Desigualdades en salud en mortalidad perinatal durante el Plan Decenal de Salud Pública 2012-2021. Cauca, Colombia

Objetivo: identificar desigualdades en salud asociadas a la mortalidad perinatal durante el Plan Decenal de Salud Pública 2012-2021 en los 42 municipios del Departamento de Cauca Colombia. Métodos: estudio ecológico que abordó el periodo 2012-2021 a partir de datos de fuentes secundarias procedentes del Departamento Administrativo Nacional de Estadística. La población de estudio fueron mujeres entre los 12 y 49 años residentes en Cauca. Se calcularon desigualdades por rangos y modelos de regresión de acuerdo con el Índice de Desigualdad de la Pendiente, el Índice de Desigualdad Relativa y el Índice de Concentración. Resultados: 42 municipios reportaron 3 110 muertes perinatales. La edad media de las mujeres afectadas fue de 25,3 años con predominio del grupo de 20 a 24 años. La región Pacifico reportó la mayor tasa de mortalidad. La pertenencia étnica, el analfabetismo y el Índice de Pobreza Multidimensional, se asociaron estadísticamente con la mortalidad. Se observó una desigualdad más pronunciada en la tasa de mortalidad perinatal en los municipios con condiciones socioeconómicas más desfavorables. Conclusiones: a pesar de la operacionalización del Plan Decenal de Salud Pública, la mortalidad perinatal en el Cauca continúa siendo un reto en el proceso salud/enfermedad. Existe disparidad en la mortalidad perinatal en relación con el nivel socioeconómico; aunque se ha observado disminución en la desigualdad en el transcurso de los años, aún persisten brechas significativas. Los hallazgos subrayan la necesidad de monitorear y dar cuenta de las desigualdades en salud al diseñar, implementar y evaluar las políticas públicas de prevención de la mortalidad perinatal.

Objective: to identify health inequalities associated with perinatal mortality during the Ten-Year Public Health Plan 2012-2021 in the 42 municipalities of the Department of Cauca, Colombia. Methods: ecological study that addressed the period 2012 - 2021 based on data from secondary sources from the National Administrative Department of Statistics. The study population was women between 12 and 49 years of age residing in Cauca. Rank inequalities and regression models were calculated according to the Slope Inequality Index, the Relative Inequality Index and the Concentration Index. Results: 42 municipalities reported 3 110 perinatal deaths. The mean age of the affected women was 25,3 years with a predominance of the 20-24 years age group. The Pacific region reported the highest mortality rate. Ethnicity, illiteracy and the Multidimensional Poverty Index were statistically associated with mortality. There was greater inequality in perinatal mortality in municipalities with worse socioeconomic status. Conclusions: despite the operationalization of the Ten-Year Public Health Plan, perinatal mortality in Cauca continues to be a challenge in the health/disease process. There is disparity in perinatal mortality in relation to socioeconomic level, and although a decrease in inequality has been observed over the years, significant gaps still persist. The findings underscore the need to monitor and account for health inequalities in the design, implementation and evaluation of public policies to prevent perinatal mortality.

Hiperplasia endometrial simple con complejo focal y sin atipia, en una paciente de 23 años de edad. A propósito de un caso y revisión de la literatura / Simple endometrial hyperplasia with focal complex without atypia, in a patient of 23 years old. A case presentation and literature review

Resumen Se presenta el caso de una paciente de 23 años de edad, previamente sana, G1P0A1, con cuadro clínico de hemorragia uterina anormal, a quien se le realizó ecografía transvaginal que reportó embarazo molar, sin embargo tras realizar la medición sérica de B-HCG, fue de 0.00 mUI/ml, por lo que requirió realización de legrado y biopsia para establecer diagnóstico histológico. El resultado evidenció hiperplasia simple, con complejo focal y sin atipia. Se destaca la importancia de la comunicación de este caso, debido a que a esta edad, la presentación de esta patología es infrecuente. Se hace una revisión de los artículos publicados en los últimos 10 años en las bases de datos Medline vía PubMed, y en LILACS en español, inglés y francés. Se tuvo como referencia además textos clásicos. La hiperplasia endometrial simple en pacientes menores de 30 años es poco frecuente, se debe tener en cuenta la presencia de atipias en la histología pues de ser positivo, es mayor el riesgo de transformación maligna.

Abstract A case of a 23-year-old patient, previously healthy, G1P0A1, with clinical symptoms of abnormal uterine bleeding. The patient was underwent transvaginal ultrasound that reported molar pregnancy, however after making the measurement of serum B-HCG was 0.00 mIU/ml. It was necessary curettage and biopsy to establish histological diagnosis. The result showed simple hyperplasia endometrial with focal complex without atypia. The importance of communication in this case, because at this age, the presentation of this disease is uncommon. The literature published in English, Spanish and French during the last 10 years in the Medline database were reviewed via Pubmed and LILACS. Besides, classical texts was referenced in this article. Simple endometrial hyperplasia in patients under 30 years old is rare. It should be taken into account the presence of atypia on histology, because the risk is greater of malignant transformation.

Factors associated with length of hospital stay in minor and moderate burns at Popayan, Colombia. Analysis of a cohort study.

OBJECTIVE: To determine the independent contribution of prognostic factors to length of hospital stay of minor and moderate burn victims at the Hospital Universitario San José (HUSJ), Popayán, Colombia, 2000-2010. METHODS: This was a retrospective cohort study of minor and moderate burn victims admitted between 2000 and 2010, at the burn unit (HUSJ). This is a further analysis of a same cohort previously published in Burns. The following variables were recorded and analyzed: age, gender, origin, depth and extent of burn, causal agent, length of hospital stay and mortality. The main outcome under study was length of stay. Survival analysis was done to explore the association of covariates and length of hospital stay and Cox regression model to adjust the effect of covariates in the outcome. RESULTS: During the study period 2000-2010, 842 of 921 (91.5%) patients treated at the Burn Unit of HUSJ that had complete data were included. There were 520 (61.8%) males and 322 (38.2%) females with a male to female ratio of 1.6:1. Their median age was 9 years (IQR 3-28). The median of percent total body surface area burned (TBSA) was 12% (IQR 7-21) and the most common degree of burn was 2nd degree with 58% (488 patients). There were 12 deaths (censored data) and 830 patients were discharged alive. After multivariate adjustment, significant associations with length of hospital stay remained for age group, burn degree and extension of the burn. The strongest relationship found was for burn degree (2nd degree superficial vs. 3rd degree hazard ratio=2.66 CI 95% [2.13-3.33]). CONCLUSIONS: In patients admitted with mild and moderate burns at HUSJ, the main predictors of length of stay were age, burn degree and extension of the burn.

Experiencia local con el uso de punción única peribulbar caruncular para anestesia oftálmica / Local experience with caruncular single injection peribulbar anesthesia

Introducción: En la actualidad la anestesia peribulbar se considera la técnica de anestesia regional de elección para diversos procedimientos quirúrgicos oftalmológicos debido a su efectividad y a su baja incidencia de complicaciones. Técnicas recientes reducen las 2 punciones a una sola y se encuentran en proceso de evaluación. Objetivos:Medir la eficacia y la seguridad de la técnica de punción única peribulbar caruncular para distintos procedimientos quirúrgicos llevados a cabo en una clínica oftalmológica en la ciudad de Popayán (Colombia). Métodos: Se incluyeron pacientes sometidos a diversos procedimientos oftalmológicos. La técnica anestésica empleada consistía en una punción única peribulbar caruncular. El anestésico utilizado fue bupivacaína 0,5% 2,5 ml, lidocaína 2% 2,5 ml con hialuronidasa 7 UI/ml. Los pacientes fueron evaluados en los minutos 10,15 y 20. Se midió la funcionalidad motora de los 4 músculos extraoculares y el control motor del párpado superior e inferior. Resultados:Se incluyeron 137 pacientes. El 54% eran de género femenino y el 77% ASA II. A los 10 min de evaluación el 92% de los pacientes alcanzan anestésico apropiado para cirugía. Treinta y seis pacientes (26,3%) requirieron el uso de refuerzo mediante una nueva punción peribulbar. Veintidós pacientes (16%) refirieron presentar un dolor leve durante el procedimiento anestésico. En 4 casos (3%) se presentó quemosis. Conclusiones: Con el uso de la técnica de punción única caruncular la gran mayoría de los pacientes alcanzan un bloqueo ocular apropiado para diversos procedimientos quirúrgicos oftalmológicos. Este bloqueo se incrementa con el tiempo y la incidencia de complicaciones es baja.

Introduction:Peribulbar anesthesia is currently considered the regional anesthetic technique of choice for various ophthalmic surgical procedures because of its effectiveness and low incidence of complications. Recent techniques have reduced the number of injections from two to one and are undergoing evaluation. Objectives:To measure the efficacy and safety of the caruncular single injection peribulbar technique for various surgical procedures performed at an ophthalmic clinic in Popayan city, Colombia. Methods:Patients undergoing various ophthalmic procedures were included. The anesthetic technique used was based on a caruncular single peribulbar injection. The anesthetic agent used contained 0.5% bupivacaine 2.5 ml, 2% lidocaine 2.5 ml with hyaluroni-dase 7 IU/ml. Patients were evaluated at 10, 15, and 20 min. The motor functionality of the four extraocular muscles and the upper and lower eyelid motor control was measured. Results: 137 patients were included; 54% were females and 77% ASA II. 10 minutes into the evaluation, 92% of the patients achieved an adequate level of anesthesia to proceed with surgery. 36 patients (26.3%) required a booster dose of an additional peribulbar injection. Twenty-two patients (16%) reported mild pain during the anesthetic procedure. There were four cases of chemosis (3%). Conclusions: Using the caruncular single peribulbar injection, most patients achieved an appropriate ocular block for multiple ophthalmic surgical procedures. As time elapses, this block becomes stronger and the incidence of complications is low.

Epidemiological profile of minor and moderate burn victims at the University Hospital San José, Popayán, Colombia, 2000-2010.

OBJECTIVES: To describe the epidemiological profile of minor and moderate burn victims at the University Hospital San José, Popayán, Colombia, 2000-2010. METHODS: This study was retrospective description of minor and moderate burn victims admitted between 2000 and 2010 at the Burn Unit of University Hospital San José (UHSJ). The following variables were recorded and analyzed: age, gender, origin, social security, depth and extent of burn, days of hospitalization, causal agent and mortality. SPSS 19.0 was used. The level of significance was p<0.05. RESULTS: During 2000-2010, 845 patients were included. 61.7% were men. The average age was 17.9 years. Most of patients were from rural areas (80.4%). Most people belonged to the Subsidized Health Colombian System (85.3%). The most common causal agent was scalding liquids (49.7%). The most frequent depth was second degree burns (57.8%) and the average burned body surface was 20%. The average hospital stay was 20.4 days, and the median hospitalization time was 14 days. Mortality was 1.4%. CONCLUSIONS: The findings of this study are the first to define the characteristics of burns in Popayán. This study is the basis for identifying preventative measures in the local health care system.