Marcela Chagas

Introdução: A extensão universitária configura-se como uma dimensão estruturante do ensino superior ao fomentar a produção de conhecimento para além dos limites institucionais e estabelecer relações dialógicas com a sociedade, ratificando seu compromisso social. Objetivo: Relatar a experiência da utilização de produtos educativos, elaborados por estudantes de Medicina durante atividades extensionistas, voltados aos usuários dos serviços de saúde. Relato de Experiência: A Universidade de Vassouras incorporou a extensão à matriz curricular do curso de Medicina por meio de disciplinas de "Prática Extensionista", alocadas do 1º ao 7º período, articuladas pelo "Projeto Comunidade" para o desenvolvimento de competências progressivas. Entre as produções desenvolvidas pelos discentes, destacam-se painéis educativos alinhados aos 17 Objetivos de Desenvolvimento Sustentável (ODS), infográficos sobre a rede de serviços de saúde e folhetos informativos. Discussão: A curricularização da extensão transcende o cumprimento de uma carga horária obrigatória, consolidando-se como uma estratégia pedagógica estruturante na formação médica e fortalecendo a integração teoria-prática e a aproximação comunitária. Conclusão: A estratégia pedagógica fortaleceu as ações extensionistas e evidenciou o potencial dos produtos educativos para ampliar o alcance do ensino-serviço-comunidade, fomentando a formação de profissionais de saúde comprometidos com a responsabilidade social.

Gestational trophoblastic disease (GTD) comprises a heterogeneous group of disorders arising from abnormal proliferation of placental trophoblastic tissue. This spectrum includes benign forms, prim...

Background: The introduction of prophylactic HPV vaccination has transformed cervical cancer prevention worldwide, yet many low- and middle-income countries face persistent challenges in implementation, coverage gaps, and vaccine hesitancy. This article presents a narrative review of global and Brazilian HPV vaccination programs, highlighting achievements, pitfalls, and lessons for future strategies. Methods: We reviewed peer-reviewed literature and official reports from WHO, PAHO, CDC, Brazilian institutions, and others, focusing on programmatic performance, coverage trends, and vaccine acceptance. Results: In high-income settings such as Australia and the United Kingdom, school-based vaccination programs have driven sharp declines in HPV prevalence, genital warts, and precancerous lesions, in some cases approaching elimination thresholds. The United States has made progress but continues to struggle with disparities in uptake linked to socioeconomic and cultural factors. In India and several African nations, recent evidence supports single-dose regimens as a cost-effective and logistically feasible strategy. In Brazil, HPV vaccination was introduced in 2014 via the National Immunization Program (PNI), initially targeting girls aged 9–13 years through school campaigns. First-dose coverage exceeded 80% in the first year but subsequently declined, with full-schedule completion rates dropping below 60%. Contributing factors include misinformation, weakening of school-based delivery, and pandemic-related disruptions. Brazil later expanded eligibility to boys and immunocompromised populations and, more recently, extended catch-up vaccination to older adolescents. Conclusions: HPV vaccination has the potential to substantially reduce cervical cancer incidence globally. However, sustained impact depends not only on infrastructure and universal access but also on consistent school-based delivery, adaptive policies such as single-dose regimens, and robust communication strategies to counter misinformation. Brazil’s experience offers both inspiration and caution, providing lessons for countries striving to meet the WHO 90-70-90 targets.

Hydatidiform mole is a trophoblastic disorder resulting from abnormal fertilization. Diagnosis is established through a combination of clinical findings, elevated serum human chorionic gonadotropin (hCG) levels, and characteristic features on transvaginal ultrasound. Timely and accurate diagnosis is essential for initiating prompt treatment and preventing medical complications. Uterine evacuation, preferably via vacuum aspiration, is the treatment of choice due to its high efficacy and safety profile. Adjunctive techniques, such as hysteroscopy and intraoperative ultrasonography, enhance the safety and effectiveness of uterine evacuation and should be available to patients, especially at specialized referral centers equipped to manage this diagnosis. In selected cases, particularly in women with fulfilled reproductive goals or those at a high risk of developing post-molar gestational trophoblastic neoplasia (GTN), total abdominal hysterectomy is appropriate. Postoperative follow-up with serial measurements of hCG is essential for monitoring remission and for the early detection of post-molar GTN, which develops in approximately 20% of cases of complete molar pregnancies and 1–4% of partial molar pregnancies. This article provides a comprehensive review of the diagnosis of hydatidiform mole and the surgical techniques employed in the treatment of this condition, emphasizing individualized care and the use of appropriate surgical strategies to treat complications associated with this trophoblastic disease.

Molar pregnancy (MP) is a gestational disorder resulting from abnormal fertilization, leading to atypical trophoblastic proliferation and the formation of a complete or partial hydatidiform mole. This condition represents the most common form of gestational trophoblastic disease (GTD) and carries a significant risk of progression to gestational trophoblastic neoplasia (GTN). Although rare in high-income countries, MP remains up to ten times more prevalent in low-income and developing countries, contributing to preventable maternal morbidity and mortality. This narrative review provides an updated, practical overview of the clinical presentation, diagnosis, treatment, and follow-up of MP. A key focus is the challenge of early diagnosis, particularly given the increasing frequency of first-trimester detection, where classical histopathological criteria may be subtle, leading to diagnostic errors. The review innovates by integrating advanced diagnostic methods—combining histopathology, immunohistochemistry using p57Kip2, Ki-67, and p53 markers, along with cytogenetic analysis—to improve diagnostic accuracy in early gestation. The central role of referral centers is also emphasized, not only in facilitating timely treatment and access to chemotherapy, but also in implementing standardized post-molar follow-up protocols that reduce progression to GTN and maternal mortality. By focusing on both advanced diagnostic strategies and the organization of care through referral centers, this review offers a comprehensive, practice-oriented perspective to optimize patient outcomes in GTD and address persistent care gaps in high-burden regions.

O artigo aborda a capacitação no processo de trabalho, escuta e produção de cuidado na saúde sexual e reprodutiva dos adolescentes. São crescentes os dados de gravidez na adolescência; cuidado e orientações são direitos garantido por lei. Com o objetivo de qualificar os médicos da Estratégia Saúde da Família (ESF) sobre Saúde Sexual e Reprodutiva de Adolescentes, utilizou-se da abordagem qualitativa, descritiva, que analisou dados coletados junto aos médicos da ESF para elaborar um manual/e-book e oficinas para capacitação. As principais dificuldades observadas foram: conflitos éticos/legais, prescrição de métodos contraceptivos e consulta a transgêneros. Conclui-se que os produtos elaborados são relevantes pela aquisição de novas tecnologias educacionais, um material de fácil acesso e disponível gratuitamente. Sugere-se a realização de novos estudos para ampliação do conhecimento e elaboração de novas tecnologias que visem um cuidado humanizado e diferenciado para esta população.