Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Paracoccidioidomycosis is an endemic systemic mycosis in the tropical regions of South America, being common in Brazil. It is caused by the fungus Paracoccidiodes brasiliensis, which infects humans via the respiratory system through inhalation. After pulmonary symptomatology, by hematogenous dissemination, it can affect several organs and systems. One of the difficulties in the diagnosis of this disease is due to its clinical similarity with tuberculosis. Clinically, the disease may present in chronic and acute/subacute forms. It is an important public health problem, because is an incapacitating disease, which can lead the patient to death. This paper describes a case of paracoccidioidomycosis in a male patient, whose resolution of care by the Basic Health Unit (UBS) was fundamental to the success of the treatment and to the good prognosis.

Introduction: The Family Physician is responsible for coordinating and providing care to address the most common diseases in a particular territory. Given that the Human Immunodeficiency Virus infection affects various segments of the population, this professional should be aware about the issue. Methods: This is a descriptive report based on what the resident and his/her tutor experienced in Florianópolis. Results: The article discusses the reorganization of the patient care model in order to serve people living with the virus. It also explores the importance of Primary Health Care strategies adopted by the city government in order to use different preventive approaches and build 90-90-90 treatment targets. Conclusion: The decentralization in this population health care appear to be a local potentiality to improve the disease control, mainly because of the structured primary care, efficient management and search of professional qualification.

Objective: To report a health education experience with community health agents about the health of the LGBT population in basic care. Methods: A continuous education action was carried out by means of the study of cases chosen by health agents within their micro-areas of action followed by group discussion and reflection on current practices. Results: Three cases presented by the health agents that dealt with the  themes of: (1) school and prejudice; (2) the importance of family and social support; and (3) the role of family health strategy and health education. It was noticed that the theme remains excluded from the great discussions, especially in medical schools and primary care, the first contact with the Brazilian health system (SUS), thus strategies that aim to discuss the peculiarities of prevention, promotion and health care of these groups should be stimulated and reproduced with a view to a better quality of care in order to capture these patients in an environment favorable to integrative practices with respect to sexual diversity. Conclusion: It was concluded that the educational activity performed was extremely important to demystify myths and prejudices involving LGBT health in the primary care setting. It was observed that after the educational activity the CHAs were more confident and sensitized on the topics addressed and changed conceptions in order to respect the decisions of the patients and to carry out an appropriate approach to the reception of these users. 

Medicine has been calling on people to carry out more and more preventive actions, from blood pressure measurements to the application of new vaccines; however, family physicians have been identifying risks and limitations of preventive actions, showing that not all of them are ethically or scientifically justifiable. This is the scope of quaternary prevention, which aims to protect people from over-medicalization and unnecessary procedures. Living in a society that excels in high technology, where terror has turned into business and self-care, an obsession, it can be very difficult to discourage some exam or to unprescribe some medication; but it is precisely in this context that quaternary prevention is deeply necessary, and the difficulty of its practice requires articulating other knowledge and resources beyond the level of evidence or the degree of recommendation of one or another action. Health beliefs are object of person-centered care, and many of them are inspired or translated by popular sayings. In this essay, I discuss the excess of interventions and quaternary prevention from some of them. Analyzing phrases such as “better safe than sorry”, I present aphorisms as tools for understanding quaternary prevention, which can be used by professionals and teachers to discuss this counter-hegemonic practice with patients and students. By articulating popular and professional knowledge, the text contributes to the cultural competence of Primary Health Care and helps to produce more harmonious clinical encounters and to promote less invasive, medicalizing and harmful care.

Objective: This paper aims to present, through a bibliographic review and case report, the Family physician as an important professional working with the health of lesbians, gays, bisexuals and transsexual individuals. Methods: Case report illustrating clinical meeting and use of family and community medicine tools. Conclusions: The Family physician manages to elaborate a common project on how to manage its problems, that beyond those with biological origins, may cause illness: the prejudice they pass through by only going to the streets, pressure of the family unhappy with their gender or sexual diversity and the person’s psychological difficulty of getting rid of their own taboos and prejudices to allow new identities.

Sharing the results of research and scientific production is crucial for the survival and development of all disciplines. Health information is becoming uncertain and powerful economic interests disrupting medical information has triggered a loss of credibility. M@dNotes project (in Spanish NotasL@cas), is the by-product of nonprofit collaborative international knowledge network with participation of students, general practitioners, family physicians, and healthcare workers. One of the aims of this network is to discuss the validity of the information available on sensitive subjects and build a knowledge exchange network inside a community of practice. It has been created to share different materials excluded from traditional academic publishing and commercial distribution channels: monographic reports, commented articles, files with references searches. These materials product of learning process are qualified with an appropriate level because there were submitted to a peer review or judged by a scientific committee to get an approval. Includes an indexing method (Q Codes and ICPC) to manage and retrieve the materials received. The project provides a particular folder to upload and share the documents. A web blog is the dissemination friendly tool or interface to share and retrieve the documents available in the network. Through a facility in the cloud, it is possible to access an excel file with all the materials shared, codes assigned and the hyperlink to get a pdf file of each material.

Introduction: The LGBT+ healthcare is marked with particularities and vulnerabilities that require differenced attention. Sensitizing and qualifying healthcare professionals to these population’s needs is fundamental to guarantee the right to health. The curriculum from health degrees, that usually does not address this issue, have been questioned by students along with LGBTphobia reports among the medical education and revindication for practical capacitation. In this context, the Integrated Family & Community Medicine (MFC) and Mental Health Internship at Faculty of Medicine of the Federal University of Rio de Janeiro, prepared a workshop on LGBT Health, presented in this article. Methods: A workshop took place in May of 2018, having a target audience of interns of MFC. It aimed to sensitize medical students regarding the referred theme and to give practical tools to be used in primary medicine and other healthcare environments. Medical undergrads who identify themselves as LGBT+ were invited to conduct the activity under the orientation of tutors from the internship. Given that those medical students were protagonists in this activity, it was possible to articulate the scientific knowledge, accomplished with regular studies on the theme, and the experiential expertise. The workshop was divided in four acts: i) sensitization; ii) case discussion; iii) information and orientations on good practice; iv) questions and feedback. The workshop lasted 4 hours, using active and participatory learning methods. Results: The objectives were achieved with a highly good evaluation as to the workshop’s organization and performance. The students and professors that coordinated the activity prepared a narrative evaluation. The workshop’s subjects, the MFC interns, took later an online feedback questionnaire, in which they positively evaluated the methods and acquired knowledge. Conclusion/Future works: The workshop, firstly implemented as an experimental activity, is now part of the regular medical internship curriculum. An optative course and an extension project are being planned, aiming to reach other medical students and public healthcare providers. Including the subject in the medical curriculum as a longitudinal discussion remains a challenge.

Objectives: To elaborate infographics for shared-decision on the benefit and risk of the use of statins as primary prevention in patients with high cardiovascular risk. Methods: From the “NNT”, which analyzed the use of statins for primary prevention in low-risk cardiovascular individuals from meta-analyzes of the US Preventive Services Task Force (USPSTF) and Cochrane, we sought to define the risk balance and the benefit of such therapy in the primary prevention of people at high risk. Because the USPSTF and Cochrane had 10 different primary studies included in their analyzes and populations at varying cardiovascular risk, an additional search was conducted for systematic reviews and meta-analyzes published since the date of the Cochrane review (December 2012) through October 2017. We searched Medline via PubMed, the Virtual Health Library, Cochrane, and NHS Evidence for studies of people with a 10-year cardiovascular risk estimated at more than 10% with one more risk factor or more than 20% without history of previous cardiovascular disease, who compared statin use with placebo or no treatment. The outcomes should be the reduction of cardiovascular and cerebrovascular diseases, cardiovascular or general mortality and the occurrence of adverse events. Results: One hundred and twenty-five studies were found between meta-analyzes and site-based reviews from December 2012 to October 2017. One hundred and twenty-four studies were excluded for several reasons. Statins for primary prevention, 2012, with a population of 100% of diabetics with no prior cardiovascular events with absolute risk reduction (RRA) for fatal stroke of 0.78 percentage points/NNT 128 and Cardio/Cerebrovascular Diseases RRA 2.6 percentage points/NNT 39, cardiovascular. Regarding the reduction of general mortality (RR 0.79, 95% CI 0.58-1.08) and revascularization (RR 0.74, 95% CI 0.55-1.00), no significant statistical difference was found. Due to the limitations found in the systematic reviews evaluated, it was not possible to compile infographic data on the incidence of diabetes and abandonment of therapy. Thus, to elaborate the part related to damages, the Aspen ECR was selected, with a population of diabetics of high risk for the development of cardiovascular events, without previous events, as for myalgia with an increase in absolute risk (ARA) of 1.43 percentage points/NND 70 (RR 1.91, IC 95% 1.03-3.53). Conclusion: An infographic was elaborated, with and without statin, for non-fatal cardiocerebrovascular outcomes, fatal stroke, need for revascularization, general mortality and for the adverse occurrence of muscular symptoms. This instrument can be used in Primary Care during the clinical meeting for shared decision making, facilitating the understanding of the risks and benefits of statin use in patients at high cardiovascular risk (RCV 10% with at least one additional risk factor or > 20% in 10 years), in whom the statin prescription is considered.

Background and goal. The translocation of the Barred Splitfin Chapalichthys encaustus (Goodeidae) in the Teuchitlán River, located at the headwaters of the Ameca river basin in the center of the state of Jalisco, is reported for the first time. Methods. The fish record was obtained approximately 1 km from the origin of the river. Fish were deposited in the ichthyology collection of the Universidad Michoacana de San Nicolás de Hidalgo (CPUM). Results. On July 17, 2015 an adult female specimen of this species with a total length of 65 mm was collected. The specimen is described and illustrated. In subsequent collections a male specimen of the same species was also obtained. Conclusion. The Barred Splitfin is one of the few documented cases of native translocated ichthyofauna for Mexico and its possible impact on the Teuchitlán River has not been determined.

Background: The Pacific sardine is a small pelagic fish which supports the most important fishery at national scale. Goals: This paper analyzes the catch information generated by the commercial fleet operating in the Gulf of California from 1969 to 2016 in order to identify the catch trends and the presence of the harmonic components that is related to environmental variability. Methods: Fast Fourier Transformation (FFT) was applied to the time series in order to establish the dominant frequencies. The Singular Spectrum Analysis (SSA) method was used to separate the trend and harmonic components. Each harmonic component was correlated to the Southern Oscillation Index (SOI), the Pacific Decadal Oscillation (PDO) and the Solar Activity data. Results: The FFT showed dominant frequencies at 7 and 11 years. An increasing linear trend was identified from 1969 to 2008 with a decreasing linear segment from 2009 to 2016, as well as two harmonic components of different frequencies (7 and 11 years respectively). The trend and the two harmonic components explain 87.49% of the total variance of the capture. The first and second harmonic components correlated positively with SOI (r= 0.2921, r= 0.3870 respectively), while the second harmonic component correlated negatively with solar activity (r= -0.5313). There were no correlations with the PDO. Conclusions: The fluctuations of Pacific sardine in the Gulf of California are mainly due to three factors: increased catch, the influence of the El Niño events and the influence of the solar activity cycle.