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dc.contributor.advisorUribe Pérez, Claudia Janethspa
dc.contributor.advisorHormiga Sánchez, Claudia Milenaspa
dc.contributor.authorAssaf Pastrana, José Ricardospa
dc.coverage.spatialSantander (Colombia)spa
dc.coverage.temporal2015-2016spa
dc.date.accessioned2020-06-26T19:59:52Z
dc.date.available2020-06-26T19:59:52Z
dc.date.issued2018
dc.identifier.urihttp://hdl.handle.net/20.500.12749/1729
dc.description.abstractEl cáncer gástrico (CG) es una de las patológicas malignas más frecuentes a nivel mundial y es un problema de igual importancia en nuestra región con una alta carga de morbi-mortalidad. La iniquidad social ha demostrado ser un factor de riesgo para un desenlace desfavorable en la sobrevida del cáncer en general. Uno de los procedimientos diagnósticos más importantes para su diagnóstico y tamizaje es la EVDA, sin embargo, esta no está disponible para la totalidad de la población por diferentes razones. El objetivo de este estudio fue caracterizar el proceso diagnóstico del CG en nuestra región, con la finalidad de encontrar diferencias en cuanto a las variables sociodemográficas y proceso diagnostico que incidan de manera negativa el diagnóstico final de CG en el departamento de Santander. Se realizo un análisis secundario de un estudio descriptivo, poblacional, prospectivo, previo, cofinanciado por COLCIENCIAS (124165741298), cuya población objeto estuvo constituida por adultos residentes en el departamento de Santander diagnosticados de CG durante el periodo 2015 – 2016. Se realizaron análisis bivariados para explorar diferencias entre variables del proceso diagnóstico según variables sociodemográficas y características del tumor y se calculó la sensibilidad diagnostica de la EVDA explorando la variable de numero de fragmentos por procedimiento endoscópico. Se incluyeron un total de 483 pacientes. La mediana de edad fue de 67 años y el 59.8% fueron hombres. 61,9% de la totalidad de los casos pertenecían al régimen contributivo y 31,1% al subsidiado. 61,4% se encontraban viviendo en el Área metropolitana de Bucaramanga (AMB). El Tipo histológico de cáncer más frecuentemente encontrado fue el de tipo intestinal (35.4%) siendo estos los casos con edad relativamente más joven. El estadio más frecuente al Diagnostico fue el estadio IV (76,5%) y la mayoría eran hombres. El método diagnostico más usado fue la endoscopia de vías digestivas altas (EVDA) y esta fue más frecuentemente realizada en los residentes del AMB (χ²=8.7838, P=0.003). El diagnostico solo por certificado de defunción alcanzo una cifra del 14.9%. En total se realizaron 456 procedimientos endoscópicos a 393 pacientes, alcanzándose una positividad en 85,7% de los casos. De los casos que aportaron información sobre el número de fragmentos se encontró una mediana de extracción de 6 fragmentos por procedimiento endoscópico, alcanzando una sensibilidad >90% cuando se obtuvieron >4 fragmentos. El tiempo total del procedimiento diagnostico que comprendía desde la toma de la primeara biopsia por EVDA hasta confirmación histopatológica por cualquier medio tuvo una mediana de 6 días. Este estudio provee una visión epidemiológica del proceso diagnóstico del CG en el departamento, donde las variables sociodemográficas y características de los tumores no difieren en gran medida de las reportadas en América latina. Factores como la residencia en sectores fuera del AMB mostró ser un factor de riesgo para la falta de confirmación histopatológica. Otros hallazgos como el tiempo de proceso diagnóstico y número de fragmentos mostraron una correlación similar con lo observado en estudios prospectivos controlados en otras poblaciones. Es importante resaltar el gran número de casos sin dato, así como también el gran porcentaje con diagnóstico solo por certificado de defunción, lo cual refleja las falencias en el proceso de notificación de la enfermedad en nuestra región y que constituye una limitación para futuros análisis. Es necesario profundizar en algunas de las asociaciones encontradas, mediante recolección de un mayor número de casos y análisis multivariados los cuales no se justificaban realizarse en este trabajo por la cantidad de casos sin dato y porque las variables calve del proceso diagnostico como el tiempo, no mostraron diferencias entre las variables analizadas.spa
dc.description.tableofcontentsRESUMEN DEL PROYECTO 4 1. JUSTIFICACIÓN DEL PROBLEMA. 6 2. MARCO TEÓRICO 8 2.1 Epidemiología 8 2.2 Etiología y factores de riesgo 9 Helicobacter Pylori 9 2.3 Manifestaciones Clínicas 10 2.4 Prevención primaria del Cáncer Gástrico 10 Cambios en el Estilo de Vida 10 Antioxidantes 10 Recomendaciones para el diagnóstico temprano del CG. 11 2.5 Diagnóstico 11 Biopsia gástrica 12 Clasificación morfológica 12 2.6 Estadificación. 14 2.7 Estadio clínico y selección de tratamiento. 15 2.8 Tratamiento 15 3. ESTADO DEL ARTE 17 4. OBJETIVOS 18 4.1 OBJETIVO GENERAL 18 4.2 OBJETIVOS ESPECIFICOS 18 5. METODOLOGIA 19 5.1 TIPO DE ESTUDIO 19 5.2 POBLACION 19 5.3 CRITERIOS DE INCLUSION 19 5.4 MUESTRA 19 5.5 RECOLECCION DE LA INFORMACION 19 5.6 VARIABLES 20 5.7 ANALISIS DE DATOS 22 5.8 CONSIDERACIONES ETICAS 23 6. RESULTADOS 24 6.1 Características de los casos 24 6.2 Características de los tumores 25 6.3 Proceso Diagnostico 29 7. DISCUSION 34 Trayectoria del Equipo de investigación 39 Bibliografía 42spa
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleCaracterización del proceso de diagnóstico histopatológico para el cáncer gástrico en Santander en el periodo 2015-2016spa
dc.title.translatedCharacterization of the histopathological diagnosis process for gastric cancer in Santander in the period 2015-2016eng
dc.degree.nameEspecialista en Medicina Internaspa
dc.coverageBucaramanga (Santander, Colombia)spa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Internaspa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsGastric neoplasmseng
dc.subject.keywordsStomach cancereng
dc.subject.keywordsHistopathological diagnosiseng
dc.subject.keywordsMedicineeng
dc.subject.keywordsInternal medicineeng
dc.subject.keywordsInvestigationseng
dc.subject.keywordsComplicationseng
dc.subject.keywordsPatientseng
dc.subject.keywordsPrevention and controleng
dc.subject.keywordsOncologyeng
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
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dc.subject.lembNeoplasias gástricasspa
dc.subject.lembCáncer de estómagospa
dc.subject.lembDiagnóstico histopatológicospa
dc.subject.lembMedicinaspa
dc.subject.lembMedicina internaspa
dc.subject.lembInvestigacionesspa
dc.subject.lembComplicacionesspa
dc.subject.lembPacientesspa
dc.subject.lembPrevención y controlspa
dc.description.abstractenglishGastric cancer (GC) is one of the most frequent malignant pathologies worldwide and is an equally important problem in our region with a high burden of morbidity and mortality. Social iniquity has been shown to be a risk factor for an unfavorable outcome in overall cancer survival. One of the most important diagnostic procedures for its diagnosis and screening is EVDA, however, this is not available for the entire population for different reasons. The objective of this study was to characterize the diagnostic process of GC in our region, in order to find differences in terms of sociodemographic variables and diagnostic process that negatively affect the final diagnosis of GC in the department of Santander. A secondary analysis of a previous descriptive, population-based, prospective study was carried out, co-financed by COLCIENCIAS (124165741298), whose target population consisted of adults living in the department of Santander diagnosed with GC during the period 2015 - 2016. Bivariate analyzes were performed to explore differences between variables of the diagnostic process according to sociodemographic variables and characteristics of the tumor and the diagnostic sensitivity of EVDA was calculated by exploring the variable of number of fragments by endoscopic procedure. A total of 483 patients were included. The median age was 67 years and 59.8% were men. 61.9% of all cases belonged to the contributory regime and 31.1% to the subsidized one. 61.4% were living in the Bucaramanga metropolitan area (AMB). The most frequently found histological type of cancer was the intestinal type (35.4%), these being the cases with a relatively younger age. The most frequent stage at diagnosis was stage IV (76.5%) and the majority were men. The most used diagnostic method was upper digestive tract endoscopy (EVDA) and this was more frequently performed in residents of the AMB (χ² = 8.7838, P = 0.003). The diagnosis only by death certificate reached a figure of 14.9%. In total, 456 endoscopic procedures were performed in 393 patients, reaching a positivity in 85.7% of the cases. Of the cases that provided information on the number of fragments, a median extraction of 6 fragments was found by endoscopic procedure, reaching a sensitivity> 90% when> 4 fragments were obtained. The total time of the diagnostic procedure that comprised from taking the first biopsy by EVDA to histopathological confirmation by any means had a median of 6 days. This study provides an epidemiological vision of the diagnostic process of GC in the department, where the sociodemographic variables and characteristics of the tumors do not differ greatly from those reported in Latin America. Factors such as residence in sectors outside the AMB were shown to be a risk factor for the lack of histopathological confirmation. Other findings such as the diagnostic process time and the number of fragments showed a similar correlation with what was observed in prospective controlled studies in other populations. It is important to highlight the large number of cases without data, as well as the large percentage with a diagnosis only by death certificate, which reflects the shortcomings in the notification process of the disease in our region and constitutes a limitation for future analyzes. It is necessary to delve into some of the associations found, by collecting a greater number of cases and multivariate analyzes, which were not justified in this work due to the number of cases without data and because the key variables of the diagnostic process, such as time, are not showed differences between the variables analyzed.eng
dc.subject.proposalOncología
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*


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Atribución-NoComercial-SinDerivadas 2.5 Colombia
Except where otherwise noted, this item's license is described as Atribución-NoComercial-SinDerivadas 2.5 Colombia