Cláudio de Souza

Aspectos éticos da experimentação animal

BACKGROUND AND OBJECTIVES This is a major subject since the aim is to grant human beings physical, mental, social and spiritual well-being without forgetting the sacred rights of all animals. Most international codes dealing with health-related research practices state that research developed in human beings should be based on previous lab animal experiments or on other scientific data. This article aimed at explaining ethics in animal experiments. CONTENTS The concepts of dissertation and thesis, experimental thesis, experimental essay or pilot experiment and experimental animal facilities are reviewed. Then, a historical retrospective is drawn about the first attempt to develop experimental research policies during the mid 19th Century, in London. It is highlighted that some criteria defined by that time still persist. The first animal research ethical committee was created in Sweden in 1979, followed by the USA in1984. In Brazil, animal research ethical committees were created as late as in the 90s. The Federal Law 6638 was passed in May 1979 and provides for the didactic-scientific practice of animal vivisection. This law, however, is still waiting for regulation. In addition, there are some drafts being analyzed by the Congress, which provide for the use of animals for teaching and research purposes. Finally, the policies adopted by the Brazilian College of Animal Experiments and the Universal Declaration of Animal Rights are presented. CONCLUSIONS Professors, postgraduates, residents and graduate students of a Medical School involved in animal research should be aware of the ethical principles aiming at protecting animals selected for scientific work.JUSTIFICATIVA E OBJETIVOS: O tema abordado e de suma importância, pois almeja-se que o ser humano atinja seu bem-estar fisico, mental, social e espiritual, sem esquecer os sagrados direitos de todos os animais. A maioria dos codigos internacionais que tratam das normas de pesquisa na area da saude cita que a pesquisa desenvolvida em seres humanos deve estar fundamentada na experimentacao previa realizada em animais, em laboratorios ou em outros fatos cientificos. O presente artigo tem por objetivo explanar os aspectos eticos da experimentacao animal. CONTEUDO: Os autores reveem os conceitos de dissertacao e tese, tese experimental, ensaio experimental ou experiencia piloto e de bioterio. A seguir fazem uma retrospectiva historica acerca da primeira tentativa para se estabelecer normas em relacao a pesquisa experimental, ocorrida em meados do seculo XIX em Londres. E ressaltado que alguns criterios definidos aquela epoca persistem ate o presente. A primeira comissao de etica em pesquisa animal foi criada na Suecia em 1979, e a seguir nos EUA em 1984. No Brasil, os comites de etica em pesquisa animal foram constituidos a partir da decada de noventa. Desde maio de 1979 existe a Lei Federal 6638 que estabelece normas para a pratica didatico-cientifica da vivisseccao de animais. Essa lei, entretanto, ainda aguarda regulamentacao. Alem dela, tramitam no Congresso Nacional alguns anteprojetos dispondo sobre o uso de animais para atividades de ensino e pesquisa. Finalmente, sao apresentadas na integra as normas adotadas pelo Colegio Brasileiro de Experimentacao Animal e a Declaracao Universal dos Direitos dos Animais. CONCLUSOES: Os docentes, pos-graduandos, residentes e graduandos de uma Faculdade de Medicina, envolvidos em pesquisas realizadas em animais, devem conhecer os principios eticos que visam proteger os animais selecionados para a realizacao de um trabalho cientifico.

Ética e telessaúde: reflexões para uma prática segura

The term eHealth (or telemedicine, telehealth) has been used to describe activities that employ information and telecommunication technologies to deliver health care. Distance is an important factor hindering the delivery of many important services, such as diagnosis, treatment, prevention, health promotion, and health research assessment. Although eHealth can provide interesting solutions such as a second specialist opinion in geographically isolated areas, a large number of ethical and legal issues must be considered. It is essential to discuss, among others, aspects relating to safety and confidentiality; professional accountability; technical standards relating to digital recording, storage, and transmission of clinical data; copyright; authorization from professional regulatory bodies; and licensing for the remote practice of medicine. In Brazil, the Federal Council of Medicine has already established rules for telemedicine; however, it is still necessary to further this discussion to involve the entire health care sector. Since there are many eHealth projects being developed in Brazil, there is an urgent need to design protocols and training programs for all professionals involved.

Telehealth in Primary Healthcare: An Analysis of Belo Horizonte's Experience

BACKGROUND Telehealth resources were implemented in the city of Belo Horizonte, providing tools for the medical assistance model as well as strengthening the quality of primary healthcare attention. OBJECTIVE The objective of this study was to analyze the characteristics of the incorporation of telehealth resources in Belo Horizonte, Brazil, and its contribution to the structuring of primary healthcare. MATERIALS AND METHODS This study focused on a description of the telehealth projects related to primary healthcare in the city and the results of the implementation process. The sources for this analysis include documents presented to financing institutions, reports from the Belo Horizonte City Department of Health, and articles and technical reports related to the evaluations of the project. RESULTS The BHTelehealth Project has been established in 148 basic health units in Belo Horizonte. It develops assistance and educational activities by using 3D modeling, interactive videos, and animations. The analysis of this implementation process identified both positive and negative aspects. Telehealth has strengthened the role of primary healthcare as the coordinator of attention. It has reinforced primary care units by widening the scope of attention offered at this level and has provided primary care staff with a powerful arsenal of up-to-date information and tools. CONCLUSION BHTelehealth served as a model for implementing the National Telehealth Program, in course in Brazil, involving 900 cities. This is attributed to its positive impact on the training of primary care unit professionals.

Avaliação hemodinâmica de anastomoses arteriais reforçadas com selante de fibrina: estudo experimental em suínos

OBJECTIVES: To evaluate the flow, tear pressure, the need of reinforcement stitches in sutured arteries reinforced or not using fibrin sealant after a cross-section. METHOD: Tissucol® fibrin sealant was used. The femoral and carotid arteries of seventeen swine from the same breed (weighing from 15 to 20 kg) were cross-sectioned after heparinization and subjected to anastomoses using a single continuous plane of prolene 7-0. We worked with 68 artery samples, 34 in the Treatment Group and 34 in the Control Group. For each animal, one carotid and one femoral artery randomly received fibrin sealant with the contralateral side being used as a control. The need and the number of reinforcement stitches were recorded. Ten minutes after protamine infusion, the animals were sacrificed and the arteries were catheterized. The arteries were measured and placed on a flow meter. The arteries were then subjected to air infusion at increasingly higher pressures (stepwise increases of 25 mmHg), the grafts were dipped in saline solution, the first air leakage was observed and the tear pressure recorded. RESULTS: The external diameters and thickness of the arteries were similar in both the Treatment and Control Group. There was no significant difference between the groups regarding the tear pressure (p=0.329), flow rate (p=0.943) and the number of samples with a tear pressure above 200 mmHg. However, the sealant reduced the number of reinforcement stitches necessary (p=0.029). CONCLUSION: Fibrin sealant reduces the need of additional stitches.

Uso de 2-octil cianoacrilato em anastomose colônica: estudo experimental em ratos wistar

OBJECTIVE: To compare the effect of 2-octyl cyanoacrylate tissue adhesive with polypropylene suture on the healing of colonic anastomosis in Wistar rats. METHODS: Thirty two animals, divided in four groups of eigth, were established concerning suture with Polypropylene or Cyanoacrylate application, and the day chose for euthanasia: third or seventh day following operation. In the control group, the anastomosis was done in a single layer with 5.0 polypropylene suture. In the adhesive group, the anastomosis was performed by using 2-octyl cyanoacrylate. Operative time, integrity and gross anastomotic healing, bursting pressure, intestinal obstruction, adhesions formation, histological healing and inflammatory process were recorded. RESULTS: Adhesion formation was more extensive in the cyanoacrylate group on the seventh postoperative day comparing with suture group (p=0.007). Mechanical strength of the anastomosis assessed on the seventh postoperative day was lower in 2-octyl cyanoacrylate group (p=0.002). Partial intestinal obstruction rate were more frequent in anastomosis using 2-octyl cyanoacrylate compared to those with polypropylene suture on the seventh postoperative day (p=0.029). Operative time were longer in groups with adhesive (p=0.004). The wound healing process, and inflammatory process did not differ statistically between groups (p>0.05). CONCLUSION: The application of 2-octyl cyanoacrylate, under experimental conditions seems to be detrimental at the seventh day of the healing, causing intense adhesion formation, colonic obstruction; and impairment healing with less mechanical strength resistance.

Ethics and animal experiments

BACKGROUND AND OBJECTIVES This is a major subject since the aim is to grant human beings physical, mental, social and spiritual well-being without forgetting the sacred rights of all animals. Most international codes dealing with health-related research practices state that research developed in human beings should be based on previous lab animal experiments or on other scientific data. This article aimed at explaining ethics in animal experiments. CONTENTS The concepts of dissertation and thesis, experimental thesis, experimental essay or pilot experiment and experimental animal facilities are reviewed. Then, a historical retrospective is drawn about the first attempt to develop experimental research policies during the mid 19th Century, in London. It is highlighted that some criteria defined by that time still persist. The first animal research ethical committee was created in Sweden in 1979, followed by the USA in1984. In Brazil, animal research ethical committees were created as late as in the 90s. The Federal Law 6638 was passed in May 1979 and provides for the didactic-scientific practice of animal vivisection. This law, however, is still waiting for regulation. In addition, there are some drafts being analyzed by the Congress, which provide for the use of animals for teaching and research purposes. Finally, the policies adopted by the Brazilian College of Animal Experiments and the Universal Declaration of Animal Rights are presented. CONCLUSIONS Professors, postgraduates, residents and graduate students of a Medical School involved in animal research should be aware of the ethical principles aiming at protecting animals selected for scientific work.JUSTIFICATIVA E OBJETIVOS: O tema abordado e de suma importância, pois almeja-se que o ser humano atinja seu bem-estar fisico, mental, social e espiritual, sem esquecer os sagrados direitos de todos os animais. A maioria dos codigos internacionais que tratam das normas de pesquisa na area da saude cita que a pesquisa desenvolvida em seres humanos deve estar fundamentada na experimentacao previa realizada em animais, em laboratorios ou em outros fatos cientificos. O presente artigo tem por objetivo explanar os aspectos eticos da experimentacao animal. CONTEUDO: Os autores reveem os conceitos de dissertacao e tese, tese experimental, ensaio experimental ou experiencia piloto e de bioterio. A seguir fazem uma retrospectiva historica acerca da primeira tentativa para se estabelecer normas em relacao a pesquisa experimental, ocorrida em meados do seculo XIX em Londres. E ressaltado que alguns criterios definidos aquela epoca persistem ate o presente. A primeira comissao de etica em pesquisa animal foi criada na Suecia em 1979, e a seguir nos EUA em 1984. No Brasil, os comites de etica em pesquisa animal foram constituidos a partir da decada de noventa. Desde maio de 1979 existe a Lei Federal 6638 que estabelece normas para a pratica didatico-cientifica da vivisseccao de animais. Essa lei, entretanto, ainda aguarda regulamentacao. Alem dela, tramitam no Congresso Nacional alguns anteprojetos dispondo sobre o uso de animais para atividades de ensino e pesquisa. Finalmente, sao apresentadas na integra as normas adotadas pelo Colegio Brasileiro de Experimentacao Animal e a Declaracao Universal dos Direitos dos Animais. CONCLUSOES: Os docentes, pos-graduandos, residentes e graduandos de uma Faculdade de Medicina, envolvidos em pesquisas realizadas em animais, devem conhecer os principios eticos que visam proteger os animais selecionados para a realizacao de um trabalho cientifico.

Evaluation of the use of videoconferencing for distance training of doctors in the family health teams within the national telehealth project

Introduction: the National Telehealth Program aims at updating and training doctors in the Family Health Teams by means of videoconferencing (VCs), with potential impact on improving the health care in remote locations and reducing the displacement of patients. In addition, it proposes increased primary care interaction with specialized centers. Objectives: presentation and evaluation of the use of the videoconferencing system allowing for better planning of action in the project. Methods: 916 evaluation /feedback questionnaires were analyzed, completed by participants at the end of 84 VCs in Medicine, between 2009 and 2013. The VCs are a branch of the National Telehealth Project and reach 50 municipalities in Minas Gerais under the coordination of the FM-UFMG. They are held via web, requiring minimal equipment in diffuser and receiver centers. Results: in the study period, an average of 12.64 municipalities and 19.42 speakers were identified. Of these, the average number of doctors was 12.97. The quality parameters achieved positive assessment (“great” or “good”) in just 62% for the sound, and 84% for the image. The theme was considered “interesting” or “very interesting” by 98%. Conclusions: the VCs have been strengthened as an alternative to educational institutions. However, the participation of speakers and municipalities in this project was less than desired. The comparative analysis of VCs from other areas also reveals a reduced adhesion of doctors. Among the problems detected, especially regarding the sound quality, the low quality of internet connection in the municipalities may have contributed to this result.

Incorporation of Telehealth Resources in Belo Horizonte's SAMU: Qualifying and Improving Care

In Brazil the use of information communication technologies increased considerably in this last few years, but there are still very incipient experiments using telemedicine for pre-hospital care. This article reports the deployment of resources of telehealth on SAMU (Emergency Mobile Assistance Service) of Belo Horizonte and the preliminary results of the project, involving European partners, the Federal University of Minas Gerais School of Medicine and the City of Belo Horizonte Department of Health. It is applied to the Brazilian reality, through the appropriation of good practices existing in Europe and the integration of technology development. We have been using multiparametric monitors, videos of the patient and ultrasound, and 3G technology to enhance transfer of pre-hospital data, from ambulances, to data banks in hospitals, to improve patient care.

Behavior of pharmaceuticals in UV photoreactors fed with sewage treated by anaerobic/aerobic system

ABSTRACT This work has assessed the seasonal changes and the dynamics in the concentration of six pharmaceutical compounds during photolysis as a tertiary treatment of sewage previously treated by an anaerobic/aerobic system comprising a UASB (Upflow Anaerobic Sludge Blanket) reactor and a trickling filter (TF). The target compounds were four antibiotics (ciprofloxacin (CPF), clindamycin (CLM), sulfamethoxazole (SMX), and trimetoprim), one β-blocker (atenolol), and one anti-inflammatory (diclofenac (DCF)). Six hydraulic retention times (HRTs) were evaluated (5, 10, 20, 40, 80, and 160 min) with the intent of varying the ultraviolet C (UVC) radiation doses applied to the effluent from biological treatment containing the target contaminants. The concentrations of pharmaceutical compounds in the effluent of the UASB/TF system were in agreement with the concentration levels reported in the literature. Aside from DCF, the seasonality seems to be a preponderant characteristic regarding the pharmaceutical concentration found in the effluent of biological treatment systems. The radiation dose of 117 mJ cm−2 seemed to be most suited for the photolysis application to tertiary treatment of domestic effluents. It was observed that lower UVC doses led to deconjugation of pharmaceuticals, which can result in increased concentrations of target pollutants in the photoreactor effluent.

Telehealth: confidentiality and informed consent

reSumO A sociedade vivencia avancos na area da informatica, com novos recursos que instrumentalizam a area da saude e oferecem outras modalidades de atendimento. Apesar dos beneficios dessas inovacoes, os principios eticos e legais devem ser preservados. Esta revisao da literatura pretende promover reflexao sobre a confidencialidade, privacidade, seguranca e veracidade das informacoes nos servicos que utilizam a telessaude. Foram pesquisadas as bases de dados Scielo e Lilacs para a busca de artigos publicados nos ultimos 12 anos em portugues, espanhol ou ingles e que abordassem a confidencialidade e o consentimento nos atendimentos por meio da telessaude. Para evitar a violacao e garantir que o procedimento seja etico nas informacoes relativas a saude, deve haver certificacao eletronica dos sistemas utilizados de acordo com padroes internacionais. Os usuarios dos sistemas devem utilizar assinatura digital conferida por autoridade publica. O termo de consentimento livre e esclarecido deve ser assinado pelo paciente para a realizacao de teleconsultorias. Palavras-chave: Telemedicina; Consulta Remota; Consulta Remota/etica; Consentimento Livre e Esclarecido; Etica Medica; Bioetica; Confianca; Validacao de Programas de Computador.