Diagnóstico prenatal del retraso de crecimiento intrauterino, en pacientes asistidas en el Hospital Regional de Ciudad del Este, año 2018

Resumen La restricción de crecimiento intrauterino es un problema de salud que aumenta su conocimiento en la población puede generar acciones en la salud pública, asimismo se asocia a mayor riesgo en adolescentes, a bajo nivel de instrucción, población marginal, bajo peso de la madre y de atención prenatal inadecuado, el objetivo de este trabajo fue la de analizar el diagnóstico prenatal del retraso de crecimiento intrauterino mediante la ecografía, en pacientes asistidas en el Hospital Regional de Ciudad del Este, año 2018, se realizó un estudio observacional descriptivo retrospectivo, la muestra de estudio estuvo constituida por 73 historia clínica de madres que presentaron restricción de crecimiento intrauterina diagnosticada por ecografía se consignaron en un formato de recolección de datos a través de la revisión de historias clínicas, se organizaron en una base de datos en Excel y se realizó un análisis descriptivo. El 41% de las madres presentaron edades entre 19 a 34 años, se observó mayor índice con el 64 con procedencia de zonas rurales respecto a las madres con procedencias de zonas urbanas, las mayorías de las madres presentaron un nivel secundario concluida, el 52% de las madres presentaron controles prenatales entre 0 a 5 controles, las madres con edad gestacional < 37 semanas tuvieron significativamente (p=0.000) mayor frecuencia recién nacido con retardo de crecimiento intrauterino, el 29% de las madres que tuvieron bajo peso presentaron recién nacidos con retardo de crecimiento intrauterino, 21 de las madres nulíparas presentaron recién nacidos con retardo de crecimiento intrauterino y el 44% de las madres con intervalo intergenésico menor de 2 años presentaron recién nacidos con retardo de crecimiento intrauterino, y el mayor índice de hijos con retardo de crecimientos intrauterina presentaron madres con una ganancia entre 6 a 9 Kg y se concluye que el retardo de crecimiento intrauterino tiene asociación con factores sociodemográficos y obstétricos, que algunos de ellos pueden ser intervenidos.

Abstract The restriction of intrauterine growth is a health problem that increases their knowledge in the population can generate actions in public health, it is also associated with increased risk in adolescents, at a low level of education, marginal population, low mother and child weight inadequate prenatal care, the objective of this work was to analyze the prenatal diagnosis of intrauterine growth retardation by ultrasound, in patients assisted in the Regional Hospital of Ciudad del Este, year 2018, a retrospective descriptive observational study was performed, the sample The study consisted of 73 clinical records of mothers who presented intrauterine growth restriction diagnosed by ultrasound were recorded in a data collection format through the review of medical records, they were organized in a database in Excel and a descriptive analysis showing the following results 41% of the madr es presented ages between 19 and 34 years old, a higher index was observed with 64 originating from rural areas with respect to mothers from urban areas, most of the mothers presented a completed secondary level, 52% of the mothers presented controls Prenatal between 0 and 5 controls, mothers with gestational age <37 weeks had significantly (p = 0.000) higher frequency newborn with intrauterine growth retardation, 29% of mothers who were underweight presented newborns with intrauterine growth retardation , 21 of the nulliparous mothers presented newborns with intrauterine growth retardation and 44% of the mothers with intergenic interval less than 2 years presented newborns with intrauterine growth retardation, and the highest rate of children with intrauterine growth retardation presented mothers with a gain between 6 to 9 Kg and it is concluded that the intrauterine growth retardation tie Ne association with sociodemographic and obstetric factors, which some of them can be intervened.

Hisopado endocervical en mujeres con síntomas de COVID-19 provenientes de departamentos del Paraguay / Endocervical swabbing in women with COVID-19 symptoms from departments of Paraguay

INTRODUCCIÓN: El COVID-19 es eminentemente una infección de transmisión e inicio respiratorio, se discute la existencia de otras fuentes de contagio. El receptor viral ACE2 también ha sido detectado en el útero y en la vagina; de allí se ha planteado el compromiso del virus SARS-CoV-2 sobre el sistema genitourinario y sus posibles repercusiones en el embarazo. OBJETIVO: Determinar la presencia de SARS-CoV-2 en muestras endocervicales de mujeres con COVID-19 en departamentos del Paraguay. PACIENTES Y MÉTODOS: Diseño observacional prospectivo, de corte transverso. Se reclutaron 200 mujeres desde agosto 2020 hasta febrero 2021, con no más de 48/72 h de un resultado previo positivo de hisopado nasofaríngeo para SARS-CoV-2 por retrotranscriptasa reversa-reacción en cadena de la polimerasa (en inglés rt-RT-PCR) y que aceptaron ingresar al estudio. Se llenó un cuestionario clínico epidemiológico. Las tomas de muestras se realizaron en servicios de salud del Ministerio de Salud Pública y Bienestar Social (MSP y BS), domicilios y albergues de los distintos departamentos de Paraguay. Cada paciente fue sometida a un hisopado con hisopos de dacron o citobrush endocervical para la detección de SARS-CoV-2 por rt RT-PCR. Resultados: Las mujeres estudiadas tenían una edad media de 46,5 años (IC 95% 31,5-62,5). Refirieron contagio comunitario con SARS-CoV-2 en 75,5%, 13,5% en el hogar, 8,5% en el lugar de trabajo y 1,5% en el extranjero. Las manifestaciones clínicas fueron: 30%, síndrome gripal, fiebre 22,5%, tos 20%, anosmia 15,5%, trastornos digestivos 15,5%, y otros se presentaron con menor frecuencia. Las muestras de hisopados o citobrush endocervical sometidas a rt-RT-PCR para la deteccción de SARS Cov-2, resultaron negativas en las 200 mujeres de estudio. Discusión: Cabe destacar que las muestras vaginales fueron tomadas dentro de las 24-72 h de haber obtenido un resultado positivo para SARS-CoV-2 en el hisopado nasofaríngeo y que 62,5% de las mujeres se encontraban internadas en módulos respiratorios. Se discute la razón de la negatividad de los exámenes y su trascendencia. CONCLUSIÓN: No se detectó infección con SARS-CoV-2 en la región endocervical de 200 mujeres con manifestaciones clínicas de COVID 19 y evaluadas dentro de las 48/72 h de un resultado positivo nasofaríngeo para SARS Cov-2. Los resultados en la población de estudio concuerdan con otros estudios reportados en la literatura científica.

BACKGROUND: COVID-19 is an eminently respiratory transmissible infection of respiratory initiation, the existence of other sources of contagion is discussed. The ACE2 viral receptor has also been detected in the uterus and vagina; Hence, the involvement of the SARS-CoV-2 virus on the genitourinary system and its possible repercussions on pregnancy has been raised. AIM: To determine the presence of SARS-CoV-2 in endocervical samples of women with COVID-19 in the departments of Paraguay. METHODS: Designed as a prospective observational of transverse cohort. Two hundred women were recruited from August 2020 to February 2021, with no more than 48/72 hours of a previous positive nasopharyngeal swab result for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (rt-RT-PCR) and who agreed to participate in the study. A clinical epidemiological questionnaire was completed. The samples were taken in health services of the MSPYBS (Public Ministry of Health and Social Welfare), homes and shelters in the different departments of Paraguay. Each patient underwent a swab (dacron swabs) or endocervical cytobrush for the detection of SARS-CoV-2 by rt-RT-PCR. RESULTS: Women recruited had a mean age of 46.5 years (95% CI 31,562.5). They reported contagion with SARS-CoV-2: 75.5% in the community, 13.5% at home, 8.5% in the place of work and 1.5% abroad. The clinical manifestations were: 30% flu syndrome, 22.5% fever, 20% cough, 15.5% anosmia, 15.5% digestive disorders, among other symptoms. The swabs or endocervical cytobrush samples subjected to rt-RT-PCR for the detection of SARS-CoV-2 were negative in the 200 study women. Discussion: It should be noted that the vaginal samples were taken within 24-72 hours after obtaining a positive result for SARS-CoV-2 in the nasopharyngeal swab and that 62.5% of the women were hospitalized in respiratory modules. The reason for the negativity of the exams and their significance are discussed. CONCLUSION: No SARS Cov-2 infection was detected in the endocervical region of 200 women with clinical manifestations of COVID 19 and evaluated within 48/72 hours of a positive nasopharyngeal result for SARS Cov-2. The results in the study population agree with the findings of other studies reported in the literature.

[Endocervical swabbing in women with COVID-19 symptoms from departments of Paraguay]. / Hisopado endocervical en mujeres con síntomas de COVID-19 provenientes de departamentos del Paraguay.

BACKGROUND: COVID-19 is an eminently respiratory transmissible infection of respiratory initiation, the existence of other sources of contagion is discussed. The ACE2 viral receptor has also been detected in the uterus and vagina; Hence, the involvement of the SARS-CoV-2 virus on the genitourinary system and its possible repercussions on pregnancy has been raised. AIM: To determine the presence of SARS-CoV-2 in endocervical samples of women with COVID-19 in the departments of Paraguay. METHODS: Designed as a prospective observational of transverse cohort. Two hundred women were recruited from August 2020 to February 2021, with no more than 48/72 hours of a previous positive nasopharyngeal swab result for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (rt-RT-PCR) and who agreed to participate in the study. A clinical epidemiological questionnaire was completed. The samples were taken in health services of the MSPYBS (Public Ministry of Health and Social Welfare), homes and shelters in the different departments of Paraguay. Each patient underwent a swab (dacron swabs) or endocervical cytobrush for the detection of SARS-CoV-2 by rt-RT-PCR. RESULTS: Women recruited had a mean age of 46.5 years (95% CI 31,562.5). They reported contagion with SARS-CoV-2: 75.5% in the community, 13.5% at home, 8.5% in the place of work and 1.5% abroad. The clinical manifestations were: 30% flu syndrome, 22.5% fever, 20% cough, 15.5% anosmia, 15.5% digestive disorders, among other symptoms. The swabs or endocervical cytobrush samples subjected to rt-RT-PCR for the detection of SARS-CoV-2 were negative in the 200 study women. DISCUSSION: It should be noted that the vaginal samples were taken within 24-72 hours after obtaining a positive result for SARS-CoV-2 in the nasopharyngeal swab and that 62.5% of the women were hospitalized in respiratory modules. The reason for the negativity of the exams and their significance are discussed. Conclusión: No SARS Cov-2 infection was detected in the endocervical region of 200 women with clinical manifestations of COVID 19 and evaluated within 48/72 hours of a positive nasopharyngeal result for SARS Cov-2. The results in the study population agree with the findings of other studies reported in the literature.

Lesiones epiteliales de cuello uterino en mujeres de la comunidad indigena Mbya-Guarani, Colonia Y´Apy, Distrito de Yrybucua-Departamento San Pedro. 2019

RESUMEN La investigación tuvo como objetivo analizar las Lesiones de Cuello Uterino en mujeres de la Comunidad Mbya-Guaraní de la Colonia Y apy del Distrito de Yrybycua-Departamento San Pedro. 2019. El diseño fue observacional de tipo descriptivo, de corte transversal, con enfoque cuantitativo. La población estuvo constituida por 219 mujeres de la comunidad indígena Mbya-Guarani, colonia Y´apy, distrito de Yrybucua, departamento San Pedro. La muestra quedó conformada por 60 mujeres. Resultados: De agosto a noviembre del 2.013 fueron estudiados 46 adolescentes de 10 a 19 años, con análisis. El 60% de las mujeres en edad fértil son adultas jóvenes de entre 19 y 38 años. El 73% de las mujeres no realizan el PAP, ya que en la comunidad se cuenta con una Unidad de Salud Familiar y las mismas no acuden. En relación a los estudios realizados, el mayor porcentaje (37%), recae en los extendidos citológicos normales, seguido del 21% correspondiente a L-SIL y H-Sil respectivamente. El ASCUS con el 13%, las tomas inadecuadas con 4% y por último el carcinoma epidermoide y AGC con el 2%. Conclusión: Los resultados obtenidos en los estudios realizados en mujeres de la Comunidad indígena Mbya Guaraní. Colonia Y apy Año 2019, se destacan el CIN I, CIN II, CIN III, Carcinoma Epidermoide, así como tomas inadecuadas.

ABSTRACT The research aimed to analyze uterine neck injuries in women in the Mbya-Guarani Community of The Colony and apy of the Yrybycua-San Pedro Department District. 2019. The design was descriptive, cross-cutting, descriptive- The population consisted of 219 women from the Mbya-Guarani indigenous community, Y apy colony, Yrybucua district, San Pedro department. The sample was made up of 60 women. Results: From August to November of 2013, 46 adolescents from 10 to 19 years were studied, with analysis. 60% of women of childbearing age are young adults between 19 and 38 years old. 73% of women do not perform the PAP, since in the community there is a Family Health Unit and they do not attend. In relation to the studies carried out, the highest percentage (37%), falls on the normal cytological spreads, followed by 21% corresponding to L-SIL and H-Sil respectively. ASCUS with 13%, inadequate intakes with 4% and finally squamous cell carcinoma and AGC with 2%. Conclusion: The results obtained in the studies carried out in women of the Mbya Guaraní indigenous community. Colonia Y apy Year 2019, the CIN I, CIN II, CIN III, Squamous Carcinoma, as well as inappropriate shots are highlighted.

Factors associated with high-risk human papillomavirus infection and high-grade cervical neoplasia: A population-based study in Paraguay.

BACKGROUND: Cervical cancer (CC) is one of the leading causes of cancer mortality among women from Paraguay, with high incidence and mortality rates (31.2 and 16 per 100 000 women, respectively). Although the risk factors associated with high-risk human papillomavirus (hrHPV) infection and preneoplastic cervical lesions are widely studied, population-based characteristics of particular settings may influence the feasibility of HPV-based CC screening implementation. This study aimed to explore factors associated with hrHPV infection and high-grade cervical neoplasia in hrHPV-positive (hrHPV+) women from Paraguay. METHODS: A total of 5677 women aged 30-64 years from the Central Department of Paraguay were screened with HPV test (Hybrid Capture 2) and Pap smear. Sociodemographic and risk factor interviews were conducted. hrHPV+ women were referred to colposcopy and women with an abnormal colposcopy had a biopsy taken. The outcomes recorded were the hrHPV status and the presence of high-grade cervical intraepithelial neoplasia or worse (CIN2+) among hrHPV+ women. Associations were investigated using multivariate logistic regressions. RESULTS: hrHPV prevalence was 13.8% (95%CI 13.0-14.8). This value decreased with the age of women (p-trend<0.001) and increased with the lifetime number of sexual partners (p-trend<0.001) and number of previous female partners of their current male partner if women had had one lifetime sexual partner (p-trend<0.001), increasing from 3.06 (95%CI 0.073-20.9) if partners had had one previous female partner to 9.19 (95%CI 2.36-61.1) if they had had eight or more. In hrHPV+ women, CIN2+ prevalence was 10.7% (95%CI 8.58-13.2) and increased with time since the last Pap smear (p-trend<0.001) and with the increasing number of pregnancies (p-trend = 0.05). CONCLUSION: In these settings, the sexual behavior of women and their male partners is associated with hrHPV infection. In hrHPV+ women, underscreening practices and multiple pregnancies are associated with CIN2+. This knowledge can contribute to public health policies for CC prevention and control in Paraguay.

Construcción del perfil del egresado del ciclo clínico / Construction of the graduate profile of clinical cycle

Esta investigación fue realizada, como parte integrante del Proyecto de Innovación Curricular, con la necesidad de la construcción de un perfil de egresado, en el ciclo o asignaturas clínicas, para posteriormente, realizar el perfil del Egresado de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción (FCM-UNA). La misma, la fuimos construyendo a partir de artículos, documentos y actores relevantes tanto dentro y como fuera de la Institución, que permitió así contribuir en la construcción de una propuesta que optimice la formación universitaria de los estudiantes de la carrera de medicina. Como docentes de la universidad hemos constatado una serie de problemas que se relacionan tanto con el aislamiento de las disciplinas que se manejan en forma totalmente independientes dificultando un aprendizaje integrado de los estudiantes, como su poca formación en gestión, en investigación y la necesidad un estudio exhaustivo y de mejor relacionamiento interhumano con los pacientes y con los propios colegas. Seria apropiada para intencionar los procesos de enseñanza y aprendizaje y el perfil de un médico acorde a las necesidades político- social, cultural y de desarrollo económico. Nuestro objetivo fue analizar e interpretar documentos y percepción de los actores relevantes en cuanto a la formación de médico, que permita aportar datos para levantar una propuesta de perfil del ciclo clínico, integrado y pertinente a través de un diseño cualitativo con un énfasis comprensivo. Para el levantamiento de información se recurrió a la revisión de artículos, donde buscamos el perfil de otras Universidades de medicinas referentes, tantos de MERCOSUR, como Internacionales. Se realizaron focus group en docentes, pacientes y egresado de la FCM-UNA, también se utilizó entrevistas a empleadores del sector privado, público y seguro social. Posteriormente, se realizó el proceso de análisis de contenidos con interés interpretativo. En cuanto al resultado obtenido podemos decir que el egresado clínico debe reunir cierta competencia clínicas, además de buenos relacionamientos con los pacientes, parientes y sus propios colegas y el personal de apoyo. Cabe además señalar algunos actores coinciden en interacción comunicativas y además en incorporar tecnología de avanzadas, actualización permanente en los saberes disciplinares y en la investigación, una formación contextualizada social y que atienda las necesidades de salud de la población. Una demanda expresada convergentemente es la consideración de la gestión como parte del desempeño del médico, asimismo, en la dimensión de la responsabilidad social, pacientes, egresados y empleadores; relevan la necesidad de formar médicos con sentido humanista, comprometidos con el proyecto de justicia social y que sean éticos, advierten del peligro de la mercantilización del acto médico como regulador de la relación médico-paciente, entre otros. Un importante hallazgo de la investigación, fue la aparición de dos dimensiones demandadas en la formación del médico como es la enseñanza/docencia

This research was conducted as part of the Curricular Project Innovation, with the need of building a graduate profile in the clinical cycle or subjects, to then make the profile of the graduate of the Faculty of Medical Science at the National University of Asunción (FCM-UNA). We were building it through articles, documents and relevant actors within and outside the institution, enabling the contribution in building a proposal that optimizes the university education of medical students. As university teachers we have found a series of problems related to both the isolation of the disciplines that are used in totally independent way hindering an integrated learning for students, as the little training in management, research and the need for a thorough study and better inter-human relationship with patients and with colleagues. This would be appropriate to address the teaching and learning and the profile of a doctor according to the social, cultural, political and economic development needs. Our objective was to analyze and interpret documents and perception of stakeholders regarding the medical training, that allow to provide data that would give a proposal of the clinical cycle, integrated and relevant through a qualitative design with a comprehensive focus. A review of articles was used to gather information, which seek the profile of other medical universities, both MERCOSUR and International. focus groups were conducted in teachers, patients and graduated from the FCM-UNA. It was also used interviews with employers from the private, public and social security sectors. Subsequently, the process of content analysis was performed with interpretive interest. As for the results obtained we can say that the clinical graduate must meet certain clinical competence, including good relationship with patients, relatives and their own colleagues and support staff. It should also be noted some actors agree in communicative interaction and also to incorporate advanced technology, continuous updating on the disciplinary knowledge and research, social contextualized training and to address the health needs of the population. A convergent expressed demand is the consideration of management as part of the physician performance, also, in the dimension of social responsibility, patients, alumni and employers; they reveal the need to train physicians with humanistic sense, committed to the project of social justice and ethics, warn against the commodification of the medical act as a regulator of the doctor-patient relationship, among others. An important finding of the research was the appearance of two demanded dimensions in the medical training such as teaching.

Detección de Chlamydia trachomatis, esporos micóticos y Trichomonas vaginalis en mujeres en edad fértil que acuden a los Hospitales San Pablo y Regional de San Lorenzo / Chlamydia trachomatis, fungal spores and Trichomonas vaginalis detection of childbearing age women who attend to San Pablo Hospital and Regional of San Lorenzo

Introducción: Las infecciones vulvo-cérvico-vaginales constituyen la causa más común por la que las mujeres en edad fértil acuden al Ginecólogo. Los agentes etiológicos involucrados incluyen a Chlamydia trachomatis, Trichomonas vaginalis, Cándida albicans, entre otros. La sospecha de vulvo-cervico-vaginitis debe orientar a la realización de estudios de secreción vaginal y muestreo endocervical a fin de detectar el agente causal, establecer un tratamiento específico y disminuir la prevalencia de los mismos así como las complicaciones. Objetivos: Determinar la prevalencia de esporos micóticos, Trichomonas vaginalis y Chlamydia trachomatis en mujeres en edad fértil. Materiales y Métodos: Estudio observacional, descriptivo, de corte transversal y prospectivo, con cuestionario realizado a mujeres en edad fértil que acudieron a los hospitales Materno Infantil San Pablo y Regional de San Lorenzo entre los meses de diciembre de 2010 a febrero de 2011. Resultados: De las 148 pacientes estudiadas, se observó una prevalencia de 27,7% de esporos micóticos, 2% de Trichomonas vaginalis y 4,1% de Chlamydia trachomatis. De las pacientes estudiadas, la mayoría tenían entre 25 a 29 años (26%). Conclusión:La prevalencia de esporos micóticos fue 27,7%, Trichomonas vaginalis 2% y Chlamydia trachomatis 4,1%.

Introduction: the vulvo cervicovaginal infections are the most common reason that women of childbearing age go to the gynecologist. The ethiological agents involved are Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, among others. The suspicion of cervico-vulvo-vaginitis should guide the studies of vaginal discharge and endocervical sampling to detect the causative agent, to stablish specific treatment and reduce the prevalence of these infections and the complications. Objective: to determine the prevalence of fungal spores, Trichomonas vaginalis and Chlamydia trachomatis in women of childbearing age. Materials and Methods: observational, descriptive, cross-sectional and prospective study performed in women of childbearing age who attended the San Pablo Hospital and Regional of San Lorenzo between the months of December 2010 to February 2011. Results: 148 patients were studied, there was a 27.7% prevalence of fungal spores, 2% Trichomonas vaginalis and 4.1% Chlamydia trachomatis. Of the patients studied, most were between 25 to 29 years (26%). Conclusion: the prevalence of fungal spores was 27.7%, Trichomonas vaginalis 2% and Chlamydia trachomatis 4.1%.