Abstract Introduction: the lack of early preventive measures in the management of Chronic Venous Disease (CVD) has burdened Brazilian public health. Objectives: to develop a mathematical pattern recognition model in the relationship between saphenofemoral junction (SFJ) insufficiency and the clinical picture of CVD, and to outline patients' sociodemographic profile. Methods: a quantitative, inductive and descriptive research was carried out, in which participants were asked objective questions. The CVD of 91 patients was clinically classified into group 0: mild disease (CEAP C2 and C3), and group 1: severe disease (CEAP C4, C5 and C6). All limbs underwent Doppler ultrasonography. A model for the evolution of CVD was developed based on 16 sociodemographic, clinical and imaging predictor variables, including reflux time, peak reflux velocity and venous reflux volume. Two methods of pattern recognition and classification were used: logistic regression and discriminant analysis with quadratic score. The participants' profile was analyzed by relative and absolute frequency. Results: the outlined profile was that of a female patient, multiparous, aged around 50 years, with high body mass index, low income and advanced disease (C4,5,6). Concerning the mathematical relationship of the variables, all the models presented satisfactory results, with average hit rates higher than 80 %: 87.06 % for prediction of mild disease (G0) and 71.88 % for severe disease (G1). Conclusion: a mathematical model for pattern recognition was established in the relationship between degree of reflux in the SFJ and the clinical picture of CVD. The model predicts CVD progression with a good accuracy.

Resumen Introducción: la falta de medidas preventivas y tempranas en el manejo de la enfermedad venosa crónica (EVC) ha sobrecargado el sistema nacional de salud pública. Objetivos: desarrollar un modelo matemático de reconocimiento de patrones que relacione la insuficiencia de la unión safenofemoral (USF) con la clínica de EVC y trazar el perfil sociodemográfico de los pacientes. Métodos: se realizó una investigación cuantitativa, inductiva y descriptiva. Se hicieron preguntas objetivas a los participantes. El grupo de pacientes diagnosticados de EVC (91) se clasificaron en 2 grupos: grupo 0, enfermedad leve (CEAP, C2 y C3), y grupo 1, enfermedad grave (CEAP, C4, C5 y C6). Se realizó una ecografía vascular con Doppler en los miembros inferiores (MI). A partir de 16 variables predictoras sociodemográficoas, clínicas y de imagen, entre ellas el tiempo de reflujo, la velocidad pico sistólica en reflujo y el volumen de reflujo, se buscó un modelo a través de dos métodos de reconocimiento y clasificación de patrones: regresión logística y análisis discriminativo con puntaje cuadrático. El perfil de los participantes se analizó por frecuencia relativa y absoluta. Resultados: como perfil encontramos una paciente femenina, multípara, de casi 50 años, con un índice de masa corporal elevado, baja renta y enfermedad avanzada (C4, C5 y C6). En cuanto a la relación matemática de las variables, los modelos arrojaron resultados satisfactorios, con una clasificación promedio de más del 80 % de aciertos, con un 87,06 % de predicciones para enfermedad leve (G0) y un 71,88 % de aciertos para enfermedad grave (G1). Conclusión: se estableció un modelo matemático de reconocimiento de patrones en la relación del grado de reflujo de la USF con la clínica de la EVC capaz de predecir la progresión de la EVC con buena precisión.

Resumen En la actualidad, la educación médica basada en competencias (EMBC) es el diseño curricular más utilizado en el mundo. Sin embargo, sus limitaciones incluyen la construcción fragmentada del aprendizaje y dificultades para lograr el uso adecuado de los conocimientos, habilidades y actitudes adquiridos mediante este modelo pedagógico. Considerando lo anterior, las actividades profesionales confiables (APROC) emergen como una herramienta para mediar la transposición del currículo basado en competencias a la práctica profesional en educación médica de posgrado. Por lo tanto, con base en una revisión narrativa de la literatura existente sobre APROC y la experiencia docente de los autores en la integración de la educación y los servicios de salud basados en la comunidad, el propósito de este estudio es reflexionar sobre el posible uso de estas actividades en la formación médica de pregrado para el desarrollo de un modelo de EMBC integrado con la atención primaria de salud y la medicina comunitaria. Las reflexiones presentadas aquí permiten sugerir que, aunque se trate de un proceso desafiante, la adopción de las APROC en la formación de pregrado en medicina es apropiada para lograr una mejor prestación de atención primaria en salud a personas, familias y comunidades en general.

Abstract Competency-based medical education (CBME) is currently the most common type of curriculum used worldwide. However, its limitations include fragmented learning and difficulties to use properly the knowledge, skills, and attitudes acquired using this educational model. Having this in mind, Entrustable Professional Activities (EPA) emerge as a tool to mediate the transfer of the competency-based curriculum into physicians' professional practice in graduate medical education. Therefore, based on a narrative review of the existing literature on EPA and the authors' experience in teaching community-based health care integration services, the aim of this paper is to reflect on the possible use of these activities in undergraduate medical education for the development of a CBME model integrated with primary health care and community medicine. The reflections presented here allow suggesting that, although it is a challenging process, incorporating EPA into undergraduate medical education is appropriate to improve the provision of primary health care to individuals, families, and communities in general.

Recentes estudos demonstraram que os radicais livres de oxigênio parecem desempenhar papel importante nas lesões de isquemia-reperfusão. O alfa-tocoferol(AT) age in vivo como um anti-oxidante. Nosso objetivo foi o de verificar se o AT atenuava as lesões de isquemia-reperfusão em pata direita de ratos. Os animais, randomizados, foram divididos nos seguintes grupos(G): G1-controle sem isquemia; G2 e G3 - quatro horas isquemia e duas reperfusão. Os animais do G2 foram tratados com salina e os do G3 com AT, 50mg/kg. Como parâmetros examinamos as alterações de volume e circunferência do pé direito ao longo do experimento, assim como a captação de 99mTc-pirofosfato e a microscopia eletrônica de transmissão do músculo soleus direito. Os aumentos de volume e circunferência do pé dos animais do G2 foram estatisticamente maiores quando comparados com o G1. As medidas do G3 não diferiram do G1. A captação de 99mTc-pirofosfato foi bem aumentada nos G2 e G3, quando comparados ao G1, porém sem diferenças entre os grupos isquêmicos. As lesões ao MET foram menos intensas em três animais do G3, quando comparados ao G2. Conclusão: O tratamento com AT diminuiu a formação do edema mas só protegeu parcialmente as células musculares contra as lesões de isquemia-reperfusão.

Studies indicate that oxygen-derived free radicals may play a major role in ischemia-reperfusion injury. Alpha-tocopherol acts in vivo as a free radical scavenger. Our purpose was to elucidate whether alpha-tocopherol could change the evolution of ischemia/reperfusion in the right hindlimb of rats. The animals were randomly allocated in the following groups: Group 1(G1)- control without ischemia. Groups 2 and 3(G2,3): four hours ischemia and two hours reperfusion. The animals of group 2 were treated with saline and those of the group 3, treated with alpha-tocopherol, 50 mg/Kg. Parameters were the foot volume and circumference, 99mTc-Pyrophosfate uptake in the soleus muscle, plasmatic creatine-phosphokinase (CPK), and transmition eletronic microscopy (TEM)of muscle cells. The foot volume and circumference of the animals of G2 were significantly greater than in G1. In the G3 these measurements did not differ from the G1. Pyrophosphate uptake and CPK measurements were increased in G2,G3 when compared to the animals of G1, but there were no differences between the ischemic groups. Cell injury, when examined by TEM, was less severe in two of three animals of G3, when compared to the G2. Conclusion: The treatment with alpha-tocopherol diminuished edema formation, but only partially protected muscle cells from injury.