Perceived academic stress in Mexican medical students. The role of sex emotional distress, burnout, academic-social support, current abuse experiences, and coping strategies / Percepción del estrés académico en estudiantes de medicina mexicanos. El papel del sexo, distrés emocional, burnout, apoyo académico-social, experiencias actual es de abuso y estrategias de afrontamiento

Abstract Introduction Academic stress is a common problem among medical students that has a negative physiological, social, and learning impact. Perceived academic stress indicates how stressed a student is about academic issues over a given period of time and the ability to handle that stress. Objective To determine the prevalence of PAS and evaluate possible risk factors, focusing on sex differences, burnout, emotional distress, academic-social support, and coping strategies. Method A cross-sectional, retrospective, and comparative study was conducted through an online survey with medical students (MS) willing to participate anonymously. Results All students reported PAS and the majority to a moderate-severe degree. Comparing the presence of abuse within the academic environment between men and women, we found differences in the frequency of reporting emotional abuse and sexual. Also, we found differences in perceived academic social support from teachers and family members. Multiple logistic regression analysis showed sex and current sexual abuse inside school had the strongest association with PAS in MS, followed by a family history of depression and perceived less academic social support from family. Discussion and conclusion Timely identification of individuals at-risk will be critical to establish preventive strategies to limit the impact of PAS in MS, stress management programs, training coping skills, and offer prompt therapeutic alternatives when needed.

Resumen Introducción El estrés académico es un problema común entre los estudiantes de medicina que tiene un impacto negativo a nivel fisiológico, social y de aprendizaje. El estrés académico percibido (PAS) indica lo estresado que está un estudiante por cuestiones académicas durante un periodo de tiempo determinado y la capacidad para manejar ese estrés. Objetivo Determinar la prevalencia del PAS y evaluar los posibles factores de riesgo, centrándose en las diferencias por sexo, burnout, el malestar emocional, el apoyo académico-social y las estrategias de afrontamiento. Método Se realizó un estudio transversal, retrospectivo y comparativo a través de una encuesta en línea con estudiantes de medicina dispuestos a participar de forma anónima. Resultados Todos los estudiantes reportaron PAS y la mayoría en un grado moderado-severo. Comparando la presencia de maltrato dentro del ámbito académico entre hombres y mujeres, encontramos diferencias en la frecuencia de denuncia de maltrato emocional y sexual. Asimismo, encontramos diferencias en el apoyo social académico percibido por parte de docentes y familiares. El análisis de regresión logística múltiple mostró que el sexo y el abuso sexual actual dentro de la escuela tenían la asociación más fuerte con PAS, seguidos por antecedentes familiares de depresión y menos apoyo social académico percibido por parte de la familia. Discusión y conclusión La identificación oportuna de las personas en riesgo será fundamental para establecer estrategias preventivas para limitar el impacto de PAS, programas de manejo del estrés, capacitación en habilidades de afrontamiento y ofrecer alternativas terapéuticas rápidas cuando sea necesario.

Tinea faciei por Trichophyton violaceum: primer caso alóctono reportado en Chile / Tinea faciei due to Trichophyton violaceum: first allochthonous case reported in Chile

Trichophyton violaceum es un dermatofito antropofílico endémico en África, Europa, Centroamérica y China. El incremento de los fenómenos de movilidad humana ha contribuido a su aparición en áreas no endémicas. Su principal manifestación clínica es la tinea capitis, seguida por la tinea corporis. En la población pediátrica afecta con mayor frecuencia el cuero cabelludo; y en adultos, la piel glabra. Presentamos el primer caso en Chile de tinea causada por T violaceum. Correspondió a una mujer chilena de 21 años que presentó placas faciales de un mes de evolución después de un viaje a Tanzania, África, sin respuesta a tratamientos médicos previos. Se sospechó una dermatofitosis alóctona y mediante cultivos especiales, se identificó una colonia de crecimiento lento, coloración violeta-negruzca, superficie cerosa y rugosa, con vellosidades aterciopeladas; compatible con T violaceum. Se confirmó mediante secuenciación de ADN ribosomal amplificando la región ITS. Se trató con terbinafina oral con respuesta clínica completa.

Trichophyton violaceum is an anthropophilic dermatophyte endemic in Africa, Europe, Central America and China. The increase in human mobility has recently contributed to the appearance in non-endemic areas. The main clinical manifestation is tinea capitis followed by tinea corporis. We present the first case in Chile of tinea caused by T violaceum. The case was a 21 year-old Chilean woman who presented asymptomatic facial plaques one month after arriving from Tanzania, Africa, with no clinical response to previous medical treatments. An allochthonous dermatophytosis was suspected and with special cultures, a slow-growing colony was identified with a violet-blackish color, waxy and rough surface, and velvety villi; all characteristics of T violaceum. The diagnosis was confirmed by ribosomal DNA sequencing amplifying the ITS region. She was treated with oral terbinafine obtaining a complete clinical response.

Darier disease: the use of dermoscopy in monitoring acitretin treatment

Abstract Darier disease is an uncommon autosomal dominant inherited disease, caused by a mutation in the ATP2A2 gene. The clinical findings are hyperkeratotic papules on the trunk, scalp, face, and neck, maceration of intertriginous areas, palmar pits, whitish papules on the oral mucosa and nail abnormalities. The main histopathologic findings are acantholysis and dyskeratotic keratinocytes. Dermatoscopic features are comedo-like openings with a central polygonal yellowish/brownish structure, surrounded by a whitish halo. First-line treatment includes acitretin. Five reports have been published describing Darier disease dermatoscopic findings. Herein, we report for the first time a patient under acitretin treatment and dermatoscopic follow-up.

Current knowledge of immunosuppression as a risk factor for skin cancer development.

This review outlines our current understanding of the relationship between immunosuppression and skin cancer. Primary immunodeficiencies increase the incidence of skin cancer, but due to their low frequency, the establishment of accurate risk ratios remains lacking. Regarding secondary immunosuppression, available data demonstrate a significant increase of skin cancer in solid organ recipients, being the most common malignancy of this population. Immunosuppressive drugs have an important role in these patients, with an impact related to both the cumulative dose and the type of regimen used. The association of skin cancer and immunosuppressive drugs in non-transplant patients is conflictive for most of the drugs except for azathioprine. Many cancers lead to secondary immunosuppression as a mechanism for tumor growth and advancement, increasing the risk of progression of the primary tumor. Novel insights related with tumorigenesis and immune-escape mechanisms have led to promising new treatments in melanoma and squamous cell carcinoma.

Darier disease: the use of dermoscopy in monitoring acitretin treatment.

Darier disease is an uncommon autosomal dominant inherited disease, caused by a mutation in the ATP2A2 gene. The clinical findings are hyperkeratotic papules on the trunk, scalp, face, and neck, maceration of intertriginous areas, palmar pits, whitish papules on the oral mucosa and nail abnormalities. The main histopathologic findings are acantholysis and dyskeratotic keratinocytes. Dermatoscopic features are comedo-like openings with a central polygonal yellowish/brownish structure, surrounded by a whitish halo. First-line treatment includes acitretin. Five reports have been published describing Darier disease dermatoscopic findings. Herein, we report for the first time a patient under acitretin treatment and dermatoscopic follow-up.

Skin collision tumour and dermoscopic diagnosis of melanoma in situ and dilated pore of Winer.

Collision tumours are a random association of two or more neoplasms arising in the same anatomical site. Dilated pore of Winer (DPW) - an adnexal tumour of pilar origin - has been described in collisions with basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and trichoblastoma. We present a literature review of melanoma-associated skin lesions and describe the first collision of a DPW with a melanoma in situ (MIS) and the sequential dermoscopic examination for diagnosis.

Dermoscopy of penile sclerosing granuloma.

Penile sclerosing granuloma is a foreign body reaction to the injection of material, usually for genital augmentation purposes. Patients commonly deny having had or performed these procedures on themselves, and diagnosis can be challenging. We describe the case of a 62-year-old man with a 10-year history of a growth on the penile shaft. Dermoscopic examination showed an orange background with shiny white structures, suggesting a granulomatous pathology. Guided biopsies confirmed a sclerosing lipogranuloma. The patient admitted to having self-injected motor oil. For the first time, we report the dermoscopic description of sclerosing granuloma, which will improve clinical diagnostic precision and guide biopsies. We also contribute the first description of a dermoscopic rainbow pattern in a granulomatous disorder; this could be due to a physical phenomenon called 'dichroism'.

Auricular Pseudocyst: Sonographic Appearance in 17 Patients.

ABSTRACT: Auricular pseudocyst (AP) is a rare benign condition that corresponds to an intracartilaginous collection resulting in a noninflammatory cystic swelling of the ear.The objective is to describe ultrasound and clinical presentation of histologically proven AP.An Institutional Review Board (IRB) approved a 6-year retrospective study. Patients with an auricular pseudocyst were selected. Fifty-nine percent of the cases were referred with clinical suspicion of AP. One hundred percent were men, and in 76% of the cases, AP was located in the scaphoid fossa. The mean age was 35 years (76% from 20 to 50 years).Unilateral lesion was present in 94% of the cases. A single lesion was found in 88% and multiple lesions in 12%. On high-resolution ultrasound increased thickness of the cartilage was observed in all patients with a cystic lesion inside the cartilage. Fifty-nine percent of the cases were totally anechoic. The other presented echoes or septa inside the cystic lesion.In conclusion high-resolution ultrasound allows to study the exact anatomic involvement of the cartilage and the surrounding tissues. The auricular pseudocyst presented a characteristic ultrasound finding permitting an adequate early diagnosis and monitoring treatment. Knowledge of this pathology and the sonographic finding is important for a correct diagnosis.

Guía de práctica para el manejo de melanoma cutáneo primario de la Sociedad Chilena de Dermatología / Practice guideline for the management of melanoma primary skin cancer of the Chilean Society of Dermatology

Introducción: Desde el año 2011 a la fecha se han realizado grandes avances en el diagnóstico y el tratamiento del melanoma cutáneo. Las diferentes sociedades dermatológicas internacionales han actualizado sus recomendaciones y guías de manejo, tomando en consideración los nuevos avances científicos y resultados de ensayos clínicos. Objetivo: El objetivo de la presente revisión es proponer recomendaciones basadas en la evidencia sobre del rol del dermatólogo en el manejo del melanoma cutáneo en el sistema de salud de Chile. Diseño: Revisión sistemática de la literatura en cinco bases de datos: Pubmed/Medline, Embase, Web of Science, Lilacs/SciELO y Cochrane Library; desde julio del 2016 a julio del 2021. Resultados: 1306 registros fueron identificados y 153 cumplieron los criterios de inclusión. Se exponen recomendaciones actualizadas con respecto al diagnóstico y manejo del melanoma cutáneo en Chile. El panel de expertos presenta un diagrama de flujo del proceso de atención de una lesión sospechosa de melanoma, la participación global del equipo médico encargado del cuidado paciente y el rol del dermatólogo. Conclusión: El rol del dermatólogo es central e indispensable en todas las etapas de atención del melanoma cutáneo.

Introduction: Since 2011 great advances have been made in the diagnosis and treatment of cutaneous melanoma. The different international dermatological societies have updated their recommendations and clinical guidelines taking into account new scientific advances and the results of clinical trials. Objective: The aim of this review is to propose evidence-based recommendations on the role of the dermatologist in the diagnosis and management of cutaneous melanoma in the Chilean healthcare system. Design. Systematic review of the literature in five databases: Pubmed/Medline, Embase, Web of Science, Lilacs/SciELO and Cochrane Library; from July 2016 to July 2021. Results: 1306 records were identified and 153 met the inclusion criteria. Updated recommendations regarding the diagnosis and management of cutaneous melanoma in Chile are presented. The expert panel presents a flowchart of the process of care of a suspected melanoma lesion, the overall involvement of the medical team in charge of patient care, and the role of the dermatologist. Conclusion: The role of the dermatologist is central and critical in all stages of cutaneous melanoma care

Medicina y Derecho. Una interdependencia socio-históricav / Medicine and Law A socio-historical interdependence

Tal vez, la primera duda que asalte al lector frente a este editorial es acerca de las conexiones que pueda tener la ciencia médica y la ciencia del derecho o la ciencia del derecho y la ciencia médica, aunque ciertamente aparentan ser sabidurías muy distantes y cada una presenta tópicos tan apartados como la responsabilidad, las definiciones del fenómeno terrorista y o bacterioterapia preventiva, existen conexiones innegables que las acercan más de lo que se sospecha.

Unusual Clinical Presentations of Malignant Melanoma: A Review of Clinical and Histologic Features with Special Emphasis on Dermatoscopic Findings.

This review presents the main challenges encountered when diagnosing unusual variants of malignant melanoma with the aim of raising awareness to allow application of the most appropriate treatment strategies. Although these melanomas are often rare, their misdiagnosis potentially jeopardizes patients' health and survival, and has medicolegal implications. The clinical and histologic presentations of melanoma vary greatly, and assessment of uncommon melanomas can be difficult for practitioners because of their scarcity and resemblance to other dermatologic entities. The most problematic melanoma types are desmoplastic melanoma, polypoid melanoma, primary dermal melanoma, verrucous malignant melanoma, pigmented epithelioid melanocytoma, mucosal melanoma, follicular melanoma and melanoma with non-melanocytic differentiation. The two most difficult-to-diagnose subtypes of melanoma are the nevoid and the amelanotic melanomas. Some specific attributes of these variants can be more easily recognized with digital dermatoscopy, facilitating early detection and possibly avoiding invasive procedures. Key cases with the most notable clinical, dermatoscopic, and histopathologic features are presented, highlighting the practical issues of making an accurate diagnosis and choosing the best therapy.

Predictive Model for Response Rate to Narrowband Ultraviolet B Phototherapy in Vitiligo: A Retrospective Cohort Study of 579 Patients.

Vitiligo is an acquired depigmenting disorder. To date, there is no predictive model for its response rate to narrowband ultraviolet B (NBUVB) phototherapy. The aim of this study was to investigate the different types of response of patients with non-segmental vitiligo undergoing NBUVB 3 times a week. Many patients who were previously considered non-responders were given the opportunity to continue the treatment. Long-term maintenance of treatment and follow-up of a cohort of 579 patients enabled different subtypes of response (very rapid, rapid, average, slow and "non-responders") to be described for the first time, and a predictive model of response to be constructed based on repigmentation rate in the first 48 sessions of NBUVB. Among those patients who did not respond during the first 48 sessions, a new subgroup of patients was found, termed "very-slow" responders, who achieved a low, but significant, level of repigmentation after 96 sessions of NBUVB.

Parvovirus B19: Un virus ADN asociado a múltiples manifestaciones cutáneas / Parvovirus B19: A DNA virus associated with multiple cutaneous manifestations

Resumen El parvovirus B19 es un virus ADN comunitario distribuido a nivel mundial con seroprevalencias que alcanzan hasta 85% en el adulto mayor. Existe un amplio espectro de manifestaciones clínicas en la infección por parvovirus B19 siendo las cutáneas las más frecuentes. Si bien, la mayoría de éstas son autolimitadas, existen numerosos síndromes y enfermedades autoinmunes en los cuales se postula al parvovirus B19 como factor gatillante, dada su capacidad de inducir la producción de numerosos autoanticuerpos y promover la presentación de autoantígenos a linfocitos T. En la presente revisión se describe el espectro de manifestaciones cutáneas de la infección por parvovirus B19 y la evidencia que apoya su asociación con cada una de ellas. Se propone una clasificación de las diferentes enfermedades con manifestaciones cutáneas vinculadas al parvovirus B19, basado en la cantidad y calidad de la evidencia disponible en la literatura científica.

Parvovirus B19 is a community DNA virus with worldwide distribution with up to 85% seroprevalence in the elderly. There is a wide spectrum of clinical manifestations in parvovirus B19 infection of which cutaneous involvement is the most frequent one. Although most of these are self-limiting conditions, there are numerous syndromes and autoimmune diseases in which parvovirus B19 is postulated as a triggering factor, given its ability to induce the production of various autoantibodies and promote the presentation of autoantigens to T cells. This review describes the spectrum of cutaneous manifestations of parvovirus B19 infection and the evidence supporting its association with each of them. We propose a new classification of different diseases with cutaneous manifestations linked to parvovirus B19, based on the amount and quality of available evidence in the literature.

The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo.

BACKGROUND: Treatment of vitiligo with narrowband ultraviolet B light (NBUVB) is an important component of the current standard of care. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo, reflected by varied treatment practices around the world. OBJECTIVE: To create phototherapy recommendations to facilitate clinical management and identify areas requiring future research. METHODS: The Vitiligo Working Group (VWG) Phototherapy Committee addressed 19 questions regarding the administration of phototherapy over 3 conference calls. Members of the Photomedicine Society and a group of phototherapy experts were surveyed regarding their phototherapy practices. RESULTS: Based on comparison and analysis of survey results, expert opinion, and discussion held during conference calls, expert recommendations for the administration of NBUVB phototherapy in vitiligo were created. LIMITATIONS: There were several areas that required further research before final recommendations could be made. In addition, no standardized methodology was used during literature review and to assess the strength of evidence during the development of these recommendations. CONCLUSION: This set of expert recommendations by the VWG is based on the prescribing practices of phototherapy experts from around the world to create a unified, broadly applicable set of recommendations on the use of NBUVB in vitiligo.