RESUMO
La COVID-19 es la enfermedad causada por el nuevo coronavirus conocido como SARS-CoV-2. Para finales del 2020, la FDA de los Estados Unidos aprobó la primera vacuna para su uso de emergencia contra el COVID-19, desarrollada por Pfizer y BioNTech (BNT162b2). Este nuevo tipo de vacuna utiliza ARN mensajero modificado, el cual le da instrucciones al organismo para generar un fragmento de la proteína espiga de la superficie del virus, y que por sí sola desencadena una respuesta inmunitaria que ayuda a proteger el organismo contra una infección por COVID-19. Dentro de los eventos adversos menos comunes reportados en los estudios clínicos iniciales está la linfadenopatía (0.3 %). Objetivo: reportar el caso de paciente masculino que acude a evaluación sonográfica por preocupación de nódulo palpable en región supraclavicular. Resultados: a la evaluación sonográfica se observa cadena ganglionar reactiva compatible con una linfadenopatía. Paciente reporta vacunación de refuerzo con la vacuna Pfizer 8 días antes de la evaluación, subsecuente a dos vacunas Coronavac, corroborando de que se trata de una linfadenopatía reactiva, secundaria a una respuesta inmune robusta al refuerzo con la vacuna Pfizer. Se realiza una medición de Anti-SARS-CoV-2 TrimericS IgG cuantitativa a los 15 días del refuerzo con Pfizer, reportando valores elevados de 10,600 BAU/mL. Se orientó al paciente a regresar en una semana para seguimiento ecográfico, el cual evidenció resolución espontánea sin secuelas. Conclusiones: los hallazgos de adenopatía axilar o supraclavicular unilateral subsecuentes a la vacunación por COVID-19 deben ser informados tanto a médicos como pacientes, como un efecto secundario temporal producto de la respuesta inmunológica post vacuna. Este hallazgo benigno no requiere seguimiento adicional de imágenes y mucho menos de procedimientos invasivos como biopsias, los cuales generan mucha ansiedad al paciente, además de ser muy costosos para los mismos
COVID-19 is a disease caused by a new coronavirus identified as SARS-CoV-2. Towards the end of 2020, the FDA of the United States approved the first vaccine for emergency use against COVID-19, which was developed by Pfizer and BioNTech (BNT162b2). This new type of vaccine uses a modified RNA Messenger, which gives instructions to the host cells of the vaccinated person to produce a fragment of the spike protein of the virus, which then generates an inmune response and protects the recipient of the vaccine against COVID-19. Among the adverse events less frequently reported in the initial clinical studies of the vaccine is lymphadenopathy which was reported by 0.3% of the participants. Objective: Presentation of a case report of a male subject that came to a ultrasound evaluation due to concern of a palpable nodule in the supraclavicular región. Results: Ultrasound exam showed reactive unilateral cervical and supraclavicular lymphadenopathy. Patient reports a third dose booster with the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine, 8 days prior to the evaluation, after completing a two-dose vaccination schedule with the Coronavac/Sinovac vaccine, confirming a vigorous immune response to the mRNA anti-COVID vaccines. This response was validated by elevated Anti-SARS-CoV-2 TrimericS IgG (10,600 BAU/mL). Patient was informed to return in a week for an echography follow-up which showed spontaneous resolution without leaving sequelae. Conclusions: It is of great importance to inform this benign finding of supraclavicular or axillar adenopathy subsequent to COVID vaccination to the medical community and patients, to avoid unnecessary medical interventions such as imaging or biopsies, which generate anxiety to the patient as well as additional costs
Assuntos
Humanos , Masculino , Adulto , Imunização Secundária , Linfadenopatia/induzido quimicamente , Vacina BNT162/efeitos adversos , Remissão Espontânea , Clavícula , Linfadenopatia/diagnóstico por imagem , COVID-19/prevenção & controle , Linfonodos , PescoçoRESUMO
Abstract Objective To compare the perinatal outcomes of fetuses with isolated congenital diaphragmatic hernia after fetal endoscopic tracheal occlusion (FETO) and antenatal expectant management. Data sources In this rapid review, searches were conducted in the MEDLINE, PMC, EMBASE and CENTRAL databases between August 10th and September 4th, 2020. Randomized controlled trials (RCTs), quasi-RCTs or cluster-RCTs published in English in the past ten years were included. Study selection We retrieved 203 publications; 180 studies were screened by abstract. Full-text selection was performed for eight studies, and 1 single center RCTmet the inclusion criteria (41 randomized women; 20 in the FETO group, and 21 in the control group). Data collection Data collection was performed independently, by both authors, in two steps (title and abstract and full-text reading). Data synthesis There were no cases of maternal mortality. The mean gestational age at delivery was of 35.6±2.4 weeks in the intervention group, and of 37.4±1.9 weeks among the controls (p<0.01). Survival until 6 months of age was reported in 50% of the intervention group, and in 5.8% of the controls (p<0.01; relative risk: 10.5; 95% confidence interval [95%CI]: 1.5-74.7). Severe postnatal pulmonary hypertension was found in 50% of the infants in the intervention group, and in 85.7% of controls (p=0.02; relative risk: 0.6; 95%CI: 0.4-0.9). An analysis of the study indicated some concerns of risk of bias. The quality of evidence was considered moderate to low. Conclusion Current evidence is limited but suggests that FETO may be an effective intervention to improve perinatal outcomes.
Resumo Objetivo Comparar os resultados perinatais de fetos com hérnia diafragmática congênita após oclusão traqueal endoscópica fetal (OTEF) e conduta expectante pré-natal. Fontes dos dados Nesta revisão rápida, pesquisas foram conduzidas nas bases de dados MEDLINE, PMC, EMBASE e CENTRAL entre 10 de agosto de 2020 e 4 de setembro de 2020. Ensaios clínicos randomizados (ECRs), quase-ECRs e ECRs em cluster publicados em inglês nos últimos dez anos foram incluídos. Seleção dos estudos Foram recuperadas 203 publicações; 180 destas foram triadas pelo resumo. Fez-se a leitura do texto completo de 8 estudos, e 1 ECR cumpriu os critérios de inclusão (41 mulheres aleatorizadas; 20 no grupo OTEF e 21 no grupo de controle). Coleta de dados A coleta de dados realizada independentemente pelos dois autores, em duas etapas (título e resumo, e leitura do texto completo). Síntese dos dados Não houve casos de mortematerna. A idade gestacionalmédia no parto foi de 35,6±2,4 semanas no grupo de intervenção, e de 37,4±1,9 semanas entre os controles (p<0,01). A sobrevida até 6 meses de idade foi relatada em 50% do grupo de intervenção, e em 5,8% dos controles (p<0,01; risco relativo: 10,5; intervalo de confiança de 95% [IC95%]: 1,5-74,7). Hipertensão pulmonar grave ocorreu em 50% dos lactentes do grupo de intervenção, e em 85,7% dos controles (p = 0.02; risco relativo: 0,6; IC95%: 0,4-0,9). Uma análise do estudo indicou algumas preocupações quanto ao risco de viés. A qualidade da evidência foi considerada de moderada a baixa. Conclusão As evidências atuais são limitadas,mas sugeremque a OTEF pode ser uma intervenção eficaz para melhorar resultados perinatais.
Assuntos
Doenças Fetais/cirurgia , Fetoscopia/métodos , Hérnias Diafragmáticas Congênitas/cirurgia , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Prognóstico , Sobrevida , Ultrassonografia Pré-Natal/métodos , Doenças Fetais/diagnóstico por imagem , Hipertensão Pulmonar/prevenção & controle , Pulmão/anormalidades , Pneumopatias/prevenção & controleRESUMO
ABSTRACT Objective: To report the case of a woman in the third trimester of pregnancy diagnosed with perforated acute appendicitis and secondary generalised peritonitis; and to review the published literatura on the usefulness of diagnostic imaging as part of the workup for this condition during the second half of pregnancy. Materials and methods: We present the case of a 29-year-old patient, gravida 3 para 2, referred to a high complexity institution at 35.2 weeks of gestation with a diagnostic impression of pre-term labour. The patient was taken to laparotomy after remaining under observation for 20 hours of observation, with a diagnosis of abdominal pain and acute appendicitis, and was found to have perforated appendicitis with secondary peritonitis. Post-operatively, the patient developed surgical site infection and premature labour, leading to preterm delivery with satisfactory maternal and perinatal outcome. A search for articles published in English or Spanish over the past 20 years was conducted in the Up to date, Medline vía PubMed and Science Direct databases using MeSH terms "Pregnancy," "Peritonitis," "Appendicitis", "Perforated Appendicitis," "Ultrasonic Diagnosis," "Magnetic Resonance Imaging," "Computed Tomography." Results: Overall, 20 titles directly related to the use of diagnostic imaging in pregnant women with suspected appendicitis were identified. Ultrasound is the first option used for diagnosis, but its diagnostic accuracy during the second and third trimesters is limited because, frequently, it is not possible to visualise the appendix. Sensitivity varies between 46% and 63%, and specificity between 80% and 100%. Nuclear magnetic resonance has better operational performance, with sensitivity ranging between 60% and 100%, and specificity ranging between 95% and 100%, although it is more expensive and has access limitations. Conclusions: The diagnosis of acute apendicitis in pregnancy is challenging. Nuclear magnetic resonance would be more useful than ultrasound for diagnosis during the second and third trimesters.
RESUMEN Objetivo: reportar el caso de una paciente con embarazo avanzado de 35,2 semanas, con diagnóstico de apendicitis aguda con perforación y peritonitis generalizada secundaria, y hacer una revisión de la literatura publicada acerca de la utilidad de las imágenes diagnósticas en el análisis de esta condición en la gestante en la segunda mitad del embarazo. Materiales y métodos: se presenta el caso de una paciente de 29 años, con 3 gestaciones, 2 partos, remitida a una institución de cuarto nivel de complejidad con gestación de 35,2 semanas e impresión diagnóstica de trabajo de parto pretérmino. Fue llevada a laparotomía luego de 20 horas de observación, con diagnóstico de dolor abdominal y apendicitis aguda; se encontró apendicitis perforada con peritonitis secundaria. En el posoperatorio presentó infección del sitio operatorio y trabajo de parto prematuro, por lo que se finalizó la gestación con evolución materna y perinatal satisfactorias. Se realizó una búsqueda con los términos MeSH: "Pregnancy", "Peritonitis", "Appendicitis", "Perforated Appendicitis", "Ultrasonic Diagnosis", "Magnetic Resonance Imaging", "Computed Tomography", en las bases de datos Up to date, Medline vía PubMed y Science Direct, para artículos publicados en inglés o español, de los últimos 20 años. Resultados: se identificaron 20 títulos relacionados directamente con el uso de imágenes diagnósticas en mujeres gestantes con sospecha de apendicitis. El ultrasonido es la tecnología diagnóstica utilizada como primera opción, sin embargo, su desempeño diagnóstico en el segundo y tercer trimestre es limitado porque frecuentemente no se logra visualizar el apéndice. La sensibilidad varía del 46 al 63 %, y la especificidad del 80 al 100 %; la resonancia magnética tiene un mejor desempeño operativo, con una sensibilidad que varía entre el 60 y el 100 %, y una especificidad del 95 al 100 %, aunque tiene restricciones por ser más costosa y tener limitaciones de acceso. Conclusiones: el diagnóstico de la apendicitis aguda en el embarazo es un reto diagnóstico, la resonancia magnética podría ser más útil que el ultrasonido para el diagnóstico en el segundo y tercer trimestre de embarazo.
Assuntos
Feminino , Gravidez , Apendicite , Peritonite , Gravidez , UltrassonografiaRESUMO
Se presenta el caso clínico de una gestante de 39 años de edad, quien fuera ingresada a las 22 semanas de gravidez en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba, luego de ser remitida del Centro Provincial de Genética por el diagnóstico ecográfico prenatal de fibroelastosis endocárdica, confirmado en el Cardiocentro de esta provincia. Después de la interrupción del embarazo, sugerida en la consulta de Genética, se realizó la autopsia al feto y con el estudio hístico del ventrículo izquierdo se corroboró la miocardiopatía.
The case report of a 39-year-old pregnant woman is presented, who was admitted at 22 weeks of pregnancy to "Tamara Bunke Bider" Teaching Gynecoobstetric Hospital of Santiago de Cuba, after being referred from the Provincial Center of Genetics due to prenatal ultrasound diagnosis of endocardial fibroelastosis, confirmed at the Heart Center of this province. After abortion, suggested at the Department of Genetics, autopsy was performed and the fetal left ventricle tissue study confirmed cardiomyopathy.