Características de los casos de óbito fetal en un hospital público de Perú: estudio descriptivo / Characteristics of cases of fetal death in a public hospital in Peru: a descriptive study

Objetivo: Describir las características de los casos de óbito fetal reportados entre el año 2017 y 2021 en un hospital público de Perú. Métodos: Estudio descriptivo y transversal, que se realizó en los casos confirmados de muerte fetal en madres con edad gestacional mayor a 22 semanas presentados en el Hospital de Vitarte de Lima, Perú. La muestra estuvo conformada por 137 casos durante el periodo de 2017 a 2021. Se presentaron frecuencias y porcentajes. Resultados: La muerte fetal tuvo una tasa de 14,8 por 1 000 nacidos vivos. La mayoría de las mujeres tenía entre 20 y 24 años (27 %), además, el 70,1 % era conviviente, 92 % era ama de casa y 83,2% estudió hasta secundaria. Por otra parte, 50,4 % era multigesta y 29,9 % tuvo antecedente de aborto y 16,7 % antecedente de cesárea. La asistencia al servicio prenatal fue el más frecuente (67,2 %) y 29,2 % tenía sobrepeso. Respecto a las patologías maternas, el 38 % tuvo infección del tracto urinario, 17,5 % preeclampsia sin signos de seguridad y 2,9 % diabetes gestacional. Las malformaciones congénitas se presentaron en el 19 % de los casos; además, el 23,4 % de muertes fetales tuvo una causa materna. Conclusiones: La tasa de muerte fetal es alta. Los casos estuvieron caracterizados mayormente por madres con cualidades de vulnerabilidad social, además de presentar características de mayor riesgo obstétrico. Las causas maternas de muerte fetal fueron las más frecuentes(AU)

Objective: To describe the characteristics of fetal death cases reported between 2017 and 2021 in a public hospital in Peru. Methods: Descriptive and cross-sectional study, which was conducted in confirmed cases of fetal death in mothers with gestational age greater than 22 weeks presented at the Vitarte Hospital in Lima, Peru. The sample consisted of 137 cases during the period from 2017 to 2021. Frequencies and percentages were presented. Results: Fetal death had a rate of 14,8 per 1000 live births. Most of the women were between 20 and 24 years old (27%), in addition, 70,1% were cohabiting, 92% were housewives and 83,2% studied up to high school. On the other hand, 50,4% were multigestational and 29,9% had a history of abortion and 16,7% had a history of cesarean section. Prenatal service attendance was the most frequent (67,2%) and 29,2% were overweight. Regarding maternal pathologies, 38% had urinary tract infection, 17,5% had preeclampsia without signs of safety and 2,9% had gestational diabetes. Congenital malformations were present in 19% of cases; in addition, 23,4% of fetal deaths had a maternal cause. Conclusions: The rate of fetal death is high. The cases were characterized mostly by mothers with qualities of social vulnerability, in addition to presenting characteristics of higher obstetric risk. Maternal causes of fetal death were the most frequent(AU)

Characterization of a group of children with eosinophilic esophagitis in Cali, Colombia.

PURPOSE: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic disease of the gastrointestinal tract. The objective of this study was to clinically and demographically describe a child population with EoE diagnosed in a high-complexity hospital in Cali, Colombia. METHODS: A retrospective study was carried out. The clinical histories of patients between 0 and 18 years with clinical suspicion and a histological diagnosis of EoE were analyzed. All patients underwent an allergy study, either by measurement of specific immunoglobulin (Ig) E and/or an intraepidermal skin-prick test. RESULTS: Thirty-five patients were included in the study, of which 21 (60%) women. The median age was 8 years (interquartile range [IQR] 5-12), and the age of onset of symptoms was 5 years (IQR 2-10). Thirty patients (85.7%) reported a history of allergic disease, with rhinitis being the most frequent (n = 25, 71.4%). Only one patient reported with food allergy mediated by IgE. The main symptoms in patients included abdominal pain (17 [48.6%]), refractory gastroesophageal reflux (16 [45.7%]), and choking (9 [25.7%]). Upper gastrointestinal endoscopy was normal in 10 patients (38.5%). The median number of eosinophils in the biopsy was 42 (IQR 31-92). Allergenic sensitization was verified in 25 of 35 patients (71.4%). Of these, dust mite allergy was positive in 21 patients (84%), while the most frequent food allergy was toward cow's milk, in five patients (31.3%). CONCLUSIONS: The majority of patients with EoE were females. The most frequent symptom was abdominal pain. Endoscopic abnormalities were also observed frequently, and the prevalence of other allergic diseases (especially rhinitis) and allergenic sensitization (especially to mites) was high.

[Tamoxifen and endometrial disease in patients with breast cancer]. / Tamoxifeno y afecciones endometriales en pacientes con cáncer de mama.

The objectives were to evaluate prevalence of endometrial disease in patients treated with tamoxifen (TAM) and analyze the epidemiological, sonographic, hysteroscopic and histopathological findings. From January 1999 to December 2008, 152 breast cancer patients treated with TAM (20 mg/day), symptomatic (with bleeding) or asymptomatic, pre-and postmenopausal, were included consecutively in a prospective and observational follow-up study. Diagnostic methods were (TV) transvaginal ultrasound, hysteroscopy and curettage biopsy. TV ultrasound was performed every 12 months for 12 to 60 months. The patients' age were 62.76 years ± 10.24 the TAM-time: 36.24 ± 19. Adenocarcinoma was observed in 3/87 patients (3.45%) with risk factors and in 1/65 (1.54%) without them (RA 1.91, IC 95% 1.88-1.94). We found benign disease in 148 patients (97.37%) and adenocarcinomas in 4 (2.63%), one within a polyp. The 4 adenocarcinomas were detected in postmenopausal women (2 asymptomatic) with endometrial thicknesses equal or greater than 16 mm. The cancer risk was significantly increased in symptomatic (2.36 versus 0.42 in asymptomatic). Three adenocarcinomas were observed between 24 and 48 months of treatment. In conclusion, we suggest an adequate transvaginal ultrasound monitoring of asymptomatic patients treated with TAM, with removal of polyps, because atypia can be present hidden within, considering risk factors and exposure time. We suggest as an acceptable cut-off = 10 mm in asymptomatic postmenopausal patients.

Tamoxifeno y afecciones endometriales en pacientes con cáncer de mama / Tamoxifen and endometrial disease in patients with breast cancer

Los objetivos fueron evaluar la prevalencia de afecciones endometriales en pacientes tratadas con tamoxifeno (TAM) y analizar los aspectos epidemiológicos, ecográficos, histeroscópicos e histopatológicos. Desde enero de 1999 a diciembre 2008 se estudiaron 152 pacientes con cáncer de mama tratadas con TAM (20 mg/día), sintomáticas (con sangrado) o asintomáticas, pre y postmenopáusicas, incluidas en forma consecutiva. El diseño fue prospectivo y observacional. Los métodos diagnósticos usados fueron ecografía transvaginal, histeroscopía y biopsia. Las pacientes fueron seguidas durante 5 años con ecografía cada 12 meses e histeroscopia con biopsia en casos que lo justificaran. Edad: 62.76 ± 10.24 años y tiempo de tratamiento: 36.2 ± 19.9 meses. El adenocarcinoma se observó en 3/87 (3.45%) pacientes con factores de riesgo y en 1/65 (1.54%) sin ellos (RA: 1.91, IC 95% 1.88 a 1.94). Las afecciones benignas se hallaron en 148 pacientes (97.37% y los adenocarcinomas en 4 (2.63%),1 en un pólipo de aspecto benigno. Los 4 se observaron en mujeres postmenopáusicas (2 asintomáticas) con grosor endometrial igual o mayor a 16 mm. El riesgo de cáncer fue significativamente mayor en sintomáticas (2.36 versus 0.42 en asintomáticas). Tres adenocarcinomas se detectaron entre 24 y 48 meses del tratamiento. Recomendamos un seguimiento con ecografía transvaginal de las pacientes asintomáticas, resección de los pólipos evaluando factores de riesgo y tiempo de exposición, en especial luego de los 24 meses. Consideramos aceptable un cut-off = 10 mm en el grosor del endometrio en postmenopáusicas asintomáticas para realizar histeroscopía y biopsia.(AU)

The objectives were to evaluate prevalence of endometrial disease in patients treated with tamoxifen (TAM) and analyze the epidemiological, sonographic, hysteroscopic and histopathological findings. From January 1999 to December 2008, 152 breast cancer patients treated with TAM (20 mg/day), symptomatic (with bleeding) or asymptomatic, pre- and postmenopausal, were included consecutively in a prospective and observational follow-up study Diagnostic methods were (TV) transvaginal ultrasound, hysteroscopy and curettage biopsy. TV ultrasound was performed every 12 months for 12 to 60 months. The patients´ age were 62.76 years ± 10.24 the TAM-time: 36.24 ± 19. Adenocarcinoma was observed in 3/87 patients (3.45%) with risk factors and in 1/65 (1.54%) without them (RA 1.91, IC 95% 1.88-1.94). We found benign disease in 148 patients (97.37%) and adenocarcinomas in 4 (2.63%), one within a polyp. The 4 adenocarcinomas were detected in postmenopausal women (2 asymptomatic) with endometrial thicknesses equal or greater than 16 mm. The cancer risk was significantly increased in symptomatic (2.36 versus 0.42 in asymptomatic). Three adenocarcinomas were observed between 24 and 48 months of treatment. In conclusion, we suggest an adequate transvaginal ultrasound monitoring of asymptomatic patients treated with TAM, with removal of polyps, because atypia can be present hidden within, considerin risk factors and exposure time. We suggest as an acceptable cut-off = 10 mm in asymptomatic postmenopausal patients.(AU)

Tamoxifeno y afecciones endometriales en pacientes con cáncer de mama / Tamoxifen and endometrial disease in patients with breast cancer

Los objetivos fueron evaluar la prevalencia de afecciones endometriales en pacientes tratadas con tamoxifeno (TAM) y analizar los aspectos epidemiológicos, ecográficos, histeroscópicos e histopatológicos. Desde enero de 1999 a diciembre 2008 se estudiaron 152 pacientes con cáncer de mama tratadas con TAM (20 mg/día), sintomáticas (con sangrado) o asintomáticas, pre y postmenopáusicas, incluidas en forma consecutiva. El diseño fue prospectivo y observacional. Los métodos diagnósticos usados fueron ecografía transvaginal, histeroscopía y biopsia. Las pacientes fueron seguidas durante 5 años con ecografía cada 12 meses e histeroscopia con biopsia en casos que lo justificaran. Edad: 62.76 ± 10.24 años y tiempo de tratamiento: 36.2 ± 19.9 meses. El adenocarcinoma se observó en 3/87 (3.45%) pacientes con factores de riesgo y en 1/65 (1.54%) sin ellos (RA: 1.91, IC 95% 1.88 a 1.94). Las afecciones benignas se hallaron en 148 pacientes (97.37% y los adenocarcinomas en 4 (2.63%),1 en un pólipo de aspecto benigno. Los 4 se observaron en mujeres postmenopáusicas (2 asintomáticas) con grosor endometrial igual o mayor a 16 mm. El riesgo de cáncer fue significativamente mayor en sintomáticas (2.36 versus 0.42 en asintomáticas). Tres adenocarcinomas se detectaron entre 24 y 48 meses del tratamiento. Recomendamos un seguimiento con ecografía transvaginal de las pacientes asintomáticas, resección de los pólipos evaluando factores de riesgo y tiempo de exposición, en especial luego de los 24 meses. Consideramos aceptable un cut-off = 10 mm en el grosor del endometrio en postmenopáusicas asintomáticas para realizar histeroscopía y biopsia.

The objectives were to evaluate prevalence of endometrial disease in patients treated with tamoxifen (TAM) and analyze the epidemiological, sonographic, hysteroscopic and histopathological findings. From January 1999 to December 2008, 152 breast cancer patients treated with TAM (20 mg/day), symptomatic (with bleeding) or asymptomatic, pre- and postmenopausal, were included consecutively in a prospective and observational follow-up study Diagnostic methods were (TV) transvaginal ultrasound, hysteroscopy and curettage biopsy. TV ultrasound was performed every 12 months for 12 to 60 months. The patients´ age were 62.76 years ± 10.24 the TAM-time: 36.24 ± 19. Adenocarcinoma was observed in 3/87 patients (3.45%) with risk factors and in 1/65 (1.54%) without them (RA 1.91, IC 95% 1.88-1.94). We found benign disease in 148 patients (97.37%) and adenocarcinomas in 4 (2.63%), one within a polyp. The 4 adenocarcinomas were detected in postmenopausal women (2 asymptomatic) with endometrial thicknesses equal or greater than 16 mm. The cancer risk was significantly increased in symptomatic (2.36 versus 0.42 in asymptomatic). Three adenocarcinomas were observed between 24 and 48 months of treatment. In conclusion, we suggest an adequate transvaginal ultrasound monitoring of asymptomatic patients treated with TAM, with removal of polyps, because atypia can be present hidden within, considerin risk factors and exposure time. We suggest as an acceptable cut-off = 10 mm in asymptomatic postmenopausal patients.

Tamoxifeno y afecciones endometriales en pacientes con cáncer de mama. / [Tamoxifen and endometrial disease in patients with breast cancer].

The objectives were to evaluate prevalence of endometrial disease in patients treated with tamoxifen (TAM) and analyze the epidemiological, sonographic, hysteroscopic and histopathological findings. From January 1999 to December 2008, 152 breast cancer patients treated with TAM (20 mg/day), symptomatic (with bleeding) or asymptomatic, pre-and postmenopausal, were included consecutively in a prospective and observational follow-up study. Diagnostic methods were (TV) transvaginal ultrasound, hysteroscopy and curettage biopsy. TV ultrasound was performed every 12 months for 12 to 60 months. The patients age were 62.76 years ± 10.24 the TAM-time: 36.24 ± 19. Adenocarcinoma was observed in 3/87 patients (3.45

) with risk factors and in 1/65 (1.54

) without them (RA 1.91, IC 95

1.88-1.94). We found benign disease in 148 patients (97.37

) and adenocarcinomas in 4 (2.63

), one within a polyp. The 4 adenocarcinomas were detected in postmenopausal women (2 asymptomatic) with endometrial thicknesses equal or greater than 16 mm. The cancer risk was significantly increased in symptomatic (2.36 versus 0.42 in asymptomatic). Three adenocarcinomas were observed between 24 and 48 months of treatment. In conclusion, we suggest an adequate transvaginal ultrasound monitoring of asymptomatic patients treated with TAM, with removal of polyps, because atypia can be present hidden within, considering risk factors and exposure time. We suggest as an acceptable cut-off = 10 mm in asymptomatic postmenopausal patients.

Ética docente: una mirada del estudiante de Enfermería / Ethics in teaching: the Nursing students view

Resumen:

Objetivo: analizar las actitudes éticas y bioéticas de los docentes de Enfermería. Metodología: estudio transversal, descriptivo, realizado a estudiantes de la carrera de Enfermería de la UNAM. El instrumento de recolección consistió en un cuestionario tipo Likert con 16 ítems basados en los cuatro principios de la bioética. Resultados: el 59,6% de los estudiantes opinó que los docentes tienen una actitud ética buena, el 38,6% una actitud regular y el 1,9% que son excelentes. La pregunta abierta reportó injusticia, inequidad y favoritismo, así como autoritarismo y que los docentes son poco humanos con los estudiantes. No se encontró correlación con las variables sociodemográficas. Conclusiones: las actitudes éticas y bioéticas de los docentes son buenas o regulares, aunque se obtuvieron expresiones abiertas que se contradicen.

Abstract:

Objective: To analyze the ethical and bioethical attitudes of teachers. Methodology: A cross-sectional study, conducted Nursing career at UNAM. Survey instrument consisted of a Likert type questionnaire with 16 items based on the 4 principles of bioethics. Results: 59.6% of students felt that teachers have a good moral attitude, regular 38.6% and 1.9% excellent. The open question reported favoritism and authoritarianism, and that teachers are not very human with students. No difference was found between the views of students from different groups. Conclusions: The research concludes that ethical and bioethical attitudes of teachers are good and regular, open expressions show a conflict.

Objetivo: Analisar o comportamento ético e bioético dos docentes de Enfermagem. Metodologia: Estudo transversal, descritivo, efectuado a estudantes do Curso de Enfermagem da UNAM. O método de recolha de dados consistiu num questionário tipo Likert com 16 itens, baseados nos 4 princípios da bioética. Resultados: 59,6% dos estudantes concluiu que os docentes têm um bom comportamento ético, 38,6% indicou o comportamento como regular, e 1,9% como excelente. A pergunta aberta sugeriu injustiça, imparcialidade e favoritismo, bem como autoritarismo e pouca humanidade para com os estudantes. Não se encontrou correlação com as variáveis sociodemográficas. Conclusões: O comportamento ético e bioético dos docentes é bom e regular, apesar de algumas opiniões contraditórias.

Augmentation mammoplasty using the retrofascia approach.

In augmentation mammoplasty, the selection of placement for implants is based on the characteristics of each patient and the tissue conditions to ensure an optimal covering of these. The location must not be arbitrarily based on the preferences of the surgeon and the patient, but must ensure adequate tissue covering, thus minimizing shorts and long-term risks. Retromammary, retropectoral, and total and mixed retromuscular implants have been used. The retrofascia location of the mammary prosthesis reported in this article was described for the first time in the year 2000. This retrofascia technique refers to the collocation of the implant behind the fascia and in front of the pectoralis major muscle with the goal of achieving proper covering and good support of the implant. This is a nonrandomized prospective study investigated 110 cases of mammary hypoplasia and ptosis levels 1 and 2 from October 2001 to October 2002 with an average follow-up period of 1 year. Periareolar incisions were used in the retrofascia collocation of the mammary implant. The types of implants used included texturized silicone gel (85%) and smooth silicone gel (15%). As demonstrated by the findings, this surgical technique can achieve a good support to keep the prosthesis in an adequate position, maintaining the superior pole with a very natural projection. The incidence of complications was 7.6%, the most frequent of which was capsular contracture (3.53%).