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Objective:To investigate the application value of the teaching evaluation method guided by cultivating "excellent doctors" in the clinical teaching of dermatology and venereology.Methods:A non-simultaneous control study was conducted, and the medical students who received theoretical learning and clinical internship in Department of Dermatology and Venereology, Affiliated Hospital of North Sichuan Medical College, from March 2020 to February 2022, were enrolled as subjects. According to the order of enrollment, 32 students who were enrolled from March 2020 to February 2021 were set up as control group, and 31 students who were enrolled from March 2021 to February 2022 were set up as experimental group. The students in the control group received lecture-based learning, and those in the experimental group received clinical teaching using a teaching and evaluation method guided by cultivating "excellent doctors". After the course ended, the two groups were compared in terms of the scores of theoretical knowledge and operation skills, clinical thinking ability [Self-Assessment of Clinical Reasoning and Reflection (SACRR)], core competence [Mini-Clinical Evaluation Exercise (Mini CEX)], and degree of satisfaction with teaching. SPSS 25.0 software was used to perform the independent samples t-test, the Mann-Whitney U test, the chi-square test, and the rank sum test. Results:One student in the control group voluntarily withdrew from the study, and one student in the experimental group did not complete the contents of internship. Finally, 31 students in the control group and 30 in the experimental group were included in the study. After 4 weeks of internship, compared with the control group, the experimental group had significantly higher scores of theoretical knowledge (88.00±4.30 vs. 85.71±4.12, t=2.12, P=0.040) and operation skills (91.87±3.99 vs. 88.23±3.84, t=3.63, P<0.05). After 4 weeks of internship, compared with the control group, the experimental group had significantly higher information systematization score (47.23±3.11 vs. 45.16±3.00), analysis problem score (34.87±2.30 vs. 31.29±2.30), truth finding score (16.30±1.49 vs. 14.45±1.52), reflective ability score [3.50 (3.00, 4.00) vs. 3.00 (3.00, 3.00)], and total score of SACRR (101.87±4.47 vs. 93.90±4.47), with significant differences between the two groups ( t/ Z=2.65, 6.17, 4.79, 3.15, and 6.96, all P<0.05). After 4 weeks of internship, the experimental group had a significantly better core competence than the control group ( Z=2.12, P=0.030); compared with the control group, the experimental group had significantly higher classroom teaching score (20.17±1.98 vs. 18.45±2.23, t=3.17, P<0.05), clinical practice score (19.83±2.10 vs. 17.65±2.17, t=4.00, P<0.05), learning plan score (18.63±2.24 vs. 17.03±2.15, t=2.85, P<0.05), teaching resource score (20.07±1.82 vs. 18.58±2.00, t=3.04, P<0.05) and total score (78.70±3.67 vs. 71.71±4.13, t=6.98, P<0.05). Conclusions:The application of the teaching and evaluation method guided by cultivating "excellent doctors" in the clinical teaching of dermatology and venereology can improve clinical theoretical knowledge, practical operation skills, clinical thinking ability, and core ability among interns and thus help to improve teaching quality. Therefore, it holds promise for clinical application.
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ABSTRACT Cutaneous involvement in paracoccidioidomycosis (PCM) can exhibit a highly polymorphic spectrum. The infiltrative pattern corresponds to up to 26.6% of observed skin lesions, including sarcoid-like plaques, a rare presentation of cutaneous lesions in PCM. This clinical expression is almost exclusively cutaneous, and its histology reveals a tuberculoid granuloma with a scarcity of fungi, leading to misdiagnosis as other granulomatous diseases. Here, we report a rare form of chronic multifocal paracoccidioidomycosis manifesting as sarcoid-like skin lesions misdiagnosed as granulomatous rosacea in a patient with severe systemic disease.
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A eletroquimioterapia é uma tecnologia inovadora usada para tratar cânceres de pele e mucosa. Consiste na administração intravenosa de bleomicina seguida pela aplicação de pulsos de eletroporação no tumor em suas margens. Esses pulsos induzem a formação de poros na membrana celular, aumentando a eficácia citotóxica da bleomicina em mais de 1.000 vezes. Como a eletroporação é um fenômeno físico, diferentes tipos de tumores podem ser tratados, independentemente de sua histologia. Geralmente, apenas uma sessão de tratamento é necessária para obter resposta satisfatória. A eletroquimioterapia é uma boa opção para tumores recidivantes nos quais outras terapias não proporcionam resposta. Além disso, os tumores podem ser reduzidos com a terapia, permitindo cirurgias menos agressivas e melhorando os resultados. Muitas diretrizes de tratamento começaram a incluir o uso dessa técnica não ablativa como uma nova opção de tratamento quando outras terapias falharam ou foram rejeitadas pelo paciente. O tratamento é realizado em regime ambulatorial com altas taxas de resposta e poucos efeitos colaterais.
Electrochemotherapy is an innovative technology used to treat skin and mucosal cancers. It consists of intravenous administration of bleomycin followed by the application of electroporation pulses to the tumor at its margins. These pulses induce the formation of pores in the cell membrane, increasing the cytotoxic efficacy of bleomycin by more than 1,000- fold. As electroporation is a physical phenomenon, different types of tumors can be treated regardless of their histology. Generally, only one treatment session is needed to obtain a satisfactory response. Electrochemotherapy is a good option for recurrent tumors in which other therapies do not provide a response. Additionally, tumors can be shrunk with therapy, allowing for less aggressive surgeries and improving outcomes. Many treatment guidelines have begun to include the use of this non-ablative technique as a new treatment option when other therapies have failed or been rejected by the patient. Treatment is carried out on an outpatient basis with high response rates and few side effects.
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Resumen Estudiar y reflexionar sobre la enfermedad es poner de relieve las formas de ver y decir acerca de lo que puede un cuerpo y su potencia de ser afectado ante las huellas o vestigios que lo degradan. Este artículo expone los soportes epistemológicos de una investigación sobre las representaciones sociales (en la que se inscribe el saber médico) de la enfermedad desde el registro de la dermatología clínica durante la segunda mitad del siglo XIX. Para esto, se recurrió a un análisis de fotografías médicas conservada en archivos de Colombia y España y como horizonte discursivo las formas de ver y decir la enfermedad que tiene efectos deformantes en el cuerpo.
Abstract To study about and reflect on the disease is to highlight the ways of seeing and saying what can a body and its power to be affected before fingerprints or traces that degrade it. This article exposes epistemological research on social representations brackets (where register know doctor) disease from the registry of Clinical Dermatology in the second half of the 19th century. This is resorted to an analysis of medical photographs preserved in archives of Colombia and Spain taking as discursive forms of seeing and saying the disease who have disfiguring effects in the body.
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Maladie , Dermatologie , Photographie , Représentation sociale , Espagne , Colombie , Histoire du 19ème siècleRésumé
Abstract Background Surgery is the treatment of choice for patients with basal cell carcinoma (BCC). When surgery is not a choice, only radiotherapy is recommended for patients with high-risk facial BCC. Interferon could be an acceptable therapeutic option for these patients. Objective To evaluate the long-term clinical response to interferon therapy in patients with high-risk facial BCC. Methods Patients with high-risk facial BCC were treated with perilesional injections of alpha-2b+ gamma interferons. Those with incomplete clinical response were reevaluated, their residual tumors excised, and declared cured. Patients treated with interferon and those treated with interferon plus surgery were followed for five years. Time to recurrence and the emergence of a new facial BCC were estimated by Kaplan-Meier survival analysis. Adverse events were documented. Results This study included 195 participants; 143 (73.3%) showed a complete response (95% CI 67.2‒80.1). Patients developed recurrence after a mean of 55 months (95% CI 53.8‒57.4). The estimated rate of recurrence was 12.3% (95% CI 7.4‒17.1). Patients developed a new BCC after a mean of 52.7 months (95% CI 50.4‒54.9). The estimated rate for development of a new BCC was 20.0% (95% CI 14.4‒25.9). Fifteen (7.7%) patients abandoned the study during follow-up. Adverse events were frequent but moderate or mild; fever and local pain were the most frequent. Study limitations Observational cohort design without a control group for comparison. Conclusions Perilesional injections of alpha-2b+ gamma interferons in patients with facial high-risk BCC offer a satisfactory cure rate after five years of follow-up with an acceptable safety profile.
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Objetivo: analisar a correlação entre os objetivos, conteúdos programáticos e as metodologias utilizadas nos cursos de especialização em enfermagem dermatológica existentes no Brasil, comparando com a legislação vigente e literatura pertinente à temática. Método: estudo documental, realizado no período de maio a julho de 2022 em sites de instituições de ensino superior que ofereceram estes cursos. Resultados: foram acessadas 46 instituições privadas, 56,6% localizadas na região Sudeste e 43,5% na modalidade de ensino à distância. O conteúdo programático foi disponibilizado por 41 instituições; 41,5% das disciplinas eram generalistas, inespecíficas da área; 26,8% sobre feridas e 17,1% dermatologia. Atividade prática apareceu em 26,8% dos cursos. Conclusão: os cursos atendem parcialmente à legislação e oferecem uma formação que não contempla a abrangência da especialidade e demandas atuais da população(AU)
Objective: to analyze the correlation between objectives, syllabus and methodologies used in Nursing Specialization courses Dermatological practices existing in Brazil, comparing with current legislation and literature relevant to the theme. Method: documentary study, carried out from May to July 2022, on websites of higher education institutions that offered these courses. Results: 46 private institutions were accessed, 56,6% located in the Southeast region and 43,5% in the distance learning modality. The programmatic content was made available by 41 institutions; 41,5% of the disciplines were generalist, not specific to the area; 26,8% about wounds and 17,1% dermatology. Practical activity appeared in 26,8% of the courses. Conclusion: the courses partially comply with the legislation and offer training that does not cover the scope of the specialty and current demands of the population(AU)
Objetivo: analizar la correlación entre los objetivos, el programa y las metodologías utilizadas en los cursos de Especialización en Enfermería Dermatológica existentes en Brasil, comparando con la legislación vigente y bibliografía relacionada con el tema. Método: estudio documental, realizado de mayo a julio de 2022, en páginas web de instituciones de educación superior que ofrecieron estos cursos. Resultados: se constató un acceso a 46 instituciones privadas, 56,6% ubicadas en la región Sudeste y 43,5% en la modalidad de enseñanza a distancia. 41 instituciones pusieron a disposición el contenido programático; el 41,5% de las disciplinas era generalista, no siendo específicas del área; 26,8% sobre heridas y 17,1% dermatología. La actividad práctica apareció en el 26,8% de los cursos. Conclusión: los cursos cumplen parcialmente con la legislación y ofrecen una formación que no cubre el ámbito de la especialidad y las demandas actuales de la población(AU)
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Humains , Mâle , Femelle , Dermatologie/enseignement et éducation , Enseignement spécialisé en soins infirmiers/tendances , Programme d'études/tendances , Recherche qualitativeRésumé
A síndrome de Reed ocorre em mulheres com múltiplos leiomiomas cutâneos e leiomiomatose uterina. Relatam-se três casos de pacientes do sexo feminino, acompanhadas em hospital universitário, com pápulas e nódulos eritêmato-acas- tanhados dolorosos em membros superiores e tórax, agravados por frio, pressão e estresse, e associados a miomatose uterina. Foram realizados diversos tratamentos prévios, sem sucesso, tais como: aplicação de corticoterapia e toxina botulínica intralesional, bloqueadores de canais de cálcio, neuromoduladores e analgésicos orais. Foi, então, realizado tratamento cirúrgico, com melhora dos sintomas. O co- nhecimento e o esclarecimento dessa síndrome é fundamental para estabelecer a relação com miomatose uterina e câncer de células renais, para que, então, a partir da lesão de pele, se faça o rastreio das demais neoplasias, diagnóstico precoce e a educação em saúde.
Reed syndrome occurs in women with multiple cutaneous leiomyomas and uterine leiomyomatosis. We report the case of three female patients followed at a university hospital with painful erythematous-brown papules and nodules on the upper limbs and chest, aggravated by cold, pressure, stress, and associated with uterine myoma- tosis. Several previous unsuccessful treatments were performed, such as the applica- tion of corticotherapy and intralesional botulinum toxin, calcium channel blockers, neuromodulators, and analgesics. Surgical treatment was performed with the im- provement of symptoms. Knowledge and clarification of this syndrome are essential to establish a relationship between uterine myomatosis and renal cell neoplasm, so that, after the skin lesion, screening for other neoplasms, early diagnosis, and health education can be carried out.
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Humains , Femelle , Malformations cutanées , Tumeurs cutanées/diagnostic , Tumeurs de l'utérus , Léiomyomatose/prévention et contrôle , Thorax/physiopathologie , Santé des femmes , Léiomyomatose/chirurgie , Membres/physiopathologie , Tumeurs du rein/diagnostic , Mutation/génétiqueRésumé
Introducción: En las prácticas de laboratorio se adquiere la habilidad que permite corroborar el diagnóstico de las enfermedades de la piel y anejos después de un diagnóstico presuntivo, con la utilización del método clínico. Esto se respalda en las exigencias establecidas en los documentos normativos de ese proceso formativo. Objetivo: Proponer un sistema de procedimientos para la formación interdisciplinar de la habilidad "diagnosticar enfermedades dermatológicas en los residentes de dermatología, a partir de insuficiencias detectadas en el programa de la especialidad. Métodos: La investigación fue cualitativa, con un estudio descriptivo en el Hospital Provincial General Docente Dr. Antonio Luaces Iraola, de Ciego de Ávila, desde 2018 hasta 2022. Se trabajó con toda la población conformada por 16 residentes de primer año en dermatología. Se utilizaron métodos de nivel teórico, empírico y estadístico. Resultados: En el sistema de procedimientos propuesto, se concretan fortalezas y debilidades, objetivo general, orientaciones metodológicas, precisión de los objetivos específicos y sistema de acciones para cada procedimiento, y sistema de control y evaluación de la efectividad de las acciones realizadas. La demostración de la formación de la habilidad diagnosticar, a través de un caso clínico real, reveló como esencial la consecutividad lógica de las acciones del residente desde la atención médica del caso y la formulación del diagnóstico presuntivo hasta el establecimiento del diagnóstico corroborativo en los laboratorios de anatomía patológica, microbiología y parasitología médica. Conclusiones: Se aporta un sistema de procedimientos que posibilita la formación de la habilidad "diagnosticar enfermedades dermatológicas en los residentes, con carácter secuencial, interdisciplinar e investigativo(AU)
Introduction: Laboratory practices provide the ability that allows corroborating the diagnosis of skin and adnexal diseases after a presumptive diagnosis, with the use of the clinical method. This is supported by the requirements established in the standardization documents of this training process. Objective: To propose a system of procedures for the interdisciplinary training of the skill to diagnose dermatological diseases in Dermatology residents, based on insufficiencies detected in the specialty program. Methods: The research was qualitative and consisted in a descriptive study carried out in Hospital General Docente Dr. Antonio Luaces Iraola, of Ciego de Avila, from 2018 to 2022. The work was done with the entire population made up of 16 first-year residents in Dermatology. Theoretical, empirical and statistical methods were used. Results: In the proposed system of procedures, strengths and weaknesses are specified, together with general objective, methodological guidelines, precision of specific objectives and system of actions for each procedure, as well as system of control and evaluation of the effectiveness of the actions. Demonstrating the received formation for the diagnostic skill, through a real clinical case, revealed as essential the logical consecutivity of the resident's actions from the medical attention of the case and the formulation of the presumptive diagnosis to the establishment of the corroborative diagnosis in the laboratories of pathological anatomy, microbiology and medical parasitology. Conclusions: A system of procedures is provided that makes possible the formation of the skill to diagnose dermatological diseases in residents, with sequential, interdisciplinary and investigative character(AU)
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Humains , Aptitude , Maladies de la peau/diagnostic , Enseignement , Enseignement professionnel , Formation Professionnelle , Stage interdisciplinaire/méthodes , Compétence professionnelle , Plans et Programmes de Santé , Épidémiologie Descriptive , Dermatologie/enseignement et éducationRésumé
Fundamento: el carcinoma basocelular es un tumor maligno muy frecuente en el ser humano. Se considera invasivo de forma local, además de agresivo y destructivo. Objetivo: mostrar el comportamiento de los pacientes con carcinoma basocelular diagnosticados por dermatoscopia en consulta de dermatología del Hospital Universitario Miguel Enríquez, entre junio de 2020 y mayo de 2021. Método: se realizó un estudio descriptivo, de corte transversal, para mostrar el comportamiento de los pacientes con carcinoma basocelular que asistieron a la consulta de dermatología del Hospital Universitario Miguel Enríquez en el periodo de junio 2020 a mayo 2021. El universo de estudio se conformó por los pacientes mayores de 18 años que presentaron una o varias lesiones presuntivas de carcinoma basocelular menores de 3 cm de diámetro. Se utilizaron las variables: edad, sexo, fototipo de piel, formas clínicas, patrones dermatoscópicos, topografía de la lesión, ocupación relacionada o no con la exposición solar. Se trabajó con frecuencias absolutas, porcentaje, media, desviación estándar, valores máximos y mínimos, la razón, pruebas de ji-cuadrado y t de student, con significación p≤0,05. Resultados: predominó en ancianos (66,4±14,9 años), en hombres (54,1 %), con fototipo 2 (57,8 %), y en nariz el 33,9 %. La forma nodular fue más frecuente (41,3 %), ocupación expuesta al sol (66,9 %), tamaño promedio de la lesión 1,4 cm. La dermatoscopia mostró predominio de los vasos arborizantes (73,4 %). Por histología se confirmó el 90,8 % de los casos. Conclusiones: predominaron entre los pacientes los ancianos, con fototipo 2. La forma nodular fue más frecuente, el tamaño promedio de la lesión fue de 1,4 cm. La dermatoscopia mostró predominio de los vasos arborizantes. La dermatoscopía resultó ser una herramienta necesaria para el uso sistemático en dermatología.
Foundation: basal cell carcinoma is a very common malignant tumor in humans. It is considered locally invasive, also aggressive and destructive. Objective: to show the behavior of patients with basal cell carcinoma diagnosed by dermoscopy in dermatology clinic of the Miguel Enríquez University Hospital, between June 2020 and May 2021. Method: a descriptive, cross-sectional study was carried out to show the behavior of patients with basal cell carcinoma who attended the dermatology consultation at the Miguel Enríquez University Hospital from June 2020 to May 2021. The universe of study was made up of patients older than 18 years who presented one or more presumptive lesions of basal cell carcinoma less than 3 cm in diameter. The variables used were: age, sex, skin phototype, clinical forms, dermoscopic patterns, topography of the lesion, occupation related or not to sun exposure. We worked with absolute frequencies, percentage, mean, standard deviation, maximum and minimum values, the ratio, chi-square and student's t tests, with significance p≤0.05. Results: it prevailed in the elderly (66.4±14.9 years), in men (54.1 %), with phototype 2 (57.8 %), and in the nose 33.9 %. The nodular form was more frequent (41.3 %), occupation exposed to the sun (66.9 %), average size of the lesion 1.4 cm. Dermoscopy showed a predominance of arborizing vessels (73.4 %). By histology, 90.8 % of the cases were confirmed. Conclusions: the elderly prevailed among the patients, with phototype 2. The nodular form was more frequent, the average size of the lesion was 1.4 cm. Dermoscopy showed a predominance of arborizing vessels. Dermoscopy turned out to be a necessary tool for systematic use in dermatology.
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A key global health objective is to promote the advancement of scientific production in disciplines with low publication volume, as opposed to specialties addressing pathologies that represent the greatest global disease burden (1). Dermatology is one such discipline, which has experienced substantial growth in research on immunopathogenic, pathophysiological, diagnostic, and therapeutic aspects (2-4). The extent to which Latin American authors and institutions have been involved in publishing scientific articles in the dermatology journals with highest impact worldwide remains unknown.
Un objetivo clave de salud mundial es promover el avance de la producción científica en disciplinas con bajo volumen de publicación, a diferencia de especialidades que abordan las patologías que representan la mayor carga de enfermedad a nivel mundial (1). La Dermatología es una de esas disciplinas que ha experimentado un crecimiento sustancial en investigación en aspectos inmunopatogénicos, fisiopatológicos, diagnósticos y terapéuticos (2-4). El alcance en el cual los autores e instituciones latinoamericanas han participado en la publicación de artículos científicos en revistas de dermatología con mayor impacto mundial permanece incierto.
Um objetivo fundamental da saúde global é promover o avanço da produção científica em disciplinas com baixo volume de publicações, em oposição às especialidades que abordam patologias que representam a maior carga de doenças em todo o mundo (1). A Dermatologia é uma das disciplinas que tem experimentado um crescimento substancial nas pesquisas em aspectos imunopatogênicos, fisiopatológicos, diagnósticos e terapêuticos (2-4). A extensão da participação de autores e instituições latino-americanas na publicação de artigos científicos em revistas de dermatologia de maior impacto global permanece incerta.
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Dermatologie , Hispanique ou Latino , Bibliométrie , Auteurs dans les publications scientifiques , Communication savanteRésumé
Background: In the Indian subcontinent, the lesbian, gay, bisexual, transgender, and queer community, commonly referred to as the third gender or transgender, is expected to exceed one million by 2030. Data on dermatologic conditions of the transgender population is deficient. Aims: This study aimed to identify the common dermatological concerns and dermatologic procedures of the lesbian, gay, bisexual, transgender, and queer community of India. Methods: This cross-sectional survey analysed the transgender participants of a non-institutionalised population in India via health camps that included 51 adult participants who self-identified as trans men and trans women. Results: This study included 51 participants aged 20–49 years, of which the majority (94%) were trans women. The common dermatological problems were terminal hairs over the face, beard distribution, androgenetic alopecia, scars of gender-affirming surgeries, facial melanosis with topical steroid damaged skin and the need for facial feminisation procedures among trans women, while trans men had testosterone-related acne, androgenetic alopecia. Overall, 40.6% of participants reported dissatisfaction with one or more of their body parts. Laser hair removal was the most common gender-affirming dermatologic procedure. Conclusion: This study provides an essential overview of the common dermatological conditions and procedures in the Indian lesbian, gay, bisexual, transgender, and queer community. Lesbian, gay, bisexual, transgender, and queer persons have insufficient access to dermatological services due to inadequate exposure and fear of discrimination. Even though transgender patients also present with similar dermatologic conditions as the general population, they have distinct cosmetic and treatment concerns during the period of transition owing to hormone-related or surgery-related changes. Addressing these challenges through enhancing dermatology residency training programs should be the focus of tomorrow. Limitations: Considering convenience sampling and representative bias, further studies need to be conducted involving multiple study locations and larger sample sizes.
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Background: Though studies have looked at the attitudes of dermatologists towards psychodermatology, few have highlighted the attitudes of pharmacists towards these conditions. Objectives: To study the knowledge, attitudes and practices of pharmacists towards the prescription of psychotropic medications to dermatology patients. Methods: This cross-sectional analysis included 80 pharmacists from Mumbai, India. We used an interviewer-administered questionnaire to collect information from pharmacists on their demographics, psychotropic medications in dermatological patients, knowledge about psychocutaneous conditions and comfort about dispensing these medications. Results: In our study, 37 (46%) of pharmacists received prescriptions of psychotropic drugs from dermatologists; however, 24 (30%) were not comfortable dispensing them. Sixty (75%) pharmacists felt that only psychiatrists should prescribe psychotropic drugs and 37 (46%) felt that they had a right to refuse to dispense prescribed medication; of these, 15 (19%) had actually refused to give medications to patients. Pharmacists who disagreed with the statement that 'the state of mind is associated with medical conditions', were more likely to discourage psychotropic prescription from dermatologists (29% vs 11%, P = 0.04). Pharmacists with experience of more than five years were significantly more likely to refuse to dispense medications (odds ratio: 5.14, 95% confidence interval: 1.02, 25.83; P = 0.047). Limitations: We did not have a list of all pharmacists in Mumbai; thus, no sampling frame could be applied. Conclusion: Pharmacists do comment on doctors’ prescriptions, discourage certain medications and even refuse to dispense them based on their personal opinions. Since they are the last stop for patients between the doctor and the medication, their inclusion (in addition to dermatologists, psychiatrists and psychologists) in integrated awareness, training and care programs would improve the quality of care of patients with psychocutaneous disorders
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Fundamento: El estudio teórico, el diagnóstico realizado y la experiencia de los investigadores, posibilitan formular como problema de la presente investigación: limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología del Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Objetivo: Elaborar una concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar enfermedades dermatológicas en los residentes de la especialidad de Dermatología, a partir de la caracterización del estado actual de esta habilidad. Metodología: Se realizó una investigación educativa con un componente descriptivo en el Hospital General Provincial Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila, en los cursos escolares desde 2016 al 2020. La población de estudio fueron los 16 residentes de 1.er año que matricularon la especialidad de Dermatología en el período de estudio. Se emplearon métodos del nivel teórico y empírico. Resultados: La caracterización realizada reveló limitaciones en el desarrollo de la habilidad diagnosticar enfermedades dermatológicas en los laboratorios de Anatomía Patológica, Microbiología y Parasitología Médica, por los residentes (100 %). La concepción didáctica del proceso de formación interdisciplinar de la habilidad diagnosticar orienta el proceso desde las actividades docentes-atencionales y prácticas de laboratorio en una consecutividad lógica y sistematización desde las diferentes formas de enseñanza y tipologías de clase. Integra la interdisciplinariedad y la utilización del método investigativo establecido en las ideas rectoras. Conclusiones: La concepción didáctica como aporte de la investigación resuelve la contradicción dialéctica entre la aplicación del método clínico y los procedimientos en la práctica de laboratorio que se da en ese proceso formativo y constituye un soporte didáctico que respalda las actividades prácticas en los laboratorios para cumplir con los objetivos del Plan de estudio de la especialidad.
Background: The theoretical study, the diagnosis conducted and the experience of the researchers make possible to formulate the problem of the present research: limitations in the development of the ability to diagnose dermatological diseases in residents of the Specialty of Dermatology of the General Provincial Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila. Objective: To elaborate a didactic conception of the interdisciplinary training process of the ability to diagnose dermatological diseases in residents of the specialty of Dermatology, based on the characterization of the current state of that ability. Methodology: An educational research with a descriptive component was conducted at the Provincial General Teaching Hospital "Dr. Antonio Luaces Iraola" of Ciego de Avila, in the 2016-2020 school years. The study population consisted of the 16 first-year dermatology residents who enrolled in the specialty during the study period. Results: The characterization conducted showed limitations in the development of the ability to diagnose dermatological diseases in anatomic pathology laboratories, Microbiology and Medical Parasitology, by residents (100%). The didactic conception of the interdisciplinary training process of diagnostic ability focuses on teaching and learning activities and laboratory practices in a logical consecutiveness and systematization from the different forms of teaching and class typologies. It integrates the interdisciplinary and the use of the research method that is established in the guiding ideas. Conclusions: The didactic conception, as a research contribution, resolves the dialectic contradiction between the application of the clinical method and the procedures in laboratory practice that occurs in this formative process which is a didactic support that backs up the practical activities in the laboratories in order to achieve the objectives of the study plan of the specialty.
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Compétence clinique , Dermatologie/enseignement et éducation , Enseignement médical/méthodes , Stage interdisciplinaire/méthodes , Corps médicalRésumé
Objetivo: Determinar las características clínicas y demográficas de los pacientes con lesiones de piel atendidos en un hospital general de Trujillo, Perú. Material y métodos: Estudio transversal, descriptivo, observacional y retrospectivo. Se hizo la revisión microscópica de 385 biopsias de piel de los archivos de Patología y de las historias clínicas de pacientes atendidos en el Hospital del Belén de Trujillo, durante el periodo comprendido entre enero del 2018 y diciembre del 2019. Resultados: La lesión más frecuente fue el carcinoma basocelular, localizado en alguna parte del rostro y de presentación mayor a edades de 60 años o más. En segundo lugar, carcinoma epidermoide. Las lesiones malignas afectaron al 66,7% de pacientes entre 55 y 79 años, con edad promedio de 67 años. En su mayoría (65,8%) fueron varones desocupados. De las lesiones benignas, la más frecuente fue el quiste de inclusión epidérmica y se ubicó en el tronco de varones entre 20 y 24 años. En segundo lugar, el pilomatrixoma se ubicó en los miembros superiores de menores de 10 años. Afectaron al 59,6%, entre los 30 y 54 años, con edad promedio de 44,1 años. En su mayoría (63,7%), se reportaron como ama de casa. Procedieron en su mayor parte de los distritos de Trujillo. No fue posible establecer el agente injuriante. Conclusiones: En personas de piel trigueña o cobriza, las lesiones tanto benignas como malignas tuvieron un patrón de presentación similar a la de otros estudios, tanto en localización, grupo etario y sexo. La procedencia y la ocupación no fueron contributorias.
SUMMARY Objective : To determine the clinical and socio demographic features of patients attended at a public hospital in Trujillo, Peru. Methods : A cross-sectional study that included 385 skin biopsies obtained from the archives of the Pathology Department and from the clinical charts of these patients at Hospital Belen in Trujillo from January 2018 to December 2019 was carried-out. Results : The most common entity was basocellular carcinoma located on the face in patients above 60 years of age. The second most common entity was epidermoid carcinoma. Malignant lesions affected 66.7% of patients between 55 and 79 years of age with a mean of 67 years. Most of the patients were unemployed males (65.8%). The most common benign lesion was the epidemic inclusion cyst mostly in the trunk among males from 20 to 24 years of age. The second most common benign lesion was the pilomatrixoma mostly located in the upper limbs of patients below 10 years of age. Benign lesions affected the 59.6% of the sample between 30 to 54 years of age with a mean of 44 years, mostly among housewives. Most of the patients came from districts of Trujillo. The causal agent was not identified. Conclusions : In mestizo patients both benign and malignant lesions had a clinical presentation similar as reported in the literature regarding location, age and gender distribution. Occupation and precedence were not contributory..
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Humains , Maladies de la peau , Manifestations cutanées , Dermatologie , Études transversalesRésumé
Abstract Background Psoriasis is a skin disease that affects 1.3% of Brazilians. The use of teledermatology (TD) in the public health sector has democratized access to dermatological care. Objective To analyze TD exams with suspected and/or diagnosed psoriasis performed between 2016‒2020 in the state of Santa Catarina (SC). Methods Analytical cross-sectional observational study that used secondary data collected from the records of TD exams from the Telemedicine and Telehealth System (TTS) of SC. The associations were evaluated by the chi-square test and Student'st test. The significance level was set at 5% (p < 0.05). Results During the period, 6,146 TD exams were related to psoriasis, 58% due to the diagnosis provided by the reporting dermatologist and 42% exclusively due to the suspected disease on the request of the examination. The male sex predominated among the diagnoses of dermatosis (51%; p < 0.001). Regarding risk classification, psoriasis diagnoses were predominantly yellow (58.7%; p < 0.001) or blue (39.7%; p < 0.001) risk, respectively indicating moderate to severe psoriasis (referral to tertiary care) and mild psoriasis (treatment in the primary health care [PHC] level). True positive tests, suspected by PHC and diagnosed with psoriasis through TD, were 34.1% (p < 0.001). Study limitations The TD service is available only for the public health network and analysis for a limited period (five years). Conclusions Psoriasis diagnoses performed by TD, when compared to other dermatoses, tend to receive treatment at the primary (p < 0.001) or tertiary (p < 0.001) health care level, reducing the number of referrals to the secondary care level.
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OBJETIVO: Mapear as competências do enfermeiro especialista em Dermatologia. MÉTODO: Trata-se de uma scoping review, desenvolvida conforme as recomendações do Joanna Briggs Institute (JBI). Para elaboração da questão de pesquisa utilizou-se a estratégia Population, Concept e Context. A busca por publicações, sem limitar idioma e recorte temporal, foi realizada nas fontes: The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (MEDLINE) via PubMed, Scopus, Embase e Cochrane Library, além de sites das associações de especialistas e no Google Acadêmico. RESULTADOS: Foram selecionadas 17 publicações, originando as categorias: avaliação integral do paciente dermatológico, prescrição de medicamentos, detecção precoce e prevenção do câncer de pele, tratamento de feridas e estética. CONCLUSÃO: Diante da vasta possibilidade de atuação do enfermeiro nesta área, constata-se a necessidade de ampliação da discussão e de pesquisas sobre o tema.
OBJECTIVE: To map the competencies of specialist nurses in Dermatology. METHOD: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute (JBI). The Population, Concept, and Context framework established the research question. The search for publications was carried out in different sources, including Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health Sciences (LILACS), National Library of Medicine (MEDLINE) via PubMed, Scopus, Embase, and the Cochrane Library. Additionally, expert association websites and Google Scholar were searched. No language or time restrictions were applied. RESULTS: Seventeen publications were selected, originating the categories: integral evaluation of the dermatological patient, drug prescription, early detection and prevention of skin cancer, wound care, and aesthetics. CONCLUSION: Faced with the vast possibilities for nurses to work in Dermatology, there is a need to expand the discussion and research on the subject.
Sujets)
Compétence professionnelle , Spécialisation , Compétence clinique , Prestations des soins de santé , Dermatologie , Infirmières et infirmiersRésumé
Objective:To investigate the impact of online teaching on dermatology study in the undergraduate stage of the eight-year program medical students of Peking University Third Hospital.Methods:Questionnaires were administered before and after dermatology theoretical lectures and probation among the eight-year program medical students of the Peking University Third Hospital. Online teaching in 2020 was compared with offline teaching from 2016 to 2019. Written examination was taken after studying and the results were analyzed. SPSS 21.0 was used to conduct t-test and Mann-Whitney U test. Results:The total number of students that received online teaching was 53, and the response rate of the questionnaire was 75.5(80/106); the number of students receiving offline teaching was 166 and the response rate of the questionnaire was 99.1% (329/332). After dermatology theoretical lectures and probation, the scores of the written examination of online teaching were better than those of offline teaching ( P<0.001). The self-evaluation of the diagnostic ability of urticaria in students that received online teaching was lower than that in offline teaching students ( P=0.008); whereas the importance rating of dermatology department in hospitals ( P<0.001) and the interest in dermatology ( P=0.002) were significantly higher in online teaching than offline teaching. No significant differences were found in the self-evaluation of the diagnostic ability of eczema and acne, the willingness to be a dermatologist, difficulty rating in dermatology study, etc. Sixty percent (24/40) of students submitted open suggestions, and the most suggestion was to increase offline probation [22.5%(9/40). Conclusion:The online teaching of dermatology theoretical lectures and probation may be better for students' knowledge than offline teaching and they can also stimulate students' interest in learning. However, students' confidence in the diagnosis and treatment of certain common disease might be slightly lower in online teaching than in offline teaching. The combination of online and offline teaching might provide more advantages in the future. The form and content of online teaching also urgently need to be further improved in practice.
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Objective:To investigate the application of modified mini-clinical evaluation exercise (Mini-CEX) in the probationary teaching of dermatology and venereology for eight-year program students.Methods:From 2019 to 2020, a modified Mini-CEX was used to grade 58 eight-year program students at the Third Affiliated Hospital of Sun Yat-Sen University at the early, middle, and late stages of the probationary teaching of dermatology and venereology. The modifications included refining various evaluation indicators. Specifically, medical history collection involved dynamic changes in rashes, negative symptoms with differential diagnostic significance, past history/personal history/family history, and other important medical history; physical examination involved the specialized condition of rashes, systematic physical examination, and negative signs with differential diagnostic significance; humanistic care involved caring for patients, health education, and privacy protection; clinical judgment involved principles of diagnosis, differential diagnosis, and treatment; communication skills involved proficiency, prioritization, and body language; organizational effectiveness involved time allocation, patient compliance, and preparation work; overall performance involved calmness and fluency, neat writing, and preliminary clinical thinking. SPSS 20.0 was used to perform the t test. Results:Compared with the early stage of probation, the 58 eight-year program students improved their scores in clinical comprehensive ability evaluation and scores in each specific evaluation at the middle and late stages of probation ( P < 0.001). The dynamic changes in rashes and the specialized situation of rashes (identification and description of rashes) were specific to this discipline. Conclusion:The modified Mini-CEX is an objective, comprehensive, concise, and efficient assessment tool, which meets the needs of teaching reform and practice of dermatology and venereology.
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O edema tardio intermitente persistente (ETIP) é uma reação inflamatória imunomediada desencadeada pela aplicação de ácido hialurônico (AH). É classificado clinicamente como não depressível, difuso e de caráter tardio, por aparecer, no mínimo, 30 dias após a aplicação. Ademais, caracteriza-se como intermitente e recorrente, visto que a reação pode reaparecer enquanto a substância perdurar no tecido. O presente estudo tem como objetivo relatar um caso de ETIP desencadeado pelo medicamento Prolia, sua apresentação clínica e evolução do quadro, bem como o tratamento realizado. No presente relato de caso, foi observada essa reação após uso do medicamento Prolia (Denosumabe), um anticorpo monoclonal que reduz a reabsorção óssea, utilizado para o tratamento da osteoporose. A paciente em questão é uma mulher de 56 anos, procedente de Joaçaba (SC), a qual apresentou placas eritematosas infiltradas na região do lábio superior, inferior e sulconasomentual, após cinco meses da aplicação do AH. Após conhecimento das medicações de uso e posterior confirmação histopatológica, foi diagnosticada com ETIP e iniciou conduta médica. A ETIP geralmente apresenta uma progressão benigna, se diagnosticada e tratada corretamente. A paciente em questão apresentou completa melhora clínica e, apesar de ainda não existir um consenso na literatura sobre como manejar a ETIP, o tratamento que melhor se adaptou ao caso foi a administração de Prednisolona por 4 semanas. Por não haver sido descrito anteriormente, na literatura mundial, o aparecimento de ETIP desencadeado pelo Denosumabe, destaca-se a importância do presente estudo para elucidação desta possível inteiração entre os compostos.
Persistent intermittent delayed swelling (PIDS) is an inflammatory reaction immune-mediated by the application of hyaluronic acid (HA). It is clinically classified as non-depressible, diffuse, and delayed, as its onset is in at least 30 days following application. Moreover, it is characterized as intermittent and reocurring, as the reaction may reappear while the substance remains in the tissue. The present study aims to report a case of PIDS caused by the drug Prolia, including its clinical presentation and development, as well as the treatment performed. In this case report the reaction was observed after the use of Prolia (Denosumab), a monoclonal antibody that reduces bone reapsorption, indicated for the treatment of osteoporosis. The patient was 56 years-old woman from Joaçaba (SC) that presented erythematous plaques in the upper and lower lip regions and in the melomental folds five months after the application of HA. After acknowledging the medications under use and histopathological confirmation, the patient was dignosed with PIDS and started medical treatment. PIDS usually has a benign progression if correctly diagnosed and treated. The patient made a full clinical recovery and, despite the lack of consensus in the literature for the management of PIDS, the treatment with best responses for this case was the administration of Prednilosone for four weeks. As the emergence of PIDS triggered by Denosumab was not previously described in the global literature, the current study is important to elucidate the possible interaction between the compounds.
La hinchazón persistente intermitente retardada (PIDS) es una reacción inflamatoria inmunomediada por la aplicación de ácido hialurónico (AH). Clínicamente se clasifica como no depresible, difusa y retardada, ya que su aparición se produce en al menos 30 días tras la aplicación. Además, se caracteriza como intermitente y recidivante, ya que la reacción puede reaparecer mientras la sustancia permanece en el tejido. El presente estudio tiene como objetivo reportar un caso de PIDS causado por el medicamento Prolia, incluyendo su presentación clínica y desarrollo, así como el tratamiento realizado. En este caso clínico la reacción se observó tras el uso de Prolia (Denosumab), un anticuerpo monoclonal que reduce la reabsorción ósea, indicado para el tratamiento de la osteoporosis. La paciente era una mujer de 56 años de Joaçaba (SC) que presentó placas eritematosas en las regiones labial superior e inferior y en los pliegues melomentales cinco meses después de la aplicación del HA. Después del reconocimiento de los medicamentos en uso y de la confirmación histopatológica, la paciente fue dignosticada con PIDS e inició tratamiento médico. El PIDS suele tener una evolución benigna si se diagnostica y trata correctamente. La paciente tuvo una recuperación clínica completa y, a pesar de la falta de consenso en la literatura para el manejo de laIDS, el tratamiento con mejores respuestas para este caso fue la administración de Prednilosona durante cuatro semanas. Como la aparición de PIDS desencadenada por Denosumab no fue descrita anteriormente en la literatura mundial, el presente estudio es importante para dilucidar la posible interacción entre los compuestos.
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Introdução: a pandemia de COVID-19 ampliou o uso de tecnologias de interação social, conectando os indivíduos virtualmente. Essa mudança trouxe uma nova tendência de insatisfação com a aparência, induzida pelas mídias sociais, motivando a busca excessiva por procedimentos estéticos. Objetivo: avaliar o impacto gerado pelo uso de apps na pandemia sobre a autoimagem dos entrevistados por sexo biológico, idade e renda familiar. Métodos: foi realizado um estudo transversal, com 350 participantes, com faixa etária a partir de 18 anos, residentes no estado de São Paulo, Brasil, por meio de divulgação on-line de um formulário eletrônico. Os dados obtidos foram tabulados e analisados por teste de qui-quadrado e de Cochran, sendo cruzadas as variáveis renda, idade e sexo biológico. Resultados: do total de participantes, 69,71% alegaram mudanças, durante a pandemia, na maneira pela qual se veem fisicamente; 58,3% relataram que os aplicativos influenciaram na sua autoimagem, sendo que 70,6% dessas respostas foram dadas por mulheres entre 18-29 anos; 73,9% das mulheres de todas as idades e rendas reconheceram a importância da pele para a autoimagem, sendo esse dado discrepante em comparação aos homens. Conclusões: o uso dos aplicativos na pandemia impactou a autoimagem dos participantes, levando-os a ter maior interesse em procurar por tratamentos e procedimentos estéticos.
Background: The COVID-19 pandemic has expanded the use of social interaction technologies, connecting individuals virtually. This change has brought a new trend of dissatisfaction with appearance induced by social media, motivating the excessive search for aesthetic procedures. Objective: To assess the impact generated by the use of apps during the pandemic on the self-image of respondents by biological sex, age, and family income. Methods: We conducted a cross-sectional study with 350 participants, aged 18 years or older, residing in the state of São Paulo - Brazil, through online dissemination of an electronic form. The data obtained were tabulated and analyzed by chi-square and Cochran tests, crossing the variables income, age, and biological sex. Results: Of the total, 69.71% claim changes in the way they see themselves physically during the pandemic; 58.3% report that apps influence their self-image, as 70.6% of the answers are women between 18-29 years old; 73.9% of women of all ages and incomes recognized the importance of skin for self-image, with this finding being discrepant among the age groups of men. Conclusions: The use of apps during the pandemic impacted the self-imag