Fiabilidad de la teledermatología de almacenamiento en un escenario real

Introduction and objectivesAlthough many studies have evaluated the diagnostic reliability of store-and-forward (SF) teledermatology, the reliability of the technique for the diagnosis of general skin conditions in a clinical practice setting has never been demonstrated. We evaluated the reliability of SF teledermatology in clinical practice by analyzing the diagnostic agreement achieved in a subgroup of patients from the DERMATEL-2 study.Material and methodsPatients referred from primary care settings were randomized to 3 groups: SF, a combination of videoconferencing and SF technology (VC-SF), and a control group. This article focuses on the SF group. Clinical data were recorded and photographs taken by primary care physicians, who forwarded the data electronically. Each SF consultation package was assessed by 3 dermatologists (D1,D2,D3). Subsequently all the patients were assessed by a single dermatologist (D1) in a face-to-face consultation. Finally, 2 other dermatologists (D4,D5) assessed the agreement between the diagnoses obtained by SF and FF.ResultsIn total, 457 patients (200 males and 257 females) aged between 2 months and 86 years were randomized (192 to SF, 176 to VC-SF, and 89 to the control group). The diagnostic categories were as follows: tumors (49.4%), inflammatory (25.7%), adnexal (11%), infectious (9.4%) and other processes (4.4%) Since 170 patients had consultations deemed valid for analysis, the study included a total of 510 SF assessments. Most of the images and clinical records were of high quality (71.2% and 91.2% respectively), and diagnostic confidence was high in 81.4% of the cases studied.In 58.4% of cases the condition was managed exclusively by teledermatology. Levels of complete and aggregate interobserver agreement between SF and face-to-face evaluators were 0,72 and 0.90, respectively, for diagnosis and 0.61 and 0.80 for treatment. Diagnostic agreement correlated with the image quality (P  <  .001), diagnostic confidence (P < .001), felt need for conventional consultation (P < .001), and the quality of the clinical record (P = .013).ConclusionThe interobserver reliability of SF diagnosis in clinical practice is good. Dermatologists are able to predict errors in diagnosis by analyzing their own diagnostic confidence and evaluating the quality of the images.     

Correlation between clinical, dermatoscopic, and histopathologic variables in atypical melanocytic nevi

IntroductionAtypical melanocytic nevi are acquired melanocytic lesions that were described for the first time by Clark in studies of melanocytic nevi in patients with melanomas. Today, the use of dermatoscopy has made identification of this type of nevus much easier.ObjectiveOur aim was to study the correlation between the clinical, dermatoscopic, and histopathologic findings of melanocytic nevi and compare our findings with those of previous studies. We also aimed to investigate the value of dermatoscopy for identifying atypical melanocytic nevi.Material and methodsIn this cross-sectional, observational study, 200 melanocytic lesions were analyzed in 166 patients examined between January 1, 2005 and December 31, 2005. We recorded the clinical, dermatoscopic, and histopathologic characteristics of each lesion and established the correlation between the different findings on a case-by-case basis. We then determined the agreement between diagnoses and assessed the value of dermatoscopy for identifying atypical melanocytic melanoma.ResultsThe clinical characteristics associated with atypical histology were a macular component (P < .001), irregular borders, and presence of 3 or more colors. Asymmetry, diameter greater than 5 or 6 mm, and progression were not associated with atypical histopathologic characteristics (P > .05). Agreement between clinical and histologic diagnosis was weak (κp = 0.38), whereas the agreement between dermatoscopic and histologic diagnosis was moderate (κp = 0.52). The area under the receiver operating characteristic curve for the model that included dermatoscopy was larger than that for the model that only included clinical data, and this difference was statistically significant.ConclusionsAtypical clinical features were not found to correspond to atypical histology. Dermatoscopy improved the accuracy of clinical diagnosis of atypical melanocytic nevus.     

Enfermedades infecciosas no venéreas atendidas en consultas de Dermatología en España: resultados del estudio DIADERM

Background and objectiveThe burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads.Material and methodsObservational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups.ResultsSpanish dermatologists diagnosed an estimated 16 190 (95% CI, 9338-23 042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P < .0020) and adults (P < .00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P < .0004) and private (P < .0002) practices.ConclusionsNonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.     

[Translated article] Nonvenereal Infections in Spanish Dermatology Clinics: Results of the DIADERM Study

Background and objectiveThe burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads.Material and methodsObservational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups.ResultsSpanish dermatologists diagnosed an estimated 16Y190 (95% CI, 9338–23Y042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P < .0020) and adults (P < .00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P < .0004) and private (P < .0002) practices.ConclusionsNonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.     

Prognosis for cutaneous melanoma according to surgical department: comparative study at a tertiary care hospital

IntroductionSurgical treatment of melanoma is performed by dermatologists and general or plastic surgeons. It is not known whether the type of specialist treating the melanoma results in a different prognosis for these patients.Material and methodsA retrospective study was carried out on the epidemiological, clinical/histological and evolutional characteristics of all patients diagnosed with melanoma at Hospital Gregorio Marañón over a 10-year period (1994--2003). The differences by hospital department where the patients were treated (dermatology, general surgery and plastic surgery) were noted.ResultsOver 90 % of the patients with melanoma were treated by the Dermatology Department. The thickness of the tumors and the presence of histologic ulceration were significantly higher in the melanomas treated by general and plastic surgeons (p < 0.05). The differences in overall average survival (105, 55 and 77 months) and disease-free time (88, 24 and 51.3 months) in the melanomas operated on by dermatologists, general surgeons and plastic surgeons, respectively, were significant (p < 0.001).ConclusionsThis study confirms that there are significant differences in the clinical and histological characteristics and the life prognosis of patients with cutaneous melanoma treated by different specialists. The melanomas treated by general or plastic surgeons have usually been developing for a longer time, and therefore are thicker and more often ulcerated than those treated by dermatologists, resulting in a lower survival period. With appropriate medical and surgical training, dermatologists are the most suitable specialists for early diagnosis and treatment.     

Store-and-forward teledermatology: assessment of validity in a series of 2000 observations

Background and objectivesThe aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group.Material and methodsDigital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared.ResultsThe percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%–71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%–89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%–61%) and teledermatology in 40% (95% CI, 38%–41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p = 0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001).ConclusionsStore-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.     

Treatment of mucosal vascular malformations with variable-pulse neodymium:yttrium-aluminum-garnet laser

Background and objectivesTreatment of mucosal vascular lesions is a challenge for dermatologists, although various approaches have proven efficacy, including surgery, sclerotherapy, intralesional injection of corticosteroids, transfixion, and laser therapy. The aim of this study was to describe the results of treatment with neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in 11 patients with venous malformations and varicosities.Patients and methodsWe describe the use of variable-pulse Nd:YAG to treat venous malformations or varicosities in the oral or genital mucosa of 8 women and 3 men seen in our hospital over a 1-year period.ResultsThe following laser parameters were used: wavelength, 1064 nm; fluence, 100 to 200 J/cm²; spot diameter, 3 to 5 mm; and pulse duration, 30 to 65 ms. The size of the lesions ranged from 5 to 30 mm. In all cases, a clearance of 75% to 100% was achieved in a single session with excellent healing and no significant side effects.ConclusionsGiven its efficacy and ease of use, Nd:YAG may become a treatment of choice for mucosal vascular lesions. Comparative studies are now required to assess its potential superiority over other treatment options.     

Impairment of myocardial functions and arterial stiffness in patients with lichen planus

BackgroundLichen planus is a chronic inflammatory mucocutaneous disease. Recent studies have suggested that it is associated with an increased risk of cardiovascular comorbidities.ObjectiveThe purpose of this study was to assess and compare arterial stiffness and cardiovascular hemodynamics in patients with lichen planus and a healthy control group.MethodsFifty-five patients with lichen planus and 42 healthy controls were enrolled. All patients underwent echocardiographic examination, and arterial stiffness was measured using applanation tonometry.ResultsNo statistically significant difference was determined between the patient and control groups in terms of arterial stiffness, but stiffness was markedly higher in patients with erosive lichen planus compared to the control group and other patients (p = 0.006, and p = 0.023, respectively). Moderate positive correlation was determined between duration of disease and arterial stiffness. Impairment of systolic and diastolic functions was also determined in patients with lichen planus compared to the control group (p < 0.001, and p = 0.005, respectively).Study limitationsRelatively low number of patients.ConclusionThe positive correlation observed between duration of disease and arterial stiffness in patients with lichen planus suggests that these patients should be followed-up in terms of cardiovascular risk in the presence of resistant and long-term disease, particularly in case of erosive lichen planus.     

Design and validation of a questionnaire to measure treatment satisfaction in patients with moderate-to-severe psoriasis: the NEODERMA study

Background and objectivesthe aim of this study was to design and assess the validity, reliability, and sensitivity to change of the Spanish Satisfaction With Treatment of Psoriasis Questionnaire (SSTPQ) for use in patients with moderate-to-severe psoriasis.Patients and methodsa prospective, multicenter, observational, naturalistic study was designed. The instrument consisted of 12 items scored on a 5-point Likert scale with scores from 0 (very satisfied) to 5 (very unsatisfied), generating a total score of 0 to 48. Patients completed the questionnaire at baseline and then at 3-, 6-, 9-, and 12-month follow-up. At each visit, data were also collected on the Psoriasis Area and Severity Index (PASI), treatment adherence (Morisky-Green questionnaire), and overall treatment satisfaction on a Visual Analogue Scale (VAS) from 0 to 100.Resultsa total of 423 patients were included in the study and 68% completed 12 months of follow-up. Responses were provided to all items in 98.8% of cases. There was a weak correlation between changes in treatment satisfaction on the SSTPQ and changes in PASI score (r = 0.38 to 0.33); in contrast, there were strong correlations with changes in the VAS score for overall treatment satisfaction (r = –0.75 to –0.81). Good internal consistency was observed (Cronbach α = 0.92). The intraclass correlation coefficient was 0.89, with a mean difference in score at 3- and 6-month follow-up of 0.07.ConclusionsThe results obtained suggest that the SSTPQ is a feasible, valid, and reliable tool for the assessment of treatment satisfaction in patients with moderate-to-severe psoriasis.     

Pattern of contact sensitization to paraphenylenediamine and its detection in hair dyes

BackgroundOne of the greatest challenges in occupational dermatology is the identification of chemical substances used by patients in their work in order to determine their allergenic potential. Numerous techniques have been described for the identification of allergenic compounds. These tests must be sensitive, specific, and safe. We describe a study to detect the presence of paraphenylenediamine (PPD) in hair dyes that are commercially available in Spain.Material and methodsWe undertook an experimental study involving qualitative and semiquantitative detection of PPD in hair dyes sold in Spain. The qualitative technique we used was a previously described colorimetric method involving dilution of the dye with isopropyl alcohol followed by addition of a reagent solution (1 g of vanilla in 15 ml of isopropyl alcohol and 7.5 ml of hydrochloric acid). A quantitative study was then done in which the dye was extracted in 96% ethanol and subjected to 1-dimensional thin-layer chromatography.ResultsA total of 15 brown and 12 blonde dyes were analyzed. PPD was identified in all of the brown dyes analyzed, irrespective of whether it was indicated (n = 12) or not (n = 3) in the composition. PPD was found in 6 of the 9 blonde dyes that indicated it in the composition and 2 of the 3 in which it was not indicated. Semiquantitative analysis by thin-layer chromatography revealed that the concentration of PPD in brown hair dyes (mean, 3%) was higher than in blonde dyes (mean, 0.1-0.3%).ConclusionsThe presence of PPD in hair dyes is related to the color of the dye. It is consistently present in darker dyes and at low levels in blonde dyes. This study highlights the clinical and epidemiological importance of identifying allergens in dermatology, particularly in occupational dermatology.     

The use of digital dermoscopy in the surveillance of melanocytic skin lesions: A real-life retrospective study comparing university hospital and private practices

BackgroundFew studies have evaluated the role of digital dermoscopy (DD) in the surveillance of pigmented lesions in real-life practice.Patients and methodsPatients followed with DD by 4 hospital dermatologists (group 1) and 4 private dermatologists (group 2) were retrospectively included if they had had at least 2 DD examinations for a minimum of 4 pigmented lesions. Their characteristics, risk factors, history of excision of benign nevi and melanomas prior to and during the DD follow-up, and characteristics of detected melanomas, were recorded.ResultsOne hundred and ninety-six patients were included in group 1 and 205 in groups 2. A family history of melanoma (25% vs. 12%, p < 0.01), a personal history of melanoma before DD follow-up (47% vs. 15%, p < 0.01), and a family (3% vs. 0%, p = 0.01) and personal (8% vs. 1%, p < 0.01) germline CDKN2a mutation were more frequent in group 1 than in group 2. In both groups, the number of excisions of benign lesions was higher before DD follow-up (380 and 347, respectively) than during DD follow-up (194 and 132). During follow-up, 29 melanomas were detected in group 1, with a median Breslow thickness of 0.4 mm, versus 1.3 mm for melanomas diagnosed before DD follow-up (p < 0.02). In group 2, 4 melanoma and 5 superficial atypical melanocytic proliferations of unknown significance were detected. The median Breslow thickness of newly diagnosed melanomas was 0.35 mm vs. 0.6 mm before DD follow-up (p = 0.1).ConclusionIn both populations in real-life practice, DD seemed to allow the detection of thin melanomas and to decrease the rate of “futile” resections.     

Evaluation of a school intervention program to modify sun exposure behaviour

IntroductionNonmelanoma skin cancer is the most prevalent and incident tumor in the world, being sun exposure the most important risk factor. Childhood and adolescence are the periods where sun exposure is greatest. An intervention to modify sun-related behaviours is essential for skin cancer prophylaxis.Material and methodsWe carried out a quasi-experimental study on a school population of Granada with ages ranging from 11-12 years. The control and study groups completed a questionnaire prior to the intervention with educational program and thereafter. We performed a random conglomerate sampling of 628 teenagers. Statistical analysis was carried out using the Mc Nemar and Wilcoxon tests.ResultsAfter the intervention, the study group showed marked improvement in the results concerning knowledge about sun exposure and skin (OR = 2.89), sun exposure and environment (OR = 2.23), and sun exposure and health (OR = 1.4) as well as in attitudes and healthy behaviour regarding sun exposure (OR = 4.2). This difference was statistically significant compared to the control group.Conclusions1. Before planning a campaign for primary prophylaxis of skin cancer it is necessary to know the information and knowledge of the target population. 2. The risk of acute, intermittent sun exposure and the use of different means of photoprotection should be stressed. 3. In our study group the rate of sun burn has decreased.     

Protein contact dermatitis: review of 27 cases

BackgroundProtein contact dermatitis (PCD) is a rare and underdiagnosed condition that many dermatologists fail to recognize. Nevertheless, increasing awareness of the condition and the substances responsible has led to a rise in the number of published cases in recent years.ObjectiveTo determine the clinical characteristics and allergens implicated in PCD in our setting.Material and methodsA retrospective observational study of all patients diagnosed with PCD in the last 10 years was undertaken in the Skin Allergies Unit of the Department of Dermatology at Hospital General Universitario in Valencia, Spain. All patients were assessed by skin-prick test with the standard GEIDAC allergen panel and by prick-by-prick test with foods or other products that were linked to immediate skin symptoms following handling.ResultsTwenty-seven patients (8 men and 19 women) were diagnosed with PCD, and 26 of the cases were occupational in origin. The mean age of the patients was 32.3 years and 51.8% had a history of atopy. The latency period varied from 2 months to 27 years. The most commonly affected areas were the backs of the hands and the forearms. Four patients had an oral allergy syndrome. In order of frequency, the substances responsible for PCD were fish (9 patients, 33.3%), latex (8 patients, 29.6%), potato (4 patients, 14.8%), chicken (3 patients, 11.1%), flour (3 patients, 11.1%), alpha amylase (2 patients, 7.4%), aubergine (2 patients, 7.4%), pork (1 patient, 3.7%), garlic (1 patient, 3.7%), and Anisakis (1 patient, 3.7%).ConclusionsPCD is a clinically relevant condition that dermatologists should include in the differential diagnosis of chronic dermatitis affecting the hands or forearms in patients at high occupational risk, particular those in the food preparation industry.     

Métodos referidos por los pacientes para aliviar el dolor asociado a la hidradenitis supurativa

BackgroundPain is a common, important symptom negatively affecting the well-being and quality of life of patients with hidradenitis suppurativa (HS). The aim of this study was to examine self-reported pain alleviating methods among outpatients attending a tertiary referral center.MethodsConsecutive patients with HS were invited to complete a questionnaire regarding their self-reported pain alleviating methods for HS associated pain. Additionally, the patients filled out the Dermatology Life Quality Index questionnaire and a visual analog scale for overall distress related to HS and for boil-associated pain in the past month. Information on disease severity and onset was obtained by interview and clinical examination.ResultsA total of 134 patients with a mean age of 38.3 years (SD 12.8) participated; 32% (n = 43) had Hurley stage i, 52% (n = 70) had Hurley stage ii, and 16% (n = 21) had Hurley stage iii. Overall, to achieve pain relief, 82% (n = 110) of the patients had previously drained pus from the lesions by manual pressure. Compared to patients who did not alleviate pain, patients who attempted to alleviate pain had a higher mean overall disease related distress score (7.43 [SD 2.81] vs. 5.47 [SD 3.37], P < .003), and a higher boil-associated pain score in the past month (6.56 [SD 3.07] vs. 4.39 [SD 3.88], P = .007).ConclusionThis study demonstrates that a large proportion of HS patients attempt to alleviate pain through various alternative and homespun methods. These results may reflect a major role of pain in HS and its potential insufficient management by dermatologists.     

Phenotypic and histologic characteristics of cutaneous melanoma in patients with melanocortin-1 receptor polymorphisms

BackgroundThe melanocortin-1 receptor (MC1R) is an important risk factor for melanoma due to its role in the production of melanin in response to sun exposure.ObjectivesTo analyze the phenotypic and histologic characteristics of cutaneous melanoma in patients carrying mutations in MC1R and assess the influence of sun exposure on the occurrence of melanoma.Material and methodsA total of 224 patients with a diagnosis of melanoma seen in the Department of Dermatology at Hospital General Universitario Gregorio Marañón in Madrid, Spain between September 2004 and December 2009 were included in the study. The genomic sequence of MC1R was analyzed by polymerase chain reaction.ResultsAt least one of the following MC1R variants was present in 58% of the patients: V60L, V92 M, I155T, R160W, D294H, and R163Q. Carriers of those variants had a history of sunburn (P = .018) and melanomas located on areas with intermittent sun exposure (P = .019), and the majority had a diagnosis of superficial spreading melanoma. These associations were especially significant in patients with the R160W and D294H variants. Carriers of R160W also had melanomas associated with melanocytic nevi (P = .028).ConclusionsThe results of our study suggest that there may be a relationship between the expression of certain MC1R variants and sun exposure, history of sunburn, and skin type. They also indicate a higher frequency of superficial spreading melanomas and melanomas associated with melanocytic nevi in patients carrying certain mutations in MC1R.     

Predictive factors of melanoma thickness

BackgroundMelanoma thickness is a relevant prognostic marker that is crucial for staging and its calculation relies on the histopathological examination. There is a risk of thickness underestimation with an incisional biopsy if the latter is not performed on a tumor area where the thickness is maximal. This occurrence may have an impact on a therapeutic decision, particularly regarding the excision margins and the need for sentinel lymph node biopsy.ObjectiveTo assess the association between melanoma thickness and dermoscopic, demographic, epidemiological and clinical variables, aiming to identify predictive factors of thickness >1 mm.MethodsThis was an observational and cross-sectional study, carried out on patients diagnosed with melanoma, from a single center over a time span of four years. Anatomopathological (thickness), dermoscopic, demographic, epidemiological, and clinical variables were collected. The associations between the variables with melanoma thickness were assessed.ResultsA total of 119 patients were included. The presence of atypical vessels on the dermoscopic examination was an independent predictive factor of thickness >1 mm. Conversely, an atypical reticular pattern predicted melanoma thickness <1 mm. The presence of ephelides and a previous history of sunburn were also associated with melanomas thinner than 1 mm in the univariate analysis.Study limitationsThe lack of data related to some variables and the absence of an optimal correlation between the dermoscopic and the anatomopathological examination constituted study limitations.ConclusionAn atypical vascular pattern on dermoscopy is associated with thickness >1 mm, helping with the choice of the optimal site to perform an incisional biopsy when an excisional biopsy is not feasible.     

Development and validation of an instrument to assess the knowledge of general practitioners and pediatricians about photoprotection and solar radiation

BackgroundThe knowledge of general practitioners about photoprotection is unknown.ObjectivesTo develop and validate an instrument to evaluate the knowledge of general practitioners and pediatricians about photoprotection, gauging the knowledge of these professionals.MethodsThe study followed the steps: (1) Literature identification and item elaboration related to the theme; (2) Content validation; (3) Apparent validation; (4) Construct validation: internal consistency analysis and discriminatory analysis; (5) Reliability analysis. In Step 4, the instrument was applied to 217 general practitioners and pediatricians who worked in the host city of the study; the scores were compared with dermatologists scores.ResultsThe final instrument had 41 items and showed satisfactory internal consistency (Cronbach's alpha = 0.780), satisfactory reproducibility and good test–retest reliability (good-to-excellent kappa statistic in more than 60% of items). The discriminatory analysis registered a mean score of 54.1 points for dermatologists and 31.1 points for generalists and pediatricians, from a total of 82 possible points, representing a statistically significant difference (p < 0.001). Generalists and pediatricians demonstrated an understanding of the relationship between excessive sun exposure and skin cancer, but they revealed lack of technical information necessary for their professional practice.Study limitationsThe instrument evaluates only knowledge, without evaluating the conduct of the participants.ConclusionThe results show that the instrument has good internal consistency and good reproducibility. It could be useful in the identification of general practitioners and pediatricians knowledge gaps on the subject, for the subsequent development of training and educational strategies.     

Evaluation of monocyte to high-density lipoprotein ratio,lymphocytes, monocytes,and platelets in psoriasis

BackgroundPsoriasis is a chronic immune-mediated inflammatory skin disease that is associated with cardiovascular comorbidities.ObjectivesThe objective of this retrospective study is to assess the C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio as inflammatory markers in patients with psoriasis and to search for a relationship between these parameters and psoriasis severity, as defined by the psoriasis area and severity index.MethodsThere were 94 patients with psoriasis and 118 healthy controls enrolled in the study. The C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio values of two groups were retrospectively evaluated.ResultsStatistically significant differences were observed in terms of C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio between the patient and control groups (p = 0.001, p = 0.003, p = 0.038, and p = 0.007, respectively). Positive correlations were found between the psoriasis area and severity index and the values of C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio (r: 0.381; p < 0.01, r: 0.203; p < 0.05, r: 0.268; p < 0.01, r: 0.374; p < 0.01, r: 0.294; p < 0.01, respectively).Study limitationsThe small sample size and the retrospective design of the study are limitations.ConclusionElevated C-reactive protein, monocyte-to-high-density-lipoprotein ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio were significantly associated with psoriasis. A positive correlation between C-reactive protein and monocyte-to-high-density-lipoprotein ratio leads to the suggestion that monocyte-to-high-density-lipoprotein ratio might be a reliable parameter in psoriasis during the follow-up. The relationship between the diasease and inflammatory parameters might provide early detection of cardiovascular morbidities in psoriasis patients.     

Infecciones por Chlamydia trachomatis en un hospital portugués de atención terciaria: estudio retrospectivo de 11 años

BackgroundChlamydia trachomatis infections remain a burden worldwide. The goals of this study were to determine the number of C. trachomatis infections per year, characterize the demographic traits of the infected population and identify the associated sexually transmitted infections (STI), over the last 11 years, in Lisbon main Hospital Centre.Materials and methodsLaboratorial confirmed C. trachomatis infections diagnosed between January 1st, 2009 and December 31st, 2019 were evaluated.ResultsA total of 6404 samples were collected, with 602 being positive for C. trachomatis, corresponding to 550 patients. 60% of diagnoses were made by dermatovenereologists and most cases occurred in males (n = 371; 67.5%), with a median age of 26.1 years (standard deviation 7.98), ranging from 13 to 68 years. More than half the cases (51.3%) occurred below the age of 25 years.In 87 patients (15.8%) there was previous history of STI, in 198 patients (36%) a concomitant STI was present and 43 patients (7.8%) developed a posterior STI.Concerning follow-up, 196 patients (corresponding to 35.6% of total patients) did not show for a re-evaluation after the diagnosis was made.ConclusionConfirmed cases of C. trachomatis infection have risen along the years, affecting mainly people younger than 25 years. C. trachomatis infection is especially associated with Neisseria gonorrhoeae infection, but other STI are also very prevalent. Considering the potential complications of C. trachomatis infection, screening and treatment are necessary. The high percentage of diagnoses made by dermatovenereologists support the pivotal role of dermatovenereology in diagnosing C. trachomatis infections.