ABSTRACT
La patología mamaria durante el embarazo y la lactancia representa un desafío debido a que los cambios fisiológicos del tejido mamario durante este periodo pueden afectar la interpretación de los hallazgos clínicos e imagenológicos. El objetivo de esta revisión es conocer el diagnóstico diferencial de las enfermedades mamarias durante el embarazo y la lactancia. La mayoría de las patologías mamarias durante el embarazo y la lactancia son benignas y pueden ser clasificadas en tres categorías: 1) aquellas relacionadas con cambios fisiológicos, 2) enfermedades inflamatorias y 3) tumores benignos. Solo el 3% de los cánceres mamarios se desarrollan durante el embarazo. Los factores de mal pronóstico, como receptores hormonales negativos o HER2/neu positivo, en las mujeres embarazadas tienen una prevalencia similar a la observada en no embarazadas de la misma edad. El diagnóstico precoz es de crucial importancia pronóstica, por lo que es necesario mantener los esquemas de tamizaje recomendados. Es importante estar familiarizado con los cambios fisiológicos durante el embarazo y la lactancia, y conocer las patologías más prevalentes que afectan a las mujeres durante este periodo.
Breast pathology throughout pregnancy and lactation represents a challenge because the physiological changes of mammary tissue during this period may affect the interpretation of clinical and imaging findings. The objective of this presentation is to review the differential diagnosis of breast diseases during pregnancy and lactation. Most of breast pathology during pregnancy and lactation is benign and can be further classified into three categories: 1) those related to physiological changes, 2) inflammatory diseases, and 3) benign tumors. Only 3% of breast cancers will develop during pregnancy. Risk factors for worst prognosis, such as negative hormonal receptors or HER2/neu positive, in pregnant women have similar prevalence than in non-pregnant women of the same age. Early diagnose is of the outmost prognostic importance, therefore it`s important to maintain screening schedule as recommended. It is important to be familiarized with the physiological changes of the breast during pregnancy and lactation, and to know the most prevalent diseases affecting women during this period.
Subject(s)
Humans , Female , Pregnancy , Breast Diseases/diagnostic imaging , Breast Feeding , Mammography , Mass Screening , Ultrasonography, Mammary , Diagnosis, DifferentialABSTRACT
Resumen El COVID-19 es un problema de salud pública mundial por su carácter epidémico que, a la fecha, carece de tratamiento farmacológico. Sin embargo, ya se cuenta con algunas vacunas autorizadas para uso en emergencia, aunque la duración de su protección, su capacidad para interrumpir la transmisión viral y su eficacia frente a variantes emergentes de SARS-CoV-2 se encuentran en estudio. La campaña de vacunación contra SARS-CoV-2 de Chile requirió de diseño y planificación, como toda campaña. Parte de estos fue la priorización de grupos objetivo de vacunar, necesaria debido a que el mundo se vería enfrentado a un suministro limitado de vacunas COVID-19. En distintos momentos del año 2020, el CAVEI emitió recomendaciones sobre priorización de grupos de población a vacunar contra SARS-CoV-2, respondiendo a diferentes necesidades y según la evidencia disponible en cada instancia. Éstas se consolidan en la Tabla 1 de este informe. Resumidamente, en fase 1 se recomendó vacunar al personal de salud, residencias de larga estadía y personal crítico del Estado. En fase 2, a personas mayores de 65 años y población con comorbilidades. En fase 3, a personas que cumplen labores esenciales y, finalmente, a la población general.
Abstract COVID-19 is a global public health issue due to its epidemic nature that, to date, lacks pharmacological treatment. However, some COVID-19 vaccines have been authorized for emergency use, although the duration of their protection, their ability to interrupt viral transmission, and their efficacy against emerging variants of SARS-CoV-2 are being studied. Chile's SARS-CoV-2 vaccination campaign required design and planning, like any other campaign. This process included the prioritization of risk groups for vaccination given the limited supply of COVID-19 vaccines globally. Throughout 2020, CAVEI issued recommendations on the prioritization of population groups to be vaccinated against SARS-CoV-2 in response to different needs and in accordance with available evidence. These recommendations are consolidated in Table 1 in this report. In summary, it was recommended that healthcare workers, people in long-term residences and essential State personnel be vaccinated in phase 1. In phase 2, persons over 65 years of age and people with comorbidities. In phase 3, essential tasks workers and, lastly, the general population.
Subject(s)
Humans , COVID-19 Vaccines , COVID-19/prevention & control , Mass Vaccination , Advisory Committees , SARS-CoV-2ABSTRACT
Background: Contact investigation is cardinal in the control of tuberculosis (TB) since it helps to stop its transmission. In Chile, the National TB Program strategy does not include latent TB infection testing, regular chemoprophylaxis or follow-up in adults. Active TB was found in only 1.2% of contacts at country-level during 2018. Aim: To evaluate the performance of a systematic screening of adult household contacts with targeted chemoprophylaxis and prolonged active follow-up. Material and Methods: Prospective cohort of household contacts in Santiago. Two face-to-face visits (at 0 and 12 weeks) that included QuantiFERON TB-Gold plus tests (QFT), chest radiography (CXR) at 0 and 24 weeks and, periodic text messaging or phone call follow-up for up to 48 weeks were implemented. Contacts with positive QFT were referred for TB chemoprophylaxis. Results: A total of 200 contacts were enrolled, 69% were migrants. At baseline evaluation, 45% had a positive QFT result and 1.6% had co-prevalent active TB. At follow-up, 13% contacts further converted to QFT (+), and 5.1% more were diagnosed with active TB (mean follow-up time 32 weeks). Of these 10 further active TB cases, 6 (60%) had a negative QFT and all (100%) had normal CXR at baseline; while three cases occurred in QFT converters. Conclusions: In this cohort of household contacts, 6.7 % were diagnosed with active TB (more than 2/3 at follow-up) and 13% had a late QFT (+) conversion. Active and prolonged contacts' follow-up are essential to detect new infections and tackle the TB epidemic in Chile.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Young Adult , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/epidemiology , Mass Screening/methods , Contact Tracing , Tuberculosis, Pulmonary/microbiology , Tuberculin Test , Family Characteristics , Family Health , Prevalence , Follow-Up StudiesABSTRACT
Abstract. Breast calcifications are frequent findings in mammography. Most of them have a benign origin, such as in the case of the response to inflammatory disease of the ducts or coarse calcifications in benign nodules. Many of these calcifications show a characteristic benign appearance, and they do not need to be magnified or monitored. However, other calcifications can show a grouped pattern, have a suspicious appearance, and transform into an in situ ductal carcinoma or a high risk breast lesion. It is important to know the morphological and distribution patterns of these calcifications in order to make right decisions for each case. In the 5th edition of the BI-RADS atlas, 2013, categories and levels of suspicion for some patterns were modified. The objective of this article is to update descriptors and categories of BI-RADS micro-calcifications, pointing out their most important features and malignancy risk linked to each descriptor.
Resumen. Las calcificaciones mamarias son un hallazgo frecuente en mamografía. La mayoría de ellas tienen un origen benigno, como puede ser la respuesta a patología inflamatoria de los conductos o calcificaciones gruesas en nódulos benignos. Muchas de estas calcificaciones presentan un aspecto benigno característico y no requieren ser magnificadas o controladas. Otras calcificaciones sin embargo pueden presentarse agrupadas, tener un aspecto sospechoso y originarse en un carcinoma ductal in situ o una lesión de alto riesgo. Es relevante conocer los patrones morfológicos y de distribución de estas calcificaciones a fin de tomar la conducta adecuada para cada caso. En la 5.ª edición del atlas BI-RADS, 2013, las categorías y grados de sospecha de algunos patrones fueron modificados. El objetivo del presente artículo es realizar una actualización de los descriptores y las categorías BI-RADS de las microcalcificaciones, señalando sus características más importantes y el riesgo de malignidad asociado a cada descriptor.
Subject(s)
Humans , Breast Diseases/classification , Breast Diseases/diagnosis , Calcinosis/classification , Calcinosis/diagnosis , Breast/anatomy & histology , Breast/pathology , Breast Diseases/pathology , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Calcinosis/pathology , Mammography , Terminology as TopicABSTRACT
Background: Thyroid nodules are common and associated to a low risk of malignancy. Their clinical assessment usually includes a fine neddle aspiration biopsy (FNAB). Aim To identify ultrasonographic characteristics associated to papillary thyroid carcinoma (PTC) and generate a score that predicts the risk of PTC. Material and methods: Retrospective review of all fine needle aspiration biopsies of the thyroid performed in a lapse of two years. Biopsies that were conclusive for PTC were selected and compared with an equal amount of randomly selected biopsies that disclosed a benign diagnosis. Results: One hundred twenty two biopsies of a total of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for the presence of micro-calcifications (Odds ratio (OR) 49.2: 95 percent confidence intervals (CI) 18.7-140.9), solid predominance (OR 25.1; 95 percent CI 6-220), hypoechogenicity (OR 23.5, 95 percent CI 6.5-122.6), irregular borders (OR 17, 95 percent CI 7.2-42.9), lymph node involvement (OR 12.3, 95 percent CI2.7-112), central vascularization (OR 12.2, 95 percent CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2; CI95 percent CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95 percent 8.9-89), hypoechogenicity (OR 9.4; 95 percent CI 1.5-59.5) and irregular borders (OR 4.7; CI 95 percent 1.5-15) as the variables independently associated with the presence of PTC. The prevalence of PTC in the presence of the three variables was 97.6 percent (Likelihood ratio (LR) 45) and 5.4 percent in their absence (LR 0.06). Conclusions: This scale predicts the presence or absence of PTC using simple ultrasound characteristics.
Subject(s)
Female , Humans , Male , Middle Aged , Carcinoma, Papillary , Thyroid Neoplasms , Biopsy, Fine-Needle , Carcinoma, Papillary/pathology , Chile , Epidemiologic Methods , Thyroid Gland/pathology , Thyroid Neoplasms/pathologyABSTRACT
We report a 74-year-old maie with liver metastases from a neuroendocrine tumor (NET) of unknown origin. Conventionai imaging studies with ultrasound, computed tomography coionoscopy and Positron emission tomography-computed tomography (PET/CT) with 18Flúor odeoxyglucose did not identify the site of orígin of the primary tumor. The patient was submitted for a PET/CT sean with a new radiopharmaceuticai, the somatostatin anaiogue 68Ga-DOTATATE. This new technique demostrated increased focal uptake at the ileocecal valve. This lesión and other two liver metastases were surgically removed. The histopathology and immunohistochemistry analysis confirmed the diagnosis of NET (carcinoid). This case illustrates the advantages of the PET/CT sean with 68Ga-DOTATATE.