Impacto del confinamiento por la pandemia de la COVID-19 en la vivencia del embarazo y la maternidad de mujeres colombianas / Impact of confinement due to the COVID-19 pandemic on the experience of pregnancy and motherhood of Colombian women

Objetivo: Analizar el impacto del confinamiento por la pandemia de la COVID-19 en la vivencia del embarazo y la maternidad de mujeres colombianas. Métodos: Cualitativo, basado en la teoría fundamentada. Se analizaron 17 entrevistas semiestructuradas realizadas a seis mujeres embarazadas y a 11 madres primerizas con bebés de hasta 11 meses de edad. El estudio fue realizado en varias ciudades de Colombia entre abril y junio de 2021. Resultados: Se identificaron cuatro categorías centrales que describen el impacto del confinamiento sobre la vivencia del embarazo y la maternidad: el apoyo social, especialmente limitado en el contacto con la familia y la pérdida de rituales de celebración de la maternidad; las emociones, reflejadas en la experiencia de agotamiento, ansiedad, soledad, frustración, y en el miedo al parto, al contagio y a las posibles secuelas del confinamiento en el desarrollo de los bebés; los cambios producto de la maternidad, evidenciados en roles y decisiones laborales; y los aspectos positivos de la pandemia, como los permisos de maternidad ampliados, la conciliación familiar y la mayor presencia e implicación de las parejas. Conclusión: La pandemia por COVID-19 afectó a la experiencia habitual del embarazo y a la maternidad de las mujeres colombianas que fueron entrevistadas. Este estudio permitió conocer sus experiencias emocionales, los principales retos a los que se enfrentaron y las estrategias que les permitieron adaptarse a esta coyuntura. (AU)

Objective: To analyse the impact of confinement due to the COVID-19 pandemic on Colombian women's experience of pregnancy and motherhood. Methods: Qualitative, based on grounded theory. Seventeen semi-structured interviews with six pregnant women and 11 new mothers with babies up to 11 months old were analysed. The study was conducted in several cities in Colombia between April and June 2021. Results: Four central categories that describe the impact of confinement on the experience of pregnancy and motherhood were identified: social support, especially limited contact with family and the loss of rituals for celebrating motherhood; emotions, reflected in the experiences of exhaustion, anxiety, loneliness, frustration, fear of childbirth, contagion, and the possible consequences of confinement on the development of babies; changes resulting from motherhood, evidenced in roles and work decisions; and the positive aspects of the pandemic, such as extended maternity leave, family balancing, and the greater presence and involvement of partners. Conclusion: The COVID-19 pandemic disrupted Colombian women's normal pregnancy and motherhood experiences. This study allowed us to learn about their emotional experiences, their main challenges, and the strategies that allowed them to adapt to these circumstances. (AU)

Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial.

BACKGROUND: Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven. METHODS: This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms. DISCUSSION: The SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04153864 . Registered on November 6, 2019.

Papiloflebitis como manifestación de poliarteritis nodosa / Papillophlebitis as manifestation of polyarteritis nodosa

Varón de 35 años de edad diagnosticado de poliarteritis nodosa que desarrolló una papiloflebitis de su ojo izquierdo. Presentó en su evolución edema macular que fue tratado con inyecciones intravítreas de aflibercept con buena evolución posterior y recuperación completa de la agudeza visual. En el curso de su enfermedad presentó también epiescleritis del ojo adelfo. La papiloflebitis consiste en una oclusión de la vena central de la retina no isquémica de origen inflamatorio. La poliarteritis nodosa es una vasculitis necrotizante sistémica caracterizada por la afectación de arterias musculares de pequeño y mediano calibre. La afectación ocular se produce en el 10-20% de los casos y típicamente afecta a las arterias coroideas. La afectación venosa es extremadamente rara y si se produce suele ser por extensión de la inflamación adyacente

A 35 year-old-man diagnosed with polyarteritis nodosa developed papillophlebitis on his left eye. Throughout the evolution of the disease, he had a macular oedema treated with intravitreal injections of aflibercept, with adequate recovery of visual acuity. He also had episcleritis on the other eye. Papillophlebitis is a non-ischaemic central retinal vein occlusion of inflammatory cause. Polyarteritis nodosa is a systemic necrotising vasculitis characterised by lesions of small and medium sized arteries. Ocular involvement occurs in 10-20% of patients, and typically affects the choroidal arteries. Only arteries are usually affected, but in very rare cases adjacent veins may be involved due to the adjacent inflammation

Asociación de tumor phyllodes y carcinoma ductal infiltrante / Association between phyllodes tumor and infiltrating ductal carcinoma

El diagnóstico de un tumor phyllodes asociado a un carcinoma de mama es muy raro (1-2% de todos los tumores phyllodes). Este tipo de asociación se produce tras la transformación maligna del componente epitelial del tumor phyllodes. Se presenta el caso de una mujer de 46 años, que consulta al presentar un nódulo en mama derecha de rápido crecimiento. Tras valoración clínica, radiológica e histológica, y con el diagnóstico de tumor phyllodes benigno, se practicó una excisión local amplia. El estudio anatomopatológico definitivo informó de la presencia de una tumoración bifásica con un tumor phyllodes de bajo grado de malignidad en el componente estromal y un carcinoma ductal infiltrante en el componente epitelial, presente únicamente en forma de émbolos tumorales en la cápsula del tumor phyllodes

The diagnosis of a phyllodes tumor associated with a breast carcinoma is very rare (1-2% of all phyllodes tumors). This type of association occurs after the malignant transformation of the epitelial component of the phyllodes tumor. We present the case of a 46-year-old woman who consulted for a fast-growing nodule in the right breast. After clinical, radiological and histological evaluation, and with the diagnosis of benign phyllodes tumor, a wide local excision was performed. The anatomopathological study reported the presence of a biphasic tumor with a phyllodes tumor of low grade of malignancy in the stromal component, and an infiltrating ductal carcinoma in the epitelial component, in the form of tumor emboli in the phyllodes tumor capsule

Carcinoma mioepitelial de mama / Myoepithelial carcinoma of the breast

El carcinoma mioepitelial de mama (o mioepitelioma maligno) es un tumor poco frecuente compuesto exclusivamente por células mioepiteliales malignas. Su diagnóstico supone un reto, y viene dado por los hallazgos anatomopatológicos apoyados por las técnicas de inmunohistoquímica. Presentamos un caso clínico y revisión bibliográfica

Myoepithelial carcinoma of the breast (or malignant myoepithelioma) is a rare tumor composed exclusively of malignant myoepithelial cells. Its diagnosis is a challenge and is reached through pathological findings supported by immunohistochemical techniques. We present a case report and a review of the literature

Papillophlebitis as manifestation of polyarteritis nodosa. / Papiloflebitis como manifestación de poliarteritis nodosa.

A 35 year-old-man diagnosed with polyarteritis nodosa developed papillophlebitis on his left eye. Throughout the evolution of the disease, he had a macular oedema treated with intravitreal injections of aflibercept, with adequate recovery of visual acuity. He also had episcleritis on the other eye. Papillophlebitis is a non-ischaemic central retinal vein occlusion of inflammatory cause. Polyarteritis nodosa is a systemic necrotising vasculitis characterised by lesions of small and medium sized arteries. Ocular involvement occurs in 10-20% of patients, and typically affects the choroidal arteries. Only arteries are usually affected, but in very rare cases adjacent veins may be involved due to the adjacent inflammation.

Enfermedad de Paget pigmentada de la mama / Pigmented mammary Paget disease

La enfermedad de Paget pigmentada de la mama es una variante clinicopatológica infrecuente de la enfermedad de Paget, la cual debe incluirse en el diagnóstico diferencial de las lesiones pigmentadas del pezón. Se presenta el caso de una mujer de 49 años que consulta al presentar una mácula pigmentada en el pezón derecho de 9 meses de evolución; y cuyo estudio histológico e inmunohistoquímico permitió diagnosticar una Enfermedad de Paget que se acompaña de una hiperplasia melanocitaria atípica, diferenciándola de un melanoma maligno

Pigmented mammary Paget disease is an uncommon clinicopathological variant of Paget's disease, which should be included in the differential diagnosis of pigmented lesions on the nipple. We present the case of a 49-year-old woman with a 9-month-old pigmented lesión on her right nipple. The histological and immunohistochemical study allowed the diagnosis of a Paget's disease with intense atypical melanocytic hyperplasia, differentiating it from a malignant melanoma

Angiosarcoma de mama radioinducido / Radiotherapy-induced angiosarcoma of the breast

El angiosarcoma radioinducido de mama tras tratamiento quirúrgico conservador y radioterapia complementaria en una paciente con cáncer de mama es una entidad poco frecuente, de difícil diagnóstico y mal pronóstico. Se presenta el caso de una mujer de 71 años, con antecedentes personales de carcinoma ductal infiltrante de mama izquierda, a la que se practicó tumorectomía y linfadenectomía axilar (pT1cpN0M0), y recibió tratamiento adyuvante con radioterapia y hormonoterapia. 77 meses después del tratamiento, la paciente consultó al presentar una lesión cutánea en la mama izquierda. Tras valoración clínica, radiológica e histológica y con el diagnóstico de angiosarcoma de mama, se practicó mastectomía izquierda. Posteriormente no recibió tratamiento complementario

Radiotherapy-induced angiosarcoma of the breast after conservative surgical treatment and complementary radiotherapy in a patient with breast cancer is a rare condition, with both difficult diagnosis and poor prognosis. We present the case of a 71-year-old woman with a personal history of infiltrating ductal carcinoma of the left breast, who underwent tumorectomy and axillary lymphadenectomy (pT1cpN0M0), and received adjuvant treatment with radiotherapy and hormone therapy. 77 months after treatment, the patient consulted with a skin lesion on her left breast. After clinical, radiological and histological assessment and with the diagnosis of angiosarcoma of the breast, a mastectomy of her left breast was performed. The patient did not receive complementary treatment

Carcinoma de células acinares de mama / Primary acinic cell carcinoma of the breast

El carcinoma de células acinares primario de mama es un tumor raro que muestra similitudes con neoplasias de las glándulas salivales; y aunque pertenece al grupo de carcinomas de mama "triple negativos", su comportamiento biológico parece ser más favorable. Se presenta el caso de una mujer de 54 años, sin antecedentes oncoginecológicos, remitida a la consulta de patología mamaria para valoración por mamografía de screening que informa de BIRADS IV en mama derecha. A la exploración física, las mamas y axilas son normales a la inspección y a la palpación, tratándose de una lesión no palpable. El estudio citológico tras punción ecoguiada informa de sospecha de malignidad, motivo por el cual se practica biopsia excisional radioguiada que informa de la presencia de un carcinoma de células acinares de mama. Se realizó tratamiento quirúrgico conservador en mama-axila derecha y recibió radioterapia adyuvante. Tras 6 años del diagnóstico, se encuentra libre de enfermedad

Primary acinic cell carcinoma of the breast is a rare tumor that shows similarities with neoplasms of the salivary glands; and although it belongs to the group of "triple negative" breast cancer, its biological behavior seems to be more favorable. We present the case of a 54-year-old woman, with no gynecological cáncer history, referred to the mammary pathology office for evaluation after mammography screening that reports BIRADS IV in the right breast. On physical examination, the breasts and axillas are normal to inspection and palpation, being this the case of a non-palpable lesion. The cytological study after echoguided puncture reports suspicion of malignancy, which is why a radioguided excisional biopsy is performed, which shows the presence of an acinic cell carcinoma of the breast. Conservative surgical treatment is performed in the right breast-axilla, together adjuvant radiotherapy. 6 years after diagnosis, the patient is free of disease

Carcinoma de células pequeñas de mama / Oat cell carcinoma of the breast

El cáncer de células pequeñas de mama es un cáncer raro y agresivo sin un tratamiento protocolizado debido a los pocos casos descritos. Presentamos el caso de una paciente de 64 años que acude a la Unidad de Patología Mamaria para estudio de nódulo de mama izquierda con diagnóstico de carcinoma ductal infiltrante de células pequeñas de mama (AU)

Oat cell breast cancer is a rare and aggressive form of cancer. Because only a few cases have been described in the literature, there is no standard treatment. We report the case of a 64-year-old woman who attended our unit for investigation of a node in her left breast that was diagnosed as infiltrative oat-cell breast carcinoma (AU)

[Guidelines of clinical practice of the SERV (Spanish Retina and Vitreous Society): management of ocular complications of diabetes. Diabetic retinopathy and macular oedema]. / Guías de práctica clínica de la SERV: manejo de las complicaciones oculares de la diabetes. Retinopatía diabética y edema macular.

OBJECTIVE: Diabetes mellitus is considered the most common cause of blindness in the working population of industrialized countries, with diabetic macular edema being the most common cause of decreased visual acuity and proliferative diabetic retinopathy (PDR) being responsible for the most severe visual deficits. We have therefore tried to establish a guide for clinical intervention whose purpose is to provide orientation on the treatment of diabetic retinopathy and its complications. This is necessary at a time when many treatment options have emerged whose role is not yet fully defined. METHOD: A group of expert retina specialists selected by the SERV (Vitreous-Retina Spanish Society) assessed the published results of different treatment options currently available, suggesting lines of action according to the degree of diabetic retinopathy present and the presence or absence of macular edema. RESULTS: PDR is primarily treated with pan-retinal photocoagulation. For clinically significant diabetic macular edema without signs of vitreomacular traction, the treatment of choice continues to be focal/grid photocoagulation. Similarly, retinovitreal surgery is indicated for both conditions. The use of antiangiogenic drugs was also analyzed but remains inconclusive. CONCLUSION: Laser therapy is effective in the management of diabetic retinopathy and diabetic macular edema. The role of antiangiogenics is not yet sufficiently defined.

[Review of the protocol for the treatment of diabetic retinopathy]. / Revisión del protocolo para el tratamiento de la retinopatía diabética.

We present general guidelines to help us with the treatment of diabetic retinopathy (DR) at a time when numerous therapeutic alternatives have been developed although their role has not yet been adequately defined. This protocol is not directed at experienced retinologists but rather at general ophthalmologists who require a practical and up to date guide of a pathology as prevalent as RD. The different therapeutic options available, and their most accepted indications depending on the degree of diabetic retinopathy that patients have, are reviewed. We propose what to do in cases of mild, moderate and severe non-proliferative diabetic retinopathy as well as in cases of proliferative diabetic retinopathy (panphotocoagulation/antiangiogenic drugs/vitreorretinal surgery). The treatment of diabetic macular edema depending on its angiographic and topographic characteristics is also discussed. The importance of metabolic control of the patient is stressed (tight glycemic control, control of arterial hypertension and dyslipemia) in aiding the treatment of diabetic retinopathy. This therapeutic proposal has been discussed widely by retinologists from the four largest hospitals in the Canary Islands, and is therefore an agreed text based on recent scientific literature.

Revisión del protocolo para el tratamiento de la retinopatía diabética / Revision of the protocol for the treatment of diabetic retinopathy

Se presentan unas directrices generales con el objetivode proporcionar una orientación en el manejo dela retinopatía diabética (RD) en un momento en elque han aparecido numerosas alternativas terapéuticascuyo papel aún no está suficientemente definido.Este protocolo está dirigido no a retinólogos expertossino a oftalmólogos generales que precisen una guíapráctica y actualizada de una patología tan prevalentecomo la RD.En este documento se revisan las distintas opcionesterapéuticas disponibles y su indicación más aceptadasegún el grado de retinopatía diabética que presenteel paciente. Se plantea así que hacer con unaretinopatía diabética no proliferativa (RDNP) leve,moderada (ambas control por su oftalmólogo dezona) y severa (en casos muy seleccionados puedeconsiderarse la realización de una panfotocoagulación–PFC–). Los pacientes con retinopatía diabéticaproliferativa (RDP) serán tratados en los centroshospitalarios (PFC/fármacos antiangiogénicos/cirugía vítreorretiniana –CVR–) hasta que sea controladosu proceso. Se discute asimismo el tratamientodel edema macular (EM) diabético según sus característicasangiográficas y topográficas.Se hace hincapié en la importancia del control metabólicodel paciente (optimizar el control glucémico,de su hipertensión arterial y de la dislipemia) comotratamiento necesario y coadyuvante de su RD.Esta propuesta terapéutica ha sido ampliamente discutidapor retinólogos de los cuatro grandes hospitalesde Canarias por lo que se trata de un texto consensuadobasado en la bibliografía científica actual(AU)

We present general guidelines to help us with thetreatment of diabetic retinopathy (DR) at a timewhen numerous therapeutic alternatives have beendeveloped although their role has not yet been adequatelydefined. This protocol is not directed atexperienced retinologists but rather at general ophthalmologistswho require a practical and up to dateguide of a pathology as prevalent as RD.The different therapeutic options available, andtheir most accepted indications depending on thedegree of diabetic retinopathy that patients have, arereviewed. We propose what to do in cases of mild,moderate and severe non-proliferative diabetic retinopathyas well as in cases of proliferative diabeticretinopathy (panphotocoagulation/antiangiogenicdrugs/vitreorretinal surgery). The treatment of diabeticmacular edema depending on its angiographicand topographic characteristics is also discussed.The importance of metabolic control of thepatient is stressed (tight glycemic control, control of arterial hypertension and dyslipemia) in aidingthe treatment of diabetic retinopathy.This therapeutic proposal has been discussedwidely by retinologists from the four largest hospitalsin the Canary Islands, and is therefore an agreedtext based on recent scientific literature(AU)