including lack of adherence to treatment), due to high chances of negative interactions.

Impacto de um modelo de tratamento não farmacológico para diabetes e hipertensão no município de Rincão: projeto saúde e vida / Impact of a model of non-pharmacological treatment to diabetes mellitus and hypertension in Rincão: health and life project

JUSTIFICATIVA E OBJETIVOS: As condições crônicas não transmissíveis representam a principal causa de mortalidade e incapacidade em todo mundo. Entre elas, o diabetes mellitus (DM) e a hipertensão arterial sistêmica (HAS) representam 59% dos 56,5 milhões de óbitos anuais. O objetivo deste estudo foi demonstrar o efeito do tratamento não farmacológico no controle do DM e HAS, propondo um modelo de abordagem aos pacientes. MÉTODO: Através do "Projeto Saúde e Vida": grupo de apoio aos portadores de DM e HAS no município de Rincão composto por dois graduandos de Medicina, um de educação física e um de enfermagem, sob orientação de um professor, realizaram palestras, atividade física, aferição de pressão arterial e glicemia na Unidade Básica de Saúde (UBS), além de orientar atividade física regular e dieta específica. RESULTADOS: Setenta e quadro pacientes voluntários portadores de DM e HAS foram seguidos no período de abril de 2005 a junho de 2006, dos quais 36 frequentaram mais de cinco encontros, havendo melhora pressórica em 25 pacientes (69,4%) e melhora glicêmica em 24 pacientes (66,7%). Entre o grupo com menos de cinco encontros (38 pacientes) 19 pacientes (55,9%) tiveram melhora pressórica e 15 pacientes (54,29%) tiveram melhora glicêmica. CONCLUSÃO: O projeto mostrou o impacto positivo de ações simples, porém constantes, no controle do DM e HAS podendo servir de modelo para atuação de profissionais de saúde de UBS.

BACKGROUND AND OBJECTIVES: The chronic diseases with a non-contagious origin such as heart diseases, cancer, and diabetes became increasingly prevalent over the last century. Today, diabetes mellitus (DM) and high systemic blood pressure (SBP) represent 59% of 56.5 million deaths a year. The aim of this study was to demonstrate the effects of non-pharmacological interventions in order to control the progression of these diseases. METHOD: This work was developed on basis of the project called "Health and Life Project". The research group consisted of two medical students, one physical education student and one nursing student supervised by a professor. The activities directed to the patients, during three months, including lectures about the importance of regular physical activity and specific diet; physical activities; measurement of the blood pressure and blood glucose at a Basic Health Unit in Rincão city. RESULTS: Seventy four patients were followed from April/2005 until June/2006. Thirty six went in more than five meetings. They had improved their blood pressure (25 patients -69.4%) and blood glucose measures (24 patients - 66.7%). Thirty eight patients had participated in less than five meetings, of this number, just 19 patients (55.9%) had presented improvements in blood pressure and 15 patients presented improvement in blood glucose.CONCLUSION: This work shows positive impact of simple but continuous actions to control of DM and SBP and it can be used as a model for Public Health Programs.