São Paulo medical journal = Revista paulista de medicina
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Assessment of clinical skills has a central role in medical education and the selection of suitable methods is highly relevant. The OSCE (Objective Structured Clinical Examination) is now established as one of the most valid, reliable and effective tests for the assessment of clinical skills. ⋯ In addition to shortage of resources and organizational difficulties, local cultural aspects and the absence of a more favorable educational climate may hinder lasting improvements in assessment methods in traditional medical schools.
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Randomized Controlled Trial Clinical Trial
A randomized and prospective study on the value of antibiotic prophylaxis administration in transurethral resection of the prostate.
Antibiotic prophylaxis in transurethral resection of the prostate is a regular practice in urology. However, its prophylactic effect can be questioned when the antiseptic surgical technique is used. Nonetheless, urine culture-oriented antibiotic therapy is the gold standard for avoiding improper medication usage and bacterial resistance. ⋯ Antibiotic prophylaxis for patients whose urine is sterile is debatable in patients who are candidates for transurethral resection of the prostate. Most of the time, the antibiotic agent used is not specific for any of the bacteria recovered from the various sources analyzed.
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Brazilian researchers have recently recognized a marked increase in the number of people using abusable drugs and the consequences of this habit. It has become a major public health problem in a potentially productive segment of the general population. In the last few years, several medical articles have given special emphasis to pulmonary complications related to cocaine use. This review is based on this information and experience acquired with groups of cocaine users. ⋯ Pulmonary complications are described. These may include infections (Staphylococcus aureus, pulmonary tuberculosis, acquired immunodeficiency syndrome/aids, etc.), aspiration pneumonia, lung abscess, empyema, septic embolism, non-cardiogenic pulmonary edema, barotrauma, pulmonary granulomotosis, branchiolitis obliterans and organizing pneumonia, pneumonitis and interstitial fibrosis, pneumonitis hypersensitivity, lung infiltrates and eosinophilia in individuals with branchial hyperreactivity, diffuse alveolar hemorrhage, vasculitis, pulmonary infarction, pulmonary hypertension and alterations in gas exchange. It is concluded that physicians should give special attention to the various pulmonary and clinical manifestations related to cocaine use, particularly in young patients.
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Loss of heterozygosity in the 9p21-p22 region, has been frequently described in a wide range of human malignancies, including familial melanomas. Also, losses and gains in other regions of chromosome 9 have frequently been observed and may indicate additional mechanisms for basal cell tumorigenesis. ⋯ This phenotype dependency suggests that there is a major distinction between the two most important forms of nonmelanoma skin cancers in their tendency to present microsatellite instability in chromosome 9. Since the CDKN2a/p16INK4a, p19ARF and p15INK4b tumor suppressor genes do not appear to be responsible for the observed abnormalities, other genes at 9p21-p22 may be involved in the pathogenesis and progression pathway of basal cell carcinomas.
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Primary hyperparathyroidism is the most common cause of hypercalcemia in unselected patients. The ectopic gland locations should be known for appropriate surgical exploration and for avoiding subsequent re-exploration that would represent higher morbidity. Multiple ectopic glands are rare and present a particular challenge in parathyroid surgery. ⋯ Routine bilateral neck surgery should be performed as a rule. We use ultrasound and technetium sestamibi scanning as a routine for preoperative localization studies. It is helpful to have an experienced surgeon for the localization.