The patient journey of fibromyalgia in Latin America.

OBJECTIVES: To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS: Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS: Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION: The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.

Mastitis granulomatosa idiopática. Características clínicas, imagenológicas, patológicas y su correlación con la respuesta al tratamiento - Hospital Dr. Cosme Argerich / Idiopathic granulomatous mastitis: clinical, imagenological, pathological characteristics and their correlation with treatment response

Introducción: La mastitis granulomatosa idiopática (MGI) es una patología inflamatoria benigna que se presenta típicamente como tumoración dolorosa. Recientemente, un subconjunto con patrón histológico neutrofilico quístico (MGNQ) fue asociado al corynebacterium. Objetivo: Revisión bibliográfica y evaluación de nuestra casuística. Material y método: Se seleccionaron 24 mujeres con MGI diagnosticada entre 2000-2019. Variables analizadas: demográficas, antecedentes, clínica, imágenes, cultivos, patología, tratamientos y evolución. Resultados: Edad media: 40.7 años. 50% tuvo ≥4 gestas y 91.6% lactó. Presentación clínica: Tumor abscedado palpable 58.33%, Palpable asintomático 25%, Palpable doloroso 12.5%. Lesión no palpable 4.17%. Tamaño promedio de lesión: 3.5 cm. Imágenes BIRADS 4/5: 87.5% Cultivo de corynebacterium 25%. Patología: Polimorfonucleares intraductales (PMNID) 62.5%, Vacuolas quísticas 50% (2 casos con baci- los). Tratamiento: Antibióticoterapia 79.1%, Inmunosupresión 79.1%, Drenaje de abscesos 45.8%. Tumorectomía 41.6%. Tiempo de resolución: 5.5 meses Tiempo libre de enfermedad: 33.6 meses. Recurrencias: 31.%. Conclusiones: Debe sospecharse en toda mujer joven con tumor mamario asociado a abscesos, fistulas y/o úlceras. El diagnóstico de MGNQ y PM- NID tienen asociación estadísticamente significativa con recurrencia. Es esencial el abordaje multidisciplinario y el tratamiento multimodal

Introduction: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory disease that typically presents as a painful mass. Recently, a subset with cystic neutrophilic histological pattern (CNGM) was related to corynebacterium. Objetive: Bibliographic review and evaluation of our casuistry. Material and method: During 2000-2019, 24 women diagnosed with IGM were selected. Variables analyzed: Demographic, background, clinical, images, cultures, pathology, treatment and evolution. Results: Average age: 40.7 years. 50% had ≥ 4 gestations and 91.6% lactated. Clinical presentation: Palpable abscessed tumor 58.33%, Palpable asymptomatic 25%, Palpable painful 12.5%. Non palpable lesion 4.17%. Average lesion size: 3.5 cm. BIRADS images 4/5: 87.5% Corynebacterium culture 25%. Findings: Intraductal polymorphonuclear cells (IDPMNC) (62.5% ), Cystic vacuoles (50%) (With bacilli in 2 cases). Treatment: Antibiotic therapy 79.1%, Immunosuppression 79.1%, Drainage of abscesses 45.8%. Lumpectomy 41.6%. Resolution time: 5.5 months Diseasefree time: 33.6 months. Recurrences: 31.8%. Conclusions: It should be suspected in any young woman with a breast tumor associated with abscesses, fistulas and/or ulcers. The diagnosis of CNGM and IDPMNC has statistically significant association with recurrence. A multidisciplinary approach and multimodal treatment is essential