Dermoscopic Evaluation of Actinic Changes in the Lips of Indigenous Children Living at High Altitude in Ecuador: A Descriptive Study.

BACKGROUND High altitude increases sunlight exposure, resulting in actinic keratosis, which predisposes people to skin cancer. The dermoscopy procedure evaluates keratotic and pigmented skin changes. This study aimed to describe the clinical and dermoscopic actinic changes in the lips of 25 indigenous children living at high altitude in Ecuador. MATERIAL AND METHODS An observational study was conducted in a public school in the Andes region of Ecuador (August-November 2019). Twenty-five children, males and females, age 5-15 years were assessed by complete physical examination, digital dermoscopic photographs, and punch biopsies. Descriptive statistics and Fisher's exact test were used to summarize and analyze the data. RESULTS We included 17 (68%) boys and 8 (32%) girls with a mean age of 9.8±2.0 years. Clinical lips findings reported desquamation [52% Upper Lip (UL); 40% Lower Lip (LL)], fissuring (8% UL; 8% LL), scabs (8% UL; 8% LL), and discoloration (40% UL; 20% LL). Dermoscopic features included a white-yellow lip color (24% UL; p=0.02). The main morphologic pattern of blood vessels was monomorphic (88% UL; p<0.001), polymorphous (60% LL; p<0.001), dotted pattern (64% UL; 28% LL; p=0.02), and linear-irregular (32% UL; 72% LL; p=0.01). Girls had radiating white structures on UL (p=0.025), while boys presented white structureless areas (UL 63.6%; LL 77.8%; p=0.032). No differences in dermoscopic findings were observed according to Fitzpatrick scale score (FSS). Punch biopsies showed no indications of actinic cheilitis. CONCLUSIONS Dermoscopic features in indigenous children living in high altitudes were related to actinic damage, but histopathological findings were negative.

Atypical Mal de Meleda in a Hispanic Patient.

Mal de Meleda (MDM) is a rare autosomal palmoplantar keratoderma (PPK) skin disorder (estimated incidence of 1 per 100,000 people) commonly associated with consanguinity and early childhood onset. MDM is characterized by bilateral diffusion of PPK plaques with delimited yellowish lesions that transgredien to the dorsum of the hands and feet. Additional features include nail dystrophy, lichenoid lesions, hyperhidrotic maceration, involvement of the knees and elbows, malodor, fungal superinfections, and digital constrictions. A male patient aged 42 years presented with asymptomatic, chronic, and diffused PPK lesions that progressed to the dorsal surface of the hands and feet, along with knees and elbows involvement. On clinical examination, asymmetrical lesions were observed on the hands, the left palm with yellowish waxy hyperkeratotic plaques, and the right palm with erythematous scaling and hyperkeratotic interphalangeal rings. The soles of the feet presented with yellow waxy hyperkeratotic plaques. In addition, nail dystrophy and loss of dermatoglyphics were observed. Initially, symptomatic topical treatment was established. However, owing to the lack of clinical response, a biopsy was performed, which revealed thickened corneal layer, acanthosis, spongiosis, and perivascular lymphohistiocytic infiltrate. MDM diagnosis was confirmed based on a personal history of consanguinity, clinical presentation with absence of systemic symptoms, and transgredien pattern of the lesions. Systemic treatment with low doses of isotretinoin (10 mg orally everyday) was initiated, and two months later, slight clinical improvement has been observed until date. The present case report describes MDM in a Hispanic patient, who presented with asymmetric PPK lesions on the hands and received isotretinoin treatment.

COVID-19 mortality and risk factors in patients with cancer in Ecuador: A retrospective, non-randomized, controlled study.

The 2019 coronavirus disease (COVID-19) pandemic has affected different human populations since March 2020 and challenged healthcare systems, especially in chronic non-communicable diseases such as cancer. The present study aimed to evaluate the mortality, risk factors, and symptoms of cancer patients and control subjects, diagnosed with COVID-19 and admitted to intensive care unit (ICU). This retrospective, observational, non-randomized, controlled study of patients admitted to ICU was conducted between March and August 2020 in an Ecuadorian oncology center. Patient information collected from electronic medical records included sociodemographic information, clinical history, symptoms, laboratory test results, COVID-19 treatment, and discharge status. For patients with neoplasia, diagnosis, type, and status of cancer, as well as antineoplastic treatment received over the past month was also recorded. Descriptive statistics and multiple logistic regression were used to analyze the data. Statistical analysis was performed with SPSS (version 22.0) and R (version 4.1.3). In total, 79 adult COVID-19 patients were studied (40 with cancer and 39 controls). The total mean time until COVID-19 symptoms onset was 6.2 ±â€…3.5 days (5.3 ±â€…3.2 days in the cancer group vs 7.2 ±â€…3.6 days in the control group; P = .016) but no difference was observed in reported symptoms. All patients received an antibiotic treatment, but only 70% of the cancer group had antivirals (P < .001). Cancer patients had lower hemoglobin levels than controls (10.7 ±â€…2.8 vs 13.3 ±â€…1.7 g/dL; P < .001). In terms of mortality, not statistically significance difference was reported between groups. The study showed that high ferritin (Absolute Odds Ratio of 3.9; 95% CI 1.1-14.6) and mechanical ventilation (Absolute Odds Ratio of 4.9; 95% CI 1.3-18.6) were independent COVID-19 mortality risk factors. COVID-19 infection did not represent an increased risk of mortality in cancer patients, but elevated ferritin levels and the need for mechanical ventilation were identified as mortality risk factors.

Jessner's Lymphocytic Infiltration of the Skin in a 73-Year-Old Woman: A Case Report.

BACKGROUND Jessner's lymphocytic infiltration of the skin (JLIS) is a rare and benign process of unknown cause. This disorder affects both sexes, most commonly in the young adult population. However, the demographic characteristics remain largely unknown, due to limited information. JLIS clinical presentation is heterogeneous; lesions can be indurated papular or erythematous plaques on the upper body. Symptoms are variable, from asymptomatic to pruritus and burning sensation. CASE REPORT A female patient aged 73 years presented with 10-day asymptomatic dermatosis on the left malar area after an insect sting. At the beginning, the lesion was clinically classified as an abscess and antibiotic therapy was prescribed with ciprofloxacin 500 mg every 12 hours for 5 days. However, due to the lack of clinical response, a biopsy was performed, which reported a predominantly lymphocytic nodular dermatitis. JLIS diagnosis was confirmed after laboratory and imaging tests. Intralesional infiltrations of triamcinolone (0.5 ml) twice within 15 days and mineral sunscreen 3 times a day were prescribed. After the treatment, the lesion had a complete resolution without recurrence to date. CONCLUSIONS The present case reports JLIS in an older woman who presented a complete healing resolution of the lesion without recurrences after triamcinolone intralesional infiltrations and sunscreen protection.

Prevalence and risk factors of depression, anxiety, and stress in an Ecuadorian outpatient population with type II diabetes mellitus: A cross-sectional study (STROBE).

Type II diabetes mellitus (DM2) is a worldwide disease with an important economic and health impact. Currently, depression, anxiety and stress are common disorders among diabetic populations but their respective prevalence may well be underestimated. So far, Latin American countries have only reported limited information about the impact of mental diseases on DM2 outpatients. The objective of this study was to evaluate the prevalence and risk factors related to depression, anxiety, and stress among ambulatory DM2 populations from two third-level hospitals in Quito, Ecuador. A cross-sectional study based on a random sample was carried out in two hospitals. Patients were evaluated by the 21-item Depression, Anxiety and Stress Scale (DASS-21). In addition, a validated survey was used to grade socioeconomic, demographic, clinical, and comorbidity variables. Descriptive statistics and multiple logistic regression were used to analyze the data. Statistical analysis was performed by SPSS (version 22.0). STROBE guidelines were used for reporting this trial. A total of 208 adult patients with DM2 were included (women 58%; men 42%). The prevalence of depression, anxiety and stress was 31.7% (95% CI, 25.5-38.5%), 33.7% (95% CI, 27.3-40.5%), and 25.0% (95% CI, 19.3-31.5%), respectively. Male gender was associated with a decreased risk for depression (OR 0.39 [95% CI, 0.18-0.81]; P = .01), anxiety (OR 0.31 [95% CI, 0.16-0.65]; P = .002), and stress (OR 0.35 [95% CI, 0.15-0.77]; P = .009). A higher level of education was associated with low risk for depression (OR 0.23 [95% CI, 0.11-0.46]; P < .001), anxiety (OR 0.47 [95% CI, 0.25-0.90]; P = .02), and stress (OR 0.24 [95% CI, 0.12-0.49]; P = .001). In contrast, patients with DM2 complications were more likely to have depression (OR 2.96 [95% CI, 1.32-6.63]; P = .008) and anxiety (OR 2.56 [95% CI, 1.20-5.48]; P = .01). Finally, an income higher than the basic salary reduced the risk of depression alone (OR 0.39 [95% CI, 0.16-0.91]; P = .03). In conclusion, a high prevalence rate of depression, anxiety, and stress was found in the DM2 outpatient population. Thus, more tailored care surveillance for DM2 patients is needed considering the bio-psycho-social environment to provide an integral health management.