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

RESUMENEl síndrome de HELLP es una complicación multisistémica del embarazo que se distingue por el trastorno hipertensivo más la triada: hemólisis microangiopática, elevación de enzimas hepáticas y disminución del conteo de plaquetas. Está asociado con la aparición de graves complicaciones perinatales e incremento de la mortalidad materna. Ocurre en 0,5 a 0,9% de todos los embarazos y en 10 a 20% de las pacientes con preeclampsia-eclampsia. Complicaciones obstétricas como ésta deben sospecharse de manera temprana para poderlas atender de manera oportuna y así prevenir situaciones potencialmente fatales tanto para la madre como para el feto. Es por ello, que deben integrarse adecuadamente los signos y síntomas, comprendiendo el reto diagnóstico que este síndrome puede significar.ABSTRACT HELLP syndrome is a severe systemic complication in pregnancy characterized by hypertensive disorder added to the clinical profile that includes: microangiopathic hemolysis, elevation of liver enzymes, and decreased platelet count. It is associated with the appearance of serious perinatal complications and increased maternal mortality. It occurs in 0.5 to 0.9% of all pregnancies and in 10 to 20% of patients with pre-eclampsia/eclampsia. Obstetric complications such as this syndrome need to be suspected in clinical practice, to prevent fatal outcomes for both, the mother and the fetus. Therefore, clinical manifestations should be identified early to approach challenges that the diagnosis may pose.   

ResumenIntroducción.  La conducta sexual ha sido ampliamente estudiada en sujetos mayores de 18 años. La edad de inicio de vida sexual ha ido disminuyendo, sin embargo, estudiar la conducta sexual en adolescentes es un reto, y la información es escasa.  En este trabajo se realiza un análisis descriptivo de la conducta sexual de un grupo de adolescentes yucatecos.Material y Método.  Se realizó un estudio prospectivo, transversal y descriptivo que incluyó a 245 adolescentes de 11 a 16 años. La recolección de datos se llevó a cabo con un instrumento autoaplicable y los resultados se analizaron con estadística descriptiva.Resultados.  El 5.71% de la población estudiada refirió ser sexualmente activos (8.26% de los varones y 3.22% de las mujeres), declarándose todos heterosexuales.  Las caricias y/o besos en genitales fue la práctica sexual más común (78.57%); la masturbación a la pareja, el sexo oral y el sexo con penetración anal  o vaginal se reportaron con la misma frecuencia (28.57%).  El 21.4% utilizaron condón en su primera relación sexual y 7.14% ha tenido relaciones sexuales en los últimos 6 meses bajo el efecto del alcohol o drogas. El 2.04% de la población estudiada practica cibersexo.Conclusión. Es baja la frecuencia de adolescentes que han iniciado su vida sexual, sin embargo, la protección es prácticamente inexistente lo que los hace vulnerables a contraer infecciones de transmisión sexual  y tener embarazos no deseados.Palabras clave: adolescentes; conducta sexual; México

Introducción: Las mutaciones, Del_E746_A750 exón 19 y L858R exón 21 del gen EGFR en células tumorales de CPNM representan biomarcadores de respuesta a fármacos inhibidores de tirosina cinasa (ITK). Pacientes con tumores positivos a mutaciones EGFR muestran mejor respuesta y mayor sobrevivencia. Estas mutaciones ocupan el 90% de las mutaciones en cancer de pulmón. Objetivo: Evaluar la frecuencia de las mutaciones Del_E746_A750-exon 19 y L858R-exon 21 del EGFR en muestras de biopsia de CPNM y en muestras de suero de población abierta de Yucatán. Material y métodos: Se seleccionaron 19 muestras de biopsia de CNPM y 101 sueros de sujetos sanos. Las mutaciones Del_E746_A750 y L858R en EGFR se determinaron mediante amplificación por PCR alelo específica (PCR-ASO). Se calcularon las frecuencias genotípicas y alélicas y su distribución según Hardy Weinberg, utilizando la plataforma SNPstats. Resultados: En muestras de suero se determinó el genotipo homocigoto (1/1) en 26.58%, 73.42% el heterocigoto (1/0) y ausencia del genotipo mutante con deleción (0/0) para Del E746_A750; en tanto que para L858R, el 21.78% resultó homocigoto (TT), 54.46% heterocigoto (T/G) y 23.76% mutantes GG. En las biopsias el heterocigoto fue más frecuente en ambas mutaciones 63.16% y 73.68% para Del_E746_A750 y L858R, respectivamente. Conclusión: La frecuencia de las mutaciones del gen EGFR en la población local de Yucatán (sueros) fue de 36.71% para la deleción Del746-750 en exón 19 y 50.99% para L858R en exón 21. La distribución de las mutaciones en muestras de biopsia CPNM  resultó en 42.11% para cada mutación estudiada. 

ResumenIntroducción: La mortalidad materna se considera un indicador significativo de la calidad de los servicios de salud, así, se conoce que aproximadamente un 95% de estas muertes en América Latina y el Caribe son prevenibles.Objetivos: Determinar si la Razón de Muerte Materna (RMM) en Yucatán es mayor a la media nacional durante los años 2013 a 2015.Material y Métodos: Estudio transversal observacional en mujeres embarazadas que fallecieron por causas directas relacionadas con el embarazo durante los años 2013 a 2015 en el estado de Yucatán. Se utilizaron datos del Instituto Nacional de Estadística y Geografía (INEGI).Resultados: En el 2013 se encontró que la RMM en Yucatán fue 38,11% mayor en comparación con la nacional, en el 2014 la RMM en este mismo estado fue 34,68% mayor en comparación con la del país y en el 2015 la RMM fue 21,14% mayor que la mexicana. Las principales causas de muerte en el estado concuerdan con lo expuesto en la bibliografía, siendo éstas los desórdenes hipertensivos y las hemorragias.Conclusiones: La RMM durante los años 2013 a 2015 en el estado de Yucatán fue mayor a la media nacional. Es importante implementar medidas preventivas que permitan reducir esta disparidad en términos de mortalidad materna en el estado de Yucatán.Palabras clave: Muerte Materna, Salud Pública, Prevención Secundaria, Salud MaternaTítulo corto: Análisis de la mortalidad materna en Yucatán. ABSTRACT.Introduction. Maternal Mortality is considered a significant indicator of the quality of the health services in any country. It is known that approximately 95% of these deaths in Latin America and the Caribbean are preventable.Objectives. Our objective is to determine whether or not the Maternal Mortality Ratio (MMR) in Yucatan is higher than the national mean during the years 2013 to 2015.Materials and methods. Transversal-observational study in pregnant women who died from direct causes related to pregnancy during the years 2013 to 2015 in Yucatan. Data from the National Institute of Statistics and Geography (INEGI) were used.Results. In 2013 the MMR in Yucatan was 38,11% higher than the national mean, in 2014 the MMR of this state was 34,68% higher in comparison to the national mean and in 2015 the MMR was 21,14% higher than the national mean. The main causes of dead in the state of Yucatan are in agreement with the national causes which are hypertensive disorders and  hemorrhagic disorders.Conclusions. The MMR during the years 2013 to 2015 in the state of Yucatan was higher than the national average. It is important to implement preventive measures to reduce this disparity in terms of maternal mortality in the state of Yucatán.Keywords: Maternal Mortality, Public Health, Secondary Prevention, Maternal Health. 

A Revista Brasileira de Medicina de Família e Comunidade (RBMFC) agradece aos Avaliadores listados abaixo que atuaram como revisores ad hoc durante o ano de 2018, dedicando horas voluntariamente para a emissão de pareceres técnicos sobre manuscritos submetidos a esta revista.

Objective: To evaluate the quality dimensions of the electronic medical records data of pregnant women followed in the Primary Health Care of Vitória, Espírito Santo, and to compare their completeness with health care models (Traditional Basic Units and Family Health with and without Matrix Support). Methods: Cross-sectional study of the dimensions of quality in the prenatal clinical records using the electronic medical record of pregnant women in the city of Vitória, Espírito Santo, Brazil from January 1, 2013 to December 31, 2014. The following were evaluated: coverage, non-duplicity, accessibility, opportunity, methodological clarity, completeness, consistency and reliability. Results: Excluding duplicate records, 690 medical records were analyzed. Prenatal coverage, considering the onset of prenatal care, was 80%. Even with the restriction of access, opportunity and lack of methodological clarity, the clinical record showed excellent consistency and completeness in the fields of obstetric procedures and laboratory tests. Variables as maternal race, marital status, pregnancy planning and gestational risk presented poor completeness, varying according to health assistance model. Reliability was not completely in agreement with the Live Births Information System. Conclusions: There is potential of the electronic medical record as a source of epidemiological information on prenatal care. However, its reliability is hampered by the lack of integration of data with other levels of attention and information systems and its completeness is deficient in some aspects. The data suggest that the presence of the Matrix Support does not significantly influence the completeness of the medical record. Greater emphasis on completing medical records and integrating with other levels of care is necessary.

Introduction: The preceptorship activity within medical education has been globally established as a model for the teaching process in the area and there are several forms and experiences of organization. The Medical Residency Program in Family Medicine of Universidade de São Paulo presents an unusual model of preceptors, composed of preceptors of the medical residency program, each one with its own and complementary specificities. Objectives: Our goal in this experience report was to share the institutional policies and preceptory experiences in our medical residency program, as well as to point out the multiple adversities and possible forms of coping. Results: Achieving the level of excellence in developing the skills needed to train the Family Medicine specialist, in adverse situations of appreciation of the specialty and the teaching staff, is an arduous task. In this difficult challenge of conducting the Medical Residency Program and ensuring the development of quality skills, the role of the preceptor of the medical residency program and the resident’s tutor is crucial. Conclusion: Faced with the challenges pointed out, there is great wear and tear on the tutors, who voluntarily perform the teaching activities even when acting on welfare overload. The lack of recognition, scarcity of institutional support and administrative management are factors that hinder the better development and expansion of the residency program.

Objective: The purpose is to carry out a literature review on Competency Based Curriculum that could support the elaboration of a matrix for the Residency Program in Family and Community Medicine of Fortaleza, Ceará. Methods: A literature review was made on the theoretical reference of competency-based education, selecting articles, guidelines, documents and curricula models of medical schools and national and international entities involved with medical education. Results: The literature review evidenced two main curriculum models repeatedly mentioned in the references: ACGME (Accreditation Council for Graduate Medical Education) Milestones and CanMEDS (Canadian Medical Education Directions for Specialists) Framework. Competency-Based Curriculum emphasizes student-centered teaching and uses a results-based approach to the design, implementation, and evaluation of medical education programs. It is organized as a framework of competencies mapped to entrustable professional activities in the form of a matrix. The evaluation is based on performance through milestones. For creating its own curricular Matrix, the CanMEDS 2015 was adopted as a model because it was approved by 12 Canadian medical organizations and it is currently used as reference in dozens of countries, being the most widely applied model in the world. Conclusion: We expect that this review would serve as a tool for other Medical Schools and their Residency Programs to develop their own Competency-Based Curricula.

Objective: The objective of this work is to analyze the organizational and pedagogical aspects of a Residency Program in Family and Community Medicine. Methods: A descriptive study was carried out, in the form of an experience report, focusing on the organizational and pedagogical aspects that were developed to foster the integration of teaching and service and the construction of pedagogical spaces in APS. Results: This is a residency program in Family and Community Medicine established in a partnership between the Universidade Federal da Paraíba (UFPB) and the Secretaria Municipal de Saúde de João Pessoa - PB. It is observed that the strengthening of the teaching-service integration and the construction of a pedagogical model that integrates actions of residence and graduation in primary care services are guiding the implementation of the program. There are organizational mechanisms for a process of co-management between the university and the municipal secretariat bringing structural innovations in the teaching-learning process. Residents take on the Family Health Team in Integrated Units, with a local preceptor hired, as well as field teachers and core university. As an offer of other relevant knowledge to perform in Primary Care, the PRMFC of UFPB has currently invested in continuing education actions to qualify the network and increase the resoluteness of Primary Care. Conclusions: It is believed that the presence of the PRMFC/UFPB has been contributing to the qualification of services, changing spaces of teaching learning through the integration of the horizontal modules, the boarding school and the residence.

Introduction: Gender dysphoria in children is a subject rarely addressed in clinical training, despite the increased interest of families on gender issues. Objective: Achieve an integrative review of papers about Gender Dysphoria in children and identify recommendations for management in Primary Health Care. Methods: Integrative literature review using MeSH terms in the Pubmed, Medline, Lilacs and Scielo databases for articles published between 2008 and 2018 that used transgender children in their analyzes. Results: From the 2,488 articles identified by the search key, 12 articles were selected. Most of them are from specialized centers for the care of transgender children in four countries. The health professional should carry out anamnesis directed to the child’s behavioral issues at home and at school, family dynamics, cultural context, family history of non-compliance of gender, social life of the child and child safety. Attention should be paid to psychosocial assessment appropriate to the child’s age. It is up to the Primary Health Care team to clarify the main doubts of the families, to carry out the diagnostic suspicion and to refer to the specialized center for the care of the transgender children of their state. Conclusion: It is up to the Primary Health Care team to provide a welcoming and non-discriminatory environment so these families can be properly evaluated and conducted.