Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review.

OBJECTIVES: Identify and summarize the available literature on the acceleration in the use of telemedicine in the midst of the COVID-19 pandemic, with an aim to provide justification and guidance for its implementation to overcome the limitations associated with the pandemic worldwide. METHODS: We conducted a scoping review through different search strategies in MEDLINE and Google Scholar to identify the available literature reporting data on implementation and usefulness of various modalities of telemedicine during the current pandemic. We summarized the included studies according to field and mode of implementation in a narrative way. RESULTS: We included 45 studies that fulfilled selection criteria. About 38% of the studies were conducted in the United States of America (USA), followed by 15.5% in India and 15.5% in China. Most studies (73%) were cross-sectional studies based on historical records. All publications were written in English with the exception of 1 studied published in Spanish. The majority of reports focused on use of telemedicine for outpatient care, followed by in-hospital care. CONCLUSION: The COVID-19 pandemic has promoted the use of telemedicine, a tool that has transformed the provision of medical services. Several modes of implementation are useful to overcome difficulties for patient care during the pandemic. Its benefits are specific to different fields of medical practice. Such benefits, along with the guidance and reported experiences should invite health systems to work for an effective and comprehensive implementation of telemedicine in various fields.

Quiloperitoneo espontáneo en el embarazo / Spontaneous chyloperitoneum in pregnancy

Introducción. El quiloperitoneo consiste en la presencia de fluido linfático en la cavidad intraabdominal, complicación poco descrita en el embarazo y cuyas repercusiones no están bien establecidas.Reporte de caso. Se presenta el caso de una mujer gestante con embarazo de 36,5 semanas, sin comorbilidades, hospitalizada por presentar cifras tensionales elevadas asociadas a síntomas de encefalopatía hipertensiva y bradicardia fetal sostenida; se le practicó una cesárea urgente en la cual se evidenció corioperitoneo incidental. La tomografía computarizada abdominal de control no demostró alteraciones.Discusión. Se descartaron las principales causas del quiloperitoneo, las cuales son neoplasia maligna y trauma. Se consideró que se trataba de un quiloperitoneo espontáneo posiblemente relacionado con la congestión pélvica propia del embarazo, por vasodilatación secundaria al influjo hormonal, aumento de la presión intraabdominal y contribución del volumen ascítico por la preeclampsia, que genera ruptura traumática de los vasos linfáticos.Conclusión. La ascitis quilosa es una entidad poco frecuente que puede verse asociada con el embarazo. Es fundamental el criterio acertado del ginecoobstetra para determinar tempranamente la etiología

Introduction: Chyloperitoneum consists of the presence of a lymphatic fluid in the intra-abdominal cavity, a complication little described during pregnancy, and whose repercussions are not well established.Case report: A pregnant woman with a pregnancy of 36.5 weeks, without comorbidities, is hospitalized in the context of high blood pressure levels associated with symptoms of hypertensive encephalopathy and sustained fetal bradycardia, leading to an emergent cesarean section where incidental chorioperitoneum was evidenced. Posterior abdominal CT control showed no alterations.Discussion: The main associated etiologies (malignancy and trauma) were ruled out. It is considered a presentation of spontaneous chyloperitoneum that could be related to the pelvic congestion of pregnancy due to: vasodilatation secondary to hormonal influence, increased intra-abdominal pressure and contribution of ascites due to preeclampsia, generating traumatic rupture of lymphatic vessels.Conclusion: Chylous ascites is a rare entity that can be associated with pregnancy. It is essential that gynecologist and obstetrician correctly approach these patients to determine the etiology early