Importancia actual del tatuaje: la vacuna BCG

En Uruguay desde 1940 hasta 1978 para la vacunación BCG se utilizó la técnica de multipunturas. Se administraban gotas de linfa vaccinal sobre la piel del brazo derecho del recién nacido y se realizaba simultáneamente un tatuaje en el dedo gordo del pie izquierdo a los nacidos en el Hospital Pereira Rossell. Teniendo de esa forma una marca indeleble que permitiría en el futuro saber si la persona había sido vacunada. Estos “tatuajes” clínicamente se describen como lesiones redondeadas de escasos milímetros, azules o azulgrisáceas que a la dermatoscopía presentan un patrón homogéneo. El diagnóstico diferencial que se debe tener presente, sobre todo si no se tiene el antecedente del tatuaje, es el de melanom

Prevenção do Câncer de Pele no Hospital de Clínicas: O que sabem os profissionais de saúde?

Camila Otero: Hospital Británico, Montevideo-Uruguay ORCID: 0000-0001-5382-7130 -- Sofía Sellanes: Hospital Británico, Montevideo-Uruguay. Hospital de Clínicas Dr. Manuel Quintela, Montevideo-Uruguay ORCID: 0000-0001-5902-0653 -- Lidice Dufrechou: Hospital Británico, Montevideo-Uruguay -- Sofía Nicoletti: Hospital Británico, Montevideo-Uruguay -- Alejandra Larre Borges: Hospital Británico, Montevideo-Uruguay. Correo electrónico: [email protected] ORCID: 0000-0002-9211-494XEl cáncer de piel es la neoplasia maligna más frecuente en Uruguay así como a nivel mundial, donde muere una persona cada menos de cuatro días por ésta causa. La medida de prevención primaria más efectiva es tener hábitos de fotoprotección, lo cual se consigue mediante la educación en salud y campañas preventivas. En el presente trabajo se resumen los resultados del examen físico realizado a funcionarios del Hospital de Clínicas en el contexto de la Campaña de Prevención de Cáncer de Piel 2017 y los hábitos y conocimientos de fotoprotección de los mismos. La amplia mayoría de los asistentes considera que cuenta con información suficiente sobre cómo protegerse del sol, que proviene, en un 39% de los casos de la televisión. Aún así, el 41% de ellos, sólo se protege en ocasiones especiales como viajes y verano y únicamente 3 de los participantes emplea medidas adecuadas. Con respecto a campañas previas, 94% no recordaba otra campaña de prevención de cáncer de piel y era la primera vez que concurría a una el 99% de los individuos, lo que pone en manifiesto la necesidad de reforzar la planificación y ejecución de campañas y medidas efectivas para la promoción y prevención del cáncer de piel en los próximos años a fin de lograr disminuir la incidencia de cáncer de piel que continúa en aumentoSkin cancer is the most frequent malignancy in Uruguay as well as worldwide, where a person dies every less than four days for this cause. The most effective prevention measure is to have photoprotective habits, which is achieved through health education and preventive campaigns. This paper summarizes the results of the physical examination performed on officials of the Hospital de Clínicas in the context of the 2017 Skin Cancer Prevention Campaign and their habits and knowledge of photoprotection. The vast majority of individuals consider that they have enough information on how to protect themselves from the sun, which comes in 39% of television cases. Still, 41% of them are only protected on special occasions such as trips and summer and only 3 of the participants use adequate measures. With respect to previous campaigns, 94% did not remember another skin cancer prevention campaign and it was the first time that 99% of the individuals attended, which highlights the need to reinforce the planning and execution of campaigns and effective measures for the promotion and prevention of skin cancer in the coming years in order to reduce the incidence of skin cancer that continues to increase.O câncer de pele é a neoplasia maligna mais frequente no Uruguai e no mundo, onde uma pessoa morre a cada menos de quatro dias por essa causa. A medida de prevenção primária mais eficaz é ter hábitos fotoprotetores, o que é alcançado por meio de educação em saúde e campanhas preventivas. Este artigo sintetiza os resultados do exame físico realizado em funcionários do Hospital de Clínicas no contexto da Campanha de Prevenção do Câncer de Pele 2017 e seus hábitos e conhecimentos sobre fotoproteção. A grande maioria das pessoas considera que possui informações suficientes sobre como se proteger do sol, o que ocorre em 39% dos casos de televisão. Ainda assim, 41% deles são protegidos apenas em ocasiões especiais, como viagens e verão, e apenas 3 dos participantes usam medidas adequadas. Com relação às campanhas anteriores, 94% não se lembraram de outra campanha de prevenção do câncer de pele e foi a primeira vez que 99% dos indivíduos compareceram, o que evidencia a necessidade de reforçar o planejamento e a execução de campanhas e medidas eficazes para a promoção e prevenção do câncer de pele nos próximos anos, a fim de reduzir a incidência de câncer de pele que continua a aumentar

Incidence of Surgical Site Infection in Patients who Underwent Surgery at Hospital Pasteur (Montevideo), July-August 2017

Martina Bañales: Estudiante de Medicina, Ciclo de Metodología Científica II, Facultad de Medicina, Universidad de la República, Uruguay. La contribución en la realización del trabajo fue equivalente a la de los demás estudiantes.-- Diego Castro: Estudiante de Medicina, Ciclo de Metodología Científica II, Facultad de Medicina, Universidad de la República, Uruguay. La contribución en la realización del trabajo fue equivalente a la de los demás estudiantes.-- Sabrina Della Mea: Estudiante de Medicina, Ciclo de Metodología Científica II, Facultad de Medicina, Universidad de la República, Uruguay. La contribución en la realización del trabajo fue equivalente a la de los demás estudiantes.-- Isabel Larre Borges: Estudiante de Medicina, Ciclo de Metodología Científica II, Facultad de Medicina, Universidad de la República, Uruguay. La contribución en la realización del trabajo fue equivalente a la de los demás estudiantes.-- Josefina Mora: Estudiante de Medicina, Ciclo de Metodología Científica II, Facultad de Medicina, Universidad de la República, Uruguay. La contribución en la realización del trabajo fue equivalente a la de los demás estudiantes.-- Manuel Soneira: Estudiante de Medicina, Ciclo de Metodología Científica II, Facultad de Medicina, Universidad de la República, Uruguay. La contribución en la realización del trabajo fue equivalente a la de los demás estudiantes.-- Alejandra Liz: Docente supervisor. Clínica Quirúrgica 1, Hospital Pasteur, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. Contacto: [email protected] infecciones del sitio quirúrgico (ISQ) son una complicación frecuente en cirugía general. Generan múltiples problemas para el paciente y aumentan los costos en salud. Existe una carencia de datos a nivel nacional sobre dicha patología. El objetivo general del estudio fue determinar la incidencia de infecciones tipo I y II de la clasificación del Centers for Disease Control and Prevention en pacientes postoperatorios de cirugía abdominal y vascular periférica internados en el Hospital Pasteur, entre julio y agosto de 2017. Los objetivos específicos fueron identificar los factores de riesgo, determinar los gérmenes más prevalentes, frecuencia de tratamiento con drenaje o antibioticoterapia y el tiempo medio entre la cirugía y el diagnóstico de ISQ. Se realizó un estudio observacional longitudinal prospectivo que incluyó a 99 pacientes. Se analizaron los datos utilizando regresión logística simple y múltiple mediante el software “R project”. La incidencia de infecciones fue de 11,11%. Diabetes mellitus (D.M.), estadía en CTI e institucionalización fueron factores de riesgo. La cirugía sucia se vinculó en forma liminal con la aparición de ISQ; la cirugía laparoscópica fue un factor protector. El microorganismo predominante fue E. Coli (42,85%), seguido de cultivos polimicrobianos (28,57%), Klebsiella Pneumoniae (14,28%) y Bacilos Gram Negativos no especificados (14,28%). En 36,6% de los pacientes infectados se administraron antibióticos, mientras que el 81,81% requirió drenaje. El tiempo medio entre la cirugía y la infección fue de 15,45 días. Se concluye que estos resultados deben ser considerados para la realización de investigaciones más exhaustivas y elaboración de protocolos pre y perioperatorios.Surgical site infections (SSI) are a common postoperative complication in general surgery, aff ecting patients prognosis and increasing health care costs. There is a lack of national data about this compli cation. The aim of this study was to determine the incidence of type I and II infections according to the Centers for Disease Control and Prevention classifi cation, in patients admitted in Hospital Pasteur who underwent abdominal or peripheral vascular surgery between July and August 2017. The specific objectives were to identify risk factors, determine most prevalent germs, treatment strategies applied (drainage or antibiotics) and delay between surgery and diagnosis of infection. A longitudinal, ob servational and prospective study was performed including 99 patients. Multiple and simple logistic regression models were used to analyze the data with R Project software. The incidence of surgical site infections was 11,11%. Diabetes Mellitus, ICU stay and institutionalization were significant risk factors. Dirty surgical wounds showed a liminal association with SSI. Laparoscopic surgery was a protective factor. E. Coli was the main germ found (42,85%), followed by polymicrobial isolation (28,57%), Klebsiella Pneumoniae (14,28%) and Gram-Negative Bacilli (14,28%). Antibiotics were administered in 36,36% of infected patients, while drainage was required in 81,81%. The mean time between surgery and infection diagnosis was 15,45 days. It is concluded that the results may provide orientation for further investigation and elaboration of pre and perioperative protocols

Dermoscopy in Selected Latin American Countries: A Preliminary Look into Current Trends and Future Opportunities Among Dermatology Residency Programs

Introduction: Dermoscopy is a useful technique that aids in early detection of skin cancer by increasing diagnostic accuracy with adequate training. However, dermoscopy is not uniformly taught to residents worldwide. Dermoscopy training in Latin American dermatology residency programs has not been explored. Objectives: To assess current dermoscopy training among dermatology residency programs in Latin America (e.g. training modalities, preferred/most effective modalities per residents, diseases/pathologies taught). Methods: Cross-sectional survey distributed via email between March and May 2021. Chief residents from Argentina, Brazil, Colombia, Costa Rica, Chile, Ecuador, Guatemala, Mexico, Panama, and Uruguay were invited to participate. Results: 81 chief residents completed the questionnaire (81/126, 64.2%). 72% of programs had an established dermoscopy curriculum, with dedicated hours of training varying greatly by program. Institutions commonly utilized sessions with “unknown” dermoscopy images and direct teaching by experts in the clinical setting as supplements to lectures, also described by residents as most effective. The most commonly taught methods included pattern analysis (74.1%), the two-step algorithm (61.7%), and the ABCD rule (59.3%). Almost all respondents reported desiring additional training during residency and believe that dermoscopy training should be a requirement to graduate from residency. Conclusion: This study highlights the current landscape in dermoscopy training among dermatology residency programs in Latin America, demonstrating room for improvement and standardization in dermoscopic education and training. Our results serve as a baseline reference and provide valuable information to guide future educational initiatives incorporating successful teaching strategies (e.g. spaced education/repetition, flipped classroom model) used in dermatology and other fields

Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma

PURPOSE: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America. METHODS: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained. RESULTS: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients. CONCLUSION: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first- or second-degree relatives.Genet Med 18 7, 727-736

Estimating CDKN2A mutation carrier probability among global familial melanoma cases using GenoMELPREDICT

Background: Although rare in the general population, highly penetrant germline mutations in CDKN2A are responsible for 5%-40% of melanoma cases reported in melanoma-prone families. We sought to determine whether MELPREDICT was generalizable to a global series of families with melanoma and whether performance improvements can be achieved. Methods: In total, 2116 familial melanoma cases were ascertained by the international GenoMEL Consortium. We recapitulated the MELPREDICT model within our data (GenoMELPREDICT) to assess performance improvements by adding phenotypic risk factors and history of pancreatic cancer. We report areas under the curve (AUC) with 95% confidence intervals (CIs) along with net reclassification indices (NRIs) as performance metrics. Results: MELPREDICT performed well (AUC 0.752, 95% CI 0.730-0.775), and GenoMELPREDICT performance was similar (AUC 0.748, 95% CI 0.726-0.771). Adding a reported history of pancreatic cancer yielded discriminatory improvement (P &lt; .0001) in GenoMELPREDICT (AUC 0.772, 95% CI 0.750-0.793, NRI 0.40). Including phenotypic risk factors did not improve performance. Conclusion: The MELPREDICT model functioned well in a global data set of familial melanoma cases. Adding pancreatic cancer history improved model prediction. GenoMELPREDICT is a simple tool for predicting CDKN2A mutational status among melanoma patients from melanoma-prone families and can aid in directing these patients to receive genetic testing or cancer risk counseling

Birth cohort-specific trends of sun-related behaviors among individuals from an international consortium of melanoma-prone families.

Funder: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior; doi: http://dx.doi.org/10.13039/501100002322Funder: Radiumhemmets Forskningsfonder; doi: http://dx.doi.org/10.13039/501100007232Funder: Swedish Cancer SocietyFunder: Lunds Universitet Paulsson TrustFunder: CIBER de Enfermedades Raras of the Instituto de Salud Carlos IIIFunder: European Regional Development Fund; doi: http://dx.doi.org/10.13039/501100008530Funder: DiagnopticsFunder: CERCA Programme Generalitat de CatalunyaFunder: Esther Koplowitz Center, Barcelona, SpainFunder: Comision Honoraria de Lucha Contra el Cancer, CSIC, Fundacion Manuel Perez, Montevideo, UruguayBACKGROUND: Individuals from melanoma-prone families have similar or reduced sun-protective behaviors compared to the general population. Studies on trends in sun-related behaviors have been temporally and geographically limited. METHODS: Individuals from an international consortium of melanoma-prone families (GenoMEL) were retrospectively asked about sunscreen use, sun exposure (time spent outside), sunburns, and sunbed use at several timepoints over their lifetime. Generalized linear mixed models were used to examine the association between these outcomes and birth cohort defined by decade spans, after adjusting for covariates. RESULTS: A total of 2407 participants from 547 families across 17 centers were analyzed. Sunscreen use increased across subsequent birth cohorts, and although the likelihood of sunburns increased until the 1950s birth cohort, it decreased thereafter. Average sun exposure did not change across the birth cohorts, and the likelihood of sunbed use increased in more recent birth cohorts. We generally did not find any differences in sun-related behavior when comparing melanoma cases to non-cases. Melanoma cases had increased sunscreen use, decreased sun exposure, and decreased odds of sunburn and sunbed use after melanoma diagnosis compared to before diagnosis. CONCLUSIONS: Although sunscreen use has increased and the likelihood of sunburns has decreased in more recent birth cohorts, individuals in melanoma-prone families have not reduced their overall sun exposure and had an increased likelihood of sunbed use in more recent birth cohorts. These observations demonstrate partial improvements in melanoma prevention and suggest that additional intervention strategies may be needed to achieve optimal sun-protective behavior in melanoma-prone families

The dermoscopic variability of Degos disease at different stages of progression

A 34-year-old woman presented with an 8-month standing eruption disseminated on the trunk and anterior upper limbs. Following their initial appearance, the skin lesions were described to occur in crops. On clinical examination, lesions of recent onset were small, dome-shaped, pale-red papules surrounded by an erythematous halo (Figure 1a), while papules of longer duration displayed a central ulceration covered by a yellowish crust and were surrounded by a whitish rim (Figure 2a). Finally, porcelain-white scars with a reddish or hyperpigmented halo were noted on the site of healed lesions

Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma

Purpose: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America. Methods: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained. Results: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients. Conclusion: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first-or second-degree relatives.GenoMEL, National Cancer Institute of the US National Institutes of Health, Fondo de Investigaciones Sanitarias, CIBER de Enfermedades Raras of the Instituto de Salud Carlos II, Catalan Government, European Commission, Instituto de Salud Carlos III, Consejo Nacional de Ciencia y Tecnologia (CONACYT), Fundacao para o Amparo da Pesquisa do Estado de Sao Paulo (FAPESP), Brazilian Post-Graduation Agency Capes (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior), Comision Honoraria de Lucha Contra el Cancer and Fundacion Manuel Perez, Montevide