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Academic misconduct during medical school is common, with multifactorial causes, and can negatively impact the training and professional performance of future physicians. This study investigated factors linked to academic misconducts among medical students during their training. It is a transversal, quantitative, and analytical study that assessed the perception of 240 students from five medical courses in Salvador, Bahia, Brazil. A virtual, semi-structured, anonymous, self-completed questionnaire was used, with sociodemographic and academic variables recorded. Behavioral patterns were analyzed using hypothetical situations based on medical students' code of ethics, and the data were compared based on participant and institutional characteristics. Results showed that medical students reported that ethical attitudes were maintained during graduation (98.3%) and the majority claimed to know the student code of ethics (89.2%). However, there was a high frequency of academic misconduct, especially "recording classes without authorization" (72.9%), "cheating on tests" (67.9%) and " improperly sign attendance lists" (65.0%). We observed a higher association of females with actions such as "cheating on exams" and taking "pictures with anatomical parts and dummies". In addition, posting pictures with patients and taking on duty without medical supervision occurred more frequently among students from private schools. Although the students considered themselves to be ethical, a high frequency of inappropriate behavior in academic situations was evidenced. This scenario points to the need for greater attention to training based on moral and ethical commitment in academic activities, with a view to future professional performance. Keywords: cross-sectional studies, higher education, medical education, medical ethics, medical students

Com a deflagração do estado pandêmico, em março de 2020, também foram destacadas as desigualdades nos sistemas de saúde em todo o mundo, inclusive no Brasil e neste contexto estão inseridos os profissionais de saúde, que têm desempenhado um papel vital no enfrentamento ao novo coronavírus. Desta forma, a pandemia da Covid-19 tem feito com que os profissionais de saúde enfrentem diversos desafios, tanto do ponto de vista físico quanto mental. O objetivo deste trabalho é descrever a partir da literatura o que tem sido publicado sobre os impactos da pandemia de COVID-19 na qualidade de vida e satisfação no trabalho dos profissionais de saúde no Brasil. Trata-se de uma revisão integrativa da literatura, a coleta de dados ocorreu em fevereiro e março de 2023, através do Banco de Dados da Biblioteca Virtual em Saúde (BVS), no recorte temporal entre os anos de 2020 a 2022, totalizando o corpus de 8 publicações. Os artigos encontrados responderam à pergunta de pesquisa e favoreceram para o conhecimento quanto aos impactos da pandemia de COVID-19 na qualidade de vida, satisfação no trabalho e necessidades humanas dos profissionais de saúde. Os resultados principais foram sobre os fatores associados ao desgaste e a exaustão físico e mental, baixo nível de realização profissional; alguns fatores sociodemográficos; condições de trabalho e efeitos da atuação na linha de frente da Covid-19 na saúde desses profissionais. A pandemia de Covid-19 teve um impacto negativo muito forte na qualidade de vida e satisfação no trabalho dos profissionais de saúde no Brasil. Assim, é extremamente importante o apoio ao trabalho destes trabalhadores, tornando-se necessário o estabelecimento de políticas públicas focadas nos profissionais de saúde, uma vez que eles são os principais responsáveis por garantir a qualidade dos serviços oferecidos a população.

Objectives: To understand the perception of medical students about their education in the healthcare context experienced by LGBT individuals. Methods: A structured questionnaire was administered regarding their assessment of theoretical and practical training in attending the LGBT public. Results: 49.52% of the students showed great interest in the topic, with most representation coming from LGBT students. Although 98.10% agreed on the need for more training, 33.33% reported that they had never read about the LGBT Health Policy. They considered necessary LGBT-focused training (86.19%) and thought the LGBT population suffers discrimination when seeking healthcare (95.24%). Conclusion: medical students are aware of the deficit in healthcare access of the LGBT community and perceive a gap in their education about LGBT health.

Resumo: Introdução: A mentoria é uma estratégia acadêmica que está cada vez mais presente no curso de Medicina por promover benefícios, como a criação de ambientes de acolhimento e afetividade, e discussão de conteúdos médicos e de temas relacionados à formação profissional. Entretanto, pouco se discute acerca dessa estratégia com finalidades científicas. Objetivo: Este estudo teve como objetivos descrever a implementação do programa de mentorias científicas, investigar a percepção dos estudantes sobre a sua implantação e execução, além de mensurar indicadores de êxito. Método: Trata-se de estudo seccional descritivo, realizado em um curso de graduação em Medicina, localizado em Salvador/Bahia. Foram incluídos estudantes do terceiro ao quarto ano da graduação. Aplicou-se um questionário virtual, estruturado, anônimo, com perguntas objetivas relacionadas ao perfil discente, às percepções sobre o programa de mentorias científicas e à publicação dos trabalhos de conclusão de curso (TCC). Resultado: Dos 143 estudantes participantes, houve predominância de solteiros (90,9%), pardos (46,2%), do sexo feminino (72,0%), com idade de 25,3 ± 5,54 anos, que não participaram de programas de iniciação científica (88,8%). Dentre aqueles que participaram das mentorias (n = 101), 97,1% afirmaram que elas contribuíram para o desenvolvimento do TCC, 98,0% se mostraram favoráveis à manutenção de sua oferta e 85,0% consideraram a estratégia inovadora. No recorte temporal de dois semestres letivos, apresentaram-se 131 TCC, dos quais 27,5% foram publicados contando com a participação de 19 professores, com média de 1,89 produção/professor. Conclusão: Os estudantes de Medicina são favoráveis à implementação do sistema de mentorias científicas, tendo essa estratégia se mostrado factível e eficaz. Abstract: Introduction: Mentoring is an academic strategy that is increasingly present in the medical course, as it promotes benefits such as the creation of welcoming and affective environments, discussion of medical content and topics related to professional training. However, little is discussed about this strategy for scientific purposes. Objectives: To describe the implementation of the scientific mentoring program, investigate the students’ perception of its implementation and performance, in addition to measuring success indicators. Methods: This was a cross-sectional, descriptive study carried out in an undergraduate medical course, located in Salvador/Bahia. Students from the 3rd to the 4th year of undergraduate school were included. A virtual, structured, anonymous questionnaire was applied, with objective questions related to the students’ profile, their perceptions in relation to the scientific mentorship program and the publication of the Term Paper (TP). Results: Of the 143 participating students, there was a predominance of single (90.9%), brown (46.2%), female individuals (72.0%), aged 25.3±5.54 years, those who did not participate in Undergraduate Research programs (88.8%). Among those who participated in mentorships (n=101), 97.1% considered that they contributed to the development of the TP, 98.0% are in favor of maintaining its offer and 85.0% consider the strategy to be innovative. In the time frame of two academic semesters, 131 TPs were presented, of which 27.5% were published with the participation of 19 teachers, with an average of 1.89 productions/teacher. Conclusion: Medical students are in favor of implementing the scientific mentoring system, and this strategy has shown to be feasible and effective.

O cenário pandêmico modificou a rotina da população mundial em diversos aspectos. No contexto da educação médica, devido às restrições impostas pelo novo Coronavírus, a migração para o modelo remoto de ensino ocasionou mudanças metodológicas sem precedentes. Esse estudo se propõe avaliar a percepção dos estudantes de Medicina acerca do ensino remoto durante a pandemia da COVID-19. Trata-se de estudo transversal, quantitativo, analítico, realizado através da aplicação de questionário virtual sobre as percepções da qualidade de aprendizagem durante a vigência do ensino remoto. Foram investigadas as percepções de 230 acadêmicos de Medicina regularmente matriculados em Instituição de Ensino Superior (IES) que aderiram ao ensino remoto. Verificou-se insatisfação dos estudantes quanto a aprendizagem durante o ensino remoto por não conseguirem manter o ritmo de estudo (74,8%) e a motivação (84,3%). A interrupção das aulas práticas foi fator destacado pela grande maioria dos respondentes (93,5%). Apesar de destacarem a possibilidade de assistirem a aula gravada como ponto positivo, apenas 43,9% acreditam que este novo cenário permitiu organizar melhor horários e afazeres. O ambiente familiar (57,1%) e a conexão com a internet (69,1%) foram considerados como fatores limitantes para um bom desempenho acadêmico. Na percepção dos estudantes, houve prejuízo na qualidade da aprendizagem durante o decurso do ensino remoto, especialmente quanto à dificuldade de manutenção do ritmo e motivação nos estudos. Além disso, sugere-se que limitações e instabilidades de conexão com a internet também interferiram negativamente com o processo de aprendizagem.

RESUMO Objetivo Avaliar a percepção dos estudantes de Medicina em relação à oferta da disciplina Língua Brasileira de Sinais (Libras) durante a sua formação acadêmica. Métodos Estudo transversal, descritivo e analítico, incluindo estudantes de Medicina da cidade de Salvador, Bahia, maiores de 18 anos. Aplicou-se um questionário virtual, semiestruturado, contendo aspectos sociodemográficos, acadêmicos e sobre a Libras (comunicação, aprendizado, importância na formação médica e oferta curricular). Resultados Dos 240 estudantes avaliados, 82,9% não sabe se comunicar através de Libras, entretanto 95,8% acreditam que a disciplina é necessária no currículo médico. Quanto à oferta curricular, os estudantes consideram que esta deveria ser obrigatória (55,2%) e na modalidade presencial (75,7%). Os principais motivos para não cursar a disciplina foram por esta ser optativa (41,7%) e por falta de tempo (33,3%). Identificou-se que as mulheres dão mais importância a esta formação (p=0,0013) e essa percepção independe de idade, natureza administrativa da instituição e ciclo acadêmico em curso. Conclusão Os estudantes de Medicina têm uma percepção favorável ao ensino de Libras na educação médica. Entretanto, a maioria desses estudantes não cursou a disciplina em seus percursos acadêmicos e acredita ser desafiador o atendimento a este público. ABSTRACT Purpose To assess the perception of medical students regarding the discipline Brazilian Sign Language (Libras) during their academic training. Methods Cross-sectional, descriptive and analytical study, including medical students from the city of Salvador, Bahia, over 18 years old. A virtual, semi-structured questionnaire was applied, containing sociodemographic, academic and Libras (communication, learning, importance in medical training and curriculum offer) aspects. Results Of the 240 students evaluated, 82.9% do not know how to communicate through Libras, however 95.8% believe that the discipline is necessary in the medical curriculum. As for the curricular offer, students consider that it should be mandatory (55.2%) and in the face-to-face modality (75.7%). The main reasons for not taking the course were because it was optional (41.7%) and lack of time (33.3%). It was identified that women give more importance to this training (p=0.0013) and this perception is independent of age, administrative nature of the institution and ongoing academic cycle. Conclusion Medical students have a favorable perception of the teaching of Libras in medical education. However, most of these students did not attend the discipline in their academic careers and believe that serving this public is challenging.

Resumo: A pandemia escancarou a necessidade de discutirmos com profundidade a qualidade da formação em Saúde no País, destacando-se o papel central do professor nesse processo. Nesse âmbito, o objetivo deste artigo foi investigar a formação e a atividade docentes no ensino superior em Saúde, considerando perfil, engajamento e principais percepções profissionais. Trata-se de um estudo transversal, quantitativo, de abordagem descritiva e analítica, que investigou a capacitação didático-pedagógica e as percepções da atividade docente de 223 professores do ensino superior em Saúde de todo o Brasil. Entre eles, a maioria considera sua função docente como principal (71,30%), afirma conhecer as Diretrizes Curriculares Nacionais dos seus respectivos cursos de atuação (91,48%) e relata familiaridade com os elementos relacionados ao corpo docente presentes nos documentos de avaliação de curso e institucionais (83,41%). Embora declarem, notadamente os profissionais da rede privada (89,8% versus 73,08% da rede pública, p

The new curriculum of medical schools has brought the need to develop a professional committed to ethics, capable of understanding the role of social factors, the insertion of the individual into the family and their role in promoting health. These skills and the use of new methodologies in teaching-learning process have demonstrated that the traditional performance assessment methods are limited in holistically evaluating the student. This study analyzed the correlation among different methods for evaluating competencies in medical internship students and Objective Structured Clinical Examination (OSCE). A cross-sectional, descriptive and analytical study was performed among 5th year medical students at Pediatric, Surgery, Medical Clinic, Family and Community Medicine and Gynecology and Obstetrics. Grades of each student obtained through different evaluations (theoretical test, conceptual evaluation and test skills) at the end of each rotation were correlated with the individual results from OSCE. In regard to correlations with the OSCE score values, it was found a weak to moderate positive and statistically significant relationship with the global cognitive score (r= .22, p< .001), global abilities score (r= .26, p< .001) and with the global behavioral score (r= .38, p< .001). The students' performance in the various assessments of performance evaluated here was positively correlated to their performance on OSCE. Furthermore, the organization of an OSCE-type assessment prepared in multiple, committed and competent hands may serve as a unique assessment and, in fact, assess the development of clinical skills for future doctors. Keywords: educational measurements, higher education, medical education, objective structured clinical examination

Highlights • There has been a recent reduction in vaccination coverage in Brazilian regions. • Most relevant reduction in vaccination coverage occurred in childhood immunization. • Increases web searches of anti-vaccine relate to reduction in immunization coverage., Objective Vaccination coverage is decreasing worldwide, favoring potential reemergence of vaccine-preventable disease. Here, we performed a longitudinal characterization of the vaccination coverage in Brazil and compared the profiles between the distinct regions in the country to test whether there has been a substantial change over the last five years. Methods We retrieved de-identified data publicly available from the repository of the Brazilian Ministry of Health, comprising detailed information on vaccination coverage, in all age groups, between 1994 and 2019. We examined the vaccination coverage from the whole country and each Brazilian region, by year, and performed a time-series pattern analysis. Results A significant decrease in overall vaccination coverage across the country regions was observed between 2017 and 2019, especially in childhood immunization. BCG, Hepatitis B, influenza and rotavirus vaccines displayed a reduction in coverage. Conversely, vaccines against measles, mumps, rubella, varicella, and meningococcus had an increase in coverage. Region-specific changes in vaccination patterns within the study period were observed. Conclusions Substantial reduction in vaccination coverage was detected in Brazil, a country already highly susceptible to emergency of epidemic infectious diseases. Recursively evaluation of the immunization program actions may help to improve vaccination coverage and prevent new epidemics.

Introduction: Common mental disorders (CMD) have been frequently identified among university students in the health area, especially in Medicine. It is believed that characteristics inherent to the course have a potential influence on the student’s mental health. When adding the pandemic context, with its inherent social restrictions, the psychological determinants related to the unknown pathology and the fear of the rapid spread of the new coronavirus, there is the possibility of increasing the risk factors for psychological distress in this population. Objective: To estimate the prevalence of CMD among medical students during the COVID-19 pandemic, analyzing its main determinants in the academic, social and economic spheres. Method: Cross-sectional study, carried out with 388 medical students in Salvador/BA., Data on sociodemographic and academic aspects, life habits, comorbidities and symptoms of non-psychotic disorders were collected using the Google Forms platform, measured by the Self-Reporting Questionnaire (SRQ-20). Results: The prevalence of CMD was 39.7% among medical students, with 47.4% in the basic cycle, 40.3% in the clinical cycle and 12.3% in the internship period. Among the factors associated with the emergence of CMD are sedentary lifestyle, smoking, use of substances that enhance academic performance, dissatisfaction with one’s academic performance, poor sleep quality, lack of appetite, frequent headaches, poor digestion, suicidal ideation and sadness. There was a higher rate of non-psychotic mental disorders among women, with no difference regarding the academic cycle and the administrative type of the educational institution. Conclusion: During the COVID-19 pandemic, a significant prevalence of CMD was demonstrated among female, white, single medical students who live with family members and do not have their own income. Although studies suggest an increase in the prevalence among university students at the present time, the data from the present study remain in agreement with the literature data prior to the pandemic, showing that the medical course itself is the main risk factor for higher rates of CMD in this population. However, further studies on the long-term impact of the pandemic on the mental health of university students are still necessary. Resumo: Introdução: Transtornos mentais comuns (TMC) têm sido frequentemente identificados entre universitários na área de saúde, especialmente em Medicina. Acredita-se que características inerentes ao curso exerçam potencial influência na saúde mental do estudante. Quando se adiciona o contexto de pandemia com as restrições sociais inerentes, os determinantes psicológicos relacionados à desconhecida patologia e o temor do rápido alastramento do novo coronavírus, existe a possibilidade de potencialização dos fatores de riscos para o sofrimento psíquico nessa população. Objetivo: Este estudo teve como objetivo estimar a prevalência de TMC entre estudantes de Medicina durante a pandemia da Covid-19, analisando seus principais determinantes nos âmbitos acadêmico, social e econômico. Método: Trata-se de estudo transversal, realizado com 388 estudantes de Medicina em Salvador, na Bahia. Por meio da plataforma Google Forms, coletaram-se dados sociodemográficos e acadêmicos, sobre hábitos de vida, comorbidades e sintomas de transtornos não psicóticos mensurados pelo Self-Reporting Questionnaire (SRQ-20). Resultado: A prevalência de TMC foi de 39,7% entre os estudantes de Medicina, sendo de 47,4% no ciclo básico, 40,3% no ciclo clínico e 12,3% no internato. Entre os fatores associados ao surgimento de TMC, estão sedentarismo, tabagismo, uso de substâncias que favoreçam o desempenho acadêmico, insatisfação com o próprio rendimento acadêmico, má qualidade de sono, falta de apetite, cefaleia frequente, má digestão, ideação suicida e tristeza. Observou-se maior índice de transtornos mentais não psicóticos entre as mulheres, não havendo diferença quanto ao ciclo acadêmico e à natureza administrativa da instituição de ensino. Conclusão: Durante a pandemia de Covid-19, demonstrou-se uma expressiva prevalência de TMC entre estudantes de Medicina do sexo feminino, brancos, solteiros, que residem com familiares e não possuem renda própria. Apesar de estudos sugerirem aumento da prevalência nos universitários no momento atual, os dados deste estudo permaneceram concordantes com a literatura anterior à pandemia, configurando o próprio curso de Medicina como principal fator de risco para taxas superiores de TMC nessa população. Entretanto, novos estudos acerca do impacto em longo prazo da pandemia na saúde mental dos universitários ainda são necessários.

Objetivo: avaliar a eficácia da simulação realística (SR) na graduação em medicina com base no conhecimento adquirido e na melhoria do desempenho clínico e analisar a percepção dos estudantes quanto à aplicabilidade do método como ferramenta de ensino. Métodos: foi realizada uma revisão sistemática de artigos científicos nas bases de dados PubMed, Lilacs e SciELO, em inglês e português, publicados no período de 2015 a 2020, utilizando a seguinte estratégia de busca: (simulation training OR simulation patient) AND (students medical AND education, medical, undergraduate). Resultados: dos 261 artigos identificados, apenas sete atenderam aos critérios de inclusão e exclusão estabelecidos, 57,2% deles com baixo ou moderado nível de evidência. Todos demonstraram que a SR promove modificações positivas no processo de construção acadêmica dos estudantes, contribuindo para o desenvolvimento de habilidades e competências essenciais para a formação médica. Além disso, houve majoritária percepção positiva dos estudantes quanto à utilização da SR como método de ensino durante a formação médica. Conclusão: houve evidências de eficácia da SR na aprendizagem e favorável percepção dos estudantes de medicina quanto à sua utilização. Todavia, os desafios relativos à sua implantação e execução, bem como o restrito número de artigos de alto rigor metodológico, limitam a inferência inequívoca de sua eficácia na educação médica.

In the field of medical education, it is possible to consider that the acquisition of professional competences can gain new contours when considering the use of active methodologies. It is important to analyze the perception of the students about the use of them in medical courses, as well as to reflect on their challenges and potentials. In the present study, a semistructured questionnaire of student perception was applied immediately after the execution of different types of active methodologies in the discipline of physiology in two medical courses. The results suggest a highly positive evaluation of the use of active methodologies by the student body of the two institutions. The students evaluated positively the application of the method (94.6%) and the perception about the learning (84.1%). On the other hand, when questioned about the substitution of the traditional expository method by the active methodologies, there was a tendency to the centrality of the answers, with 84.0% of the responses concentrated at positions 2, 3, and 4 on a scale of 1 (minimum) to 5 (maximum) on the Likert scale. There were no statistically significant differences when comparing variables of age, sex, and previous graduation. Although there was no consensus regarding the full replacement of traditional for active methodologies, one can conclude that the students’ perception about the introduction of said methodologies in the teaching of physiology in medical courses is positive, regardless of the subgroups evaluated. These results encourage the insertion of these and other methodologies into medical courses.

INTRODUÇÃO: A pandemia por SARS-CoV-2 impactou os modelos educacionais ofertados nos cursos de Medicina. Nesse contexto, com a autorização para oferta de disciplinas remotamente, evidencia-se uma aceleração sem precedentes na migração do modelo presencial para ensino remoto, o que já vinha ocorrendo gradativamente no sistema de educação superior brasileiro. Devido ao isolamento social para enfrentamento da crise, este modelo está sendo aplicado integralmente em muitas Instituições de Ensino Superior (IES) do país, podendo repercutir em mudanças metodológicas na educação médica. OBJETIVOS: Discutir o impacto da pandemia do SARS-CoV-2 na educação médica, analisando a migração para o modelo remoto. MÉTODO: Baseado na experiência dos autores na gestão da educação médica, foi realizada uma reflexão a partir de reuniões gerenciais de duas IES privadas. RESULTADOS: O contexto de pandemia global promoveu impactos no ensino no âmbito do corpo discente, docente e IES. Os altos investimentos na migração do modelo de ensino e a alta taxa de evasão vêm repercutindo na suspensão de contratos de docentes de IES privadas. A desigualdade de acesso tecnológico, ambientes não propícios e a má qualidade da telefonia/internet no país podem impactar no desempenho acadêmico. CONCLUSÕES: É inegável que a educação médica está sendo profundamente transformada por essa crise global de saúde. Entretanto, ainda é cedo para afirmar com segurança o tamanho desse impacto. Futuramente, será necessário adaptar o conceito de Ensino Médico baseado em evidências para avaliar com clareza as repercussões práticas dessa pandemia no ensino da Medicina.

Introduction: Breast cancer is the second most frequent cancer in the world and the first among women. Online searches are used to acquire information about symptoms and treatment. Therefore, such searches can be used in trend analysis, helping to predict outbreaks. Objectives: Describe/compare the epidemiologic patients’ profile with benign and malignant breast cancer and investigate the relationship between the number of cases of benign and malignant breast cancer with internet searches for “breast cancer”, from 2009 to 2013, in different age range. Methods: This epidemiological study used Google Trends and DATASUS (SISMAMA) data. The data were standardized in Microsoft Excel and for statistical analysis, we used the chi-square test and Pearson’s correlation test. Results: Our sample is characterized by the predominance of patients in the age group between 35 and 54 years (73.91% and 51.55% for the benign and malignant group, respectively), with an increase in the frequency of older patients in the malignant group (p

Objetivo: Este estudo visa descrever e analisar a capacidade operacional dos Estados Brasileiros para o enfrentamento da COVID-19. Metodologia: Foram levantados dados da quantidade de médicos (intensivistas e pneumologistas), leitos de UTI e respiradores em cada unidade federativa do país e, em seguida, foi avaliada a relação da oferta desses fatores com as demandas regionais. A taxa de letalidade da doença foi calculada quinze dias após o registro do 1º óbito por COVID-19, relacionando-a com a capacidade regional de enfrentamento da pandemia. Resultados: Evidenciou-se que há discrepâncias na oferta de médicos, leitos de UTI e ventiladores mecânicos para o atendimento das demandas regionais oriundas da pandemia. O Distrito Federal se destaca como a unidade federativa com a melhor relação de médicos e equipamentos hospitalares para o enfrentamento da crise, enquanto estados do norte e nordeste apresentam, majoritariamente, relações piores que as médias nacionais. Esta distribuição desigual parece interferir na condição de enfrentamento da doença com a possibilidade de impactar nas taxas de letalidade pela COVID-19. Conclusão: Existe uma discrepância da disponibilidade de recursos humanos e equipamentos hospitalares no país sugerindo uma capacidade de enfrentamento desigual da crise que pode impactar nas taxas de letalidade pela COVID-19 e colapso do sistema de saúde.

We have been developing a therapy for liver cirrhosis using cultured autologous bone marrow–derived mesenchymal stem cells (BMSCs). Before human clinical trials can be considered, the safety and efficacy of BMSC infusion in medium to large animals must be confirmed; thus, we developed a canine liver fibrosis model. A small amount of bone marrow fluid was aspirated from the canine humerus to assess the characteristics of BMSCs. We implanted a venous catheter in the stomach and a subcutaneous infusion port in the back of the neck of each canine. Repeated injection of CCl4 through the catheter was performed to induce liver cirrhosis. After 10 weeks of CCl4 injection, eight canines were equally divided into two groups: no cell infusion (control group) and autologous BMSC infusion through the peripheral vein (BMSC group). A variety of assays were carried out before and 4 weeks after the infusion. The area of liver fibrosis stained with sirius red was significantly reduced in the BMSC group 4 weeks after BMSC infusion, consistent with a significantly shortened half‐life of indocyanine green and improved liver function. Conclusion: We established a useful canine liver fibrosis model and confirmed that cultured autologous BMSC infusion improved liver fibrosis without adverse effects. (Hepatology Communications 2017;1:691–703)

It is estimated that more than 600,000 new cases of cancer will be reported in Brazil during the 2018-2019 biennium, especially with regard to prostate, breast, lung and colorectal cancers. Due to the high prevalence, incidence and mortality rates of these diseases, cancer campaigns such as 'Pink October' and 'Blue November' were strongly promoted in the past decade throughout the country to raise awareness of breast and prostate cancer, respectively. Nevertheless, whether the implementation of these campaigns has been proven efficient is still unknown. In the present study, we analysed the effectiveness of these campaigns on eliciting population online interest for cancer information. The Google Trends database was evaluated for the relative Internet search popularity for the terms 'breast cancer' and 'prostate cancer' from 2014 to 2019. Aside from some regional differences, we found that there was a high demand for 'breast cancer' and, to a lesser extent, 'prostate cancer' searches in a seasonal fashion (during October and November, respectively). Despite the worldwide high incidence of lung and colorectal cancers, searches including these keywords did not show increases in any specific period of the year, demonstrating the efficiency of the 'Pink October' and 'Blue November' campaigns in engaging the interest of the Brazilian population on the subject. These results allow us to infer that campaigns are effective in mobilising the attention of the Brazilian population with regard to breast and prostate cancers, but the practical aspects in reducing incidence and mortality should still be discussed.

O ensino superior brasileiro passou por expansão significativa nos últimos anos. A combinação de políticas públicas e desenvolvimento socioeconômico do país condicionou um aumento substancial do número de instituições, de vagas, de regiões atendidas por cursos de Medicina e, consequentemente, de professores. Apesar de majoritariamente pós-graduados, esses professores têm treinamento técnico na área específica da Saúde sem, em geral, desenvolverem competências pedagógicas. Dada a importância da Medicina na assistência à saúde brasileira, a formação dos estudantes é tópico fundamental de estudo e de constante melhoria. Avaliar a capacitação do professor, um dos principais atores envolvidos nesse processo, é, portanto, fundamental. O objetivo deste estudo foi avaliar o grau de envolvimento didático-pedagógico dos professores de graduação em Medicina da cidade de Salvador, Bahia. Cento e oitenta professores registrados e atuantes em cursos de graduação de Medicina em instituições de ensino superior da cidade receberam acesso virtual a um questionário estruturado com perguntas referentes à formação e atuação profissional no magistério superior, além de questões de cunho sócio demográficos. Os professores de Medicina, apesar de majoritariamente relatarem conhecer as Diretrizes Curriculares Nacionais do curso, em geral não têm a atividade docente como principal ofício. Além disso, parcela considerável jamais fez nenhum tipo de capacitação pedagógica e baseia sua atuação docente exclusivamente pela experiência prática no seu campo de atuação. O presente estudo demonstra que há muito a ser desenvolvido no âmbito do desenvolvimento docente no ensino médico e propõe maior investimento na capacitação didático-pedagógica desses profissionais.

AIM Less invasive therapies using mesenchymal stem cells (MSC) are being developed to treat patients with severe liver cirrhosis. MSC constitute a promising cell source for regenerative therapy and are frequently isolated from bone marrow (BMSC) or adipose tissue (ASC). Therefore, this study assessed the characteristics of these two cell types and their safety for cell infusion. METHODS In vitro, exhaustive genetic analysis was performed using human (h)BMSC and hASC. Subsequently, the expression of mRNA and protein was evaluated. In vivo, mouse (m)BMSC or mASC was infused into serial mice via the peripheral vein, and 24-h survival rate, prothrombin time and cause of death were analyzed. RESULTS On polymerase chain reaction, western blotting, enzyme-linked immunoassay and fluorescence-activated cell sorting, tissue factor was found to be expressed at higher levels in hASC than in hBMSC. Prothrombin time in mice infused with mASC (>120 s) was markedly longer than that of untreated mice (6.5 ± 1.7 s) and that of mice infused with BMSC (6.7 ± 0.8 s) (P

RESUMO A educação superior tem encontrado grandes desafios em função das velozes transformações da sociedade e, neste sentido, a aplicação de métodos pedagógicos inovadores que estimulem os alunos a criar e a desenvolver o espírito científico e reflexivo é constantemente requisitada. Entretanto, primeiramente, deve-se considerar a utilização de estratégias de aproximação com os estudantes, especialmente com os mais jovens, nascidos a partir de meados da década de 1990, que estão, atualmente, ingressando nas universidades. Para este grupo de estudantes, denominado de Geração Z, é essencial que os educadores renovem seus métodos de ensino para melhorar o processo de aprendizagem. Neste estudo, é avaliado se a utilização de tecnologias virtuais como Facebook e YouTube apresenta bons resultados no processo de ensino-aprendizagem de estudantes de uma universidade de Salvador. O Facebook foi utilizado como principal canal de comunicação entre professor e alunos; o YouTube, como um canal para compartilhamento de videoaulas desenvolvidas pelos próprios estudantes. Ambas as propostas foram sugeridas e não impostas aos estudantes. Ao final foi aplicado um questionário semiestruturado para avaliar a percepção discente. Verificou-se um alto grau de participação dos estudantes nas atividades propostas. Além disso, a percepção deles de que tais atividades foram eficazes para a construção do conhecimento foi o principal indicador positivo da análise, o que permitiu inferir que o uso dessas tecnologias é eficaz no processo de aprendizado dos estudantes, especialmente dos mais jovens. ABSTRACT Higher education has been facing great challenges due to rapidly occurring transformations in society. In this context, the application of innovative teaching methods that encourage students to create and develop scientific and critical thinking is constantly required. Nevertheless, one should first consider the use of strategies for approaching students - especially those from a younger generation, born in the mid-90s, who are currently initiating college. For this group of students, collectively referred to as Generation Z, it is essential that educators renew their teaching methods to improve the learning process. In this study, the use of virtual tools such as Facebook and YouTube was evaluated to determine their effect in higher-education student learning at the University of Salvador, Bahia. Facebook was used as the main communication tool between professors and students, and YouTube was used as a channel for virtual lessons developed by the students themselves. Both proposals have been suggested to but not demanded from the students. In the end, a semi-structured questionnaire was applied to assess student perception. As a result, we observed a high degree of student participation in the methodologies proposed. Moreover, their perception that the methods were effective for knowledge acquisition was the main positive indicator of the analysis. In conclusion, the use of virtual tools can be an effective method in the learning process of students, especially where younger ones are concerned.

Regenerative therapy has begun to be clinically applied in humans and dogs to treat neurological disorders, such as spinal cord injury (SCI). Here, we show the therapeutic potential of transplantation of cultured canine bone marrow stromal cells (BMSCs) into mice with SCI. Canine BMSC transplantation therapy was performed, immediately after the spinal cord was injured. Canine BMSC therapy enhanced functional recovery of the hind limbs in mice with SCI. Nestin-positive cells were observed only in the lesion of mice with SCI that received BMSCs. These results suggest that canine BMSCs promote functional recovery in mice with SCI and that migration of nestin-positive cells may contribute to the efficacy of the BMSC treatment.

Aim To overcome current limitations of therapy for liver diseases, cell-based therapies using mesenchymal stem cells (MSC) have been attempted through basic and clinical approaches. Oxidative stress is a crucial factor in hepatology, and reactive oxygen species (ROS) are well-established molecules responsible for its deleterious effects. The antioxidant properties of MSC were recently demonstrated, and therefore we examined the antioxidant activity of canine MSC (cMSC), their effects on isolated hepatocytes in vitro and their curative potential against thioacetamide (TAA)-induced liver injury in vivo. Methods To evaluate the ability of cMSC to challenge oxidative stress, cell viability, cytotoxicity and ROS were measured in cultured cMSC treated with TAA. Also, cMSC were co-cultured with hepatocytes in the same injury condition, and the ROS level was measured exclusively in hepatocytes. Finally, to verify the curative potential of cMSC, 2.0 × 106 cells or phosphate-buffered saline were injected systemically in non-obese diabetic/severe combined immunodeficiency mice that received TAA injections twice a week for 13 weeks. We then evaluated histological parameters, serum injury markers and redox homeostasis. Results cMSC overcame TAA-induced oxidative stress in vitro, as shown by increased viability and lower cytotoxicity and ROS levels. Moreover, hepatocytes co-cultured with cMSC also showed decreased cellular ROS. The in vivo study showed that mice treated with cMSC presented with an ameliorated histological pattern, suppressed fibrosis, lower serum injury marker levels and better oxidative parameters. Conclusion We concluded that cMSC injection reduce TAA-induced liver injury through antioxidant activities and hepatoprotective effects, showing a curative potential in liver diseases.

Mesenchymal stem cells (MSCs) are multipotent cells showing potential for use in regenerative medicine. Culture techniques that are more stable and methods for the more efficient production of MSCs with therapeutic efficacy are needed. We evaluate the effects of growing bone marrow (Bm)-derived MSCs in the presence of L-carnitine, which is believed to promote lipid metabolism and to suppress apoptosis. The presence of L-carnitine decreased the degree of drug-induced apoptosis and suppressed adipogenic differentiation. Metabolomic analysis by means of the exhaustive investigation of metabolic products showed that, in addition to increased β-oxidation and the expression of all carnitine derivatives other than deoxycarnitine (an intermediate in carnitine synthesis), polysaturated and polyunsaturated acids were down-regulated. An integrated analysis incorporating both serial analysis of gene expression and metabolomics revealed increases in cell survival, suggesting the utility of carnitine. The addition of carnitine elevated the oxygen consumption rate by BmMSCs that had been cultured for only a few generations and those that had become senescent following repeated replication indicating that mitochondrial activation occurred. Our exhaustive analysis of the effects of various carnitine metabolites thus suggests that the addition of L-carnitine to BmMSCs during expansion enables efficient cell production.

Mannheimer EG, Quintanilha LF, Carvalho AB, Paredes BD, Carvalho FG, Takyia CM, Resende CMC, Rezende GFM, Campos de Carvalho AC, Schanaider A, Goldenberg RCS. Bone marrow cells obtained from cirrhotic rats do not improve function or reduce fibrosis in a chronic liver disease model. Clin Transplant 2011: 25: 54–60. © 2009 John Wiley & Sons A/S. Abstract: Background: The objective of this study was to evaluate the therapeutic potential of bone marrow cells (BMCs) obtained from cirrhotic donors in a model of chronic liver disease. Methods: Chronic liver injury was induced in female Wistar rats by the association of an alcoholic diet with intraperitoneal injections of carbon tetrachloride. BMCs obtained from cirrhotic donors or placebo were injected through the portal vein. Blood analysis of alanine aminotransferase (ALT) and albumin levels, ultrasound assessment including the measurement of the portal vein diameter (PVD) and liver echogenicity, histologic evaluation with hematoxylin and eosin and Sirius red staining, and quantification of collagen deposition were performed. Results: ALT and albumin blood levels showed no significant differences between the experimental groups two months after injection. Additionally, no significant variation in PVD and liver echogenicity was found. Histological analysis also showed no significant variation in collagen deposition two months after placebo or BMC injection. Conclusion: This study suggests that, even though BMC therapy using cells from healthy donors has previously shown to be effective, this is not the case when BMCs are obtained from cirrhotic animals. This result has major clinical implications when considering the use of autologous BMCs from patients with chronic liver diseases.

We tested the effect of bone marrow cell (BMC) transplantation in either preventing or reversing cirrhosis on an experimental model of chronic liver disease. Female Wistar rats were fed a liquid alcohol diet and received intraperitoneal injections of carbon tetrachloride (CCl4) over 15 weeks. Ten animals (cell-treated group) received five injections of BMCs during the cirrhosis induction protocol (on the 4th, 6th, 8th, 10th, and 12th weeks) and four animals received the cells after liver injury was established through tail vein. Nine animals (nontreated group) were submitted to the previously described protocols; however, they received vehicle injections. Analyses were performed to verify whether the infusion of cells was effective in preventing the development of cirrhosis in our model of induction, and if the cells could reverse cirrhosis once it was established. Hepatic architecture and fibrotic septa were analyzed in liver slices stained with hematoxilin & eosin and Sirius red, respectively. Fibrosis quantification was measured by Sirius red histomorphometry. Indirect immunofluorescence was performed to detect the amount of tissue transglutaminase 2. Blood analyses were performed to assess liver injury and function by the assessment of alanine aminotransferase and albumin. Ultrasound was performed to analyze the portal vein caliber and presence of ascitis. Cirrhosis features (regenerative nodules and fibrous septa) were observed in histopathology after 15 weeks of continuous hepatic injury in nontreated and cell-treated groups. Collagen content, immunofluorescence analysis, and biochemical and ultrasound parameters were similar in nontreated and cell-treated groups; however, both groups showed significant differences compared to a normal control group. Cell infusions with bone marrow-derived cells seem to be ineffective in improving morphofunctional parameters of the liver when applied to chronic cases either during or after establishment of the hepatic lesion.

Less invasive therapies using mesenchymal stem cells (MSC) are being developed to treat patients with severe liver cirrhosis. MSC constitute a promising cell source for regenerative therapy and are frequently isolated from bone marrow (BMSC) or adipose tissue (ASC). Therefore, this study assessed the characteristics of these two cell types and their safety for cell infusion.In vitro, exhaustive genetic analysis was performed using human (h)BMSC and hASC. Subsequently, the expression of mRNA and protein was evaluated. In vivo, mouse (m)BMSC or mASC was infused into serial mice via the peripheral vein, and 24-h survival rate, prothrombin time and cause of death were analyzed.On polymerase chain reaction, western blotting, enzyme-linked immunoassay and fluorescence-activated cell sorting, tissue factor was found to be expressed at higher levels in hASC than in hBMSC. Prothrombin time in mice infused with mASC (120 s) was markedly longer than that of untreated mice (6.5 ± 1.7 s) and that of mice infused with BMSC (6.7 ± 0.8 s) (P 0.001), indicating that pro-coagulation activity was potently enhanced after ASC infusion. The 24-h survival rates in the mASC- and mBMSC-infused groups were 46.4% (13/28) and 95.5% (21/22), respectively; in the former, the rate decreased with increasing number of infused mASC. This cell number-dependent effect was not observed with mBMSC. A histopathological analysis of mice that died immediately following mASC infusion revealed multiple thrombi in the blood vessels of the lungs.These results indicate that BMSC are a superior and safer cell source for regenerative therapy.

Introdução: hepatopatias crônicas figuram entre as principais causas de morte no mundo e o transplante hepático permanece como a única alternativa terapêutica curativa disponível. A terapia celular utilizando células tronco tem sido demonstrada como uma alternativa potencial, porém os mecanismos envolvidos na resolução da doença permanecem em debate. Metodologia: trata-se de uma revisão de literatura, na qual foi realizada uma consulta por artigos científicos selecionados através de busca no banco de dados do PubMed e Scielo no período de agosto de 2016 a junho de 2017. Objetivo: este estudo tem como objetivo descrever os mecanismos envolvidos na regeneração/reparo da cirrose hepática através do tratamento com células tronco mesenquimais derivadas do tecido adiposo (AD-MSCs). Resultados e discussão: os estudos utilizando terapia celular apontam como principais mecanismos a fibrinólise, imunomodulação e atividade antioxidante. Com relação a atividade fibrinolítica, o aumento proeminente na expressão de enzimas como MMP2, MMP3 e MMP9 explica a redução da fibrose normalmente observada. A atividade imunomodulatória das ADMSCs parece estar relacionada com a secreção de agentes imunossupressores e fatores que promovem a hematopoiese. Finalmente, as AD-MSCS são capazes de aumentar a atividade do NF-E2-related fator (Nrf2), um fator de transcrição crucial na expressão de diversas enzimas relacionadas à resolução do estresse oxidativo. Conclusão: os estudos utilizando a terapia celular evidenciaram que fibrinólise, imunomodulação e efeito antioxidante podem, de forma associada, contribuir para os bons resultados apresentados. Apesar dos principais mecanismos propostos terem sido apresentados neste presente trabalho, mais estudos são necessários a fim de determinar a precisa contribuição de cada um deles.

To overcome current limitations of therapy for liver diseases, cell-based therapies using mesenchymal stem cells (MSC) have been attempted through basic and clinical approaches. Oxidative stress is a crucial factor in hepatology, and reactive oxygen species (ROS) are well-established molecules responsible for its deleterious effects. The antioxidant properties of MSC were recently demonstrated, and therefore we examined the antioxidant activity of canine MSC (cMSC), their effects on isolated hepatocytes in vitro and their curative potential against thioacetamide (TAA)-induced liver injury in vivo.To evaluate the ability of cMSC to challenge oxidative stress, cell viability, cytotoxicity and ROS were measured in cultured cMSC treated with TAA. Also, cMSC were co-cultured with hepatocytes in the same injury condition, and the ROS level was measured exclusively in hepatocytes. Finally, to verify the curative potential of cMSC, 2.0 × 10(6) cells or phosphate-buffered saline were injected systemically in non-obese diabetic/severe combined immunodeficiency mice that received TAA injections twice a week for 13 weeks. We then evaluated histological parameters, serum injury markers and redox homeostasis.cMSC overcame TAA-induced oxidative stress in vitro, as shown by increased viability and lower cytotoxicity and ROS levels. Moreover, hepatocytes co-cultured with cMSC also showed decreased cellular ROS. The in vivo study showed that mice treated with cMSC presented with an ameliorated histological pattern, suppressed fibrosis, lower serum injury marker levels and better oxidative parameters.We concluded that cMSC injection reduce TAA-induced liver injury through antioxidant activities and hepatoprotective effects, showing a curative potential in liver diseases.

The peculiar capacity of the liver to maintain a constant size despite injury has fascinated biologists for years and has made it the example for mammalian organ regeneration. This intrinsic process has a great potential benefit in the management of hepatic disorders. Over decades, hepatocytes, the main cell type in the hepatic regeneration process, have been the focus of intense research dedicated to exploring their use to repopulate the liver. However, therapeutic benefits are brief and limited in terms of overall efficacy and survival. The major limiting factor is the lack of good-quality hepatocytes. In this scenario, liver stem/progenitor cells appear as an alternative source that can generate a limitless supply of useful cells for therapeutic purposes. Liver stem cells or hepatic progenitors can be harvested, expanded, and cryopreserved for immediate use. Also these cells can repopulate liver matrix to produce a bioartificial organ or can be used for drug tests.

AIM: To investigate the contribution of bone marrow (BM) cells to hepatic fibrosis. METHODS: To establish a model of chimerism, C57Bl/6 female mice were subjected to full-body irradiation (7 Gy) resulting in BM myeloablation. BM mononuclear cells obtained from male transgenic mice expressing enhanced green fluorescent protein (GFP) were used for reconstitution. Engraftment was confirmed by flow cytometry. To induce liver injury, chimeric animals received carbon tetrachloride (CCl4) 0.5 mL/kg intraperitoneally twice a week for 30 d (CCl4 30 d) and age-matched controls received saline (Saline 30 d). At the end of this period, animals were sacrificed for post mortem analysis. Liver samples were stained with hematoxylin and eosin to observe liver architectural changes and with Sirius red for collagen quantification by morphometric analysis. α-smooth muscle actin (α-SMA) was analyzed by confocal microscopy to identify GFP+ cells with myofibroblast (MF) characteristics. Liver tissue, BM and peripheral blood were collected and prepared for flow cytometric analysis using specific markers for detection of hepatic stellate cells (HSCs) and precursors from the BM. RESULTS: Injury to the liver induced changes in the hepatic parenchymal architecture, as reflected by the presence of inflammatory infiltrate and an increase in collagen deposition (Saline 30 d = 11.10% ± 1.12% vs CCl4 30 d = 12.60% ± 0.73%, P = 0.0329). Confocal microscopy revealed increased reactivity against α-SMA in CCl4 30 d compared to Saline 30 d, but there was no co-localization with GFP+ cells, suggesting that cells from BM do not differentiate to MFs. Liver flow cytometric analysis showed a significant increase of CD45+/GFP+ cells in liver tissue (Saline 30 d = 3.2% ± 2.2% vs CCl4 30 d = 5.8% ± 1.3%, P = 0.0458), suggesting that this increase was due to inflammatory cell infiltration (neutrophils and monocytes). There was also a significant increase of common myeloid progenitor cells (CD117+/CD45+) in the livers of CCl4-treated animals (Saline 30 d = 2.16% ± 1.80% vs CCl4 30 d = 5.60% ± 1.30%, P = 0.0142). In addition the GFP-/CD38+/CD45- subpopulation was significantly increased in the CCl4 30 d group compared to the Saline 30 d group (17.5% ± 3.9% vs 9.3% ± 2.4%, P = 0.004), indicating that the increase in the activated HSC subpopulation was not of BM origin. CONCLUSION: BM progenitor cells do not contribute to fibrosis, but there is a high recruitment of inflammatory cells that stimulates HSCs and MFs of liver origin.

The objective of our study was to evaluate the therapeutic potential of bone marrow mesenchymal stromal cells (MSC) in a rat model of severe chronic liver injury. Fourteen female Wistar rats were fed exclusively an alcoholic liquid diet and received intraperitoneal injections of carbon tetrachloride every other day during 15 weeks. After this period, eight animals (MSC group) had 1 × 107 cells injected into the portal vein while six animals (placebo group) received vehicle. Blood analysis was performed to evaluate alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin before cell therapy and 1 and 2 months after cell or placebo infusion. Fibrosis was evaluated before and 1 month after cell or placebo injection by liver biopsies. Two months after cell delivery, animals were sacrificed and histological analysis of the livers was performed. Fibrosis was quantified by histomorphometry. Biopsies obtained before cell infusion showed intense collagen deposition and septa interconnecting regenerative nodules. One month after cell injection, this result was unaltered and differences in fibrosis quantification were not found between MSC and placebo groups. ALT and AST returned to normal values 2 weeks after cell or placebo infusion, without significant differences between experimental groups. Two months after cell or placebo injection, albumin had also returned to normal values and histological results were maintained, again without differences between MSC and placebo groups. Therefore, under our experimental conditions, MSC were unable to reduce fibrosis or improve liver function in a rat model of severe chronic liver injury. Disclosure of potential conflicts of interest is found at the end of this article.

Background Domestic dogs and cats are very well known to develop chronic hepatic diseases, including hepatic lipidosis and cirrhosis. Ultrasonographic examination is extensively used to detect them. However, there are still few reports on the use of the ultrasound B-mode scan in correlation with histological findings to evaluate diffuse hepatic changes in rodents, which represent the most important animal group used in experimental models of liver diseases. The purpose of this study was to determine the reliability of ultrasound findings in the assessment of fatty liver disease and cirrhosis when compared to histological results in Wistar rats by following up a murine model of chronic hepatic disease. Results Forty Wistar rats (30 treated, 10 controls) were included. Liver injury was induced by dual exposure to CCl4 and ethanol for 4, 8 and 15 weeks. Liver echogenicity, its correlation to the right renal cortex echogenicity, measurement of portal vein diameter (PVD) and the presence of ascites were evaluated and compared to histological findings of hepatic steatosis and cirrhosis. Liver echogenicity correlated to hepatic steatosis when it was greater or equal to the right renal cortex echogenicity, with a sensitivity of 90%, specificity of 100%, positive and negative predictive values of 100% and 76.9% respectively, and accuracy of 92.5%. Findings of heterogeneous liver echogenicity and irregular surface correlated to liver cirrhosis with a sensitivity of 70.6%, specificity of 100%, positive and negative predictive values of 100% and 82.1% respectively, and accuracy of 87.5%. PVD was significantly increased in both steatotic and cirrhotic rats; however, the later had greater diameters. PVD cut-off point separating steatosis from cirrhosis was 2.1 mm (sensitivity of 100% and specificity of 90.5%). One third of cirrhotic rats presented with ascites. Conclusion The use of ultrasound imaging in the follow-up of murine diffuse liver disease models is feasible and efficient, especially when the studied parameters are used in combination. The potential implication of this study is to provide a non-invasive method that allows follow-up studies of fatty liver disease and cirrhosis of individual rats for pre-clinical drug or cell based therapies.