Desenlaces obstétricos y perinatales en embarazadas con obesidad. Estudio de prevalencia / Obstetric and perinatal results in pregnant women with obesity. Prevalence study

Resumen OBJETIVO: Evaluar la prevalencia de obesidad en el área de influencia del Hospital Universitario Infanta Leonor y analizar los desenlaces obstétricos y perinatales de embarazadas obesas. MATERIALES Y MÉTODOS: Estudio observacional, transversal y retrospectivo efectuado con base en los datos de partos atendidos en el año 2019 en el Hospital Universitario Infanta Leonor y asentados en las historias clínicas. Se evaluaron y determinaron la prevalencia de obesidad, las variables maternas y el desenlace perinatal en embarazadas con obesidad. RESULTADOS: Se analizaron 428 embarazadas, con obesidad, de 2048 partos atendidos. La prevalencia de obesidad fue 21.59%. La edad materna fue 32 años y 39.10% eran migrantes; el índice de masa corporal (IMC) medio fue 33.61 kg/m2; 33.18% eran primíparas; 14.12% recibieron algún tratamiento y 18.63% seguimiento endocrinológico. Las semanas de embarazo al parto fueron 39; 43.93% de los partos se indujeron. La tasa de cesáreas fue 26.17% y en el 51.45% hubo complicaciones. El peso medio de los recién nacidos fue 3345.9 g. La mediana del Apgar al primer minuto fue 9 y 10 a los 5. El 16.24% de los recién nacidos tuvo pH en sangre de cordón ≤ 7.20; 1.96% de los recién nacidos ingresó a cuidados intensivos y 0.93% fue la tasa de muerte fetal. CONCLUSIONES: La prevalencia de obesidad fue superior a la media nacional. Factores como la migración y la multiparidad se asociaron con mayor IMC, y éste con más complicaciones (ingreso a cuidados intensivos y muerte fetal anteparto). La obesidad se asoció con mayor tasa de inducción de parto, cesáreas, desgarros perineales, peso fetal y menor pH al nacimiento.

Abstract OBJECTIVE: To evaluate the prevalence of obesity in the healthcare area of Hospital Universitario Infanta Leonor and analyze the obstetric and perinatal outcomes of obese patients. MATERIALS AND METHODS: This is a retrospective transversal observational study based on data from births in Hospital Universitario Infanta Leonor during 2019. 2048 clinical records were evaluated in order to determine prevalence of obesity, as well as maternal and perinatal outcomes variables in pregnant women with obesity. RESULTS: A total of 428 pregnant women with obesity were analyzed out of 2048 deliveries attended. The prevalence of obesity was 21.59%. Maternal age was 32 years; 39.10% of the patients were migrants; the mean BMI was 33.61 kg/m2; 33.18% were primiparous; 14.2% received any pharmacological treatment and 18.63% had endocrinological follow-up. Gestational age at labour was 39 weeks; 43.93% of deliveries were induced; caesarean delivery rate was 26.17% and 51.45% presented complications. Newborn's mean weight was 3345.9 g. The 1-minute Apgar score median was 9 and the 5-minute Apgar score was 10; 16.24% of newborns had cord pH≤7.20; 1.96% ICU admission and 0.93% of fetal death. CONCLUSIONS: The prevalence of obesity in pregnant women in the Hospital Universitario Infanta Leonor healthcare area was higher than the national mean. Factors such as migration and multiparity are associated with higher BMI, which leads to an increased risk of complications, especially ICU admission and antepartum fetal death. Obesity is associated with a higher rate of labour induction, caesarean delivery, tears, higher neonatal weight and lower pH.

Competencias del Grado en Pedagogía: Percepción desde el punto de vista de los egresados / Competências da Licenciatura em Pedagogia: Percepção do ponto de vista dos licenciados / Competences of the Degree in Pedagogy: Perception from the point of view of the graduates

El presente trabajo pretende evaluar el grado de adquisición y la relevancia de las competencias desarrolladas en el Grado en Pedagogía de la Universidad de Salamanca (España), así como identificar las posibles diferencias de percepción entre egresados empleados y no empleados. Tras la aplicación de un cuestionario ad hoc validado por expertos a 78 egresados y el análisis cuantitativo de los datos obtenidos, se encuentra que el nivel de adquisición y la relevancia de las competencias promovidas en la titulación se adecuan a los requerimientos del mundo socio-laboral, advirtiendo que los egresados empleados otorgan una mayor importancia a las competencias específicas, las cuales se identifican como objetivo prioritario de refuerzo en las estrategias formativas.

O presente trabalho pretende avaliar o grau de aquisição e a relevância das competências desenvolvidas na Licenciatura em Pedagogia da Universidade de Salamanca (Espanha), bem como identificar as possíveis diferenças de percepção entre graduados empregados e não-empregados. Após a aplicação de um questionário ad hoc validado por especialistas a 78 graduados e a análise quantitativa dos dados obtidos, constata-se que o nível de aquisição e a relevância das competências promovidas no diploma são adaptadas às exigências do mundo social e trabalhista, advertindo que os graduados empregados dão maior importância às competências específicas, que são identificadas como objetivo prioritário de reforço nas estratégias de treinamento.

The article aims to assess the degree of acquisition and importance of the competencies developed in the Degree in Pedagogy in the University of Salamanca (Spain), differentiating between employed and non-employed graduates. 78 graduates filled an ad-hoc questionnaire validated by experts. After the quantitative analysis of the data gathered, the results allowed us to conclude that the competences of the degree adequately fit in with the demands from the social-labour world, and that graduates who are currently employed perceive specific competences as more important. Therefore, these competences are identified as a priority target for reinforcement within educational strategies in the degree.

Prevalence and mortality in children with congenital diaphragmatic hernia: a multicountry study.

PURPOSE: This study determined the prevalence, mortality, and time trends of children with congenital diaphragmatic hernia (CDH). METHODS: Twenty-five hospital- and population-based surveillance programs in 19 International Clearinghouse for Birth Defects Surveillance and Research member countries provided birth defects mortality data between 1974 and 2015. CDH cases included live births, stillbirths, or elective termination of pregnancy for fetal anomalies. Prevalence, cumulative mortality rates, and 95% confidence intervals (CIs) were calculated using Poisson regression and a Kaplan-Meier product-limit method. Joinpoint regression analyses were conducted to assess time trends. RESULTS: The prevalence of CDH was 2.6 per 10,000 total births (95% CI: 2.5-2.7), slightly increasing between 2001 and 2012 (average annual percent change = 0.5%; 95% CI:-0.6 to 1.6). The total percent mortality of CDH was 37.7%, with hospital-based registries having more deaths among live births than population-based registries (45.1% vs. 33.8%). Mortality rates decreased over time (average annual percent change = -2.4%; 95% CI: -3.8 to 1.1). Most deaths due to CDH occurred among 2- to 6-day-old infants for both registry types (36.3%, hospital-based; 12.1%, population-based). CONCLUSIONS: The mortality of CDH has decreased over time. Mortality remains high during the first week and varied by registry type.

Operación cesárea. Una revisión histórica / Caesarean section. A historical review

La operación cesárea que hoy en día realizamos de forma casi rutinaria en la mayoría de centros hospitalarios del mundo es consecuencia de una apasionante búsqueda de mejoras por las generaciones precedentes de obstetras. A lo largo de los años, la cesárea ha experimentado importantes cambios en la técnica quirúrgica, en la frecuencia de su práctica y en sus indicaciones, tanto maternas como fetales. En los siglos XVII, XVIII y XIX implicaba una elevadísima mortalidad materna, por lo que únicamente se realizaba en casos desesperados, con la esperanza del salvar al nasciturus. La introducción de los principios de asepsia-antisepsia por Semmelweis, Koch, Lister y Halsted, la sutura de la herida uterina, la incisión en el segmento uterino inferior y la incisión transversa en el segmento inferior del útero supusieron una importante disminución de la mortalidad materna. En la segunda mitad del siglo XX, el empleo de la antibio-ticoterapia, la transfusión sanguínea, el perfeccionamiento de la anestesia y de los cuidados perioperatorios, así como la modificación ulterior de algunas técnicas quirúrgicas, ha conseguido reducir ampliamente la morbimortalidad asociada a esta intervención. Todos estos cambios han conseguido que la cesárea haya pasado de ser una operación in extremis que condenaba con gran probabilidad a la paciente, a una técnica que en la actualidad es demandada por algunas mujeres como sustitución del parto vaginal.

The cesarean section is an operation routinely performed in the majority of hospitals around the world. The cesarean section came to be as an early generation of obstetricians passionately searched for a way to improve their field. Throughout the years, it has experien-ced numerous changes: the surgical technique, it's frequency, and it's medical indications (both fetal and maternal). During the 17th, 18th, and 19th centuries it implied a very high maternal mortality rate, which left it as a last resort option with the only hope to save the nasciturus. The introduction of asepsis and antisepsis (Semmelweis, Koch, Lister, and Halsted at the end of the 19th century), the suture of the uterine wall, and the transverse incision in the lower uterine segment drastically reduced maternal mortality. During the second half of the 20th century, the use of antibiotics and blood transfusions, improvements in anesthesia and perioperative care, and the further modifications to the surgical technique considerably reduced the morbidity and mortality associated with the operation. All these changes transformed the cesarean section from a surgical intervention done in extremis, where the mother would probably die, to a technique currently demanded by some women as a substitute to the vaginal delivery.

Eritema gyratum repens idiopático: presentación de un caso en una mujer joven / Idiopathic erythema gyratum repens: presentation of a case in a young woman

El eritema gyratum repens es una dermatosis muy infrecuente incluida dentro del abanico diagnóstico de las lesiones figuradas. Aparece sobre todo en varones entre la sexta y séptima décadas de vida. Clásicamente se ha relacionado con neoplasias, sobre todo de pulmón, esófago y mama. Sin embargo, en los últimos años se ha visto que aproximadamente el 30% de los casos no son paraneoplásicos, pudiendo deberse a fármacos, enfermedades reumáticas, manifestaciones atípicas de procesos cutáneos, e incluso ser idiopáticos, por lo que es importante realizar un adecuado proceso diagnóstico para filiar la etiología, y considerar un amplio diagnóstico diferencial. Presentamos el caso de una mujer de 40 años con lesiones eritematosas anulares concéntricas sugestivas de eritema gyratum repens, del tipo idiopático tras el correspondiente estudio diagnóstico.

Erythema gyratum repens is an unusual dermatosis included within the group of figurate lesions. It usually appears in men at the age of sixty or seventy. Classically it has been related to neoplasms, especially of the lung, esophagus and breast, however recently it has been seen that 30% of cases are not paraneoplastic approximately, and might be caused by drugs, rheumatologic diseases, atypical presentation of common skin diseases, and also it could be idiopathic, so it is important to carry out an adequate diagnostic process to determine the etiology, and to consider a broad differential diagnosis. We present the case of a 40-year-old woman with concentric annular erythematous lesions suggestive of idiopathic erythema gyratum repens after the diagnostic process

Resultados después de la implementación del test de DNA fetal libre circulante en sangre materna (DNA-lc) para cribado de cromosomopatías fetales / Results after the implementation of the cell-free fetal DNA test in maternal plasma (cfDNA) in screening for fetal aneuploidies

Objetivo: Evaluar la disminución de la tasa de técnicas invasivas de diagnóstico prenatal tras la introducción del cribado contingente de cromosomopatías con test de DNA fetal libre circulante (DNA-lc)y demostrar que este método de cribado es coste-efectivo. Método: estudio observacional prospectivo y estudio de coste efectividad. Primero se describen los resultados del cribado combinado en dos tiempos de primer trimestre desde febrero de 2008 a junio 2018 diez primeros años del hospital): 21744 cribados realizados de un total de 23000 partos. En abril de 2016 se implementa un modelo de cribado contingente de cromosomopatías con test de DNAlc (se oferta el test a pacientes con resultado de riesgo intermedio en el cribado combinado). En segundo lugar se analizan los resultados tras la implementación del test y se comparan dos períodos de tiempo con y sin cribado contingente (año 2015 con el período abril 2016 hasta marzo de 2019). Resulta-dos: disminución total de las técnicas invasivas del 54% por disminución de la tasa de amniocentesis, manteniéndose constante la tasa de biopsias coriales. La tasa de pérdidas fetales por técnica invasiva alcanza el 0%. Usamos seis indicadores de calidad para evaluar el test. Se hanahorrado 70200 euros con la implementación del test de DNA-lc. Discusión: el test de DNAlc resulta útil en el cribado contingente de cromosomopatías porque reduce la tasa de amniocentesis por indicación de alto riesgo y además es coste efectivo. El cribado combinado de primer trimestre es la técnica de elección para el cribado de aneuploidias. El test de DNAlc no puede sustituir al cribado combinado porque es caro, pero resulta muy útil si se realiza cribado contingente a la población seleccionada de riesgo intermedio.

Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012.

BACKGROUND: Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains. OBJECTIVES: To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries. METHODS: We conducted an observational study, using data from 24 population- and hospital-based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution. RESULTS: Between years 2001 and 2012, the overall first-week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first-week mortality occurred on the first day of life. In programmes where information on long-term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%-96% in Europe, and 86%-96% in North America. CONCLUSIONS: Our multi-country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.

[Methicillin resistance and vancomycin susceptibility pattern among blood isolates of Staphylococcus aureus]. / Resistencia a meticilina y susceptibilidad a vancomicina de Staphylococcus aureus aislados de sangre.

BACKGROUND: Staphylococcus aureus is capable of acquiring resistance against all antimicrobial agents. Vancomycin has been the cornerstone therapy for serious methicillin-resistant S. aureus infections. However, vancomycin treatment failures have been reported. METHODS: From March to August 2010, S. aureus blood isolates were included to determine methicillin-resistance and the vancomycin susceptibility by using a standard microdilution method. To detect methicillin-resistance, a Mueller-Hinton agar plate added with oxacillin 4 µg/mL and 2 % NaCl, and an agglutination test were used. Growth of S. aureus on the agar plate and/or reactive agglutination defined a methicillin-resistant organism. Vancomycin susceptibility was assessed by determining the minimal inhibitory concentration (MIC) in Muelller-Hinton agar plates prepared with dilutions ranging from 16 to 0.5 µg/mL. RESULTS: A total of 25 blood-isolates of S. aureus were included. A 60 % was methicillin-resistant. All isolates were vancomycin-susceptible (MIC ≤ 2 µg/mL) showing the next MICs distribution: 48 % ≤ 0.5 µg/mL; 44 % 1 µg/mL, and 8 % 2 µg/mL. CONCLUSION: The high proportion of methicillin-resistance among S. aureus and the presence of vancomycin susceptible phenotypes (MIC of 2 µg/mL) not only claim for an enforcement of standard precautions and antimicrobial control, but also for a regular surveillance of vancomycin susceptibility pattern using a reference method.

Introducción: el Staphylococcus aureus es capaz de desarrollar resistencia a todos los antimicrobianos. La vancomicina es clave para tratar infecciones graves causadas por S. aureus meticilino-resistente. Sin embargo, últimamente se reportan fallas terapéuticas. El objetivo fue establecer la resistencia a la meticilina y el perfil de susceptibilidad a la vancomicina del S. aureus. Métodos: de marzo a agosto del 2010, se determinó la meticilino-resistencia y la susceptibilidad a vancomicina de S. aureus aislados de hemocultivos, mediante el método estándar de microdilución. Para la meticilino-resistencia se utilizó una placa de agar Mueller-Hinton con 4 µg/mL de oxacilina, más NaCl al 2 % y una prueba de aglutinación. El desarrollo bacteriano o la aglutinación positiva identificaron al microorganismo meticilino-resistente. Para la susceptibilidad a vancomicina se determinó la concentración mínima inhibitoria (CMI) en placas de agar Mueller-Hinton con dilución de 16 a 0.5 µg/mL. Resultados: en total se incluyeron 25 S. aureus. El 60 % fue meticilino-resistente; el 100 % sensible a vancomicina (CMI ≤ 2 µg/mL), con las siguientes CMI: el 48 %, ≤ 0.5 µg/mL; 44 %, 1 µg/mL; y el 8 %, 2 µg/mL. Conclusión: la proporción alta de meticilino-resistencia y la evidencia de fenotipos sensibles a la vancomicina, pero asociados a falla terapéutica (CMI 2 µg/mL), demandan no solo el reforzamiento continuo de las precauciones estándar y el control de antimicrobianos sino también la vigilancia sistemática del patrón de susceptibilidad a la vancomicina con un método de referencia.

[Hospital outbreak of urinary tract infections by lubricant gel contaminated with Burkholderia cepacia]. / Infecciones urinarias nosocomiales. Contaminación de gel con Burkholderia cepacia.

BACKGROUND: Burkholderia cepacia (B. cepacia) has been the causal agent of infectious hospital outbreaks. METHODS: a case-controls study was conducted to describe an outbreak of urinary tract infection associated to lubricant-gel contaminated with B. cepacia. Patients who developed UTIsc were included in this study. Their clinical data, urine cultures, antiobiograms and the molecular bacterial analysis were analyzed. RESULTS: the urine culture was positive in 101 (55.8 %); the bacterial strains isolated were: B. cepacia 30.7 %, Escherichia coli 22.7 %, Enterococcus faecalis 9.9 %, Enterococcus spp. 8.9 %. They were 31 patients with B. cepacia isolation that was taken as the cases group and 63 with UTIsc due to another organism as control group. The Charlson comorbidity index was 5.3 ± 1.8 for cases and 4.5 ± 1.2 for controls. The factors associated with death were: heart disease, diabetes, pneumonia, bacteremia and UTIsc B. cepacia. CONCLUSIONS: the lubricant gel used for urinary catheter placement originated the outbreak. Heart disease, pneumonia, bacteremia and UTIsc B. cepacia were related to patients' death.

Cyclopia: an epidemiologic study in a large dataset from the International Clearinghouse of Birth Defects Surveillance and Research.

Cyclopia is characterized by the presence of a single eye, with varying degrees of doubling of the intrinsic ocular structures, located in the middle of the face. It is the severest facial expression of the holoprosencephaly (HPE) spectrum. This study describes the prevalence, associated malformations, and maternal characteristics among cases with cyclopia. Data originated in 20 Clearinghouse (ICBDSR) affiliated birth defect surveillance systems, reported according to a single pre-established protocol. A total of 257 infants with cyclopia were identified. Overall prevalence was 1 in 100,000 births (95%CI: 0.89-1.14), with only one program being out of range. Across sites, there was no correlation between cyclopia prevalence and number of births (r = 0.08; P = 0.75) or proportion of elective termination of pregnancy (r = -0.01; P = 0.97). The higher prevalence of cyclopia among older mothers (older than 34) was not statistically significant. The majority of cases were liveborn (122/200; 61%) and females predominated (male/total: 42%). A substantial proportion of cyclopias (31%) were caused by chromosomal anomalies, mainly trisomy 13. Another 31% of the cases of cyclopias were associated with defects not typically related to HPE, with more hydrocephalus, heterotaxia defects, neural tube defects, and preaxial reduction defects than the chromosomal group, suggesting the presence of ciliopathies or other unrecognized syndromes. Cyclopia is a very rare defect without much variability in prevalence by geographic location. The heterogeneous etiology with a high prevalence of chromosomal abnormalities, and female predominance in HPE, were confirmed, but no effect of increased maternal age or association with twinning was observed.

Frecuencia del polimorfismo Gly1057Asp del gen IRS-2 en un grupo de la población cubana, y su relación con la diabetes mellitus 2 y el sobrepeso / Frequency of Gly105Asp polymorphism of the IRS-2 gene in a group of the Cuban population: its relation to Type 2 diabetes mellitus and the overweight

La diabetes mellitus tipo 2 es una de las epidemias de mayor impacto a nivel mundial. La susceptibilidad genética constituye un importante factor de riesgo en ella, que se adiciona al efecto de los factores ambientales y al modo de vida. Explorar el papel del polimorfismo Gly1057Asp del gen IRS-2 en la susceptibilidad genética para la diabetes mellitus tipo 2. Se estudió la frecuencia del polimorfismo Gly1057Asp del IRS-2 en 499 ciudadanos cubanos, con IMC³22 y <30, con edades comprendidas entre los 40 y 70 años, de ellos 272 (54,5 por ciento) diabéticos y 227 (45,5 pro ciento) no diabéticos. Para la comparación de las frecuencias de este polimorfismo en ambos grupos utilizamos la prueba chi cuadrado (p<0,05) y para la cuantificación de las asociaciones se utilizó la razón de productos cruzados. La frecuencia del alelo Asp1057 del polimorfismo Gly1057Asp del gen IRS-2 fue de 49,8 por ciento en el grupo de pacientes diabéticos, y de 58,8 por ciento en el grupo de los no diabéticos (p<0,05), lo cual sugiere que este alelo confiere protección contra la diabetes. Sin embargo, este patrón de distribución de frecuencias cambia en personas con sobrepeso, en las que la presencia del alelo Asp1057 llega a asociarse al hiperinsulinismo. En sujetos con antecedentes paternos y/o maternos de diabetes mellitus tipo 2 la acción protectora del alelo Asp1057 no se expresa. En el grupo de la población cubana estudiada el alelo Asp1057 del gen IRS-2 confiere protección para la diabetes mellitus tipo 2. El sobrepeso y los antecedentes maternos y/o paternos de diabetes modifican esta acción protectora(AU)

Type 2 diabetes mellitus is one of the more hard-bitting pandemic at world level. Genetic susceptibility is an important risk factor of it, as well as the effect of environmental factors, and lifestyles. to explore role of Gly1057Asp polymorphism of IRS-2 gene in genetic oversensitivity for Type 2 diabetes mellitus. Frequency of Gly1057Asp polymorphism of IRS-2 gene in was studied in 499 Cuban citizens, with IMC³22 and <30, aged from 40 to 70, of them, 272 (54,5 percent) were diabetic people and 277 (45,5 percent) were non-diabetic. For comparison of frequency of this polymorphism in both groups, we used 2Chi test (p<0,05), and to quantify associations, we used crossed-products ratio. Frequency of Asp1057 allele of Gly1057Asp polymorphism of IRS-2 gene was of 49,8 percent in diabetic patient group, and of 58,8 percent in the group on non-diabetic one (p<0,05), suggesting that this allele confers protection against diabetes. However, this pattern of frequency distribution changes in persons overweighed, in which presence of Asp1057 allele becomes associated with hyperinsulinism. In subjects with family backgrounds of Type 2 diabetes mellitus, protection of Asp1057 allele is not expressed. In group of study Cuban population, Asp1057 allele of IRS-2 gene confers protection against Type 2 diabetes mellitus. Overweight and family backgrounds modify this protective action(AU)

Diagnóstico de necesidades de tratamientos de operatoria dental en escolares de 4-6, 7-8 y 12-14 años de edad que pertenecen al programa de escuela saludable del sistema básico de salud integral de Cojutepeque / Diagnosis of dental surgery treatment needs in schoolchildren aged 4-6, 7-8 and 12-14 who belong to the healthy school program of the basic comprehensive health system of Cojutepeque

El alto número de obturaciones indicadas para limitar el daño causado por caries dental en niños beneficiarios del Programa Escuela Saludable del SIBASI Cojutepeque, dio origen a la inquietud de establecer mediante una investigación las cantidades promedios de tratamientos de operatoria dental que es necesario realizar en cada escolar cubierto por el Programa Gubernamental de Salud Pública. En el año 2002 el equipo de profesionales encargados del componente odontológico del Programa Escuela Saludable estableció un 23.57% de obturaciones realizadas con respecto al 70.74% de dientes cariados. La caries dental se define según F.V. Domínguez como una secuencia de procesos de destrucción localizados en los tejidos duros dentarios que evoluciona en forma irreversible y que comienza en la superficie del diente y luego avanza en profundidad (BARRANCOS M. 1999); esta enfermedad es de alta prevalencia en la comunidad, y en los últimos años se ha producido un importante incremento en países desarrollados y subdesarrollados. Una vez establecida es progresiva y no tiene cura espontánea, si su tratamiento se pospone es cada vez más complejo y costoso. Para detener el proceso de la caries dental existe una rama de la odontología que enseña a restaurar el diente afectado por procesos patológicos, traumáticos, defectos congénitos, alteraciones estéticas, deficiencias funcionales o toda otra causa que puede alterar su función dentro del aparato masticatorio y a prevenir la iniciación de lesiones futuras denominada Operatoria Dental (BARRANCOS M. 1987). En la presente investigación, la caries dental se estableció como variable independiente y el grado de avance de la caries como variable dependiente, con la medición de ambas variables se obtuvo indirectamente las necesidades de tratamientos de operatoria dental. El propósito de realizar el estudio fue elaborar el diagnóstico de necesidades de tratamientos de operatoria dental en los escolares de 4-14 años que pertenecen al Programa Escuela Saludable. La importancia de los resultados radica en el aporte al Ministerio de Salud Pública y Asistencia Social para planificar con datos completos las diferentes estrategias para abordar la demanda de tratamientos y la asignación de insumos y recursos humanos que deben incluirse en el Plan Operativo anual; en base a los recursos asignados se debe establecer la búsqueda de alternativas que permitan brindar una mejor atención odontológica a dicho programa, con el fin de disminuir los índices de caries a un mediano plazo. Durante el desarrollo de esta investigación la principal limitante la constituyó el hecho de trabajar con fichas previamente elaboradas por diferentes odontólogos, encontrando datos incompletos, escolares con fichas faltantes y poca colaboración de algunos odontólogos.

The high number of fillings indicated to limit the damage caused by dental caries in children benefiting from the Healthy School Program of the SIBASI Cojutepeque, gave rise to the concern to establish through an investigation the average amounts of dental surgery treatments that need to be carried out in each school. covered by the Government Public Health Program. In 2002, the team of professionals in charge of the dental component of the Healthy School Program established 23.57% of fillings made compared to 70.74% of decayed teeth. Dental caries is defined according to F.V. Domínguez as a sequence of destruction processes located in dental hard tissues that evolves irreversibly and begins on the surface of the tooth and then progresses in depth (BARRANCOS M. 1999); This disease is highly prevalent in the community, and in recent years there has been a significant increase in developed and underdeveloped countries. Once established, it is progressive and has no spontaneous cure, if its treatment is postponed it is increasingly complex and expensive. To stop the process of dental caries there is a branch of dentistry that teaches to restore the tooth affected by pathological, traumatic processes, congenital defects, aesthetic alterations, functional deficiencies or any other cause that can alter its function within the masticatory apparatus and to prevent the initiation of future injuries called Operatoria Dental (BARRANCOS M. 1987). In the present investigation, dental caries was established as an independent variable and the degree of advancement of caries as a dependent variable, with the measurement of both variables, the needs for dental surgery treatments were indirectly obtained. The purpose of conducting the study was to make a diagnosis of dental surgery treatment needs in schoolchildren aged 4-14 who belong to the Healthy School Program. The importance of the results lies in the contribution to the Ministry of Public Health and Social Assistance to plan with complete data the different strategies to address the demand for treatments and the allocation of supplies and human resources that should be included in the annual Operational Plan; Based on the resources assigned, a search for alternatives should be established that allow better dental care to be provided to said program, in order to reduce caries rates in the medium term. During the development of this research, the main limitation was the fact of working with files previously prepared by different dentists, finding incomplete data, school children with missing files and little collaboration from some dentists.