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Resumen ANTECEDENTE: El síndrome de Karsch-Neugebauer o ectrodactilia del pie o pie hendido, es una enfermedad congénita sumamente rara, caracterizada por aplasia-hipoplasia de las falanges y metatarsianos del pie. Cuando aparece de forma aislada se debe a una forma autosómica dominante de expresión variable, aunque también puede ser de carácter autosómico recesivo. CASO CLÍNICO: Paciente de 31 años, sin antecedentes heredofamiliares de importancia, con IMC de 25.95 kg/m2, signos vitales en parámetros normales. Con dos embarazos, cesárea previa sin complicaciones. El ultrasonido estructural 20 a 23.6 semanas del embarazo actual reportó un feto vivo, de sexo femenino y 22.2 semanas de gestación, con múltiples alteraciones anatómicas: arteria umbilical única, hueso nasal hipoplásico, micrognatia en ángulo facial y miembros inferiores con ectrodactilia bilateral. CONCLUSIONES: Los estudios ultrasonográficos, en especial el de las semanas 20 a 23.6 de gestación son decisivos para la detección de malformaciones congénitas. Sin embargo, a partir de las 11 a 13.6 semanas es posible establecer diagnósticos estructurales de manera temprana. Muchas alteraciones y síndromes, como el de Karsch-Neugebauer, suelen ser incapacitantes y al combinarse con otras anomalías pueden llegar a ser incompatibles con la vida. Se requieren diagnósticos tempranos para la toma de decisiones de manera consensuada con la familia y el equipo multidisciplinario.

Abstract BACKGROUND: Karsch-Neugebauer syndrome, or ectrodactyly of the foot or cleft foot, is an extremely rare congenital disorder characterized by aplasia-hypoplasia of the phalanges and metatarsals of the foot. When it occurs in isolation, it is due to an autosomal dominant form of variable expression, although it can also be autosomal recessive. CLINICAL CASE: 31-year-old female patient with no significant hereditary family history, BMI of 25.95 kg/m2, vital signs within normal parameters. With two pregnancies, previous caesarean section without complications. Structural ultrasound 20 to 23.6 weeks of the current pregnancy showed a live fetus, female sex and 22.2 weeks gestation, with multiple anatomical anomalies: single umbilical artery, hypoplastic nasal bone, micrognathia in the facial angle and lower limbs with bilateral ectrodactyly. CONCLUSIONS: Ultrasound examinations, especially at 20 to 23.6 weeks of gestation, are crucial for the detection of congenital malformations. However, from 11 to 13.6 weeks it is possible to make early structural diagnoses. Many disorders and syndromes, such as Karsch-Neugebauer syndrome, are often disabling and, in combination with other anomalies, can become incompatible with life. Early diagnosis is necessary to make informed decisions with the family and the multidisciplinary team.

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En la Séptima Cumbre Iberoamericana de Medicina Familiar, Cali ­ Colombia 2018, el grupo de trabajo Salud Mental (SM) reflexionó sobre como la Medicina Familiar (MF) puede actuar para apoyar a las personas que enfrentan situaciones de estrés frente a la vida diaria, conflictos (armados/no armados), emergencias y desastres naturales. Estudio descriptivo de corte transversal basado em una encuesta de 42 preguntas a 99 profesionales sanitarios iberoamericanos provenientes de 15 países, 98 médicos y 1 psicólogo, 8% residentes de MF, 85% especialistas en MF, 4% médicos generales, 2% psiquiatras y 1% internista. El 47% de los médicos percibe como buena la capacidade de los médicos de familia en el abordaje de la SM. En cuanto a los problemas de SM observados, 30% indica Trastorno de Ansiedad, 27% depresión, 17% insomnio, 10% alcoholismo, 7% adicción a drogas ilícitas, 5% trastornos alimentarios y 4% trastorno de estrés postraumático. En este contexto se realizaron las recomendaciones para la Carta de Cali que consideran la formación en SM necesaria para los Médicos Familiares, con estrategias de autocuidado costo efectivas, mediante el fortalecimiento del trabajo comunitario. El cuerpo docente de las residencias de MF debe hacerse cargo de acciones tendientes al autocuidado de los alumnos, propendiendo a facilitar el processo de aprendizaje y la preparación para ejercer la profesión en un medio tan complejo como son los centros del primer nivel de atención o en cualquier contexto en el que se trabaje con la estratégia de Atención Primaria de Salud.

During the Seventh Iberoamerican Summit of Family Medicine, Cali Colombia 2018, the Mental Health (MH) working group reflected on how Family Medicine (FM) can act to support people facing stressful situations in daily life as well as in conflicts (armed/unarmed), emergencies and natural disasters. Descriptive cross-sectional study, based on a survey of 42 questions to 99 Iberoamerican health professionals from 15 countries; 98 physicians and 1 psychologist. 8% residents of family medicine, 85% family physicians (FP), 4% general doctors, 2% psychiatrists and 1% internists. 47% of physicians perceive as good the ability of FP in the approach to MH. Concerning the MH problems observed, 30% where anxiety disorder, 27% depression, 17% insomnia, 10% alcoholism, 7% illicit drug abuse, 5% eating disorders and 4% post-traumatic stress disorder. Wich such results, recommendations for the Cali Declaration consider the necessary MH training for Family physicians, with cost-effective self-care strategies through strengthening community work. The teachers of FP must take actions tending to the self-care of their students, to facilitate the learning process and the preparation to practice the profession in such a complex environment as the Primary Care (PC) centers or in any place based on PC strategy.

Na Sétima Cúpula Ibero-Americana de Medicina Familiar, Cali ­ Colombia 2018, o grupo de trabalho Saúde Mental (SM) refletiu sobre como a Medicina de Família (MF) pode atuar em para apoiar a saúde integral das pessoas que enfrentam situações de estresse na vida diaria, como conflitos armados/desarmados, emergências e desastres naturais. Estudo descritivo transversal com base em um levantamento de 42 perguntas a 99 profissionais de saúde ibero-americanos provenientes de 15 países; 98 médicos e 1 psicólogo. 8% de residentes de MF, 85% de especialistas em MF, 4% de clínicos gerais, 2% de psiquiatras e 1% de internistas. 47% dos médicos percebem como boa a capacidade dos médicos de família na abordagem da SM. Em relação aos problemas SM, 30% indicam Transtorno de Ansiedade, 27% de depressão, 17% de insônia, 10% de alcoolismo, 7% de dependência de drogas ilícitas, 5% de transtornos alimentares e 4% de transtorno de estresse pós-traumático. Neste contexto, foram feitas recomendações para a Carta de Cali que consideram o treinamento de SM necessário para médicos de família, com estratégias de autocuidado custo-efetivas através do fortalecimento do trabalho comunitário. O corpo docente das residências do MF deve se encarregar de ações que promovam o autocuidado dos alunos, visando facilitar o processo de aprendizagem e o preparo para a prática da profissão em um ambiente tão complexo como os centros de Atenção Primária à Saúde (APS) ou em qualquer contexto em que se trabalhe com a estratégia APS.

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La disfagia se define como un trastorno de la deglución caracterizado por una dificultad en la preparación oral del bolo alimenticio o en el desplazamiento del alimento desde la boca hasta al estómago. Se asocia con la cuarta causa de muerte más frecuente en adultos mayores y se identifica como un agente contribuyente a la malnutrición. Los alimentos destinados a las personas que padecen disfagia son preparados con productos que modifican la viscosidad de forma que al ser ingeridos puedan ser más seguros. En el presente trabajo se pretende establecer la interacción entre la glucosa y tres espesantes comerciales de origen vegetal (dos a base de almidón y un tercero constituido por una mezcla de maltdextrina, goma xantana y goma guar) a efectos de identificar el más adecuado para uso en dietas de pacientes con disfagia orofaríngea, en las condiciones ensayadas. Para ello se determina el grado de estabilidad que presentan en función del tiempo de reposo (0, 24 horas) y su comportamiento en el intervalo de temperatura comprendido entre 25 y 50 °C. Se han estudiado concentraciones de espesante hasta el máximo del 6% en combinación con 5 concentraciones de glucosa hasta un máximo de 27%. Se constata la interacción conjunta de la goma xantana, la goma guar y la maltodextrina con la glucosa. Estos espesantes, potencialmente aptos para regular el grado de consistencia de productos alimentarios destinados a la alimentación de pacientes con disfagia orofaríngea, presentan un proceso de hidratación lento que, además, se ve agravado por la interacción de la glucosa.

Dysphagia is defined as a swallowing disorder characterized by a difficulty in the alimentary bolus preparation or in food displacement from the mouth to the stomach. It is the fourth cause of death in adults and it is identified as a malnutrition agent. Food destined to individuals with dysphagia is prepared with products which modify their viscosity to make them safer to swallow. The present job tries to establish an interaction between glucose and three commercial thickeners of vegetal origin (two from starch and a third one made from a mix of maltodextrin, xanthan gum and guar gum in order to identify the most suitable one to be used in diets of patients with oropharyngeal dysphagia on the tested conditions. The stability degree in concordance with the time relation (0-24 hours) and its performance on the gap temperature between 25 and 50 ºC is determined. Tests have been done with thickener concentrations up to a maximum of 6% in combination with 5 glucose concentration up to a maximum of 27%. The common interaction of xanthan gum, guar gum and maltodextrin with glucose is found. Those thickeners potentially suitable to regulate the consistency degree of food products destined to the nourishment of patients with oropharyngeal dysphagia show a slow hydration process which is also aggravated by the glucose interaction.

A disfagia é definida como um distúrbio de deglutição caracterizado por uma dificuldade na preparação do bolo alimentar ou na passagem do alimento da boca até o estômago. Associa-se à quarta causa de morte mais frequente em adultos idosos e é identificada como um agente que contribui à má nutrição. Alimentos destinados a pessoas que sofrem de disfagia são preparados com produtos que modificam a viscosidade de forma que ao serem ingeridos possam ser mais seguros. O presente trabalho visa a estabelecer a interação entre a glicose e três espessantes comerciais de origem vegetal (dois com base de amido e um terceiro feito a partir de uma mistura de maltodextrina, goma xantana e goma guar) a fim de identificar o mais adequado, para ser utilizado em dietas de pacientes com disfagia orofaríngea nas condições testadas. Para isso é determinado o grau de estabilidade que apresenta em função do tempo de repouso (0-24 horas) e seu desempenho no intervalo de temperatura compreendido entre 25 e 50 °C. Concentrações de espessantes foram estudadas até o máximo de 6% em combinação com 5 concentrações de glicose até um máximo de 27%. Pode ser encontrada a interação conjunta da goma xantana, a goma guar e a maltodextrina com a glicose. Estes espessantes, potencialmente adequados para regular o grau de consistência de produtos alimentares destinados à alimentação de pacientes com disfagia orofaríngea, apresentam um processo de hidratação lento que, além disso, é agravado pela interação da glicose.

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Introducción: los Cuidados Centrados en la Persona (CCP) secaracterizan por cuatro dimensiones: alianza terapéutica, el paciente como persona, el médico como persona, y el enfoque biopsicosocial. Los objetivos de este estudio fueron determinar y analizar el nivel de Preferencia por los Cuidados Centrados en la Persona (PCCP) encentros de salud de dos países de Sudamérica. Materiales y métodos:Se realizaron encuestas en siete centros de salud de Argentina yBolivia, utilizando el cuestionario ECP1. Resultados: Se analizaron 844cuestionarios, en los que se observó un porcentaje general de PCCPde 70%. Conclusiones: Los CCP demostraron tener una importantepreferencia en los siete centros de salud evaluados en los dos países de Sudamérica.

Background: person-Centered Care (PCC) is characterized by fourdimensions: the therapeutic alliance, the patient as a person, thephysician as a person, and the biopsychosocial approach. The objectivesof this study were to determine and analyze the level of Preferencefor Person-Centered Care (PPCC) in healthcare centers of two SouthAmerican countries. Materials and methods: Surveys were conductedin seven healthcare centers in Argentina and Bolivia, using the ECP1questionnaire. Results: 844 questionnaires were analyzed, in whichan overall percentage of 70% PPCC care was observed. Conclusions:PCC showed to have an important preference in the healthcare centersevaluated.

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La disfagia orofaríngea está presente en una gran parte de la población y se describe como un síntoma que puede afectar a la formación y manejo del propio bolo alimenticio al transferirlo al estómago. Es un síntoma muy prevalente que puede presentarse en cualquier momento de la vida, si bien es en la tercera edad cuando este síntoma es más común. Con el fin de prevenir las consecuencias que puede ocasionar esta alteración fisiológica, los alimentos destinados a las personas que la padecen son preparados con productos que modifican la viscosidad de manera que al ser deglutidos puedan seguir el curso normal de la deglución y posterior digestión. Este estudio tiene como objetivo comprobar si determinados productos recomendados para ser utilizados en dietas destinadas a personas afectadas por disfagia cumplen adecuadamente las funciones para las que han estado diseñados y elaborados, independientemente de si son productos farmacéuticos o, simplemente, aditivos alimentarios. Los resultados indican que el almidón de maíz presenta un comportamiento distinto al de patata, siendo muy importante el tipo de agua utilizada. Se han detectado diferencias significativas relacionadas con el tiempo de reposo de la muestra y el porcentaje de espesante aplicado para conseguir las consistencias sanitarias: líquido fino, néctar, miel y pudding.

Oropharyngeal dysphagia is present in a large part of the population and described as a symptom that may affect the formation and handling of the patient’s own bolus food when transferred into the stomach. Although it is a very prevalent symptom that can occur at any time of life, it is at senior age when this symptom is more common. In order to prevent the consequences that can result in this physiological alteration, food for people who suffer from this disorder is prepared with products that modify their viscosity, so that it follows the normal course of swallowing and later digestion. This study aims at verifying whether certain products recommended for use with people affected by dysphagia diets properly meet the functions for which they have been designed and produced, regardless of whether they are pharmaceutical products or, simply, food additives. The results indicate that corn starch presents a different behaviour from potato, the type of water used being very important. Significant differences related to the dwell time of rest from the sample and the percentage of thickener applied to achieve the valued health consistencies of thin liquid, nectar, honey and pudding were detected.

A disfagia orofaríngea está presente em grande parte da população e é descrita como um sintoma que pode afetar a formação e a digestão do próprio bolo alimentar ao transferi-lo ao estômago. É um sintoma muito prevalente, podendo ocorrer a qualquer momento da vida, embora seja na terceira idade quando este sintoma se torna mais comum. Para evitar as consequências que podem resultar nessa alteração fisiológica, os alimentos destinados às pessoas que a padecem são preparados com produtos que modificam a viscosidade de maneira que, ao serem deglutidos, possam continuar o curso normal de deglutição e posterior digestão. Este estudo tem como objetivo comprovar se determinados produtos recomendados para uso em dietas destinadas a pessoas afetadas por disfagia cumprem adequadamente as funções para as quais foram concebidos e elaborados, independentemente de se são produtos farmacêuticos ou, simplesmente, aditivos alimentares. Os resultados indicam que o amido de milho apresenta um comportamento diferente da batata, sendo muito importante o tipo de água utilizada. Foram encontradas diferenças significativas relacionadas com o tempo de repouso da amostra e o percentual de espessante aplicado para conseguir as consistências sanitárias: líquido fino, néctar, mel e pudim.

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OBJECTIVES: To guide the clinician in taking decisions on the best strategies for assessing and monitoring the risk of blood disorders in adults diagnosed with schizophrenia in pharmacological treatment. METHOD: A clinical practice guideline was developed following the guidelines of the Methodological Guide of the Ministry of Social Protection to collect evidence and grade recommendations. De novoliterature researchwas performed. RESULTS: With the use of antipsychotics there isriskofreducción in the leukocyte count and the risk of agranulocytosis,the later associated with the use of clozapine, although it is a rare event(0.8%) can be fatal; this effect occurs most frequently in the first twelve weeks of treatment and the risk is maintained aroundthe first year of it. CONCLUSION: The recommendations were considered strongin all hematologic related monitoring.A blood count should be taken at the start of pharmacological treatment. If the patient is started on clozapine one shouldbe taken weekly during the first three months, monthly until completing one year and every six months thereafter. If there is a decrease in white blood cell count the patient should be monitored regularly, stopping if is a less than 3,500 cells/mm(3) and consider referral if is less than 2,000 cells/mm(3).

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Objetivos: Ayudar al clínico en la toma de decisiones sobre las estrategias de evaluación y el seguimiento por el riesgo de alteraciones hematológicas en adultos con diagnóstico de esquizofrenia en tratamiento farmacológico. Método: Se elaboró una guía de práctica clínica bajo los lineamientos de la Guía Metodológica del Ministerio de Salud y Protección Social para identificar, sintetizar, evaluar la evidencia y formular recomendaciones respecto al manejo y seguimiento de los pacientes adultos con diagnóstico de esquizofrenia. Se adoptó y actualizó la evidencia de la guía NICE 82, que contestaba la pregunta acá planteada. Se presentó la evidencia y su graduación al grupo desarrollador de la guía (GDG) para la formulación de las recomendaciones siguiendo la metodología propuesta por el abordaje GRADE. Resultados: Un evento conocido con el uso de antipsicóticos es la disminución en el conteo de leucocitos y el riesgo de agranulocitosis, este asociado al uso de clozapina, que aunque es un evento raro (0,8%), puede tener consecuencias fatales; este efecto se presenta con mayor frecuencia en las primeras doce semanas y se mantiene el riesgo hasta un año aproximadamente. Conclusión: se consideraron como recomendaciones fuertes todas las relacionadas con el seguimiento hematológico, se recomienda la toma de un hemograma al inicio del tratamiento farmacológico. Si el paciente inicia clozapina debe realizar uno semanal durante los tres primeros meses, mensual hasta el ano y cada seis meses a partir del primer año. Si se encuentra una disminución del conteo de leucocitos se debe hacer un seguimiento periódico, suspenderlo si hay un recuente menor a 3.500 células/mm³ y se recomienda la suspensión y remisión si el recuento es menor a 2.000 células/mm³.

Objectives: To guide the clinician in taking decisions on the best strategies for assessing and monitoring the risk of blood disorders in adults diagnosed with schizophrenia in pharmacological treatment. Method: A clinical practice guideline was developed following the guidelines of the Methodological Guide of the Ministry of Social Protection to collect evidence and grade recommendations. De novoliterature researchwas performed. Results:With the use of antipsychotics there isriskofreducción in the leukocyte count and the risk of agranulocytosis,the later associated with the use of clozapine, although it is a rare event(0.8%) can be fatal; this effect occurs most frequently in the first twelve weeks of treatment and the risk is maintained aroundthe first year of it. Conclusion: The recommendations were considered strongin all hematologic related moni-toring.A blood count should be taken at the start of pharmacological treatment. If the patient is started on clozapine one shouldbe taken weekly during the first three months, monthly until completing one year and every six months thereafter. If there is a decrease in white blood cell count the patient should be monitored regularly, stopping if is a less than 3,500 cells/mm³ and consider referral if is less than 2,000 cells/mm³.

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BACKGROUND: Current communication technologies can be used in health education. The aim was to assess the process of an online program designed to prevent cancer risk behaviours using an educational website and mobile phones. METHODS: High school students from Spain and Mexico were recruited during 3 academic years (2009-12) to participate in a web-based program supplemented with mobile phone messages (SMS) which aim was to prevent cancer risk behaviours. The program was designed as a randomized trial, with control and experimental group (EG). Recruitment and adherence were analyzed using data of the Web management platform and Google Analytics. RESULTS: 3,855 students started the logging on the program of which 2,001 (51.9%) completed the questionnaire.77.5% were Mexicans, 13 years old (40.6%), with good academic level (68.7%) and with parents (49.6%) and mothers (53.9%) having university degree. 56.4% recorded a phone number to receive SMS. The EG consisted of 1,014 students and the averages of their visits to the website were 31.6 in the first year, 21.8 in the second and 21.9 in the third. Each adolescent of the EG was able to incorporate 1.16 adults (total 1,172) and other 1,076 were recorded spontaneously. Retention rate at the end of follow-up was 41.5% and was higher among those who were best students (OR: 12,5), Mexicans (OR: 4.4), 12 years old (OR: 3.1) and have been incorporated in the first three months of the implementation (OR: 2.8). CONCLUSION: Students' recruitment and retention was scarce, mainly in Spain. However students involved visited the program website with sufficient amount of time to achieve good results.

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INTRODUCTION: Neural tube defects are congenital malformations of brain and spinal cord. There is evidence that adequate amounts of folic acid supply to women before and during early pregnancy decreases the risk of having a neural tube defects affected child. Main sources of folic acid are food rich in folic acid, multivitamins with folic acid supplementation, and folic acid fortification of cereal products. OBJECTIVES: To assess folic acid consumption from food and from medication in a group of mothers. To analyze their knowledge about using folic acid to prevent neural tube defects. To evaluate association between inadequate consumption and information, level of education, and concurrence to private or public health sector. To measure the amount of folic acid in bread sold within the region. DESIGN: Observational cross-sectional study. SURVEYS: Mothers of children under 2 months of age that were assisted by 38 pediatricians in five cities in the Region, collected between November 2006 and March 2007. Amount of folic acid in bread: bread samples acquired in the same cities. RESULTS AND CONCLUSIONS: 327 surveys were collected. The average daily intake of folic acid from food was 481 Hg; 43,4% of women consume less than 400 Hg daily. Medical supplementation was suitable in 27,8% of the sample. 52,9% had appropriated knowledge about folic acid and prevention of neural tube defects. Differences were observed between mothers concurring to private or public health sector, and those who had or had not completed secondary school in relation to both supplementation and knowledge of folic acid. The media amount of folic acid in bread samples was 192,34 Hg / 100 g. All samples were manufactured with fortified flour.

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