RESUMO A contemporaneidade e a docência nas áreas de saúde e formação profissional, tem se transformado e evoluído nos últimos tempos, com a introdução das metodologias ativas no processo ensino-aprendizagem, nas instituições de ensino superior no Brasil. Essas metodologias ativas de aprendizagem, como a ABP, Aprendizagem Baseada em Problemas, são utilizadas com a finalidade de que estudantes da área da saúde adquiram o conhecimento de forma significativa, em relação ao ensino tradicional. A educação médica no Brasil tem sido assunto de muitas discussões sobre a formação profissional em saúde e vem passando por significativas mudanças nos últimos anos. O presente artigo tem por objetivo relatar uma experiência docente no ensino de graduação em Medicina, nos componentes curriculares Mecanismo de Agressão e Defesa I e II (MADs), na Universidade do Estado da Bahia – Campus I. MADs é um componente curricular atualmente presente em diferentes cursos da área de saúde do Brasil. Este componente é composto pelas disciplinas microbiologia, parasitologia, imunologia e patologia, lecionado de forma integrada. Foram aplicadas metodologias ativas de ensino, do tipo aprendizagem baseada em problemas (ABP), que abrangeram sessões tutoriais, atividades em laboratórios, apresentações científicas e o uso de filmes. Além disto, foram utilizados recursos lúdicos e a ferramenta MOODLE no campus virtual. Esta proposta teve início no ano de 2012 e vem sendo aplicada a partir desta data até os dias atuais. A experiência vivenciada nas MADs, com a utilização de variadas formas de metodologias de ensinagem, tem permitido “romper” com o tradicional, isto é, tem levado o discente a desenvolver habilidades, competências e construção dos saberes. Estas novas alternativas de ensino nos permitiu uma interação mais ampla entre a relação discente-docente e nos fez refletir e avançar no processo avaliativo, que tem sido realizado de forma ampla e processual. Além disso, um impacto positivo para sua formação pode ser observado. No que se refere ao processo de ensino, aprendizagem e avaliações, novas propostas pedagógicas devem ser inseridas priorizando o caráter formativo e de desenvolvimento dos discentes, para que haja a construção de competências necessárias ao perfil estabelecido pelas DCNs, Diretrizes Curriculares Nacionais, do curso de Graduação em Medicina e demais cursos de saúde.

ABSTRACT Changes are occurring in health teaching and professional training, due to the introduction of active methodologies to the teaching-learning process in Brazilian higher education institutions. These active learning methodologies, such as PBL (Problem-Based Learning), are used to help medical students acquire knowledge in a more relevant way, compared to traditional teaching. Medical education in Brazil has been the subject of much discussion, and has undergone significant changes in recent years. The objective of the present work is to report the teaching experience in the curricular components Mechanisms of Aggression and Defense I (MAD I) and Mechanisms of Aggression and Defense II (MAD II) of Universidade do Estado da Bahia [State University of Bahia] - Campus I in undergraduate teaching in Medicine. These subjects are composed of the disciplines microbiology, parasitology, immunology (MAD I and II) and pathology (MAD II), taught in an integrated way. Active teaching methodologies were applied, such as problem-based learning, laboratory activities, scientific presentations and the use of film. In addition, the MOODLE tool was used in the virtual campus. This proposal began in 2012 and has been applied since then. The experience of the MADs, with the use of different forms of teaching methodologies, has led to a transformation of traditional teaching, leading students to develop their skills and competencies and build knowledge. These new teaching alternatives allow for a broader interaction between the students and the teacher and led us to reflect and advance in the evaluation process, which has been carried out in a broad and procedural way. Moreover, a positive impact on the students’ training was observed. As for the processes of teaching, learning and evaluation, new pedagogical proposals should be introduced, prioritizing the formative and developmental character of students so that the necessary competences can be built into the profile established by the National Curricular Guidelines (DCNs) of the Undergraduate Medicine course and other courses in the area of health.

OBJECTIVES: Suppressor of cytokine signaling 3, myxovirus resistance protein and osteopontin gene polymorphisms may influence the therapeutic response in patients with chronic hepatitis C, and an association with IL28 might increase the power to predict sustained virologic response. Our aims were to evaluate the association between myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 gene polymorphisms in combination with IL28B and to assess the therapy response in hepatitis C patients treated with pegylated-interferon plus ribavirin. METHOD: Myxovirus resistance protein, osteopontin, suppressor of cytokine signaling 3 and IL28B polymorphisms were analyzed by PCR-restriction fragment length polymorphism, direct sequencing and real-time PCR. Ancestry was determined using genetic markers. RESULTS: We analyzed 181 individuals, including 52 who were sustained virologic responders. The protective genotype frequencies among the sustained virologic response group were as follows: the G/G suppressor of cytokine signaling 3 (rs4969170) (62.2%); T/T osteopontin (rs2853744) (60%); T/T osteopontin (rs11730582) (64.3%); and the G/T myxovirus resistance protein (rs2071430) genotype (54%). The patients who had ≥3 of the protective genotypes from the myxovirus resistance protein, the suppressor of cytokine signaling 3 and osteopontin had a greater than 90% probability of achieving a sustained response (p<0.0001). The C/C IL28B genotype was present in 58.8% of the subjects in this group. The sustained virological response rates increased to 85.7% and 91.7% by analyzing C/C IL28B with the T/T osteopontin genotype at rs11730582 and the G/G suppressor of cytokine signaling 3 genotype, respectively. Genetic ancestry analysis revealed an admixed population. CONCLUSION: Hepatitis C genotype 1 patients who were responders to interferon-based therapy had a high frequency of multiple protective polymorphisms in the myxovirus resistance protein, osteopontin and suppressor of cytokine signaling 3 genes. The combined analysis of the suppressor of cytokine signaling 3 and IL28B genotypes more effectively predicted sustained virologic response than IL28B analysis alone.

OBJECTIVE: The goal of this project was to analyze the association between Crohn's disease, its clinical features, and the tumor necrosis factor alpha (TNF-α) -308 polymorphism. METHODS: This is a case-control and cross-sectional study that enrolled 91 patients with Crohn's disease and 91 controls. Patients with Crohn's disease were characterized according to the Montreal Classification, along with their clinical and surgical treatment history. Analysis of the TNF-α -308 polymorphism was performed using a commercial kit. A stratified analysis was applied using an OR (odds ratio) with a 95% confidence interval. The chi-square and Fisher's exact tests were utilized for analysis of the association between the polymorphism and the clinical features of Crohn's disease. RESULTS: The low producer predicted phenotype was present in 76.9% of Crohn's disease cases and 75.8% of controls (OR 0.94 [0.45-1.97]). The TNF2 allele and the high producer predicted phenotype were more frequent among patients with Crohn's disease penetrating behavior (p = 0.004). The TNF2 allele and the high producer predicted phenotype were also associated with a history of colectomy (p = 0.02), and the TNF2 allele was associated with small bowel resection (p = 0.03). CONCLUSIONS: The TNF-α -308 polymorphism appears to affect the severity of the disease. However, TNF-α -308 polymorphism does not appear to be important for the susceptibility in the development of Crohn's disease.

Host genetic factors play an important role in mediating resistance to HIV-1 infection and may modify the course of infection. HLA-B alleles (Bw4 epitope; B*27 and B*57) as well as killer cell immunoglobulin-like receptors have been associated with slow progression of HIV-1 infection. OBJECTIVE: To evaluate the association between serological epitopes HLA-Bw4 and HLA-Bw6 and prognostic markers in AIDS. METHODS: 147 HIV-infected individuals in Bahia, Northeast Brazil, were genotyped for HLA class I locus. HLA class I genotyping was performed by hybridization with sequence-specific oligonucleotide probes following amplification of the corresponding HLA-A, HLA-B and HLA-C genes. Statistical analysis was performed using Fisher's exact and ANOVA tests for categorical and continuous variables, respectively. RESULTS: We detected a significant association (χ2 = 4.856; p = 0.018) between the presence of HLA-Bw4 and low levels of viremia. Eighteen out of the 147 HIV-infected individuals presented viremia <1,800 copies/mL and 129 presented viremia > 2,000 copies/mL. Ninety and four percent (17/18) of all individuals with viremia < 1,800 copies/mL carried HLA-Bw4, compared to 67.4% (87/129) of individuals with viremia > 2,000 copies/mL. Additionally, we found a significantly higher frequency of B*57 (OR = 13.94; 95% CI = 4.19-46.38; p < 0.0001) and Cw*18 (OR = 16.15; 95% CI = 3.46-75.43; p < 0.0001) alleles, favoring the group with lower viremia levels, in comparison with those with higher viral load. CONCLUSION: HLA-Bw4-B*57 and Cw*18 alleles are associated with lower level of viral load in HIV-infected Brazilian patients. These findings may help us in understanding the determinants of HIV evolution in Brazilian patients, as well as in providing important information on immune response correlates of protection for such population

A predisposição genética ao diabetes melito tipo 1 (DM1) é associada a múltiplos genes do sistema de histocompatibilidade humano (HLA) de classe II. Em caucasianos, os antígenos HLA-DR3 e -DR4 são associados à susceptibilidade e o -DR2, à proteção. No Brasil, um país constituído por grande miscigenação entre caucasianos europeus, índios nativos e negros africanos, a base genética do DM1 tem sido pouco estudada. O objetivo desse trabalho foi apresentar uma revisão crítica dos artigos indexados nos bancos de dados MEDLINE e LILACS-BIREME sobre a associação do HLA com DM1 em brasileiros. Todos os oito estudos encontrados foram realizados no sudeste do país. A susceptibilidade imunogenética para o DM1 em brasileiros foi associada com os alelos HLA-DRB1*03, -DRB1*04, -DQB1*0201, -DQB1*0302 e a proteção com os alelos -DQB1*0602 e -DQB1*0301 e os antígenos -DR2 e -DR7. Por ser o Brasil constituído por grande miscigenação, não se pode extrapolar para todo o país estudos realizados em apenas uma região. Faz-se necessário pesquisar populações de várias regiões, analisando sua diversidade alélica para identificar novas associações ou reforçar aquelas já existentes. Esse conhecimento contribuirá para futuras intervenções profiláticas e terapêuticas nos grupos de brasileiros com maior risco de desenvolver DM1.

The genetic predisposition to type 1 diabetes (DM1) is associated with genes of the human leukocyte antigen (HLA) system, specially the HLA-DR and -DQ. In Caucasians, the HLA-DR3 and -DR4 antigens are associated with susceptibility and the -DR2, with protection. In Brazil, a country with a large miscegenation of Europeans Caucasians, Native Amerindians and African Blacks, the genetic basis of DM1 has not been adequately studied. The aim of this paper is to present a critical review of articles indexed in the MEDLINE and LILACS-BIREME data basis about the association of HLA with DM1 in Brazilians. Eight papers, all of them from the Southeast region, were found. Immunogenetic susceptibility to DM1 in Brazilians was associated with HLA-DRB1*03, -DRB*04, -DQB1*0201, -DQB1*0302 alleles, and protection against DM1 was associated with HLA-DQB1*0602, -DQB1*0301 alleles and -DR2 and -DR7 antigens. Since the Brazilian population is not racially homogeneous, it is not possible to extrapolate studies from a single region to the remaining of the country. It is necessary to study populations from different regions to identify new associations or to strengthen associations with the ones already identified. This knowledge will contribute to future prophylactic or therapeutic interventions in the group of Brazilians at risk of developing DM1.