Lucélio B. Couto

Development of Anatomophysiologic Knowledge Regarding the Cardiovascular System: From Egyptians to Harvey.

Our knowledge regarding the anatomophysiology of the cardiovascular system (CVS) has progressed since the fourth millennium BC. In Egypt (3500 BC), it was believed that a set of channels are interconnected to the heart, transporting air, urine, air, blood, and the soul. One thousand years later, the heart was established as the center of the CVS by the Hippocratic Corpus in the medical school of Kos, and some of the CVS anatomical characteristics were defined. The CVS was known to transport blood via the right ventricle through veins and the pneuma via the left ventricle through arteries. Two hundred years later, in Alexandria, following the development of human anatomical dissection, Herophilus discovered that arteries were 6 times thicker than veins, and Erasistratus described the semilunar valves, emphasizing that arteries were filled with blood when ventricles were empty. Further, 200 years later, Galen demonstrated that arteries contained blood and not air. With the decline of the Roman Empire, Greco-Roman medical knowledge about the CVS was preserved in Persia, and later in Islam where, Ibn Nafis inaccurately described pulmonary circulation. The resurgence of dissection of the human body in Europe in the 14th century was associated with the revival of the knowledge pertaining to the CVS. The main findings were the description of pulmonary circulation by Servetus, the anatomical discoveries of Vesalius, the demonstration of pulmonary circulation by Colombo, and the discovery of valves in veins by Fabricius. Following these developments, Harvey described blood circulation.

Brazilian medical students' perceptions of expert versus non-expert facilitators in a (non) problem-based learning environment.

Background In problem-based learning (PBL), the facilitator plays an important role in guiding the student learning process. However, although content expertise is generally regarded as a useful but non-essential prerequisite for effective PBL facilitation, the perceived importance of content knowledge may be subject to cultural, contextual, and/or experiential influences. Aim We sought to examine medical students’ perceptions of subject-matter expertise among PBL facilitators in a region of the world (Brazil) where such active learning pedagogies are not widely used in university or pre-university settings. Results Of the 252 Brazilian medical students surveyed, significantly (p≤0.001) greater proportions viewed content expert facilitators to be more effective than their non-expert counterparts at building knowledge (95% vs. 6%), guiding the learning process (93% vs. 7%), achieving cognitive learning (92% vs. 18%), generating learning goals (87% vs. 15%), and motivating self-study (80% vs. 15%). Discussion/conclusion According to Brazilian medical students, subject-matter expertise among PBL facilitators is essential to the learning process. We believe this widespread perception is due, in large part, to the relative lack of prior educational exposure to such pedagogies.Background In problem-based learning (PBL), the facilitator plays an important role in guiding the student learning process. However, although content expertise is generally regarded as a useful but non-essential prerequisite for effective PBL facilitation, the perceived importance of content knowledge may be subject to cultural, contextual, and/or experiential influences. Aim We sought to examine medical students’ perceptions of subject-matter expertise among PBL facilitators in a region of the world (Brazil) where such active learning pedagogies are not widely used in university or pre-university settings. Results Of the 252 Brazilian medical students surveyed, significantly (p≤0.001) greater proportions viewed content expert facilitators to be more effective than their non-expert counterparts at building knowledge (95% vs. 6%), guiding the learning process (93% vs. 7%), achieving cognitive learning (92% vs. 18%), generating learning goals (87% vs. 15%), and motivating self-study (80% vs. 15%). Discussion/conclusion According to Brazilian medical students, subject-matter expertise among PBL facilitators is essential to the learning process. We believe this widespread perception is due, in large part, to the relative lack of prior educational exposure to such pedagogies.

Curcumin Analog CH-5 Suppresses the Proliferation, Migration, and Invasion of the Human Gastric Cancer Cell Line HGC-27

Gastric cancer is one of the most frequent malignant tumors in the world. The majority of patients are diagnosed with metastatic gastric cancer, which has a low survival rate. These data reinforce the importance of studying the anticancer activity of new molecules with the potential to suppress gastric cancer metastasis. Curcumin is a well-studied compound that has demonstrated anti-metastatic effects. Here we investigated if CH-5, a curcumin derivative compound, has anti-metastatic properties in the human gastric cancer cell line HGC-27. Firstly, we found that CH-5 decreased viability and induced apoptosis in HGC-27 cells in a dose-dependent manner. Additionally, CH-5 suppressed the migration and invasion of HGC-27 cells by downregulating the expression and collagenase activity of matrix metalloproteinase 2 in a dose-dependent manner. In conclusion, CH-5 showed anticancer activities, including the induction of apoptosis, and the suppression of migration and invasion in HGC-27 cells, suggesting that CH-5 can be a lead molecule for the development of anti-metastatic drugs for gastric cancer therapy.

Contextual considerations in implementing problem-based learning approaches in a Brazilian medical curriculum: the UNAERP experience.

Background Despite being a well-established pedagogical approach in medical education, the implementation of problem-based learning (PBL) approaches hinges not only on educational aspects of the medical curriculum but also on the characteristics and necessities of the health system and the medical labor market within which it is situated. Aim To report our experiences implementing a PBL-based approach in a region of Brazil where: 1) all pre-university education and the vast majority of medical courses are based on traditional, lecture-based instructions; and 2) students’ career interests in primary care, arguably the prototypical PBL trainee, are heavily disfavored because of economics. Results Brazilian guidelines require that clinical training take place during the last 2 years of the medical program and include intensive, supervised, inpatient and outpatient rotations in pediatrics, family medicine, obstetrics and gynecology, internal medicine, and surgery. Throughout the pre-clinical curriculum, then, students learn to deal with progressively more difficult and complex cases – typically through the use of PBL tutors in a primary care context. However, because of curricular time constraints in the clerkships, and students’ general preoccupation with specialty practice, the continuation of PBL-based approaches in the pre-clinical years – and the expansion of PBL into the clerkships – has become exceedingly difficult. Discussion and conclusion Our experience illustrates the importance of context (both cultural and structural) in implementing certain pedagogies within one Brazilian training program. We plan to address these barriers by: 1) integrating units, whenever possible, within a spiral curriculum; 2) introducing real patients earlier in students’ pre-clinical coursework (primarily in a primary care setting); and 3) using subject experts as PBL tutors to better motivate students.

Evaluation of the Hypoglycemic Properties of Anacardium humile Aqueous Extract.

The antihyperglycemic effects of several plant extracts and herbal formulations which are used as antidiabetic formulations have been described and confirmed to date. The main objective of this work was to evaluate the hypoglycemic activity of the aqueous extract of Anacardium humile. Although the treatment of diabetic animals with A. humile did not alter body weight significantly, a reduction of the other evaluated parameters was observed. Animals treated with A. humile did not show variation of insulin levels, possibly triggered by a mechanism of blood glucose reduction. Levels of ALT (alanine aminotransferase) decreased in treated animals, suggesting a protective effect on liver. Levels of cholesterol were also reduced, indicating the efficacy of the extract in reestablishing the balance of nutrients. Moreover, a kidney protection may have been achieved due to the partial reestablishment of blood glucose homeostasis, while no nephrotoxicity could be detected for A. humile. The obtained results demonstrate the effectiveness of A. humile extracts in the treatment of alloxan-induced diabetic rats. Therefore, A. humile aqueous extract, popularly known and used by diabetic patients, induced an improvement in the biochemical parameters evaluated during and following treatment of diabetic rats. Thus, a better characterization of the medicinal potential of this plant will be able to provide a better understanding of its mechanisms of action in these pathological processes.

Behavioral and enzymatic bioassays with Serjania erecta Radlk., Sapindaceae, correlated with cognitive dysfunctions

The purpose of this study was to investigate the crude extract of Serjania erecta Radlk., Sapindaceae, and its bioactive agents as preventive or inhibitor of memory loss in rodents, as well as other factors correlated with Alzheimers syndrome: antioxidant and anticholinesterase activity, mainly as plant adaptogen - low toxicity and regulation action. The blocking cholinergic reversion activity (scopolamine) in the test of the passive avoidance was detected by measuring latency in young and adult animals. It presented low toxicity, with protective effect as shown by biochemical analysis (hypoglycemic/hypotriglyceridemic). Elevated levels (above 83%) of antioxidant activity were detected. AchE and BuChE inhibition were also detected in the chromatographic fractions, which were active both orally and directly on CNS (ICV).

Assessment test before the reporting phase of tutorial session in problem-based learning

Purpose In our context, problem-based learning is not used in the preuniversity environment. Consequently, students have a great deal of difficulty adapting to this method, particularly regarding self-study before the reporting phase of a tutorial session. Accordingly, the aim of this study was to assess if the application of an assessment test (multiple choice questions) before the reporting phase of a tutorial session would improve the academic achievement of students at the preclinical stage of our medical course. Methods A test consisting of five multiple choice questions, prepared by tutors of the module at hand and related to the problem-solving process of each tutorial session, was applied following the self-study phase and immediately before the reporting phase of all tutorial sessions. The questions were based on the previously established student learning goals. The assessment was applied to all modules from the fifth to the eighth semesters. The final scores achieved by students in the end-of-module tests were compared. Results Overall, the mean test score was 65.2±0.7% before and 68.0±0.7% after the introduction of an assessment test before the reporting phase (P<0.05). Students in the sixth semester scored 67.6±1.6% compared to 63.9±2.2% when they were in the fifth semester (P<0.05). Students in the seventh semester achieved a similar score to their sixth semester score (64.6±2.6% vs 63.3±2%, respectively, P>0.05). Students in the eighth semester scored 71.8±2.3% compared to 70±2% when they were in the seventh semester (P>0.05). Conclusion In our medical course, the application of an assessment test (a multiple choice test) before the reporting phase of the problem-based learning tutorial process increases the overall academic achievement of students, especially of those in the sixth semester in comparison with when they were in the fifth semester.

Letter by Bestetti et al Regarding Article, “Inflammatory Cardiomyopathic Syndromes”

We have read with great interest the superb review by Trachtemberg and Hare1 on inflammatory cardiomyopathies. Among other interesting scientific points, in that article, the authors summarize the knowledge about chronic Chagas disease, a disease caused by the protozoan Trypanosoma cruzi . This disease is the cause of a cardiomyopathy that primarily plagues Latin America, but nowadays is globalized to the point to affect ≈400 000 people in the United States, and to cause chronic heart failure in 19% of patients with nonischemic cardiomyopathy in Los Angeles.2 Trachtemberg and Hare1 correctly pointed out that Chagas disease runs 2 forms: the acute and the chronic stage. Whereas the acute stage lasts up …

Problem-based learning in primary care at University of Ribeirão Preto (UNAERP) in Brazil

php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Advances in Medical Education and Practice 2018:9 27–30 Advances in Medical Education and Practice Dovepress

Good teacher, good tutor

© 2016 Couto et al. This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at http://creativecommons.org/licenses/by/4.0/. The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 2016 Couto et al. This work is published and licensed by Dove Me l Press Lim ted. The full terms of this license are ava lable at https://www.dovepress.com/terms. p p and incorporate the Creative Commons Attribution – Non Commercial (unp rted, v3.0) Licen e (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Advances in Medical Education and Practice 2016:7 377–380 Advances in Medical Education and Practice Dovepress