Conocimientos de los trabajadores de la salud sobre aspectos generales de la COVID-19

El surgimiento del SARS-CoV-2 conllevó en sus inicios al tratamiento de las consecuencias, mucho antes de saber la forma de propagación y contención; el Trabajador de Salud (TS) constituye una población de alto riesgo para adquirir la enfermedad. Se buscó determinar el conocimiento de los TS sobre aspectos generales de la COVID-19. Es un estudio descriptivo, exploratorio, transversal. Se investigó el conocimiento sobre la COVID-19 en TS, del 15 al 22/4/2020, a través de una encuesta en línea con diferentes variables relacionados con el SARS-CoV-2. De 617 participantes hubo diferencia de hasta 9 números en las respuestas. Hubo una relación 2:1 de mujeres/hombres; 33.8 % se encontraban entre 51-60 años y el 78,2 % estaban residenciados en Venezuela. De 608 TS, el 25,5 % eran Gineco-Obstetras. Los encuestados demostraron conocimientos asertivos sobre el virus SARS-CoV-2, sobre el origen y período de incubación, y se observaron diferencias en las formas de transmisión y manifestaciones clínicas atípicas. Se concluyó que identificar las fortalezas y debilidades ante cualquier patógeno permite implementar nuevas acciones preventivas, elaborar estrategias educativas y comunicacionales con la finalidad de realizar conductas médicas adecuadas.

The emergence of SARS-CoV-2 initially led to the treatment of the consequences, long before knowing the form of spread and containment; The Health Worker (TS) constitutes a population at high risk for acquiring the disease. It was sought to determine the knowledge of the TS on general aspects of COVID-19. It is a descriptive, exploratory, cross-sectional study. Knowledge about COVID-19 in TS was investigated, from April 15 to 22, 2020, through an online survey with different variables related to SARS-CoV-2. Of 617 participants there was a difference of up to 9 numbers in the answers. There was a 2: 1 ratio of women / men; 33.8 % were between 51-60 years old and 78.2 % were resident in Venezuela. Of 608 TS, 25.5 % were OB / GYN. Respondents demonstrated assertive knowledge about the SARS-CoV-2 virus, its origin and incubation period, and differences were observed in the forms of transmission and atypical clinical manifestations. It was concluded that identifying the strengths and weaknesses in the face of any pathogen allows the implementation of new preventive actions, the elaboration of educational and communication strategies in order to carry out appropriate medical behaviors.

Complete molar pregnancy in adolescents from North and South America: Clinical presentation and risk of gestational trophoblastic neoplasia.

OBJECTIVES: To compare complete hydatidiform mole (CHM) clinical presentation and risk factors associated with GTN development between North American and South American adolescents. METHODS: This non-concurrent cohort study was undertaken including adolescents with CHM referred to centers in North America (New England Trophoblastic Disease Center, Harvard University, USA), and South America (Botucatu Trophoblastic Disease Center-São Paulo State University, Brazil; Trophoblastic Unit of Central University of Venezuela and Maternidad Concepcion Palacios of Caracas, Venezuela) between 1990 and 2012. Data were obtained from medical records and pathology reports. Study participants were allocated into 2 groups: North America (NA) and South America (SA). RESULTS: In NA and SA, 13.1% and 30.9% of patients with hydatidiform mole were adolescents, respectively. Of these, 77.6% in NA and 86.1% in SA had pathologic diagnosis of CHM (p=0.121). Vaginal bleeding (SA=69% vs NA=51%; p=0.020), anemia (SA=48% vs NA=18%; p<0.001), and elevated serum hCG (SA=232,860mIU/mL vs NA=136,412mIU/mL; p=0.039) were more frequent in SA than in NA. Median gestational age at diagnosis (SA=12weeks, NA=11weeks; p=0.030) differed whereas GTN development rate (SA=20%, NA=27%; p=0.282) showed no significant difference between groups. Compared to NA, medical complications and clinical factors associated with post-molar GTN were more frequent among SA adolescents. CONCLUSIONS: Medical complications and clinical factors associated with GTN development were more frequent in SA than in NA adolescents with CHM, suggesting that, in South America, awareness about the importance of diagnosing molar pregnancy early and considering CHM in the differential diagnosis in adolescents suspected to be pregnant should be raised.

Mieloma múltiple IgA en paciente obstétrica / Multiple Myeloma in an obstetric patient

El mieloma múltiple es una neoplasia caracterizada por la proliferación anómala de células plasmáticas en la médula ósea, usualmente diagnosticada en pacientes mayores de 60 años, siendo rara su presentación antes de los 40 años de edad. Se presenta el caso de paciente femenina de 29 años de edad, sin antecedentes patológicos conocidos, a quien se le realiza el diagnóstico de mieloma múltiple IgA lambda en el primer trimestre del embarazo. Durante su estancia hospitalaria presenta hipercalcemia en rango de malignidad, con falla renal expresada en elevación de azoados y acidosis metabólica compensada. Se realizó serie radiológica ósea que mostró lesiones líticas en bóveda craneana. En la RMN de columna lumbar se evidencian fracturas patológicas de en columna lumbar (L4). Asimismo se solicitó electroforesis de proteínas en suero y orina e inmunofenotipo, corroborándose el diagnóstico de mieloma múltiple IgA lambda estadío IIIA según criterios de Durie Salmon. La paciente fue tratada con esteroides, evidenciándose disminución de la lesión en región frontal y mejoría de la función renal. El MM durante el embarazo es raro, habiendo sólo 42 casos descritos desde 1968 hasta la actualidad; de los cuales 4 corresponden a MM IgA. Reportamos el quinto caso en la literatura de mieloma múltiple IgA en una paciente obstétrica(AU)

Multiple myeloma is a hematologic malignancy characterized by the abnormal proliferation of plasma cells in the bone marrow. This disease is usually diagnosed in patients older than 60 years, with rare presentation before 40 years of age. We present the case of a female, 29 years - old patient, with no medical history, with IgA lambda myeloma diagnosed in the first trimester of pregnancy and who, during her hospitalization, presented malignant hypercalcemia, with renal failure. Bone survey revealed litic lesions in the skull. The MRI scan showed pathologic fractures of lumbar spine. The patient was treated with steroids, with a decrease of the frontal lesion and improvement of renal function. A protein electrophoresis is also requested in serum and urine, and immunophenotype, corroborating diagnosis of multiple myeloma IgA lambda IIIA stage according to Durie Salmon criteria. Myeloma multiple during pregnancy is extremely rare and there are 42 cases described from 1968 to date, and 4 of them are IgA MM. We report the fifth case in the literature of IgA multiple myeloma in an obstetric patient(AU)

Determining the time required to achieve negative human chorionic gonadotropin value after a nonmolar pregnancy: preliminary results.

OBJECTIVE: To determine the time of human chorionic gonadotropin (hCG) regression in nonmolar gestation. STUDY DESIGN: Patients treated at our institution between June 2012 and July 2013 were selected by a deterministic sequential sampling distributed among 2 phases. Distribution of the patients included resolved cases by vaginal delivery and cesarean section in preterm and term pregnancies, ectopic, and abortion. Phase 1: serum hCG values were determined at 4, 5 and 6 weeks of obstetric resolution. Phase 2: hCG serum values were determined immediately at obstetric resolution and at 2, 3 and 4 weeks of the resolution of the cases, too. RESULTS: Phase 1: After the analysis of serum hCG of 63 patients at 4, 5 and 6 weeks postresolution, a negative result was corroborated in 100% of cases, in any period of the sample, with average values of 1.71, 0.55, and 0.18 mIU/mL, respectively. Phase 2 included 398 patients, with serum hCG in the first 72 hours postresolution, showing an average hCG value of 1,483.5 mIU/mL (range, 0.07-10,789), noting that 1% of cases had negative results. We then obtained hCG values at 2, 3 and 4 weeks of resolution, showing the regression in 73.4% of cases in the 2nd week, in 96.7% of patients in the 3rd week, and in all cases in the 4th week. CONCLUSION: The regression of hCG after nonmolar pregnancy does not exceed 3 weeks.

Hydatidiform mole in ectopic pregnancy: clinical, imaging, pathological and immunohistochemical characteristics.

OBJECTIVE: To determine the clinical, pathological, immunohistochemical and imaging characteristics of hydatidiform mole in ectopic pregnancy (HMEP) in all the cases admitted to the Department of Obstetrics and Gynecology, University Hospital of Caracas (HUC), Central University of Venezuela. STUDY DESIGN: Retrospective and comparative study, based on clinical records review of 2 groups: 10 cases with a diagnosis of HMEP and 20 cases with intrauterine hydatidiform mole (IUHM) admitted to the Obstetrics and Gynecology Department of HUC from 1996 to 2010. Clinical, pathological, immunohistochemical and imaging features were analyzed. RESULTS: The prevalence of HMEP in this study was 0.14:1,000 pregnancies; in this group the mean age was 28.8 years, and the mean gestational age at admission was 8.6 weeks. Both groups (HMEP and IUHM) were comparable in these last variables. Abdominal pain and genital bleeding were the most common clinical symptoms in the HMEP group, while it was vaginal bleeding in the IUHM group. Ultrasound findings were similar to those traditionally described in nonmolar ectopic pregnancy. Histology and immunohistochemistry showed that all cases of HMEP were partial mole. CONCLUSION: Although in this study the prevalence of HMEP was high, the size of the sample limits definitive conclusions. This study concludes that all cases of HMEP are partial mole.

Gestational trophoblastic neoplasia: clinical trends in 8 years at Hospital Universitario de Caracas.

OBJECTIVE: To analyze the clinical trends of gestational trophoblastic neoplasia (GTN) at the Department of Obstetrics and Gynecology, Hospital Universitario de Caracas (HUC). STUDY DESIGN: A medical record review was performed of epidemiologic, clinical and diagnostic features of 25 cases of GTN at HUC from 1997 to 2004. RESULTS: During the study period, 35,300 deliveries occurred, and 25 patients were diagnosed with GTN; the prevalence was 0.70:1,000 deliveries. The mean age was 29.2 years. Fifty-six percent were posthydatidiform mole (HM), 36% postchoriocarcinoma (CC), 4% postinvasive mole and 4% postabortion with abundant intermediate trophoblast. Vaginal bleeding was the main symptom in patients with CC. Two cases resembled ectopic pregnancy, and another resembled a vaginal endometrioma. Fifty-two percent of cases were at stage Ib; 76% received single-agent chemotherapy. Hysterectomy was performed in 6 cases. Twenty-one patients achieved remission, 2 showed regression and 2 died. CONCLUSION: GTN had a high prevalence because HUC is a reference center. The most common presentation was post-HM GTN. Vaginal bleeding is frequent in CC and can mimic other gynecologic diseases. Chemotherapy is helpful, and hysterectomy can be performed in selected cases at early stages or with severe vaginal bleed-with a good ing. GTN has a good prognosis, and early diagnosis is possible.