In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients.

BackgroundDespite 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.AimTo 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.ResultsBrazilian 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 conclusionOur 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.

BackgroundIn 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.AimWe 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.ResultsOf 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/conclusionAccording 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.

Mitochondria are organelles responsible for oxidative phosphorylation, the main energy source for all eukaryotic cells. In oocytes and embryos, it seems that mitochondria provide sufficient energy for fecundation by supporting spindle formation during meiosis II, and for implantation. Since mitochondria are inherited from mother to child, it is important that oocyte mitochondria should be intact. Older women seem to have more mitochondrial DNA mutations, which can be responsible for poor implantation and aneuploidy, two conditions that occur more often in this group. In the present report we propose a new model to explain why older women have poor implantation rates.

ResumoOBJETIVO: comparar marcadores séricos de estresse oxidativo entre pacientes inférteis com e sem endometriose e avaliar a associação destes marcadores com o estadiamento da doença. MÉTODOS: estudo prospectivo envolvendo a inclusão consecutiva de 112 pacientes inférteis, não-obesas, com idade inferior a 39 anos, divididas em dois grupos: Endometriose (n=48, sendo 26 com endometriose mínima e leve -Estádio I/II e 22 com endometriose moderada e grave -Estádio III/IV) e Controle (n=64, com fator tubário e/ou masculino de infertilidade). Durante a fase folicular precoce do ciclo menstrual, foram coletadas amostras sanguíneas para análise dos níveis séricos de malondialdeído, glutationa e níveis totais de hidroperóxidos, por espectrofotometria e vitamina E, por cromatografia líquida de alto desempenho. Os resultados obtidos foram comparados da seguinte forma: os grupos endometriose versus controle; endometriose estádio I/II e controle, endometriose estádio III/IV e controle e entre os dois subgrupos de endometriose. Em todas as análises, foi considerado o nível de significância de 5% (p<0,05). RESULTADOS: os níveis de vitamina E e glutationa foram mais baixos no soro de mulheres inférteis com endometriose moderada/grave (21,7±6,0 µMol/L e 159,6±77,2 nMol/g proteína, respectivamente) quando comparadas a mulheres com endometriose mínima e leve (28,3±14,4 µMol/L e 199,6±56,1 nMol/g proteína, respectivamente). Os níveis totais de hidroperóxidos foram significativamente mais elevados no grupo endometriose (8,9±1,8 µMol/g proteína) em relação ao Grupo Controle (8,0±2 µMol/g proteína) e nas portadoras de doença III/IV (9,7±2,3 µMol/g proteína) em relação à I/II (8,2±1,0 µMol/g proteína). Não se observou diferença significativa nos níveis séricos de malondialdeído entre os diversos grupos. CONCLUSÕES: foi evidenciada uma associação positiva entre infertilidade relacionada à endometriose, avanço do estadiamento da doença e aumento dos níveis séricos de hidroperóxidos, sugerindo aumento da produção de espécies reativas em portadoras de endometriose. Esses dados, associados à redução dos níveis séricos de vitamina E e glutationa, sugerem a ocorrência de estresse oxidativo sistêmico em portadoras de infertilidade associada à endometriose.Abstract PURPOSE: to compare serum markers of oxidative stress between infertile patients with and without endometriosis and to assess the association of these markers with disease staging. METHODS: this was a prospective study conducted on 112 consecutive infertile, non-obese patients younger than 39 years, divided into two groups: Endometriosis (n=48, 26 with minimal and mild endometriosis -Stage I/II, and 22 with moderate and severe endometriosis -Stage III/IV) and Control (n=64, with tubal and/or male factor infertility). Blood samples were collected during the early follicular phase of the menstrual cycle for the analysis of serum malondialdehyde, glutathione and total hydroxyperoxide levels by spectrophotometry and of vitamin E by high performance liquid chromatography. The results wer...