Trends and characteristics of fetal and neonatal mortality due to congenital anomalies, Colombia 1999-2008.

OBJECTIVE: To describe fetal and neonatal mortality due to congenital anomalies in Colombia. METHODS: We analyzed all fetal and neonatal deaths due to a congenital anomaly registered with the Colombian vital statistics system during 1999-2008. RESULTS: The registry included 213,293 fetal deaths and 7,216,727 live births. Of the live births, 77,738 (1.08%) resulted in neonatal deaths. Congenital anomalies were responsible for 7321 fetal deaths (3.4% of all fetal deaths) and 15,040 neonatal deaths (19.3% of all neonatal deaths). The fetal mortality rate due to congenital anomalies was 9.9 per 10,000 live births and fetal deaths; the neonatal mortality rate due to congenital anomalies was 20.8 per 10,000 live births. Mortality rates due to congenital anomalies remained relatively stable during the study period. The most frequent fatal congenital anomalies were congenital heart defects (32.0%), central nervous system anomalies (15.8%), and chromosomal anomalies (8.0%). Risk factors for fetal and neonatal death included: male or undetermined sex, living in villages or rural areas, mother's age >35 years, low and very low birthweight, and <28 weeks gestation at birth. CONCLUSIONS: Congenital anomalies are an important cause of fetal and neonatal deaths in Colombia, but many of the anomalies may be preventable or treatable.

Sensibilidad y Especificidad de la Citología Cervicouterina y la prueba PCRhrHPV con el diagnóstico Histopatológico, en el Hospital "Solon Espinosa Ayala", Solca-Quito / Sensitivity and Specificity of cervical cytological diagnoses, PCR-hrHPV test and histopathological diagnoses, at the "Solón Espinosa Ayala" Hospital, Solca Quito

Introducción: La implementación de las pruebas moleculares para la detección de la infección por hrHPV ha generado cambios en las directrices del tamizaje en la detección oportuna del carcinoma cervicouterino. El objetivo del estudio es presentar la sensibilidad y especificidad de los estudios citológicos y las pruebas moleculares con los estudios histológicos. Métodos: Se realizó un estudio transversal, retrospectivo en el hospital de Solca-Quito de enero a diciembre 2014. Se recolectaron los casos con los diagnósticos citológicos cervicouterinos, los resultados de la prueba de PCR tiempo real de hrHPV (Hibribio®) y los diagnósticos histopatológicos en las pacientes a las que se realizó biopsia. El análisis realizado fue "de prueba diagnóstica" para medir la sensibilidad y especificidad de las pruebas. Resultados: 730 estudios moleculares de hrHPV conjuntamente con estudios citológicos fueron realizados. Los casos positivos para hrHPV fueron 301/730 casos (41.2 %). La mayoría de casos hrHPV positivos corresponde a los genotipos 16/18 (59.5 %) y se encuentra en los rangos de edad entre 30 y 49 años (58.8 %). En 168 casos se realizó además estudio histopatológico, en los que se determinó la sensibilidad (S) de la citología Vs Histología la cual fue de 76 %, la especificidad (E) fue de 48 %, con un valor predictivo positivo (VPP) de 90 %. La S de HrHPV vs Histología fue de 74%, E 39 %, VPP 89 %; la S de Citología + HrHVP vs Histología fue de 91 %, E 40 %, VPP 90 %. Conclusión: La mayor sensibilidad para el diagnóstico de cáncer cervicouterino la realización de la Citología y la presencia de HrHVP. La mayor especificidad se consiguió con el estudio de Citología.

Introduction: The implementation of molecular tests for the detection of hrHPV infection has generated changes in the screening guidelines in the timely detection of cervical carcinoma. The aim of the study is to present the sensitivity and specificity of cytological studies and molecular tests with histological studies. Methods: A cross-sectional, retrospective study was carried out in the Solca-Quito hospital from January to December 2014. Cases were collected with cervical cytological diagnoses, the results of the real-time PCR test of hrHPV (Hibribio®) and the diagnoses Histopathological findings in patients who underwent a biopsy. The analysis performed was "diagnostic test" to measure the sensitivity and specificity of the tests. Results: 730 molecular studies of hrHPV in conjunction with cytological studies were performed. The positive cases for hrHPV were 301/730 cases (41.2 %). The majority of hrHPV positive cases correspond to genotypes 16/18 (59.5 %) and are in the age ranges between 30 and 49 years (58.8 %). In 168 cases, a histopathological study was also carried out, in which the sensitivity (S) of the cytology Vs Histology was determined, which was 76 %, the specificity (E) was 48 %, with a positive predictive value (PPV) of 90 % The S of HrHPV vs Histology was 74%, E 39%, PPV 89 %; S for Cytology + HrHVP vs Histology was 91 %, E 40 %, PPV 90 %. Conclusion: The highest sensitivity for the diagnosis of cervical cancer is the completion of Cytology and the presence of HrHVP. The highest specificity was obtained with the Cytology study.

[Geographic distribution of perinatal mortality due to congenital malformations in Colombia, 1999-2008: An analysis of vital statistics data].

INTRODUCTION: During 2012, 13% of the deaths worldwide in children under the age of 28 days were due to congenital malformations. In Colombia, congenital malformations are the second leading cause of infant mortality. Objective: To determine the geographical distribution of extended perinatal mortality due to congenital malformations in Colombia between 1999 and 2008. Materials and methods: We conducted a cross-sectional study. We revised all death certificates issued between 1999 and 2008. We defined perinatal mortality as fetal or non-fetal deaths within the first 28 days after delivery in children with body weight ≥500 grams, and congenital malformations according to ICD-10 diagnostic codes Q000 - Q999. The annual birth projection was used as the denominator. We defined high mortality areas due to congenital malformations as those in the 90th percentile. Results: We recorded 22,361 perinatal deaths due to congenital malformations. The following provinces exceeded the 90th perinatal mortality percentile: Antioquia, Caldas, Risaralda, Huila, Quindío, Bogotá, Valle del Cauca and Guainía. Among the municipalities, the highest perinatal mortality rates were found in Giraldo, Ciudad Bolívar, Riosucio, Liborina, Supía, Alejandría, Sopetrán, San Jerónimo, Santa Fe de Antioquia and Marmato (205.81 and 74.18 per 10.000 live births).The perinatal mortality rate due to malformations of the circulatory system was 28.1 per 10.000 live births, whereas the rates for central nervous system defects and chromosomal abnormalities were 13.7 and 7.0, respectively. CONCLUSIONS: The Andean region showed high perinatal mortality rates due to congenital malformations. There is an urgent need to identify possible risk factors of perinatal mortality and implement successive prevention programs in that particular region.

Áreas de alta mortalidad perinatal debida a anomalías congénitas: análisis de estadísticas vitales, Colombia, 1999-2008 / Geographic distribution of perinatal mortality due to congenital malformations in Colombia, 1999-2008: An analysis of vital statistics data

Introducción. Durante 2012, las anomalías congénitas fueron la causa de 13 % de las muertes en menores de 28 días a nivel mundial y, en Colombia constituyeron la segunda causa de mortalidad infantil. Objetivo. Determinar la distribución geográfica de la mortalidad perinatal por anomalías congénitas en Colombia entre 1999 y 2008. Materiales y métodos. Se hizo un estudio descriptivo revisando los certificados de defunción de Colombia. La muerte perinatal se definió como muerte fetal y no fetal en niños con un peso de 500 g o más y 28 o menos días de edad, y las anomalías congénitas, como causa básica de la muerte (Clasificación Internacional de Enfermedades - CIE10: Q000 a Q999). La proyección nacional de nacimientos se tomó como el denominador de las tasas específicas. Se calcularon los percentiles para analizar las áreas de alta mortalidad (percentil de 90 o más). Resultados. Se encontraron 22.361 muertes perinatales por anomalías congénitas. Antioquia, Caldas, Risaralda, Huila, Quindío, Bogotá, Valle del Cauca y Guainía superaron, en promedio, el percentil 90 durante los diez años de estudio. Los municipios con mayores tasas de mortalidad fueron: Giraldo, Ciudad Bolívar, Riosucio, Liborina, Supía, Alejandría, Sopetrán, San Jerónimo, Santa Fe de Antioquia y Marmato, en donde oscilaron entre 205,81 y 74,18 por 10.000 nacimientos. Las tasas de mortalidad perinatal por 10.000 nacidos vivos fueron de 28,1 para el grupo de malformaciones del sistema circulatorio; de 13,7 para anomalías del sistema nervioso central, y de 7,0 para anomalías cromosómicas. Conclusión. La alta mortalidad perinatal por anomalías congénitas en la región andina requiere acciones urgentes de investigación sobre los posibles riesgos y medidas de prevención.

Introduction: During 2012, 13% of the deaths worldwide in children under the age of 28 days were due to congenital malformations. In Colombia, congenital malformations are the second leading cause of infant mortality. Objective: To determine the geographical distribution of extended perinatal mortality due to congenital malformations in Colombia between 1999 and 2008. Materials and methods: We conducted a cross-sectional study. We revised all death certificates issued between 1999 and 2008. We defined perinatal mortality as fetal or non-fetal deaths within the first 28 days after delivery in children with body weight =500 grams, and congenital malformations according to ICD-10 diagnostic codes Q000 - Q999. The annual birth projection was used as the denominator. We defined high mortality areas due to congenital malformations as those in the 90 th percentile. Results: We recorded 22,361 perinatal deaths due to congenital malformations. The following provinces exceeded the 90th perinatal mortality percentile: Antioquia, Caldas, Risaralda, Huila, Quindío, Bogotá, Valle del Cauca and Guainía. Among the municipalities, the highest perinatal mortality rates were found in Giraldo, Ciudad Bolívar, Riosucio, Liborina, Supía, Alejandría, Sopetrán, San Jerónimo, Santa Fe de Antioquia and Marmato (205.81 and 74.18 per 10.000 live births).The perinatal mortality rate due to malformations of the circulatory system was 28.1 per 10.000 live births, whereas the rates for central nervous system defects and chromosomal abnormalities were 13.7 and 7.0, respectively. Conclusions: The Andean region showed high perinatal mortality rates due to congenital malformations. There is an urgent need to identify possible risk factors of perinatal mortality and implement successive prevention programs in that particular region.

Maternal mortality due to pandemic influenza A H1N1 2009 virus in Colombia.

AIMS: The 2009 H1N1 pandemic illustrated the higher morbidity and mortality from viral infections in peripartum women. We describe clinical features of women who recently died of H1N1 in Colombia. METHODS: This is a case series study that was gathered through a retrospective record review of all maternal H1N1 deaths in the country. The national mortality database of confirmed mortality from H1N1 in pregnancy and up to 42 days after delivery was reviewed during the H1N1 season in 2009. Women with H1N1 infections were confirmed by the laboratory of virology. Demographic, clinical, and laboratory data were reviewed. Statistical analyses were performed and median values of non-parametric data were reported with inter-quartile range (IQR). RESULTS: A total of 23 H1N1 maternal deaths were identified. Eighty-three percent occurred in the third trimester. None of the mothers who died had received influenza vaccination. The median time from symptom onset to the initiation of antiviral treatment was 8.8 days (IQR 5.8-9.8). Five fatalities did not receive any anti-viral therapy. Median PaO2/FiO2 on day 1 was 80 (IQR, 60-98.5). All patients required inotropic support and mechanical ventilation with barotrauma-related complications of mechanical ventilation occurring in 35% of patients. CONCLUSION: In Colombia, none of the women suffering H1N1-related maternal deaths had received vaccination against the disease and most had delayed or had no anti-viral therapy. Given the lack of evidence-based clinical predictors to identify women who are prone to die from H1N1 in pregnancy, following international guidelines for vaccination and initiation of antiviral therapy in suspected cases would likely improve outcomes in developing countries.

Interculturalidad entre chapacos, quechuas, aymaras y cambas en tarija

El conocimiento sistemático de la trama social en permanente construcción como producto de la influencia de factores económicos, culturales y siciopolíticos con los que conviven cotidianamente los pobladores de las nuevas urbanizaciones de Tarija, es una de las contribucuiones de este trabajo. Busca esclarecer las interrelaciones entre las culturas chapaca, camba, quechua y aymara, identificar las formas en que se integran y relacionan, e indagar sobre los valores que se mantienen y se reconstruyen permanentemente considerando el cambio en los lenguajes y costumbres cotidianas de los grupos sociales que se analizan.