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Avaliação da prática deliberada em ciclos rápidos no ensino do exame neurológico para estudantes de medicina

Thu, 01 Jan 2026 00:00:00 GMT

Título: Avaliação da prática deliberada em ciclos rápidos no ensino do exame neurológico para estudantes de medicina Autor(es): Queiroga, Morgana Feitosa de Abstract: The Neurological Examination (NE) is an essential tool for topographic diagnosis in Neurology. In medical education, Rapid Cycle Deliberate Practice (RCDP) is an innovative clinical simulation technique that enables skills acquisition through repetitive practice with immediate, assertive feedback following every error. To the best of our knowledge, no studies have been identified reporting the use of RCDP for teaching NE. This study aims to assess the impact of RCDP on teaching NE for medical students. This is a quasi-experimental study, with a quantitative approach, conducted at the Schools of Medicine of University Christus (Unichristus) and Federal University of Ceará (UFC) in Fortaleza, Brazil. The sample consisted of 158 students, 111 from Unichristus (intervention group) and 47 from UFC (traditional group). The intervention group participated of the RCDP in addition to traditional teaching of NE. Three instruments were utilized for data gathering: an objective pre-test and post-test questionnaire on Neuroanatomy and NE, a Screening NE Model, and an RCDP Application and Evaluation Guide. The instruments were validated with the Content Validity Index (CVI) of 1 by a committee of 12 neurologists. Data were analyzed using GraphPad Prism® version 8 and IBM SPSS® version 19. The intervention group demonstrated a statistically significant increase in 73.3% of post-test scores (p < 0.0001; 95% CI), in contrast to traditional group with an increase in 60% of post-test scores (p=0.0651). RCDP is an effective auxiliary tool for teaching NE to medical students. Screening EN was essential to optimize practice time. The RCDP Application and Evaluation Guide in NE shows competency milestones for cycle progression, identifies errors leading to interruptions, facilitates immediate feedback and quantifies the repetitions required for each task. Tipo: Dissertação

O impacto de um protocolo de exercício físico de longa duração na melhoria da capacidade cardiovascular e funcional em pacientes dialíticos

Thu, 01 Jan 2026 00:00:00 GMT

Título: O impacto de um protocolo de exercício físico de longa duração na melhoria da capacidade cardiovascular e funcional em pacientes dialíticos Autor(es): Caminha, Juan de Sá Roriz Abstract: INTRODUCTION: It is estimated that around 850 million people worldwide live with chronic kidney disease, a condition associated with high morbidity and mortality. In this population, hypertension, sarcopenia, and impaired quality of life are frequent, with a high incidence of cardiovascular events and mortality. In this scenario, intradialytic exercise (IDE) emerges as a low-cost strategy with potential to reduce these outcomes. OBJECTIVE: To evaluate the effects of a long-term exercise program on the cardiovascular and functional status of dialysis patients. METHOD: This study was a clinical trial conducted at a Federal University Hospital located in Manaus, Amazonas, between September 2023 and November 2024. The sample consisted of adult dialysis patients, aged 18 to 75 years, of both sexes. Data collection was performed through medical record review and physical-functional assessments (6-minute walk test—6MWT, handgrip strength test—HGS, 1-minute sit-to-stand test—1- min STS, and Berg Balance Scale), as well as body composition assessments (skinfolds, calf circumference measurements, and bioimpedance analysis—BIA). Participants were divided into two groups: trained (TG) and control (CG). A 95% confidence interval was adopted, considering p < 0.05. Categorical variables were presented as absolute counts and relative frequencies (percentages). Continuous variables were assessed for distribution using the Shapiro–Wilk test; variables with normal distribution were described as mean ± standard deviation. RESULTS: In functional tests, the 6MWT distance increased from 320±150 m to 400±120 m (p < 0.01). Maximum HGS increased from 15.2±4.8 kgf to 25.8±9.3 kgf (p = 0.008), while the CG declined, and 1-min STS repetitions increased from 17.0±7.0 to 22.1±2.6 (p < 0.001) in the TG. In BIA, phase angle increased in the TG from 4.5±0.6° to 5.1±0.7° after 16 months (p < 0.05), with no changes in the CG. Sarcopenia risk was assessed by the combination of functional tests and calf circumference, decreased from 30.3% (10/33) to 12.1% (4/33) in the exercise group (p = 0.04), remaining at ~27% in the control group. CONCLUSION: Individualized IDE promoted morphofunctional gains, improving cardiovascular capacity, cellular integrity and strength, in addition to improving indicators of sarcopenia. Tipo: Tese

Zebrafish como modelo experimental potencial para compreensão de inflamação renal aguda após a exposição a anti-inflamatórios não esteroides

Thu, 01 Jan 2026 00:00:00 GMT

Título: Zebrafish como modelo experimental potencial para compreensão de inflamação renal aguda após a exposição a anti-inflamatórios não esteroides Autor(es): Rolim, Laís Araújo Abstract: Acute Kidney Injury (AKI) is a syndrome with a complex pathophysiology, frequently triggered by the indiscriminate use of nephrotoxic medications. Among the most common agents in clinical practice are non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac and ibuprofen, which act by inhibiting cyclooxygenase enzymes (COX-1 and COX-2). Although effective in controlling inflammation and pain, the continuous use or high doses of these drugs can compromise renal hemodynamics through the inhibition of vasodilatory prostaglandins, resulting in a reduction of the glomerular filtration rate, oxidative stress, and inflammatory processes in the kidney. In this context, the zebrafish has stood out as a robust biomedical model for toxicology and human disease studies due to its high genetic homology with humans, rapid development, and a functional renal anatomy comparable to that of mammals. Thus, the present study aimed to propose and apply a histopathological scoring system for the evaluation and quantification of renal damage in adult zebrafish subjected to nephrotoxicity protocols induced by diclofenac and ibuprofen. For this purpose, adult animals were exposed to different forms of drug administration, and acute toxicity assays were performed to determine the dose-response relationship, in addition to histological analyses of the animal's kidney. The evaluation of the tissue slides allowed the identification of structural alterations compatible with kidney injury, including glomerular changes, tubular congestion, inflammatory processes, and tissue disorganization, enabling the application of a score classification system. In animals exposed to the highest concentrations of each drug, more intense renal damage alterations were detected. The results suggest that diclofenac and ibuprofen exert detectable nephrotoxic effects in the teleost model, reinforcing the utility of the zebrafish as a sensitive tool for renal toxicity studies. Furthermore, the application of the scoring system proved to be effective in standardizing and quantifying the observed renal lesions, contributing to more objective and reproducible analyses in experimental models. Tipo: Dissertação

Efeito do pré-tratamento com propionato na infecção por Clostridioides difficile e na resposta da glia entérica às toxinas A e B

Thu, 01 Jan 2026 00:00:00 GMT

Título: Efeito do pré-tratamento com propionato na infecção por Clostridioides difficile e na resposta da glia entérica às toxinas A e B Autor(es): Loureiro, Andréa Viana Abstract: Gastrointestinal (GI) dysfunction following Clostridioides difficile infection (CDI) has been reported in mouse and human. Enteric glia, part of the enteric nervous system, contribute to GI motility and are vulnerable to C. difficile toxins, which cause cell death and trigger an inflammatory response. Little is known about the effect of propionate, a short-chain fatty acid (SCFA). Therefore, this study aimed to evaluate whether pre-treatment with propionate prevents GI dysfunction after CDI and modulates enteric glia responses (cell death and pro- inflammatory responses) to C. difficile toxins. Regarding the in vivo study, 8-week-old mice were pre-treated with propionate (150 mM in drinking water) or not, and then infected with C. difficile. After infection, mice were monitored daily to assess disease severity. On day 14 post- infection, GI function was assessed using the Evans blue method. In vitro, rat enteric glia were incubated with TcdA (50 ng/mL) or TcdB (1 ng/mL), alone or with propionate (10 mM), one hour before toxin. After 2, 12, and/or 18 hours of incubation with the toxins, cells were collected for analysis of SCFA transporter/receptor expression (MCT1, MCT4, FFAR2, and FFAR3 via qPCR), pro-inflammatory markers (S100B and IL-6 via qPCR and immunofluorescence, respectively), as well as nuclear translocation of pSTAT3 (by immunofluorescence) and cell death. In vivo, infected mice lost weight and developed severe diarrhea, which was completely resolved by day 13 post-infection, accompanied by delayed total gastrointestinal transit (TTGIT) on day 14. On the other hand, pre-treatment with propionate improved survival, reduced weight loss, prevented diarrhea, and decreased delay in TTGIT. In vitro, enteric glial cells express SCFA transporters (MCT1 and MCT4) and receptors (FFAR2 and FFAR3), which were altered by exposure to C. difficile toxins. TcdA or TcdB promoted cell death, increased caspase 3/7 activity, reduced Bcl2 expression (protein and transcripts), increased levels of pro- inflammatory mediators S100B (transcripts) and IL-6 (protein) in enteric glia, and promoted nuclear translocation of pSTAT3. Whereas propionate supplementation elevated Bcl2 levels, it did not prevent cell death, but decreased IL-6 protein expression, S100B transcripts, and reduced nuclear translocation of pSTAT3 challenged with TcdA or TcdB. Overall, pre- treatment with propionate is effective in preventing gastrointestinal dysfunction after CDI, improving survival, and reducing disease severity in the acute phase. Additionally, propionate supplementation modulates the pro-inflammatory response (reducing IL-6/STAT3 expression and the positive regulation of S100B) induced by TcdA or TcdB in enteric glia. These findings offer new insights into how microbiota-derived products can influence gastrointestinal system function after infection and the enteric glial response to C. difficile toxins. Tipo: Tese