BackgroundHuman cytomegalovirus (CMV) infection still causes significant morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Therefore, it is extremely important to diagnosis and monitor active CMV infection in HSCT patients, defining the CMV DNA levels of virus replication that warrant intervention with antiviral agents in order to accurately prevent CMV disease and further related complications.MethodsDuring the first 150 days after allogeneic HSTC, thirty patients were monitored weekly for active CMV infection by pp65 antigenemia, nested-PCR and real-time PCR assays. Receiver operating characteristic (ROC) plot analysis was performed to determine a threshold value of the CMV DNA load by real-time PCR.ResultsUsing ROC curves, the optimal cutoff value by real-time PCR was 418.4 copies/104 PBL (sensitivity, 71.4%; specificity, 89.7%). Twenty seven (90%) of the 30 analyzed patients had active CMV infection and two (6.7%) developed CMV disease. Eleven (40.7%) of these 27 patients had acute GVHD, 18 (66.7%) had opportunistic infection, 5 (18.5%) had chronic rejection and 11 (40.7%) died - one died of CMV disease associated with GVHD and bacterial infection.ConclusionsThe low incidence of CMV disease in HSCT recipients in our study attests to the efficacy of CMV surveillance based on clinical routine assay. The quantification of CMV DNA load using real-time PCR appears to be applicable to the clinical practice and an optimal cutoff value for guiding timely preemptive therapy should be clinically validated in future studies.

BackgroundBased on sequence variation in the UL55 gene that encodes glycoprotein B (gB), human cytomegalovirus (CMV) can be classified into four gB genotypes. Previous studies have suggested an association between CMV gB genotype and clinical outcome in patients who underwent an allogeneic hematopoietic stem cell transplant (HSCT). The goals of this study were identify patients with active infection caused by CMV in recipients of HSCT; determine the prevalence of CMV genotypes in the study group; correlate genotype with CMV disease, acute GVHD and overall survival.MethodsThe diagnosis of active CMV infection after allogeneic HSCT was detected by antigenemia (AGM) and/or nested-PCR (N-PCR). Positive samples from patients with active CMV infection were submitted to genotyping using N-PCR to amplify a region of UL55, followed by restriction analysis based on HinfI and RsaI digestion. Real-time PCR (qPCR) was used to determine the viral load during active CMV infection and antiviral treatment.ResultsSixty-three allogeneic HSCT recipients were prospectively evaluated; 49/63 (78%) patients were infected with CMV genotypes – gB1 19/49 (39%), gB2 17/49 (35%), gB3 3/49 (6%), gB4 7/49 (14%) – and 3 (6%) had mixed CMV genotypes (gB1 + gB3, gB1 + gB4 and gB2 + gB4). Characterized by gastrointestinal disease, CMV disease occurred in 3/49 (6.1%) patients, who had CMV gB3 genotype. These gB3 genotype patients presented an increasing AGM number, mean 125 (± 250) (P = 0.70), and qPCR copies/ml, mean 37938 (SD ± 50542) (P = 0.03), during antiviral treatment, when compared with other CMV genotypes. According to CMV genotypes, stratified overall survival was 55% for gB1, 43% for gB2; 0% for gB3 and 57% for gB4 (P = 0.03).ConclusionsOne of the restrictions of the presented study was the low number of CMV gB sub-cohorts). However, we demonstrated that the frequency of active CMV infection in this HSCT population was high, and the most prevalent genotype in these patients with active CMV infection was gB1 and gB2 genotype (74%). In Brazil, HSCT recipients seem to carry mainly gB1 and gB2 CMV genotype.

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Resumo: Por meio de reflexões sobre o desenvolvimento da autoavaliação, no contexto do Sistema Nacional de Avaliação da Educação Superior (SINAES), o presente artigo descreve a experiência de docentes que compõem a Comissão Própria de Avaliação de uma Universidade privada do estado de São Paulo, desde as primeiras participações em processos avaliativos até a elaboração da metodologia, construção dos instrumentos de coleta de dados e divulgação dos relatórios. Embora não sejam enfatizados os resultados da autoavaliação, a descrição e a análise desse processo levam em consideração o impacto da criação dos índices de avaliação das instituições de ensino superior.Palavras-chave: Autoavaliação institucional. SINAES. Comissão própria de avaliação. REFLECTIONS ON THE PROCESS OF INSTITUTIONAL SELF-EVALUATION: THE VIEW OF A SELF-EVALUATION COMMITTEEAbstract: Through considerations on the development of self-evaluation in the context of the National Higher Education Evaluation System (SINAES), this article describes the experience of professors' who are part of the Self-Evaluation Committee of a private university in the state of São Paulo, discussing since the first involvements in evaluation processes to methodology settings, elaboration of data collecting techniques and disclosure of reports. Although it does not emphasize the results of self-evaluation, the description and analysis of this process take into account the impact of the creation of higher education evaluation indexes.Key words: Institutional self-evaluation. SINAES. Self-evaluation committee. INTRODUÇÃOAvaliar é tarefa das mais difíceis. Mesmo levando-se em conta o sentido mais usual de avaliação em uma instituição universitária -a avaliação da aprendizagem -é certo que haverá pontos discordantes quanto ao melhor meio de realizá-la e quanto à aferição dos resultados. Tais características também se aplicam ao processo de autoavaliação, que requer um olhar interno para

Background: Medical programmes that implement problem-based learning (PBL) face several challenges when introducing this innovative learning method. PBL relies on small group as the foundation of study, and tutors facilitate learning by guiding the process rather than teaching the group. One of the major challenges is the use of strategies to assess students working in small groups. Self-, peer-and tutor-assessment are integral part of PBL tutorials and they're not easy to perform, especially for non experienced students and tutors. The undergraduate PBL medical programme was introduced in 2003, and after two years the curriculum committee decided to evaluate the tutorial assessment in the new program.

OBJECTIVE: Group B Streptococcus (GBS) serotypes (Ia, Ib and II to IX) are classified based on variations in their capsular polysaccharide; their prevalence differs between different geographic areas. We examined the prevalence of all GBS serotypes in rectal and vaginal swab samples obtained from 363 pregnant women followed at a Brazilian referral center (Hospital da Mulher Professor Doutor José Aristodemo Pinotti); bacterial susceptibility to antibiotics was further determined. METHOD: Prevalence of positive GBS was evaluated by latex agglutination and by multiplex PCR analysis; bacterial susceptibility to antibiotics, such as clindamycin, erythromycin, levofloxacin, linezolid, penicillin and tetracycline was determined by the disk diffusion method. RESULTS: (a) standard GBS culture and the multiplex PCR analysis tested positive for 83 swabs, collected from 72 women (prevalence of GBS colonization: 72/363; 20%); the most prevalent Serotype was Ia (n=43/83; 52%), followed by serotype V (n=14/83; 17%); according to anatomical origin, serotype Ia accounted for 27/59 (46%) and 16/24 (67%) of the vaginal and rectal samples, respectively; PCR also identified serotypes Ib, II, III and VI. Serotype VI is rarely described and had not been previously reported in Brazil or in Latin America. (b) The latex agglutination test only identified 44 positive samples, all of which were serotyped: 34 of these samples (77%) had serotypes matching those identified by multiplex PCR. (c) Only one sample (serotype Ia) showed resistance to erythromycin and clindamycin. CONCLUSION: Regional studies on GBS serotypes prevalence are essential to guide immunoprophylactic interventions (vaccines) and the implementation of adequate antibiotic prophylaxis or treatment. In this study, the incidence of the serotype VI, a new and rare serotype of GBS was described for the first time in a Brazilian population.

ResumoUm quebra-cabeças da glicólise em papel tem sido utilizado como estratégia para o ensino de metabolismo.Essa forma de jogo em papel demanda um número grande de instrutores e limita o acompanhamento das dificuldades apresentadas pelos alunos. A tecnologia denominada Realidade Aumentada (RA) foi empregada para favorecer o uso da estratégia de montagem de vias metabólicas em classes numerosas e armazena dados de utilização, que fornecem feedback para alunos e professores. Cartas com estruturas moleculares são lidas por um aplicativo instalado em dispositivos móveis que exibem informações como a estrutura 3D das moléculas, pistas para a montagem da sequência correta da via metabólica e resultados da progressão na atividade. A utilização de RA possibilitou maior autonomia para os estudantes resolverem os exercícios propostos e fornece dados de avaliação de desempenho que permite compreender, e posteriormente sanar, as dificuldades apresentadas pelos alunos. Palavras-chave: Vias metabólicas, Realidade aumentada, Aprendizagem ativa. AbstractA glycolysis paper puzzle has been used as strategy to teach metabolic pathways, but this kind of game demands a higher number of instructors and limits the follow up of the students' difficulties. A technology called Augmented Reality (AR) was applied to enable the puzzle usage in large audiences, and to provide feedback to students and instructors. Drafted as flashcards readable by an app installed in tablets, it conveys information as molecules 3D-structure, clues for correct assembling of the metabolic pathway and results of student progression in the activity. Such technological improvement brought more autonomy to students for solving proposed exercises and an embedded performance data collection system helpful to understand, and after to unravel students' difficulties.

Evolution has been recognized as a key concept for biologists. To enhance comprehension and motivate biology undergraduates for the contents of central energetic metabolism, we addressed the Krebs cycle structure and functions in an evolutionary view. To this end, we created a study guide that contextualizes the emergence of the cyclic pathway, in light of the prokaryotic influence since the early anaerobic condition of the Earth to increase oxygen in the atmosphere. The study guide is composed of three interrelated sections: (1) a problem, designed to arouse curiosity, inform and motivate students, (2) a text about life evolution, including early microorganisms and the emergence of the Krebs cycle, and (3) questions for debate. The activity consisted on individual reading and peer discussion based on this written material, under the guidance of the instructors. The questions were designed to foster debate in an ever-increasing level of complexity and to strengthen the main contextual aspects leading to emergence, evolving, and permanency of a complex metabolic pathway. Based on classroom observation, analysis of student's written responses, and individual interviews, we noticed they were engaged and motivated by the task, especially during group discussion. The whole experience suggests that the study guide was a stimulus to broaden the comprehension of the Krebs cycle, reinforcing the evolutionary approach as an important subject for learning purposes. © 2016 by The International Union of Biochemistry and Molecular Biology, 44:288-296, 2016.