Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care.

Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment of basic specifiers such as ICD-Diagnosis, therapeutic suggestions, and diagnostic suggestions, among others. This article aims to evaluate the teledermatology system of the Chilean public health service by analyzing 243 randomly extracted consultations, representative of the 20,716 electronic consultations performed during 2020. Compliance with basic specifiers is evaluated. From these, fulfillment of core teledermatology functions, such as diagnostic and therapeutic suggestions, is observed in most consultations. There are statistically significant relationships between the patient's destination (primary health center [PHC] or face-to-face referral), pharmacological prescription, coverage of the drug prescribed by the public system, and the education received by the consulting physician. If the consultation is resolved in the PHC, there is a higher chance for pharmacological prescription, prescribing mostly drugs that are covered by the government. This is less likely to occur when patients are referred for face-to-face evaluation. A targeted evaluation of education, pharmacological prescriptions, and their applicability is key to improving the quality of teledermatology systems.

Recomendaciones Rama de Dermatología Pediátrica, Sociedad Chilena de Pediatría. Pandemia COVID-19 / Recommendations Pediatric Dermatology Branch, Chilean Society of Pediatrics. COVID-19 pandemic

Resumen: La actual pandemia por Covid-19 (SARS-CoV-2) corresponde a una zoonosis viral altamente con tagiosa que ha requerido extremar las medidas de protección personal con el fin de disminuir la transmisión del virus, tanto en ambientes hospitalarios como fuera de ellos, siendo necesaria la adopción de estrictos métodos de aislamiento tanto de contacto como aerosoles. Esto ha reque rido la adopción de múltiples equipos de protección personal, dentro de los que se encuentran la protección ocular, mascarillas, escudo de protección facial, gorros, guantes, etcétera. Lo anterior ha generado un aumento en el daño de la barrera cutánea y, por lo tanto, la aparición de diversas dermatosis dentro de las que se encuentran dermatitis de contacto irritativa o alérgica, reaccio nes acneiformes, agravamiento de dermatosis previas, entre otras, cobrando así vital importancia el cuidado y restablecimiento de la barrera cutánea con medidas esenciales como aplicación de productos humectantes o emolientes y el correcto uso de los equipos en mención. No obstante, no solo se generan dermatosis derivadas del uso de equipos de protección personal, sino que tam bién, dentro del amplio espectro de manifestaciones dermatológicas que puede generar la enfer medad por Covid-19 propiamente tal, incluyendo compromiso cutáneo, piloso (efluvio telógeno) o ungueal (onicomadesis). Por otro lado pero no motivo de este artículo, el compromiso cutáneo puede corresponder a la primera expresión clínica de la enfermedad o ser un predictor de su evolu ción. Dentro de lo anterior encontramos la urticaria aguda, exantema maculo-papular, exantema varicela-like, erupción petequial, perniosis-like y lívedo reticularis como las principales formas de afección cutánea hasta el momento.

Abstract: The current Covid-19 pandemic (SARS-CoV-2) corresponds to a highly contagious viral zoonosis that has required to extreme measures in order to decrease the transmission of the virus in hospi tal settings and outside of them, requiring adoption of strict isolation methods, both contact and aerosols. This has required the adoption of multiple personal protective equipment, including eye protection, masks, face shield, medical caps, gloves, etc. The aforementioned has generated an in crease in the damage of the skin barrier, and therefore, the appearance of various dermatoses, among which are irritative o alergic contact dermatitis, acneiform reactions, aggravation of previous der matoses, and others, thus becoming vital protection and restoration of the skin barrier with mea sures such as the application of moisturizing or emollient products and the correct use of personal protection equipment. However, not only dermatoses are generated derived from the use of perso nal protection equipment, but also, within the wide spectrum of dermatological manifestations that Covid-19 disease itself can generate, including cutaneous, hairy involvement (telogen effluvium) or nail (onychomadesis). Cutaneous involvement may correspond to the first clinical expression of the disease or be a predictor of its evolution. Among the above we find acute urticaria, maculo-papular rash, chickenpox-like rash, petechial rash, perniosis-like, and livedo reticularis as the main forms of skin condition to date.

Estimación y comparación de la masa muscular por segmento, en deportistas juveniles chilenos / Muscle mass estimation and comparison by segment, in young Chilean athletes

El objetivo de este trabajo fue determinar y comparar la composición corporal de deportistas chilenos juveniles destacados, pertenecientes a las selecciones nacionales en el año 2011, de diferentes disciplinas deportivas mediante métodos antropométricos. Fueron evaluados 4 grupos de deportistas juveniles de alto rendimiento, con un número total de 92 individuos, pertenecientes a las disciplinas de lucha olímpica, halterofilia, básquetbol y fútbol. La Masa Muscular de los miembros superiores (MMES) es mayor en basquetbolistas y Halterofilistas con 7,49 (±1,25) y 7,50 (±2,54) kg respectivamente, al ser comparado con futbolistas, quienes obtuvieron un promedio de 5,27 (±0,37) kg. Por otra parte la lucha olímpica posee un promedio de masa muscular de 6,46 (±1,50) kg, la cual está por debajo de los basquetbolistas y Halterofilistas, debido a que la utilización de los miembros superiores es menor que en las disciplinas anteriormente mencionadas, pero a su vez, es mayor que la de los futbolistas. No se aprecian diferencias importantes en la masa muscular total, pero que son marcadas en la masa muscular por segmentos. Concluimos que la estimación de la masa muscular total, no es un elemento suficiente para determinar y predecir el rendimiento deportivo de los sujetos, a diferencia de la segmentación de la masa muscular que permite comparar de mejor forma, la manera en que se distribuye este componente en las distintas disciplinas deportivas, mejorando la especificidad del conocimiento.

The aim of this study was to determine and compare by anthropometric methods, the body composition of elite young Chilean athletes, who were part of the 2011 national team in different sports. Four groups of elite young athletes were evaluated, with a total number of 92 individuals belonging to the wrestling, weightlifting, basketball and football disciplines. The muscle mass of the upper extremities (MMES) is higher in basketball players and bodybuilders with 7.49 (±1.25) and 7.50 (±2.54) kg respectively, when compared with players who scored an average of 5.27 (±0.37) kg. Moreover, wrestling has an average muscle mass of 6.46 (±1.50) kg which is below that of basketball players and bodybuilders, because the use of upper limbs is less than in disciplines mentioned above, but in turn, is greater than that of football players. No significant differences in total muscle mass are reported, however, there are marked differences in muscle mass segment. We concluded that the estimate of total muscle mass is not sufficient basis to determine and predict athletic performance of the subjects. Muscle mass segment on the other hand, provides a better comparison range for the way in which this component is distributed among different sports disciplines, improving specific knowledge and information.

Specific gel-cream as adjuvant to oral isotretinoin improved hydration and prevented TEWL increase--a double-blind, randomized, placebo-controlled study.

BACKGROUND: Hydrating and emollient products are often recommended to patients under isotretinoin therapy to control the most frequent mucocutaneous side effects and to improve adherence to treatment. AIMS: To assess, using noninvasive biophysical tests, the clinical and instrumental effectiveness of a hydrating gel-cream compared with placebo as an adjuvant to isotretinoin for treatment of facial skin in patients with inflammatory acne. METHODS: Prospective, double-blind, randomized study, using MULTI SKIN MC750, on the adjuvant effect of a hydrating gel-cream for acne (active product) vs. a gel-cream without active substances (placebo). Follow-up lasted 3 months. RESULTS: Sixty-six patients were included. Thirty-four were administered the active product, and 32 placebo. Though the number of lesions fell significantly in both groups, the mean number of papules on day 30 was significantly lower in the active product group. The active product group showed a significant increase in hydration, while the placebo group showed a significant increase in transepidermal water loss (TEWL). Seborrhoea decreased significantly in both groups; there were no differences between them. CONCLUSIONS: Compared with placebo, the specific gel-cream with active products as an adjuvant to oral isotretinoin improved hydration, prevented TEWL increase, and reduced inflammatory acne lesions after 30 days.

Manifestaciones cutáneas en pacientes con diabetes mellitus / Cutaneous manifestations in patients with mellitus diabetes

La Diabetes Mellitus es una patología frecuente en la población, caracterizada por el aumento del nivel plasmático de la glucosa y por disturbios en el metabolismo de carbohidratos y lípidos. según diversos estudios, entre un 30 por ciento y un 100 por ciento de los pacientes diabéticos presentan alteraciones en la piel, las cuales pueden clasificarse en 4 grandes grupos: manifestaciones cutáneas relacionadas con descompensación metabólica, tales como infecciones de diversos tipos, aquellas relacionadas con complicaciones degenerativas crónicas como el pié diabético, desórdenes cutáneos que son más comunes en Diabetes Mellitus y que no se correlacionan con descompensación metabólica ni con cambios degenerativos como la acantosis nigricans y, por último, reacciones como consecuencia del tratamiento de la Diabetes Mellitus, entre las cuales se mencionan las erupciones morbiliformes