Violencia doméstica y riesgo de conducta suicida en universitarios adolescentes / Domestic violence and risk of suicidal behavior among university students

OBJETIVO: Estimar el grado de asociación entre violencia doméstica física, verbal y sexual con la conducta suicida en adolescentes universitarios. MATERIAL Y MÉTODOS: Estudio de casos y controles pareado en estudiantes universitarios de Colima. Los casos fueron 235 adolescentes que presentaron tanto ideación suicida como intento suicida; los controles fueron 470 individuos de la misma edad y sexo. RESULTADOS: El abuso sexual mostró el mayor grado de asociación con conducta suicida (RM= 27.4), seguido de violencia verbal (RM= 9.28), uso de drogas (RM= 8.6), violencia física (RM= 5.5) y tabaquismo (RM= 3.6). La regresión logística multivariada mostró que la violencia verbal se asoció con conducta suicida en forma independiente, mientras que violencia física, abuso sexual, tabaquismo y uso de drogas parecen depender de aquella. CONCLUSIONES: La violencia intrafamiliar, particularmente la verbal, está fuertemente asociada con la conducta suicida en adolescentes y debe ser considerada dentro de programas preventivos contra suicidio.

OBJECTIVE: To estimate the degree of association between domestic violence -physical, verbal or sexual- with suicidal behavior among university students. MATERIAL AND METHODS: A matched case-control study was done with students attending the University of Colima, Mexico. The cases were 235 teenagers who presented both suicidal ideation and suicide attempt; the controls were 470 individuals of the same age and sex. RESULTS: Sexual abuse showed the highest degree of association with suicidal behavior (OR= 27.4), followed by verbal violence (OR= 9.28), drug use (OR= 8.6), physical violence (OR= 5.5) and smoking (OR= 3.6). Multivariate logistic regression showed that verbal violence was associated with suicidal behavior independently of the other variables, while physical violence, sexual abuse, smoking and drug use seem to depend on verbal violence. CONCLUSIONS: Domestic violence, particularly verbal or sexual, is strongly associated with suicidal behavior in adolescents and should be considered in suicide prevention programs.

Reporte de un caso de dengue neonatal / Neonatal dengue. Case report

Introducción. Existe poca información sobre los efectos por dengue en el embarazo y feto, a pesar de que el riesgo se incrementa durante epidemias, por lo cual los reportes son pocos a pesar del número documentadas de éstas en países tropicales. La transmisión vertical del dengue se ha descrito poco. En Colombia se reportó una frecuencia de 0.3% en 10 años en recién nacidos y ningún caso en Guinea. Caso clínico. Nace al quinto día de enfermedad febril materna, parto eutócico, de 40 semanas, masculino, calificación de Apgar 8/9 en tiempos convencionales, peso, talla y perímetro cefálico en percentil 50, exploración física normal. Al tercer día de vida (octavo día de dengue hemorrágico materno), presentó fiebre, se sospechó sepsis neonatal y se inició antibióticos; al cuarto día de vida requirió fototerapia y presentó leucopenia, irritabilidad, llanto intenso e hiperreflexia, con sospecha de neuroinfección. Se agregó cefotaxima (sin punción lumbar por trombocitopenia y TPT prolongado). Hemocultivo negativo. Serología IgM positiva para virus del dengue del binomio madre-producto. A los 12 días de vida se encuentra asintomático y con exámenes de laboratorio normales. Conclusión. Las embarazadas con dengue clásico por lo general presentan un parto y puerperio normales, como en este caso. En el dengue hemorrágico existe mayor riesgo de retardo en el crecimiento intrauterino, amenazas de aborto y parto pretérmino, ruptura prematura de membranas, preeclampsia y muerte materno-fetal.

Introduction. There is little information about the effects of dengue infection upon the fetus, although the risk for this event increases during epidemic outbreaks. The vertical transmission of dengue is a rare event, a case is described below. Case report. The patient was a male, born after 40 weeks of gestation and on the 5th day of a maternal febrile illness. His Apgar score was 8/9, with weight, size and cephalic perimeter in the range of the 50 percentile. On the first 24 hours after the delivery the patient developed fever and antibiotics was given for neonatal sepsis. On the postpartum day 4 he showed irritability, intense crying and hypereflexia, meanwhile the laboratory revealed thrombocytopenia and leucopoenia. Neuroinfection was presumed and treatment with phototherapy and cefotaxime was begun (the lumbar puncture was avoided because thrombocytopenia and prolonged TPT). The blood culture was negative. IgM antibodies for dengue virus were positive in both, mother and neonate. On postpartum day 12, both, mother and child were discharged from the hospital, asymptomatic and with normal laboratory values. Conclusions. Usually, pregnant women with classic dengue have normal parturition and puerperium, as in this case. However, in the hemorrhagic dengue form there is an increased risk of delayed intrauterine growth, abortion, prematurity, premature rupture of membranes, preeclampsia and maternal or fetal death. The neonatal transmission of dengue is very rare, even in endemic countries with large epidemics; however it is an important condition that needs to be considered in the differential diagnosis of septic new-borns in endemic areas.

Resurgimiento de enfermedad hemorrógica del recién nacido. Implicaciones para su prevención / Re-emergence of hemorrhagic disease in newborns. Implications for its prevention

OBJECTIVE: To describe the occurrence of hemorrhagic disease of the newborn (HDN) at a tertiary care pediatric hospital of Morelos state. MATERIAL AND METHODS: A retrospective case series study was conducted between 1997-2000 at Hospital del Niño Morelense (Morelos State Children's Hospital), in 46 newborns aged under 12 weeks. Study subjects were referred from peripheral units with a diagnosis of HDN. RESULTS: The severe late-onset form of HDN was present in 91 of the cases. Fifty-two percent of childbirths were assisted by a physician and 48 by an empiric midwife. Application of vitamin K was unknown in 61 of cases, in 39 it was not applied and in 4 it was applied. The majority of infants presented severe symptoms due to intra-cranial bleeding, 11 died, and 41 had severe disease sequelae. CONCLUSIONS: Given the high prevalence of HDN in the State of Morelos, reproductive health programs should be reviewed and training programs intensified to promote the utilization of vitamin K by physicians and nurses for preventing this disease.