Introduction: The Brazilian National Curriculum Guidelines (NCG) for undergraduate courses in Medicine since 2014 have highlighted the need to include gender and sexuality in the medical school curricula, aiming at better care for people. Method: Thus, the objective is to identify and analyze the approach of gender and sexuality in the Curriculum Pedagogical Projects (CPP) of the medical courses of the Federal Institutions of Brazil. This is a cross-sectional study of descriptive and documentary analysis, carried out through the analysis of CPP, of the undergraduate medical courses of the Federal Universities of Brazil. Data were obtained from the website of the undergraduate medical course of each higher education institution. In addition, emails were sent to the coordinators of these courses to obtain the updated CPPs. For the quantitative analysis, an initial description of the sample was performed followed by a statistical analysis using the chi-square test to assess whether or not there was an association between the presence of gender and / or sexuality debate in CPP, with the publication of the 2014 NCG and with the Brazilian geographic region, as well as between the nature of the curricular unit (compulsory or complementary / optional) and the perspective of the approach. The documentary analysis was used for the qualitative analysis with the content analysis technique, through the thematic analysis method. Results: It was found that 48 (69.56%) of the 69 analyzed CPP discuss the topics gender and / or sexuality in one or more subjects offered by the course. There is a predominance of the sexuality topic, of compulsory curricular units (88.32% of 137 curricular units) and an approach beyond the exclusively biological perspective (63.5% of 48 CPPs and 62.04% of curricular units). No statistical significance was evidenced by the chi-square test. Regarding the documentary analysis, two categories were constructed: “gender and sexuality associated with a biological perspective”, “gender and sexuality associated with a predominantly broader perspective or social determinants in health”. It was observed that the first category predominates in curricular units associated with organs, systems or life cycles of the human being, while the second, to social and human sciences applied to health and Primary Health Care. Conclusions: We conclude there is a significant number of CPPs and, consequently, also of curricular units that have a perspective beyond the exclusively biological approach. Nevertheless, there is difficulty with comprehensive health care that may be related to a selective visibility to pathology and technical aspects of medical practice and a difficulty in effectively promoting an interdisciplinary dialogue between the biological, exact and human sciences as proposed by the NCG.
Introduction: The Brazilian National Curriculum Guidelines (NCG) for undergraduate courses in Medicine since 2014 have highlighted the need to include gender and sexuality in the medical school curricula, aiming at better care for people. Method: Thus, the objective is to identify and analyze the approach of gender and sexuality in the Curriculum Pedagogical Projects (CPP) of the medical courses of the Federal Institutions of Brazil. This is a cross-sectional study of descriptive and documentary analysis, carried out through the analysis of CPP, of the undergraduate medical courses of the Federal Universities of Brazil. Data were obtained from the website of the undergraduate medical course of each higher education institution. In addition, emails were sent to the coordinators of these courses to obtain the updated CPPs. For the quantitative analysis, an initial description of the sample was performed followed by a statistical analysis using the chi-square test to assess whether or not there was an association between the presence of gender and / or sexuality debate in CPP, with the publication of the 2014 NCG and with the Brazilian geographic region, as well as between the nature of the curricular unit (compulsory or complementary / optional) and the perspective of the approach. The documentary analysis was used for the qualitative analysis with the content analysis technique, through the thematic analysis method. Results: It was found that 48 (69.56%) of the 69 analyzed CPP discuss the topics gender and / or sexuality in one or more subjects offered by the course. There is a predominance of the sexuality topic, of compulsory curricular units (88.32% of 137 curricular units) and an approach beyond the exclusively biological perspective (63.5% of 48 CPPs and 62.04% of curricular units). No statistical significance was evidenced by the chi-square test. Regarding the documentary analysis, two categories were constructed: “gender and sexuality associated with a biological perspective”, “gender and sexuality associated with a predominantly broader perspective or social determinants in health”. It was observed that the first category predominates in curricular units associated with organs, systems or life cycles of the human being, while the second, to social and human sciences applied to health and Primary Health Care. Conclusions: We conclude there is a significant number of CPPs and, consequently, also of curricular units that have a perspective beyond the exclusively biological approach. Nevertheless, there is difficulty with comprehensive health care that may be related to a selective visibility to pathology and technical aspects of medical practice and a difficulty in effectively promoting an interdisciplinary dialogue between the biological, exact and human sciences as proposed by the NCG.
Introdução: A colestase intra-hepática da gravidez (CIHG) é reversível e seu principal sintoma é o prurido leve ou intenso, acompanhado pelo aumento da concentração de ácidos biliares séricos e/ou enzimas hepáticas. Para o diagnóstico é necessário excluir outras doenças hepatobiliares ou sistêmicas que cursam com as mesmas alterações, no entanto alguns autores consideram a elevação dos níveis dos ácidos biliares o padrão-ouro para o diagnóstico. Está associada a vários desfechos adversos gestacionais, que são diretamente proporcionais à elevação dos ácidos biliares, podendo levar à morte súbita fetal mesmo após monitoramento fetal normal. Relato de caso: Paciente do sexo feminino, 24 anos, 130 kg, parda, do lar, obesidade grau III, hipertensão crônica sem tratamento prévio, internada com 26 semanas e cinco dias de idade gestacional (IG), assintomática, em uso de metildopa 1,5 g/dia e ácido acetilsalicílico 100 mg/dia há 19 semanas para a investigação do aumento de enzimas hepáticas (transaminase oxalacética — TGO 85 U/L e transaminase pirúvica — TGP 114 U/L), revelado com IG de 24 semanas e seis dias. De início foi realizada ultrassonografia de abdome superior e exames laboratoriais com função hepática e sorologias para hepatites, sem alterações. Foi feita a troca da metildopa para nifedipino 60 mg/dia diante da possibilidade de hepatite medicamentosa, porém as transaminases continuaram em ascensão. Com IG de 28 semanas e um dia, TGO de 683 U/L e TGP de 1.130 U/L, aventou-se hipótese diagnóstica de CIHG, mesmo sendo a paciente assintomática. O caso foi discutido com equipe de hepatologia e iniciou-se o tratamento com ácido ursodeoxicólico 900 mg/dia com IG de 28 semanas e um dia. O diagnóstico foi realizado com dosagem de ácidos biliares de 16 mmol/L com IG de 29 semanas. A paciente foi submetida a parto cesáreo com 32 semanas em razão da confirmação diagnóstica de CIHG e da manutenção dos níveis de transaminases em dez vezes o valor de referência mesmo com tratamento. Após o parto, realizou-se a troca da dosagem do ácido ursodeoxicólico para 450 mg/dia, e observou-se queda mantida dos níveis de transaminases. Por fim, houve retorno aos valores de referência 16 dias pós-parto, e assim finalizou-se o uso da medicação. Conclusão: Segundo a literatura atual, o quadro de CIHG inicia-se com prurido, principalmente noturno, que acomete palma das mãos e planta dos pés, piora progressivamente, evoluindo com icterícia, e que normalmente ocorre no terceiro trimestre. Poucos casos são relatados na literatura em que há alteração laboratorial clássica, com ausência de sintomas; He et al. citam um aumento consideravelmente maior de desfecho adverso em casos de elevação de ácidos biliares em pacientes assintomáticas, de 28%, em relação a pacientes hígidas; quando sintomática, porém, a CIHG atingiu aproximadamente 52% de chance de desfecho adverso fetal. O grande desafio está no diagnóstico, manejo e definição do momento ideal para a interrupção, pois assim como a dosagem de ácidos biliares, a sintomatologia é um importante fator prognóstico e definidor de conduta (Wood, 2018).
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