RESUMO
Contexto: A doença de Gaucher (DG) é uma doença lisossômica de depósito, presente com maior prevalência entre judeus asquenazes, e está relacionada à mutação N370S. Apresenta-se clinicamente de três formas: não neuropática ou tipo 1, mais prevalente e com bom prognóstico; neuropática aguda ou tipo 2; neuropática crônica ou tipo 3. No tratamento, emprega-se o imiglucerase, um repositor enzimático. Descrição do caso: Paciente com 20 anos, primigesta, nulípara, com 36 semanas de idade gestacional, diagnosticada com DG tipo I aos oito anos, foi internada para acompanhamento de sua afecção de base, controle da pré-eclâmpsia e infecção do trato urinário. Devido à variação dos índices hematimétricos, foi induzido o parto com 37 semanas e 2 dias. O recém-nascido não apresentou quaisquer distúrbios e seguiu em alojamento conjunto. Discussão: Observou-se a necessidade de controle clínico ativo, mesmo com a paciente em uso regular do imiglucerase, evitando repercussões graves para o binômio materno-fetal. Conclusões: Salienta-se a necessidade de controle hematológico ativo, via de parto conforme indicação obstétrica, seja via alta ou baixa, e níveis plaquetários superiores a 50.000/mm³.
Assuntos
Humanos , Feminino , Adulto , Complicações na Gravidez , Gravidez , Desenvolvimento Fetal , Doença de Gaucher , HematologiaRESUMO
BACKGROUND: The fourth-year Obstetrics and Gynaecology course at our institution had previously been taught using theory classes alone. A new teaching model was introduced to provide a better link with professional practice. We wished to evaluate the impact of the introduction of case discussions and other practical activities upon students' perceptions of the learning process. METHODS: Small-group discussions of cases and practical activities were introduced for the teaching of a fourth-year class in 2003 (Group II; 113 students). Comparisons were made with the fourth-year class of 2002 (Group I; 108 students), from before the new programme was introduced. Students were asked to rate their satisfaction with various elements of the teaching programme. Statistical differences in their ratings were analysed using the chi-square and Bonferroni tests. RESULTS: Group II gave higher ratings to the clarity of theory classes and lecturers' teaching abilities (p < 0.05) and lecturers' punctuality (p < 0.001) than did Group I. Group II had greater belief that the knowledge assessment tests were useful (p < 0.001) and that their understanding of the subject was good (p < 0.001) than did Group I. Group II gave a higher overall rating to the course (p < 0.05) than did Group I. However, there was no difference in the groups' assessments of the use made of the timetabled hours available for the subject or lecturers' concern for students' learning. CONCLUSIONS: Students were very receptive to the new teaching model.