Time management of Internal Medicine medicalresidents, São Paulo, Brasil

SUMMARY INTRODUCTION Medical Residency is a recognized form of professional qualification, but there are criticisms regarding the overload of work activities. Given the length of the daily and weekly workdays, residents develop practices that enable them to reconcile the Residency with their personal life. AIM To describe time management strategies in the daily routine of Internal Medicine Medical Residents of a university hospital in São Paulo, Brasil. METHODS Eight interviews were conducted with resident physicians of the second year, addressing aspects of personal and family life, theoretical study, practical activities, and work bonds. Content analysis was carried out using the MaxQDA software. RESULTS Six thematic categories emerged from the reports: work organization at the Medical Residency; learning and/or professional activities; housing, financial planning, and household activities; time for leisure and interpersonal relationship; family planning/children; rest/sleep. DISCUSSION Several strategies are adopted for time management: residing near the hospital, domestic activities helped by housekeepers, postponement of maternity leave, and social support centered on interacting with other residents. There are paid activities not associated with the Residency, which lead to reduced time for rest, study, and leisure, with a greater loss during work at night shifts. CONCLUSIONS Residents experience a period of intense learning, which requires a high workload and complex work. The evaluation of the work organization of medical residents should include not only time for rest but also time management strategies for daily activities, which can reduce the negative outcomes associated with long working hours.

RESUMO INTRODUÇÃO A Residência Médica é uma forma reconhecida de capacitação profissional, mas há críticas em relação à sobrecarga de trabalho. Dada a extensão das jornadas de trabalho diária e semanal, os residentes desenvolvem práticas para poder conciliar a Residência com sua vida pessoal. OBJETIVOS Descrever estratégias de gestão do tempo no cotidiano de médicos residentes de Clínica Médica em hospital universitário de São Paulo, Brasil. MÉTODOS Realizadas oito entrevistas com médicos residentes do 2o ano, abordando aspectos da vida pessoal, familiar, estudo teórico, atividades práticas e vínculos de trabalho. Realizada análise de conteúdo com auxílio do programa MaxQDA. RESULTADOS Seis categorias temáticas emergiram dos relatos: organização do trabalho na Residência Médica; atividade para aprendizado ou atividade profissional?; moradia, planejamento financeiro e atividades domésticas; tempo para lazer e relacionamentos interpessoais; planejamento familiar∕filhos; repouso∕sono. DISCUSSÃO Diversas estratégias são adotadas para gestão do tempo: residir próximo ao hospital, auxílio das atividades domésticas por diaristas, adiamento da maternidade e apoio social centrado no convívio com outros residentes. Há realização de atividades remuneradas não vinculadas à Residência, o que leva à redução do tempo previsto para repouso, estudo e lazer, com maior prejuízo nos períodos de plantões noturnos. CONCLUSÕES Os residentes vivenciam um período de aprendizado intenso, mas que exige uma carga horária elevada e trabalho complexo. A avaliação da organização do trabalho de médicos residentes deve incluir não somente tempo para repouso, mas também estratégias de gestão do tempo para atividades cotidianas. Estas podem reduzir o prejuízo associado às longas jornadas de trabalho.

Errores de medicación en el Servicio de Medicina de un hospital de alta complejidad / Monitoring medication errors in an internal medicine service

Background: Patients admitted to internal medicine services receive multiple drugs and thus are at risk of medication errors. Aim: To determine the frequency of medication errors (ME) among patients admitted to an internal medicine service of a high complexity hospital. Material and Methods: A prospective observational study conducted in 225 patients admitted to an internal medicine service. Each stage of drug utilization system (prescription, transcription, dispensing, preparation and administration) was directly observed by trained pharmacists not related to hospital staff during three months. ME were described and categorized according to the National Coordinating Council for Medication Error Reporting and Prevention. In each stage of medication use, the frequency of ME and their characteristics were determined. Results: A total of 454 drugs were prescribed to the studied patients. In 138 (30,4%) indications, at least one ME occurred, involving 67 (29,8%) patients. Twenty four percent of detected ME occurred during administration, mainly due to wrong time schedules. Anticoagulants were the therapeutic group with the highest occurrence of ME. Conclusions: At least one ME occurred in approximately one third of patients studied, especially during the administration stage. These errors could affect the medication safety and avoid achieving therapeutic goals. Strategies to improve the quality and safe use of medications can be implemented using this information.

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards / Estudo comparativo da prevalencia de sepse em pacientes internados nas enfermarias de dermatologia e de clinica medica

BACKGROUND: Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES: To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS: It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS: We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION: It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. .

FUNDAMENTOS: A sepse é causa comum de morbimortalidade em pacientes internados. A sua prevalência está aumentando significativamente em diversas partes do mundo. Pacientes internados em enfermarias de dermatologia apresentam extensas áreas de perda da barreira cutânea, além de uso frequente de corticosteróides sistêmicos, condições favoráveis ao desenvolvimento de sepse. OBJETIVOS: Avaliar a prevalência de sepse em pacientes internados em uma enfermaria de dermatologia e compará-la com a prevalência na enfermaria de clínica médica. MÉTODOS: Trata-se de estudo observacional transversal comparativo de análise de prontuários realizado na Santa Casa de Belo Horizonte. Foram coletados os dados de todos os pacientes internados em quatro leitos da clínica médica e da dematologia no período de julho de 2008 e julho de 2009. Foram analisados em busca da ocorrência de sepse, diagnósticos dermatológicas, comorbidades, tipos de patógenos mais associados e perfil de antibióticos mais utilizados. RESULTADOS: Foram analisados 185 prontuários e a prevalência de sepse entre os pacientes internados na enfermaria de dermatologia foi de 7,6% e na enfermaria de clínica médica 2,2% (p=0,10). Pacientes portadores de comorbidades, diabetes mellitus e neoplasias não demostraram maior ocorrência de sepse. O principal agente encontrado foi Staphylococcus aureus e os antibióticos mais utilizados foram ciprofloxacino e oxacilina. Houve significativa associação de sepse com o uso de corticosteróides sistêmicos (p<0,001). CONCLUSÃO: Torna-se claro que devem ser realizados estudos epidemiológicos mais amplos e acurados no Brasil sobre a sepse, para que os esforços na prevenção e no tratamento dessa grave doença possam ser direcionados ...

La investigación clínica en residencias de medicina interna de la Argentina: Facilitadores y barreras / Clinical research in internal medicine residencies in Argentina: Supporters and detractors

En el proceso de formación de los residentes de medicina interna, distintas organizaciones académicas y gubernamentales han recomendado incluir competencias específicas en investigación clínica. El estado actual de la investigación en este contexto no ha sido todavía relevado en nuestro país. El objetivo de este trabajo fue describir las actividades de investigación en las residencias de medicina interna como indicador de la adquisición de dichas competencias e identificar los facilitadores y barreras para la misma. Se realizó un estudio de corte transversal, se analizaron múltiples niveles para considerar las residencias como conglomerados. Se incluyeron 382 residentes de 24 residencias. Predominaron las mujeres, la mediana de edad fue 29 años. El 71% de los residentes informaron actividades de investigación. La mitad de ellos habían participado como autores de trabajos en congresos, solo el 9% había publicado su experiencia. Los factores predictores de desarrollar tareas de investigación fueron pertenecer a una residencia numerosa, OR 16.99 (IC 95%, 2.096-137.87), pertenecer al tercer año de residencia, OR 9.95 (IC 95%, 2.84-34.82), y haber realizado un curso de investigación, OR 2.78 (IC 95%, 1.10-7.04). Las variables que disminuyen la probabilidad de realizar investigación fueron la localización en el Gran Buenos Aires o Capital Federal, OR 0.25 (IC 95%, 0.0072-0.91), ser mujer, OR 0.34 (IC 95 0.14-0.79) y la carga asistencial, OR 0.97 (IC 95%, 0.95-0.99). Conocer los factores que influyen en la investigación contribuye a mejorar la formación de los residentes de medicina interna.

Several academic and government organizations have strongly recommended the inclusion of specific competences in clinical research. So far, the current state of research within this framework has not been modified in our country. The main goal of this study was to provide a thorough description of the research activities in medical residencies, which could be used as an indicator of the acquisition of such competences and to identify the supporters and detractors to achieve them. A cross section study was carried out and several levels were analyzed in order to consider residencies as a cluster; 382 residents from 24 different residencies were included. The study showed a preponderance of women. The average age was 29 years old. A 71% of the residents asserted doing research. Half of those residents have stated being authors of papers presented in congresses; only 9% have published their experience. Factors which predict the development of research assignments were: to belong to a large residency, OR 16.99 (IC 95%, 2.096-137.87), being in the 3rd year of the residency, OR 9.95 (IC 95%, 2.84- 34.82), completion of a research course, OR 2.78 (IC 95%, 1.10-7.04). Variables which reduce the chance to do research: location in Buenos Aires, OR 0.25 (IC 95%, 0.0072-0.91), being a woman, OR 0.34 (IC 95%, 0.14-0.79) and patients assistance workload, OR 0.97 (IC 95%, 0.95-0.99). We believe that the identification of factors which influence the possibility of doing research will lead to a improvement in the training of medical residents.

Proyecto institucional para la educación médica continua en investigación clínica / Continuing medical education: A clinical research institutional project

En la Argentina, educar en investigación clínica consiste principalmente en cursos teóricos. En países desarrollados existen programas que generan el entorno propicio para un aprendizaje práctico y continuo. En el 2006, en el Servicio de Clínica Médica del Hospital Italiano de Buenos Aires se creó el Área de Investigación en Medicina Interna para formar profesionales capaces de participar en todas las etapas de la investigación clínica. El propósito de este estudio es describir el área y su impacto en la educación en investigación en medicina interna durante el período 2006-2008. El proyecto cuenta con un programa de capacitación en investigación clínica para residentes y otro de perfeccionamiento para becarios. Además de becas, asesoramiento en proyectos, ateneos sobre investigación clínica y registros de enfermedades prevalentes en medicina interna. Participan el 33% (6/18) de los clínicos de internación, se encuentran en formación 3 becarios y 7 monitores de investigación. 25 residentes pasaron por el programa de capacitación, completaron una propuesta de investigación 19 (76%). Se hicieron 59 presentaciones en congresos. Se encuentran en proceso de publicación 6 artículos originales y 2 en revisión por comités editoriales. De un cuestionario de evaluación del área, el 76% (35/46) considera que ha adquirido nuevas habilidades, y 93% (44/47) refiere que las utiliza en la práctica diaria. El 100% (47/47) considera que ha recibido orientación adecuada. El 97% (45/46) considera que sus ideas han sido respetadas. La implementación del área de investigación logró aumentar la capacitación y producción científica en investigación clínica independiente.

In Argentina, education in clinical investigation is based on courses with theoric content. In developed countries programs with ongoing and practical content exist, generating the proper context to learn. In 2006, the Hospital Italiano de Buenos Aires (HIBA) created an area to train physicians, Research Area in Internal Medicine, and enable them to participate in every step of the clinical investigation process. The objective of this study is to describe this teaching area and its impact on the investigation in Internal Medicine in the HIBA, in the period 2006-2008. This area counts with fellow positions and provides training in Clinical Investigation for rotating residents. It has different activities including lectures, project counseling and 3 ongoing Institutional Registers for prevalent medical problems, 33% (6/18) of Intern staff are currently participating, with 3 fellows and 7 monitors for the Registers; 25 residents rotated in the area and generated their own research projects. 59 posters were presented in local and international congresses. Currently 6 original articles are in process of publication and 2 in peer review evaluation. A survey was carried out to evaluate the area where 76% (35/46) of the participants believed that they have acquired new skills; with 93% (44/47) using these knowledges in their every day practice. A 100% thought that they were adequately oriented in their projects, their ideas being fully respected (97%) (45/46). The inclusion of the Research Area in Internal Medicine improved the knowledge of the process of clinical Investigation and increased independent scientific production.

Surveillance of psychosomatic disorders in internal medicine in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

AIM: to examine certain characteristics of patients who suffer from psychosomatic disorders. METHODS: We called data through medical report outpatient clinic of the Psychosomatic Division, Department of internal medicine, Cipto Mangunkusumo Central General Hospital/Faculty of Medicine of the University of Indonesia (FKUI/RSUPN-CM), Jakarta, Indonesia, in 1996. The data was processed manually and by computer from which table and graphic were obtained. The descriptive analysis was performed to the objective the study. RESULTS: the FPD patients consisted of those with vegetative imbalance (multiple psychosomatic syndrome) (30.2%), dyspepsia (20.8%), functional heart disease (11.3%) and others 1%-6%. All of SPD consisted of chronic disease, such as hypertension (38.3%), diabetes mellitus (29.8%), bronchial asthma (10.6%), coronary artery disease (6.4%), and others 2%-5%. According to DSM IV, among the psychosomatic patients, 52.7% met the criteria for anxiety, 29.3% for depression, 14.2% for mixed anxiety and depression, and 3.8% unclear. The psychosocial stressor groups were family problems (38%), physical conditions (16%), work-related problems (13.4%), marriage problems (8.4%) and others (1%-4%). CONCLUSION: The most common physical symptoms of psychosomatic disorders were functional. Common functional psychosomatic disorders were multiple psychosomatic syndrome, dyspepsia and functional heart disease. Structural disorders found were chronic diseases. There was no difference in prevalence between males and females. The most frequent functional disorders were more commonly found among those under 40 years of age, while those with structural disorders were more common among patients 40 years of age or more. The psychological diagnoses were anxiety and depression. The most frequent psychological stressors were family problems, medical conditions, work-related problems and marriage problems.

Relación entre el motivo de ingreso y la causa de muerte en pacientes fallecidos en un Servicio de Medicina Interna / Relationship between the cause of admission and the cause of death in patients admitted to an internal medicine departament

Background: When patients are admitted to an internal medicine ward, they and their relatives believe that they will leave the internal medicine service in a better health condition or, if they die, their cause of death will be the same that motivated the hospital admission. Sometimes, patients die due to a different disease than the cause of admission or due to complications of diagnostic or therapeutic procedures. Aim: To assess the proportion of deaths that occurred in internal medicine wards for causes that differ from the cause for admission and the proportion of deaths related to complications of diagnostic or therapeutic procedures. Patients and methods: Three hundred and three consecutive patients were studied during 28 months. Their cause of death was classified in four groups: A. If it was the same illness of admission; B. A frecuent or expected complication of the illness that motivated the admission; C. A complication of one of their chronic diseases and not the one of admission; D. If it was not related to an already present chronic illness or the cause for admission. Results: Sixty nine percent of deaths corresponded to group A, 7.9 percent to group B, 11.2 percent to group C and 11.9 percent to group D. Diagnostic or therapeutic procedures were the cause of death in 0.7 and 3.6 percent of cases respectively. Conclusions: Twenty three percent of patients died due to causes that differ from the cause of admission. A low percentage of deaths were related to procedures and most of them were due to complications of therapeutic measures (Rev Méd Chile 2004; 132: 707-17).

Evaluation of the utilization management programme at Salmaniya Medical Complex, Bahrain

In 1993, the Ministry of Health in Bahrain implemented a utilization management programme at the largest public hospital in the country, aimed at reducing patients' mean length of stay from 8.3 days in 1993 to 6.0 days in 2000. Time series analysis, using linear trend modelling and the annual disparity reduction rate, were used to estimate performance towards achieving the targets. The study found that the length of stay declined consistently between 1984 and 2000, with a steeper decline in the period 1994-2000, which could be attributed to the utilization management programme. Overall, length of stay was reduced by 20.5% between the two periods, short of the target 27.8% proposed in 1993. Individual clinical departments showed mixed results, with better performance demonstrated by the Departments of Medicine and Surgery

Prescribing patterns and cost of antihypertensive drugs in an internal medicine clinic.

BACKGROUND: Antihypertensive agents are selected primarily for their ability to prevent morbidity and mortality related to hypertension. METHODS AND RESULTS: Prescribing trends and the cost of antihypertensive drugs were studied in 300 patients attending an internal medicine clinic. Beta-blockers were the most frequently used group of drugs (46.7%), followed by calcium-channel antagonists (34.3%) and angiotensin-converting enzyme inhibitors (30%). Diuretics were used in only 13.2% of the prescriptions. Atenolol (36%), amlodipine (29.3%) and enalapril (19%) were the most frequently used individual drugs. Propranolol, furosemide, amlodipine and atenolol were the least expensive drugs used, with annual drug acquisition costs of Rs 80, 102, 182 and 318, respectively. Benazepril (Rs 1778), diltiazem SR (Rs 1777), lisinopril (Rs 1660), prazosin (Rs 1416) and losartan (Rs 1365) were the most expensive drugs in terms of annual drug acquisition costs. CONCLUSIONS: The results of our study emphasize the need to encourage frequent use of diuretics. Since the costs of different antihypertensives vary considerably, newer and relatively expensive antihypertensives should be prescribed only when clearly indicated.

Incidencia de dislipidemias en un servicio de medicina interna / Dislipidemia incidence at the internal medicine service

Antecedentes: las alteraciones del metabolismo de los lípidos con importantes dada su relación con las enfermedades crónico degeneraltivas. Objetivo: determinar la incidencia de estas alteraciones y los padecimientos con que se asocian frecuentemente en un servicio de medicina interna. Material y métodos: estudio retrospectivo, descriptivo, observacional y transversal, realizado con una muestra representativa de los ingresos al servicio de medicina interna durante un año, escogiéndose al azar los meses de septiembre y noviembre de 1996 y enero de 1997. Se estudiaron las siguientes variables: edad, sexo, diagnóstico de ingreso, concentraciones séricas de colesterol, triglicéridos y lípidos totales. En el análisis estadístico se utilizaron medidas de tendencia central como promedios y porcentajes. Resultados: ingresason 189 pacientes al estudio, excluyéndose cinco por diversos motivos, por lo cual la muestra total fue de 184 pacientes, la edad promedio fue de 65 años. Dieciséis pacientes (8.69 por ciento) tenían alteraciones en lípidos, de los cuales nueve (546.26 por ciento) presentaban trastornos en triglicéridos y colesterol, y siete sólo hipercolesterolemia. En tres pacientes se encontró relación con evento vascular cerebral, ocho con diabetes mellitus y cinco con cardiopatía isquémica. Conclusiones: la incidencia de dislipidemias asociadas con enfermedades crónico degenerativas es alta, por lo que en pacientes con factores de riesgo debe realizar un perfil de lípidos en forma rutinaria

La productividad en la atención médica / Productivity in medical attention

Se presenta la productividad en el Servicio de medicina Interna del Hospital General Dr. Gonzalo Castañeda, ISSSTE, en los últimos tres años. Se Tomaron en cuenta ingresos, egresos, defunciones, estancia hospitalaria total y promedio, porcentaje de ocupación mensual, ocupación diaria y su relación con el número de camas censables. Así mismo, se describen algunos rasgos demográficos de la población estudiada como son sexo y edad. Se concluye que el conocimiento de tales indicadores permite mejorar la atención de los pacientes y entender el conportamiento del grupo poblacional que uno atende, la mayoría de las veces, sin pensar en las características particulares que presenta

Mortalidad y sus causas en un servicio de medicina interna / Mortality in an internal medicine hospital

Se reportan las causas de mortalidad en un Servicio de Medicina Interna de un Hospital General y se comparan con las de la población general. Se observa que no existen variaciones de importancia en constantes como sexo y edad pero sí en los grupos de enfermedades que explican la mortalidad. A diferencia de la población general; en el grupo control, las enfermedades infecciosas y parasitarias y del aparato digestivo desplazaron por su frecuencia a las traumáticas y por envenenamiento, a las de las glándulas endocrinas y a las neoplasias. Por tal motivo debe considerarse a cada grupo poblacional como un microuniverso con una morbimortalidad específica

Magnitud y características de la consulta externa atendida por médico generalista en centros sanitarios periféricos / Magnitud and characteristics of external care by general physicians in peripheric health centers

Se aborda la problemática de la relación entre médicos generalistas y especialistas y su disociación con las frecuencias de las patologías susceptibles de ser resueltas en el primer nivel de atención (80 a 93,5 por ciento). El objetivo formulado para esta primera etapa del estudio consiste en establecer la magnitud y las características de la consulta atendida por médico generalista a nivel de centros de salud situados en la periferia de la ciudad de La Plata (Argentina). El volumen más importante de consultas se ubicó dentro de las causadas por morbilidad. La demanda predominante responde a patologías propias de las condiciones de vida, con amplio predominio de infecciones respiratorias, seguidas por las gastrointestinales. Por otro lado, los controles se hallan predominantemente referidos al binomio materno-infantil, observándose una reducida carga de exámenes de salud propios del adulto. La concentración de consultas resulta sumamente reducida como consecuencia del modelo prestacional vigente, el que carece de capacidad de retención. Los controles representan algo más del 20 por ciento de la demanda, con una concentración un poco más alta. El predominio de la demanda femenina es notorio, pero deben ser contempladas las causas obstétricas a fin de establecer el alcance genuino de esta preponderancia

Type of statistical techniques in rheumatology and internal medicine journals

Con fines educativos se realizó una comparación de la prevalencia y el tipo de técnicas estadísticas empleadas en revistas de medicina interna y de reumatología. Se seleccionaron cuatro revistas representativas de cada especialidad y se obtuvieron al azar doce artículos originales de cada revista. El mismo evaluador revisó los artículos en dos ocasiones, con un intervalo de tres meses, y clasificó las técnicas estadísticas de acuerdo a definiciones publicadas. Las revistas de reumatología utilizaron las técnicas estadísticas con menor frecuencia (80 versus 115) y emplearon habitualmente técnicas más sencillas (X3= 4.28, DF = 1, p = 0.03; OR, 95 por ciento CI = 3.21, 1.05-10.85). Se encontró una diferencia estadísticamente significativa en el empleo de los procedimientos estadísticos en las cuatro categorías evaluadas. Se requirieron siete técnicas estadísticas utilizadas en las revistas de reumatología (prueba t, tablas de contingencia, estadística descriptiva, estadística no paramétrica, anova, regresión múltiple, correlación de Pearson). Las de medicina interna necesitaron seis técnicas estadísticas para tener acceso al 85 por ciento de las pruebas t, estadística no paramétrica, anova). Nuestros resultados podrían utilizarse en la planeación de la educación médica bioestadística para enfatizar la enseñanza de las técnicas más empleadas en estas áreas

Motivos de consulta mas frecuentes en la consulta externa de medicina interna: a proposito de una casuistica en un hospital privado / More often motives of consultation in external consultation of internal medicine: apropos of a casuistic in a private hospital

Los autores presentan los resultados de un estudio prospectivo realizado en un trimestre del ano 1991 en el Hospital Coromoto de Maracaibo (hospital privado), destinado primordialmente a investigar los principales motivos de consulta de los pacientes que durante ese lapso concurrieron por primera vez a la consulta externa de Internistas que laboran en esa institucion, e igualmente los diagnosticos mas frecuentemente realizados por dichos medicos. Para tal fin se utilizo una encuesta que fue aplicada a las historias de primera consulta. Conclusiones: Se analizaron 238 historias, de las cuales 151 correspondieron al sexo femenino y 87 masculino. De ellos 136 estaban conprendidos entre la 4a y 6a decada de la vida. Los adolescentes constituyeron el 10,5% de la muestra. El dolor musculoesqueletico fue el motivo de consulta mas frecuente en las mujeres (17,21%), seguido de cefalea, dispepsia y dolor abdominal, tumoracion, mareos y vertigos, erupciones y manchas, parestesias, lumbalgia, astemia y anemia. En los hombres tambien el dolor musculoesqueletico constituyo la primera causa de consulta, seguido por vertigos y mareos, cefalea, dolor toracico, evaluacion de sanos, alteraciones del peso, lumbalgia y tumoraciones. Se hacen otras consideraciones sobre diagnostico formulados y en relacion a las caracteristicas de la muestra en sus aspectos economicos y sociales

Patologia medica del embarazo en un departamento de Medicina Interna / Medical pathology of pregnancy in departament of Internal Medicine

La patologia medica del embarazo represento el 0,9% de las pacientes ingresadas en un lapso de 2 anos (1990-1992). Las patologias mas frecuentes fueron : asma bronquial, infecciones y transtornos psiquiatricos. La terminacion del parto fue por via vaginal en la mayoria de los casos. El peso promedio de los recien nacidos fue superior a 2.500 g y la puntuacion en la escala de Apgar en el 84,6% fue igual o superior a 6. Hubo 2 muertes maternas (6,5%)