Comportamiento de la enfermedad inflamatoria pélvica aguda en la atención primaria de salud. Matanzas, 2017-2018 / Behavior of the acute inflammatory pelvic disease in the health primary care. Matanzas, 2017-2018

RESUMEN Introducción: la enfermedad inflamatoria pélvica aguda es una entidad frecuente en mujeres jóvenes en edad reproductiva, y constituye causa de infertilidad y otras complicaciones. Objetivo: caracterizar el comportamiento de la enfermedad inflamatoria pélvica aguda en pacientes atendidas en el Policlínico Docente Samuel Fernández, del municipio Matanzas, en el período de enero de 2017 a enero de 2018. Materiales y métodos: se realizó un estudio descriptivo, longitudinal y prospectivo a 76 mujeres, a las que se les hizo caracterización sociodemográfica y clínico-ecográfica, que permitió su clasificación como pacientes con enfermedad inflamatoria pélvica aguda leve-moderada, requerida de tratamiento y seguimiento en atención primaria. Se evaluó la respuesta clínico-ecográfica al tratamiento médico indicado, a partir de la disminución de la intensidad del dolor pélvico y de las modificaciones de los hallazgos ecográficos iniciales. Resultados: la enfermedad inflamatoria pélvica aguda leve-moderada representó el 87,4 % de los casos evaluados en Consulta Ginecológica de la atención primaria de salud, en el período estudiado. La media de edad fue de 31,2 años. Clínicamente predominaron los casos con dolor severo. El hallazgo ecográfico inicial más frecuente fue el de anejos engrosados. La antibioticoterapia oral combinada y el uso de antiinflamatorios fue la terapia médica empleada, con resultados clínico-ecográficos favorables en el 98,4 y el 92,2 % de los casos, respectivamente. Conclusiones: la enfermedad inflamatoria pélvica leve-moderada resultó una entidad frecuente en el Servicio de Ginecología de la atención primaria de salud en el período estudiado, con evolución satisfactoria al tratamiento médico.

ABSTRACT Introduction: acute inflammatory pelvic disease is a frequent entity in young women in reproductive age, and is cause of infertility and other complications. Objective: to characterize the behavior of the acute inflammatory pelvic disease in patients attended at the TeachingPoliclinic Samuel Fernandez, of the municipality of Matanzas, in the period from January 2017 to January 2018. Materials and methods: a descriptive, longitudinal and prospective study was carried out in 76 women, who were object of socio-demographic and clinic-echographyc characterization that allowed their classification as patients with mild-moderated acute inflammatory pelvic disease requiring treatment and follow up in primary care services. The clinic-echographyc answer to medical treatment was evaluated from the decrease of the intensity of the pelvic pain and the modification of the baseline echographyc findings. Results: mild-moderated acute inflammatory pelvic disease represented 87.4 % of the cases evaluated in the primary care Gynecological consultation in the studied period. The average age was 31.2 years. The cases with severe pain predominated clinically. The most frequent baseline echographyc finding was increased annexes. Oral combined antibiotic therapy and the use of anti-inflammatory drugs was the used medical therapy, with favorable clinic-echographyc results in 98.4 % and 92.2 % of cases respectively. Conclusions: mild-moderated inflammatory pelvic disease was a frequent entity in the Gynecology service of the primary health care in the studied period, with satisfactory evolution to medical treatment.

A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador.

Background: Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods: A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results: A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions: No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.

Ascitis secundaria a chlamydia trachomatis tras procedimiento de reproducción asistida / Ascites secondary to chlamydia trachomatis after assisted reproduction procedure

El desarrollo de ascitis moderada o severa es infrecuente tras una enfermedad inflamatoria pélvica por Chlamydia trachomatis, una de las principales causas de infección de transmisión sexual a nivel mundial. Caso clínico: Paciente de 29 años que tras aborto diferido (gestación tras inseminación artificial) que inicia a las seis semanas con cuadro de dolor abdominal inespecífico y ascitis de predominio linfocitario. El diagnostico se realizo mediante PCR (Werfen®) tanto el liquido ascítico como en exudado endocervical. La paciente recibió tratamiento antibiótico con doxiciclina. Conclusión: Las enfermedades de transmisión sexual deben ser consideradas cuando se realiza un diagnóstico diferencial de una mujer sexualmente activa con dolor abdominal y ascitis, instaurar tratamiento antibiótico y evitar pruebas e intervenciones quirúrgicas innecesarias.

The development of moderate or severe ascites is infrequent after a pelvic inflammatory disease from Chlamydia trachomatis, one of the main causes of sexually transmitted infection worldwide. Clinical case: A 29-year-old patient who, after a delayed abortion (gestation after artificial insemination), started at six weeks with symptoms of non-specific abdominal pain and predominantly lymphocytic ascites. The diagnosis is made by PCR (Werfen®) both the ascitic fluid and the endocervical exudate. The patient received antibiotic treatment with doxycycline. Conclusion: Sexually transmitted diseases should be considered when making a differential diagnosis of a sexually activated woman with abdominal pain and ascites. Establishing antibiotic treatment, and avoiding unnecessary tests and surgical treatments.

Pelvic actinomycosis mimicking pelvic malignancy / Actinomicose pélvica simulando neoplasia maligna pélvica

Abstract Asymptomatic female genital tract colonization with Actinomyces spp is not uncommon, particularly among intrauterine device users. Pelvic actinomycosis is an extremely rare disease. The clinical picture can resemble an advanced ovarian malignancy. We report a case of pelvic actinomycosis mimicking ovarian malignancy diagnosed postoperatively. Preoperative diagnosis is possible if there is a high index of suspicion, obviating extensive surgery and preserving fertility, since long term antibiotic treatment can be completely effective. Pelvic actinomycosis should be included in the differential diagnosis of women presenting a pelvic mass, especially if there is intrauterine device use history.

Resumo A colonização assintomática do aparelho genital feminino por Actinomyces spp não é infrequente, sobretudo em utilizadoras de dispositivo intra-uterino. A actinomicose pélvica é uma doença extremamente rara. O quadro clínico pode assemelhar-se ao de uma neoplasia maligna do ovário avançada. Relatamos um caso de actinomicose pélvica, simulando uma neoplasia maligna do ovário, com diagnóstico pós-operatório. O diagnóstico pré-operatório é possível se houver um elevado grau de suspeição, permitindo evitar cirurgias extensas e preservar a fertilidade, uma vez que o tratamento antibiótico prolongado pode ser totalmente eficaz. A actinomicose pélvica deve ser incluída no diagnóstico diferencial da mulher que apresente uma massa pélvica, sobretudo se houver história de uso de dispositivo intra-uterino.

Pelvic Actinomycosis Mimicking Pelvic Malignancy.

Asymptomatic female genital tract colonization with Actinomyces spp is not uncommon, particularly among intrauterine device users. Pelvic actinomycosis is an extremely rare disease. The clinical picture can resemble an advanced ovarian malignancy. We report a case of pelvic actinomycosis mimicking ovarian malignancy diagnosed postoperatively. Preoperative diagnosis is possible if there is a high index of suspicion, obviating extensive surgery and preserving fertility, since long term antibiotic treatment can be completely effective. Pelvic actinomycosis should be included in the differential diagnosis of women presenting a pelvic mass, especially if there is intrauterine device use history.

A colonização assintomática do aparelho genital feminino por Actinomyces spp não é infrequente, sobretudo em utilizadoras de dispositivo intra-uterino. A actinomicose pélvica é uma doença extremamente rara. O quadro clínico pode assemelhar-se ao de uma neoplasia maligna do ovário avançada. Relatamos um caso de actinomicose pélvica, simulando uma neoplasia maligna do ovário, com diagnóstico pós-operatório. O diagnóstico pré-operatório é possível se houver um elevado grau de suspeição, permitindo evitar cirurgias extensas e preservar a fertilidade, uma vez que o tratamento antibiótico prolongado pode ser totalmente eficaz. A actinomicose pélvica deve ser incluída no diagnóstico diferencial da mulher que apresente uma massa pélvica, sobretudo se houver história de uso de dispositivo intra-uterino.

Diagnóstico ultrasonográfico de las masas pélvicas ginecológicas / Ultrasonographic Diagnosis of Gynecologic Pelvic Masses

Introducción: el ultrasonido constituye el examen diagnóstico ideal para el estudio de los tumores ginecológicos. Es un método efectivo, fácil de realizar, económico y no invasivo. Objetivo: caracterizar las masas pélvicas ginecológicas analizadas por ultrasonido. Métodos: se realizó un estudio observacional descriptivo transversal en el Hospital Universitario Ginecobstétrico Provincial Ana Betancourt de Mora desde enero hasta diciembre de 2013. El universo estuvo constituido por 312 féminas. El tamaño de la muestra fue de 151 pacientes seleccionadas al azar. Los datos se obtuvieron del libro de registro del salón de operaciones ginecológicas. La información se obtuvo de las historias clínicas. Se confeccionó una hoja de vaciamiento que se convirtió en el registro definitivo de la investigación y se determinaron estadísticas descriptivas. Resultados: la mayoría de las masas ginecológicas fueron fibroma uterino. Dentro de los hallazgos imagenológicos la mayoría de las masas tenían localización uterina, mostraron una tumoración única, fueron hipoecogénicos. Los diagnósticos clínicos y ultrasonográficos coincidieron por Anatomía Patológica. Conclusiones: el ultrasonido es de gran utilidad en el diagnóstico de las masas pélvicas(AU)

Introduction: Ultrasound is the ideal diagnostic test for the study of gynecologic tumors. It is an effective method, easy to perform, economical and non-invasive. Objective: Characterize gynecological pelvic masses by ultrasound. Methods: Atraverse descriptive observational study was carried out from January to December 2013; at the Provincial Obtetrics-Gynecology University Hospital. The study universe consisted of 312 women, 151 patients was the size of the sample, selected at random. The data were obtained from the registration book of the gynecological surgery room and from the clinical histories. A data sheet that became the definitive record of the investigation was constructed. Descriptive statistical was determined. Results: Most of the gynecological masses were uterine fibromas. Most of the masses, within the imaging discoveries, had uterine localization. They showed a unique tumor, they were hypoecogenic and clinical and ultrasonographic diagnosis pathologically agreed. Conclusions: ultrasound is useful in the diagnosis of pelvic masses(AU)