RESUMEN
BACKGROUND: Around the world, it is very expensive to become a physician. Although public medical schools are less expensive than private medical schools, tuition fees are charged at public medical schools in the majority of countries. In Brazil, public medical schools, with the exception of municipal schools, are free. There has been little investigation of any differences in conditions offered by paid or free medical schools or what occurs in public and private clerkships in Brazil. We investigated the clerkship conditions offered to the students in both public and private Brazilian medical schools by gathering the opinions of clerkship coordinators and others responsible for clerkships. METHODS: A cross-sectional, descriptive, analytical study using an electronic questionnaire was answered by clerkship coordinators to compare the clerkships of 30 public and 38 private Brazilian medical schools from all regions of the country. The questionnaires covered various aspects of the clinical environments, student supervision, faculty development, student assessments, rotation evaluations and extracurricular activities developed by students. RESULTS: We observed significant differences between public and private medical schools in several aspects investigated. Based on the opinions of the clerkship coordinators, with the exception of access to university hospitals, which was predominantly offered by public medical schools, private medical schools offer better clerkship conditions. The main differences were related to the number of positions, infrastructure, clinical learning environments, faculty development, student assessments, rotation evaluations and students' extracurricular activities. CONCLUSION: This is the first study comparing Brazilian medical clerkships in private and public medical schools and provides a general vision of these programmes. It is necessary to further investigate clerkship development in the Brazilian medical school system and to study the differences between private and public medical schools globally.
Asunto(s)
Prácticas Clínicas , Estudiantes de Medicina , Brasil , Estudios Transversales , Humanos , Facultades de MedicinaRESUMEN
Autotransplantation of spleen tissue has been done, in the past ten years, in children with schistosomiasis mansoni with bleeding varices. The purposes of this investigation were: (1) to study the morphology and function of the remnant spleen tissue; (2) to quantify the production of tuftsin; and (3) to assess the immune response to pneomococcal vaccine of these patients. Twenty three children, who underwent splenectomy and autologous implantation of spleen tissue into the greater omentum were included in this investigation. The average postoperative follow-up is five years. Splenosis was proved by colloid liver-spleen scans. Search for Howell-Jolly bodies assessed the filtration function. Tuftsin and the titer of pneumococcal antibodies were quantified by ELISA. Splenosis was evident in all children; however, it was insufficient in two. Howell-Jolly bodies were found only in these two patients. The mean tuftsin serum concentration (335.0 ± 29.8 ng/ml) was inside the normal range. The immune response to pneumococcal vaccination was adequate in 15 patients; intermediate in four; and inadequate in four. From the results the following conclusions can be drawn: splenosis was efficient in maintaining the filtration splenic function in more than 90 percent and produced tuftsin inside the range of normality. It also provided the immunologic splenic response to pneumococcal vaccination in 65 percent of the patients of this series
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Esquistosomiasis mansoni/cirugía , Bazo/fisiología , Bazo/trasplante , Esplenosis/cirugía , Anticuerpos Antibacterianos/aislamiento & purificación , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Hipertensión Portal/complicaciones , Hipertensión Portal/etiología , Epiplón , Vacunas Neumococicas , Esquistosomiasis mansoni/complicaciones , Bazo/inmunología , Streptococcus pneumoniae/inmunología , Trasplante Autólogo , Tuftsina/biosíntesis , Tuftsina/sangreRESUMEN
Objetivando analisar os resultados do protocolo cirúrgico de esplenecatomia e ligadura da veia gástrica esquerda associado à esplenose por auto-implante esplênico, em bolsa, no omento maior, utilizado nos últimos dez anos, em 63 crianças e adolescentes portadores de esquistossomose mansônica hepato-esplênica e varizes sangrentas do esôfago, foram avaliadas 40 pacientes que apresentavam um seguimento médio de cinco anos. Os resultados evidenciam: mortalidade cirúrgica de 1,6por cento, considerada aceitável; mortalidade tardia de 2,5por cento e recidiva hemorrágica de 10por cento, para os pacientes com seguimento médio de cinco anos, respectivamente, menor e similar a de adultos submetidos a esplenectomia e ligadura interna das varizes do esôfago; melhora do padrão endoscópico das varizes esofageanas e da gastropatia por hipertensão porta; cura dos casos de hiperesplenismo, melhora dos canais de crescimento de peso e altura; e estabilização da reserva funcional hepática. A esplenose resultante do auto-implante esplênico tem se mostrado efetiva na proteção dos pacientes contra septicemia fulminante pós-essplenectomia
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Hipertensión Portal/cirugía , Esquistosomiasis mansoni , Esplenectomía , Esplenosis , Ligadura , Várices Esofágicas y Gástricas/cirugíaRESUMEN
Esplenectomia e ligadura da veia gátrica esquerda em crianças portadoras de hepatoesplenomegalia esquistossomótica com varizes sangrantes de esôfago determinam uma diminuiçÝo no fluxo portal e um aumento do fluxo arterial hepático. Os efeitos dessa alteraçÝo hemodinâmica no fígado poderiam, teoricamente, agravar a reserva funcional hepática desses pacientes. Quarenta crianças portadoras desta patologia submetidas àquele tipo de tratamento foram seguidas prospectivamente, em média de 42 meses, com relaçÝo a reserva funcional hepática. No pré-operatório, treze crianças foram diagnosticadas como grau A, na classificaçÝo de Child, enquanto vinte e sete eram grau B. A concentraçÝo média de albumina desses pacientes pacientes foi de 3,16g/dl+/-0,62g/dl. Apenas um paciente apresentou bilirrubina discretamente superior a 2mg/dl. Após seguimento entre dezoito e setenta e dois meses, quinze pacientes foram diagnosticados como grau A e vinte e cinco como grau B. A concentraçÝo média de albumina foi de 3,25g/dl+/-0,50g/dl. De forma similar ao pré-operatório um paciente vem apresentando bilirrubina acima de 2mg/dl. Os achados nÝo indicam que tenha havido agravamento da reserva funcional hepática desses pacientes