Suicidios de indígenas en Valle del Cauca, Cauca y Nariño (Colombia) antes (2018-2019) y durante la pandemia de la COVID-19 (2020-2021) / Indigenous suicides in Valle del Cauca, Cauca and Nariño (Colombia) before (2018-2019) and during the COVID-19 pandemic (2020-2021)

RESUMEN Introducción : El Centro para el Control y Prevención de Enfermedades (CDC) define el suicidio como el acto de autoagresión con la intención de causar la muerte propia de manera voluntaria. En pueblos indígenas de países como Canadá, Australia, Groenlandia, Estados Unidos, Nueva Zelanda, Brasil y Siberia, se evidencia que este evento sucede con mayor frecuencia que en la población general, principalmente como consecuencia del colonialismo y las dificultades que enfrentan las comunidades indígenas, factores que se citan hoy como comunes a nivel mundial. Método : Estudio cuantitativo, descriptivo y retrospectivo en el que se analizaron 48 casos de suicidios de indígenas del suroccidente colombiano, ocurridos durante el período de prepandemia (2018-2019) y pandemia de la COVID-19 (2020-2021), registrados en el Instituto Nacional de Medicina Legal y Ciencias Forenses (INMLYCF) de los departamentos de Valle del Cauca, Cauca y Nariño. Resultados : En la región estudiada se suicidaron más personas durante el período pandémico (2020-2021). Las víctimas fueron, predominantemente, individuos del sexo masculino, de edad joven (entre 19 y 26 años), con estudios de primaria y bachillerato, que tenían ocupación de agricultores o estudiantes, que usaron el ahorcamiento como modalidad principal para acabar con su vida, y cuya razón de suicidio más frecuente era el conflicto con la pareja o expareja. Conclusiones : La tasa de suicidio en indígenas en el Valle del Cauca, Cauca y Nariño fue más alta que la registrada en la población general de los mismos departamentos durante la pandemia de la COVID-19 (2020-2021). Es necesario considerar factores socioculturales y trayectorias del evento suicida en el seno de cada comunidad distintivamente estudiada.

ABSTRACT Introduction : The Center for Disease Control and Prevention (CDC) defines suicide as an act of self-harm with the intent to cause a voluntary death. In indigenous peoples from countries such as Canada, Australia, Greenland, the United States, New Zealand, Brazil and Siberia, it is evident that this event occurs more frequently than in the general population, mainly as a consequence of colonialism and difficulties faced by indigenous communities, factors that are now considered as common throughout the world. Methods : A retrospective, descriptive, quantitative and retrospective study that analyzes 48 cases of suicide in indigenous people from Southwestern Colombia during the COVID-19 pre-pandemic (2018-2019) and pandemic (2020-2021) periods and registered in the National Institute of Legal Medicine and Forensic Sciences of the departments of Valle del Cauca, Cauca and Nariño. Results : In the studied region more people committed suicide during the pandemic period (2020-2021). The victims were, predominantly, males of young ages (between 19 and 26 years), with a primary and high school educational level, of primary and high school, with farmer or student occupations, use of hanging as the main modality, and conflict with partner or ex-partner as the most frequently cited reason. Conclusions : The suicide rate among indigenous people in the departments of Cauca Valley, Cauca and Nariño was higher than that recorded in the general population of the same departments during the COVID-19 pandemic (2020-2021). It is necessary to consider sociocultural factors and the trajectories of the suicide event within each distinctly studied community.

Targeting the vim by direct visualization of the cerebello-thalamo-cortical pathway in 3 T proton density MRI: correlation with focused ultrasound lesioning.

Surgical targeting of the ventral intermediate nucleus of the thalamus (VIM) has been historically done using indirect strategies. Here we depict the cerebello-thalamo-cortical tract (CTCT) through 3 T proton density (PD) in a cohort of patients who underwent high-intensity focus ultrasound (HIFUS) thalamotomy. Forty-seven patients treated in our institution with MR-guided HIFUS VIM thalamotomy were included in this study. PD weighted 3 T MRI used for presurgical planning was compared with postoperative MRI obtained 1 month after surgery. Images were processed with ISTX software (Brain lab, Munich, Germany). The coordinates of the VIM lesion concerning the inter-commissural line (ICL) were annotated. Deterministic tractographies using three ROIs were used to verify the different tracts. The triangle seen in the 3 T PD sequence at the level of the mesencephalic-diencephalic junction was systematically recognized. The posterior angle of this triangle at the junction of the CTCT and the ZI was denominated as "point P." The area of this triangle corresponds to the posterior subthalamic area (PSA) harboring the Raprl fibers. The CTCT was visible from 1 to 2.5 mm below the ICL. The average center of the final HIFUS lesion (point F) was 11 mm from the medial thalamic border of the thalamus (14.9 mm from the midline), 6.4 mm anterior to PC, and 0.6 mm above the ICL. The FUS point was consistently 1-2 mm directly above point P. The anterior border of the external angle of this triangle (point P) can be used as an intraparenchymal point for targeting the ventral border of the VIM. Three ROIs placed in a single slice around this triangle are a fast way to originate tractography of the CTCT, lemniscus medialis, and pyramidal tract.