Hypothyroidism associated with short bowel syndrome in children: a report of six cases

SUMMARY Short bowel syndrome (SBS) is the leading cause of intestinal failure in children, a condition of absence of sufficient bowel to meet the nutritional and metabolic needs of a growing individual. The treatment of patients in this situation is based on the association of parenteral and enteral nutrition for prolonged periods of time until intestinal rehabilitation occurs with complete enteral nutrition autonomy. Six consecutive cases of children with SBS (residual intestinal length of 5 cm to 75 cm) were managed with this program and were diagnosed with associated hypothyroidism during the treatment (ages at the diagnosis 5 months to 12 years). All patients were successfully treated with oral hormone reposition therapy and in one patient, the replacement was performed via rectal enemas due to a complete absence of small bowel. Although iodine deficiency associated to long-term parenteral nutrition is a well-known condition, this is the first report in the literature about an expressive number of patients with hypothyroidism detected in patients with SBS during the prolonged treatment for intestinal rehabilitation.

Hypothyroidism associated with short bowel syndrome in children: a report of six cases.

Short bowel syndrome (SBS) is the leading cause of intestinal failure in children, a condition of absence of sufficient bowel to meet the nutritional and metabolic needs of a growing individual. The treatment of patients in this situation is based on the association of parenteral and enteral nutrition for prolonged periods of time until intestinal rehabilitation occurs with complete enteral nutrition autonomy. Six consecutive cases of children with SBS (residual intestinal length of 5 cm to 75 cm) were managed with this program and were diagnosed with associated hypothyroidism during the treatment (ages at the diagnosis 5 months to 12 years). All patients were successfully treated with oral hormone reposition therapy and in one patient, the replacement was performed via rectal enemas due to a complete absence of small bowel. Although iodine deficiency associated to long-term parenteral nutrition is a well-known condition, this is the first report in the literature about an expressive number of patients with hypothyroidism detected in patients with SBS during the prolonged treatment for intestinal rehabilitation.

Traditional learning and problem-based learning: self-perception of preparedness for internship.

OBJECTIVE: This study aims to evaluate Pontificia Universidade Católica de São Paulo (PUC-SP) medical students' perception of their preparedness to attend the internship course by comparing students who entered the internship in 2009, who were taught according to the traditional learning method, and those who entered the internship in 2010, who were taught according to the new method, i.e. problem-based learning (PBL). METHODS: 50 traditional learning method students answered a standard Lickert scale questionnaire upon entering internship in 2009. In 2010, the process was repeated with PBL students. The questionnaire was based upon the Preparation for Hospital Practice Questionnaire. This questionnaire was evaluated by professors from three medical schools in Brazil regarding its applicability. The original questions were classified according to the importance these professors attributed to them, and less important questions were removed. Scores obtained from the Student's t-test were considered significant with p < 0.05. RESULTS: A significant statistical difference was observed in 16 questions, and the traditional learning method students reported higher average scores. When questions were divided into dimensions, a significant statistical difference appeared in the dimensions " social aspects of health", "medical skills", and "ethical concepts"; traditional learning method students again reported higher scores (p < 0.001 for all dimensions). Higher scores were also reported when the average of the answers to the whole questionnaire was calculated. CONCLUSION: Traditional learning method students consider themselves to be better prepared for internship activities than PBL students, according to the following three comparative means: by analyzing the answers to each question, by grouping these answers into dimensions, and by calculating the means of answers to the whole questionnaire.

Traditional learning and problem-based learning: self-perception of preparedness for internship / Método tradicional e aprendizado baseado em problemas: autopercepção do preparo para o internato

OBJECTIVE: This study aims to evaluate Pontificia Universidade Católica de São Paulo (PUC-SP) medical students' perception of their preparedness to attend the internship course by comparing students who entered the internship in 2009, who were taught according to the traditional learning method, and those who entered the internship in 2010, who were taught according to the new method, i.e. problem-based learning (PBL). METHODS: 50 traditional learning method students answered a standard Lickert scale questionnaire upon entering internship in 2009. In 2010, the process was repeated with PBL students. The questionnaire was based upon the Preparation for Hospital Practice Questionnaire. This questionnaire was evaluated by professors from three medical schools in Brazil regarding its applicability. The original questions were classified according to the importance these professors attributed to them, and less important questions were removed. Scores obtained from the Student's t-test were considered significant with p < 0.05. RESULTS: A significant statistical difference was observed in 16 questions, and the traditional learning method students reported higher average scores. When questions were divided into dimensions, a significant statistical difference appeared in the dimensions " social aspects of health", "medical skills", and "ethical concepts"; traditional learning method students again reported higher scores (p < 0.001 for all dimensions). Higher scores were also reported when the average of the answers to the whole questionnaire was calculated. CONCLUSION: Traditional learning method students consider themselves to be better prepared for internship activities than PBL students, according to the following three comparative means: by analyzing the answers to each question, by grouping these answers into dimensions, and by calculating the means of answers to the whole questionnaire.

OBJETIVO: Este estudo visa avaliar a percepção dos alunos de Medicina da Pontifícia Universidade Católica de São Paulo (PUC-SP) quanto ao seu preparo para cursar o internato, comparando os alunos que ingressaram no internato em 2009, no método tradicional, e aqueles que o iniciaram em 2010, no novo método, o aprendizado baseado em problemas (ABP). MÉTODOS: Aplicou-se um questionário padronizado, respondido através de uma escala de Lickert, a cinquenta alunos do método tradicional, no início do internato, em 2009. Em 2010, o processo foi repetido com os alunos do novo método. O questionário foi baseado no Preparation for Hospital Practice Questionnaire. Esse questionário foi avaliado, no Brasil, quanto à sua aplicabilidade, por professores de três cursos de Medicina. As questões originais foram classificadas de acordo com a importância atribuída por eles e as consideradas menos relevantes foram retiradas. Compararam-se os resultados por meio do teste t de Student com p < 0,05. RESULTADOS: Observa-se diferença estatística significante em dezesseis questões, sendo que os alunos do método tradicional apresentaram maiores médias. Quando se separam as questões em dimensões, nota-se diferença estatística significante em "aspectos sociais da saúde", "habilidades clínicas" e "conceitos éticos": os alunos do método tradicional demonstraram, novamente, maiores valores (p < 0,001 para todas as dimensões). Calculando-se a média de respostas do questionário inteiro, também observam-se maiores valores. CONCLUSÃO: Conclui-se que os alunos do método tradicional se julgam melhor preparados para as atividades do internato do que os do ABP, nas três vias de comparação: analisando-se as respostas de cada questão, agrupando-as em dimensões e calculando-se a média de respostas do questionário inteiro.