Eletroquimioterapia, uma nova terapia para pacientes com câncer cutâneo na América Latina: revisão da literatura / Electrochemotherapy, a new therapy for patients with skin cancer in Latin America: literature review

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.

Teledermatología en pandemia de COVID-19 en un hospital público / Teledermatology during de COVID-19 pandemic in a public hospital

Resumen La telemedicina es la prestación de servicios de salud mediante tecnologías de la información y la comunicación. La dermatología es la especialidad clínica que más se adapta a esta modalidad de atención. La pandemia de COVID-19 aceleró el desarrollo de la telemedicina en todo el mundo. Esta última demostró ser una herramienta útil para promover el distanciamiento social y evitar la sobrecarga del sistema de salud. Presentamos un estudio observacional de teledermatología en el sector colagenopatías de un hospital público de la Ciudad Autónoma de Buenos Aires durante esta pandemia. El objetivo principal fue evaluar si la teledermatología es una herramienta útil para resolver el motivo de consulta del paciente y así evitar la derivación al hospital. Se incluyeron 120 consultas. El 93.3% fue de mujeres. El promedio de edad fue 38.4 años. El 57.5% de las consultas fueron de pacientes de Gran Buenos Aires y 33.3% de Ciudad Autónoma de Buenos Aires. El 47.5% provenían de pacientes sin cobertura de salud. Del total, 17 (14.2%) requirieron derivación a un centro de salud. La mayoría fue por seguimiento y un porcentaje menor por reactivación de la enfermedad de base u otro motivo. Todos los pacientes que contestaron la encuesta refirieron no haber presentado dificultades y haber resuelto su consulta de manera virtual. Todos los médicos se sintieron conformes con la teledermatología, opinaron que fue un recurso válido para continuar con la formación médica y elegirían usarla en un futuro próximo.

Abstract Telemedicine refers to the use of information and communication technologies to provide health care. Dermatology is particularly suited for this virtual modality. The COVID-19 pandemic significantly increased the use of telemedicine worldwide which has demonstrated to be useful in promoting social distancing and in avoiding the overload of the healthcare system. This is an observational study about the use of teledermatology during the pandemic in the area of connective tissue diseases in a public hospital in Buenos Aires City. The main objective was to assess if teledermatology is useful to resolve patient's consultation and thus to avoid the referral to the hospital. There were 120 teledermatological consultations included, from which 93.3% were made by women. The average age was 38.4 years. The 57.5% of the consultations were from patients of the outskirts of Buenos Aires and 33.3% from Buenos Aires City. The 47.5% of consultations were from patients with no medical insurance. Of the total, 17 (14.2%) required referral to a health center. Most of the consultations were follow-up´s and in a lower percentage, due to reactivation of the underlying disease or another reason. Patients who completed the survey reported not having difficulties and were able to resolve their consultations through virtual care. Doctors involved in this study were totally satisfied with the experience and they felt that teledermatology was a valid resource to continue with their medical training and would choose to use it in the near future.

[Teledermatology during de COVID-19 pandemic in a public hospital]. / Teledermatología en pandemia de COVID-19 en un hospital público.

Telemedicine refers to the use of information and communication technologies to provide health care. Dermatology is particularly suited for this virtual modality. The COVID-19 pandemic significantly increased the use of telemedicine worldwide which has demonstrated to be useful in promoting social distancing and in avoiding the overload of the healthcare system. This is an observational study about the use of teledermatology during the pandemic in the area of connective tissue diseases in a public hospital in Buenos Aires City. The main objective was to assess if teledermatology is useful to resolve patient's consultation and thus to avoid the referral to the hospital. There were 120 teledermatological consultations included, from which 93.3% were made by women. The average age was 38.4 years. The 57.5% of the consultations were from patients of the outskirts of Buenos Aires and 33.3% from Buenos Aires City. The 47.5% of consultations were from patients with no medical insurance. Of the total, 17 (14.2%) required referral to a health center. Most of the consultations were follow-up's and in a lower percentage, due to reactivation of the underlying disease or another reason. Patients who completed the survey reported not having difficulties and were able to resolve their consultations through virtual care. Doctors involved in this study were totally satisfied with the experience and they felt that teledermatology was a valid resource to continue with their medical training and would choose to use it in the near future.

La telemedicina es la prestación de servicios de salud mediante tecnologías de la información y la comunicación. La dermatología es la especialidad clínica que más se adapta a esta modalidad de atención. La pandemia de COVID-19 aceleró el desarrollo de la telemedicina en todo el mundo. Esta última demostró ser una herramienta útil para promover el distanciamiento social y evitar la sobrecarga del sistema de salud. Presentamos un estudio observacional de teledermatología en el sector colagenopatías de un hospital público de la Ciudad Autónoma de Buenos Aires durante esta pandemia. El objetivo principal fue evaluar si la teledermatología es una herramienta útil para resolver el motivo de consulta del paciente y así evitar la derivación al hospital. Se incluyeron 120 consultas. El 93.3% fue de mujeres. El promedio de edad fue 38.4 años. El 57.5% de las consultas fueron de pacientes de Gran Buenos Aires y 33.3% de Ciudad Autónoma de Buenos Aires. El 47.5% provenían de pacientes sin cobertura de salud. Del total, 17 (14.2%) requirieron derivación a un centro de salud. La mayoría fue por seguimiento y un porcentaje menor por reactivación de la enfermedad de base u otro motivo. Todos los pacientes que contestaron la encuesta re firieron no haber presentado dificultades y haber resuelto su consulta de manera virtual. Todos los médicos se sintieron conformes con la teledermatología, opinaron que fue un recurso válido para continuar con la formación médica y elegirían usarla en un futuro próximo.