Impacto de uma campanha educativa do WhatsAppⓇ na hidradenite supurativa em médicos da demanda espontânea de um hospital universitário

Antecedentes. La escasa difusión de la hidradenitis supurativa (HS) entre los médicos generalistas, conduce a retrasos en el diagnóstico. Objetivos. Evaluar el impacto de una campaña educativa a corto y largo plazo sobre HS en los médicos que atienden la demanda espontánea (DE) del Hospital Italiano de Buenos Aires (HIBA) Materiales y Métodos. Estudio cuasi experimental con una intervención educativa mediante la difusión de un pieza de información sobre HS en 142 médicos de demanda espontánea del HIBA. Se realizó una misma encuesta anónima sobre conocimientos de la HS, en 3 oportunidades: basal, 1 y 9 meses luego de la intervención. Se compararon las respuestas correctas antes, al mes y a los 9 meses. La encuesta y la pieza de información fueron enviadas por WhatsAppⓇ. Resultados. Del total, 64 (45%) respondieron en la primera etapa, 48 (34%) en la segunda y 56 (39%) en la tercera. En la encuesta basal, sólo la mitad conocía la naturaleza inflamatoria de la enfermedad, 3 de cada 5 médicos elegían un esquema antibiótico inadecuado, la cirugía mayormente indicada era el drenaje, apenas la quinta parte consideraba de utilidad la ecografía, y un tercio de los médicos no creían que el paciente pudiera beneficiarse de la derivación a un dermatólogo. Luego de la campaña educativa, observamos un aprendizaje en el manejo de la HS, que se sostuvo a los 9 meses. Discusión. Observamos una falta de entrenamiento sobre HS entre los médicos generalistas. La plataforma WhatsAppⓇ podría ser útil como herramienta educativa.Background: The limited diffusion about hidradenitis suppurativa (HS) among general practitioners, leads to diagnosis delays.Objectives: To assess the impact of a short and long-term educational campaign on HS among the walk-in clinic physicians of the Hospital Italiano de Buenos Aires (HIBA)Materials and methods: Quasi-experimental study with an educational intervention by disseminating a piece of information about HS among 142 walk-in clinic physicians of the HIBA. The same anonymous survey on knowledge of the HS was carried out on 3 occasions: baseline, 1 and 9 months after the intervention. The correct answers were compared before, after 1 and 9 months. The survey and the piece of information were sent by WhatsAppⓇ.Results: Of the total, 64 (45%) answered in the first stage, 48 (34%) in the second stage and 56 (39%) in the third stage. In the baseline survey, only half knew the inflammatory nature of the disease, 3 out of 5 physicians chose an inadequate antibiotic scheme, the surgery mostly indicated was drainage, only a fifth considered ultrasound useful, and a third did not believe that the patient could benefit from referral to a dermatologist. After the educational campaign, we observed a learning in the HS management, which was held at 9 months.Discussion: We observed a lack of HS training among general practitioners. The WhatsAppⓇ platform could be useful as an educational tool.Keywords: hidradenitis suppurativa; general practitioners; awareness; medical education; WhatsAppⓇ.Antecedentes. A difusão limitada da hidradenite supurativa (HS) entre os clínicos gerais leva a atrasos no diagnóstico.Objetivos. Avaliar o impacto de uma campanha educacional de curto e longo prazo no HS em médicos que atendem à demanda espontânea (DE) do Hospital Italiano de Buenos Aires (HIBA)Materiais e métodos. Estudo quase-experimental com intervenção educacional, divulgando uma informação sobre HS em 142 médicos de demanda espontânea do HIBA. A mesma pesquisa anônima sobre o conhecimento do HS foi realizada em 3 ocasiões: linha de base, 1 e 9 meses após a intervenção. As respostas corretas foram comparadas antes, em um mês e em 9 meses. A pesquisa e as informações foram enviadas pelo W hatsAppⓇ.Resultados. Do total, 64 (45%) responderam na primeira etapa, 48 (34%) na segunda etapa e 56 (39%) na terceira etapa. Na pesquisa inicial, apenas metade conhecia a natureza inflamatória da doença, 3 em cada 5 médicos escolheram um esquema antibiótico inadequado, a cirurgia mais indicada foi a drenagem, apenas um quinto considerou o ultrassom útil e um terço dos Os médicos não acreditavam que o paciente pudesse se beneficiar do encaminhamento a um dermatologista. Após a campanha educativa, foi observado um estágio na gestão do HS, realizado aos 9 meses.Discussão. Observamos uma falta de treinamento em HS entre os clínicos gerais. A plataforma W hatsAppⓇpode ser útil como uma ferramenta educacional.Fil: Zimman, Sabina. Hospital Italiano; ArgentinaFil: Posadas Martinez, Maria Lourdes. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; ArgentinaFil: Mazzuoccolo, Luis Daniel. Hospital Italiano; Argentin

Treatment of Psoriasis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Objective. Our aim was to summarize and evaluate the current quality of evidence regarding the efficacy of therapies for cutaneous psoriasis (PsO) in patients with psoriatic arthritis (PsA).Methods. A literature search of MEDLINE, Embase, Cochrane Library databases, and conference abstracts was conducted to identify interventional randomized controlled trials in patients with PsA between February 2013 and December 2021. Studies were included if PsO outcomes included achieving at least 75% improvement in the Psoriasis Area and Severity Index and the blinded comparison period was >= 10 weeks. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was employed to assess quality of the evidence to inform and update the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations.Results. A total of 116 studies and 36 abstracts identified in the initial search were screened. A total of 37 studies (40 treatment arms) met the criteria for final inclusion. Phosphodiesterase 4 inhibitors, Janus kinase inhibitors, and tyrosine kinase 2 inhibitors, interleukin 17 inhibitors (IL-17i), IL-12/23i, IL-23i, and tumor necrosis factor inhibitors (TNFi) had high-quality data broadly supporting the efficacy of each class for plaque PsO over placebo. Head-to-head studies with high-quality data supported both IL-17i and IL-23i over TNFi.Conclusion. Several pharmacologic therapeutic classes have high-quality evidence demonstrating efficacy for cutaneous PsO in the PsA population. The findings will be integrated into the 2021 GRAPPA treatment recommendations, intended to guide selection of a therapeutic class where efficacy in 1 or more cutaneous or musculoskeletal domains is required

A Challenging Giant Dermatofibrosarcoma Protuberans on the Face

Dermatofibrosarcoma protuberans (DFSP) is a malignant fibrohistiocytic tumor that appears exclusively on the skin. It is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence but seldom metastasizes. It may rarely occur on the head and neck accounting for less than one percent of total head and neck malignancies. We present a man with a giant DFSP on the face. Oncological, functional, and aesthetic aspects are set forth

A dataset of skin lesion images collected in Argentina for the evaluation of AI tools in this population

Abstract In recent years, numerous dermatological image databases have been published to make possible the development and validation of artificial intelligence-based technologies to support healthcare professionals in the diagnosis of skin diseases. However, the generation of these datasets confined to certain countries as well as the lack of demographic information accompanying the images, prevents having a real knowledge of in which populations these models could be used. Consequently, this hinders the translation of the models to the clinical setting. This has led the scientific community to encourage the detailed and transparent reporting of the databases used for artificial intelligence developments, as well as to promote the formation of genuinely international databases that can be representative of the world population. Through this work, we seek to provide details of the processing stages of the first public database of dermoscopy and clinical images created in a hospital in Argentina. The dataset comprises 1,616 images corresponding to 1,246 unique lesions collected from 623 patients

Real-life approach and treatment of chronic urticaria in Argentina: a national survey

The management of chronic urticaria (CU) has been controversial. Recently updated international guidelines propose evidence-based diagnosis and treatment. Nevertheless, dermatologists have heterogeneous approaches to managing CU. To estimate the percentage of dermatologists who have an optimal approach to CU according to the international guidelines, and to explore the variables associated with optimal management a cross-sectional study using a 17-question survey was delivered by email to dermatologists from Argentina. Optimal first, second, and third line treatment were considered when dermatologists chose a nonsedative antihistamine; increased the dosage of nonsedative antihistamines, and added omalizumab, respectively. Logistic regression was used to identify variables associated with optimal management. A total of 165 questionnaires were available for analysis. An optimal first, second, and third-line treatment approach was identified in 50%, 35%, and 15% of the dermatologists, respectively. The dermatologists' age being above 55 years old (OR: 0.12, 95% CI: 0.01–0.99, p.005) and having more than 5 years of expertise (OR: 0.4, 95% CI: 0.19–0.81, p.001) were significantly associated with a suboptimal approach in second-line treatment. We could not find variables associated with an optimal first or third-line treatment. The real-life management of CU in Argentina is partly suboptimal according to the international guidelines.Fil: Torre, Ana C.. Hospital Italiano; ArgentinaFil: Bollea Garlatti, Maria L.. Hospital Italiano; ArgentinaFil: Marciano, Sebastián. Hospital Italiano; ArgentinaFil: Posadas Martinez, Maria Lourdes. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; ArgentinaFil: Parisi, Claudio A. S.. Hospital Italiano; ArgentinaFil: Mazzuoccolo, Luis Daniel. Hospital Italiano; Argentin

Telemedicina: Validação de um questionário para avaliar a experiência dos profissionais de saúde

Objetivo. El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina. Métodos. A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen. Resultados. Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discrimi- nante fueron apropiadas. La validez de criterio externo mostró resultados óptimos. Conclusiones. El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.Objective. This objective of this work is to develop and validate a questionnaire to evaluate health professionals' experience with telemedicine systems. Methods. Based on an abbreviated, locally validated Spanish-language version of the patient questionnaire developed by Parmanto et al., a group of experts developed a version to evaluate the experience of health professionals who provide telemedicine services. The psychometric behavior of the items was tested in an initial sample of 129 professionals, using exploratory factor analysis. The comprehensibility of the items was then assessed through cognitive interviews. Finally, in a new sample of 329 professionals, the construct validity of the questionnaire was evaluated by means of confirmatory factor analysis (CFA); its criteria of external validity were assessed by comparing the score with that of a summary question. Results. A 12-item questionnaire was obtained, with a two-factor structure and acceptable adjustment indicators documented through CFA. Reliability, convergent validity, and discriminant validity were appropriate. The criteria of external validity showed optimal results. Conclusions. The instrument obtained has adequate psychometric properties and will contribute to the objective evaluation of the experience of health professionals who perform telemedicine.Objetivo. Desenvolver e validar um questionário para avaliar a experiência dos profissionais de saúde com os sistemas de telemedicina. Métodos. Com base na versão abreviada em espanhol e validada localmente do questionário para pacientes desenvolvido por Parmanto et al., um grupo de especialistas gerou uma versão de consenso para avaliar a experiência de profissionais de saúde que prestam serviços de telemedicina. O comportamento psicométrico dos itens foi testado em uma primeira amostra de 129 profissionais, por meio de análise fatorial exploratória. Em seguida, sua compreensibilidade foi avaliada por meio de entrevistas cognitivas. Por fim, em uma nova amostra de 329 profissionais, avaliouse a validade de construto do questionário por meio de uma análise fatorial confirmatória (AFC), e sua validade de critério externo, mediante a avaliação de sua pontuação com a de uma pergunta resumo. Resultados. Obteve-se um questionário de 12 itens com estrutura de dois fatores, com indicadores de ajuste aceitáveis, documentados pela AFC. A confiabilidade, a validade convergente e a validade discriminante foram adequadas. A validade de critério externo apresentou ótimos resultados. Conclusões. O instrumento obtido possui propriedades psicométricas adequadas e contribuirá para a ava- liação objetiva da experiência dos profissionais que realizam telemedicina.Fil: Sommer, Janine. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Torres, Ana Clara. Hospital Italiano; ArgentinaFil: Bibiloni, Nuria. Hospital Italiano; ArgentinaFil: Plazzotta, Fernando. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Vázquez Peña, Fernando. Hospital Italiano; ArgentinaFil: Terrasa, Sergio Adrián. Hospital Italiano; ArgentinaFil: Boietti, Bruno Rafael. Hospital Italiano; ArgentinaFil: Bruchanski, Lucila. Hospital Italiano. Departamento de Informática En Salud.; ArgentinaFil: Mazzuoccolo, Luis Daniel. Hospital Italiano; ArgentinaFil: Luna, Daniel Roberto. Hospital Italiano. Departamento de Informática En Salud.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; Argentin

Nevoid Basal Cell Carcinoma Syndrome: <i>PTCH1</i> Mutation Profile and Expression of Genes Involved in the Hedgehog Pathway in Argentinian Patients

Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder characterized by multiple basal cell carcinomas (BCC), mainly caused by PTCH1 gene mutations. Our current study aimed to establish (1) PTCH1 germinal and somatic mutational status, (2) component and Hedgehog (HH) pathway targets gene expression patterns, and (3) profile variations according to the genetic background in BCC and normal surrounding skin (NSS). We collected 23 blood and 20 BCC patient samples and analyzed the PTCH1 gene using bidirectional sequencing and multiplex ligation-dependent probe amplification. Quantitative PCR was used to determine the mRNA expression levels of PTCH1, SMO, GLI3, and CCND1 in paired samples of BCC and NSS from 20 patients and four non-NBCCS skin controls (C). Our analyses identified 12 germline and five somatic sequence variants in PTCH1. mRNA levels of PTCH1, SMO, and GLI3 were higher in NSS compared to C samples, reaching maximum values in BCC samples (p &lt; 0.05). NSS with PTCH1 germline mutations had modified SMO, PTCH1, and GLI3 mRNA levels compared to samples without mutation (p &lt; 0.01). Two PTCH1 mutations in BCC led to an increase in PTCH1, SMO, and GLI3, and a decrease in CCND1 mRNA levels (p &lt; 0.01 vs. BCC with germline mutation only). These results indicate that besides PTCH1, other genes are responsible for NBCCS and BCC development in a population exposed to high UV radiation. Additionally, the mutational events caused increased expression of HH-related genes, even in phenotypically normal skin

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021

Since the second version of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations were published in 2015, therapeutic options for psoriatic arthritis (PsA) have advanced considerably. This work reviews the literature since the previous recommendations (data published 2013–2020, including conference presentations between 2017 and 2020) and reports high-quality, evidence-based, domain-focused recommendations for medication selection in PsA developed by GRAPPA clinicians and patient research partners. The overarching principles for the management of adults with PsA were updated by consensus. Principles considering biosimilars and tapering of therapy were added, and the research agenda was revised. Literature searches covered treatments for the key domains of PsA: peripheral arthritis, axial disease, enthesitis, dactylitis, and skin and nail psoriasis; additional searches were performed for PsA-related conditions (uveitis and inflammatory bowel disease) and comorbidities. Individual subcommittees used a GRADE-informed approach, taking into account the quality of evidence for therapies, to generate recommendations for each of these domains, which were incorporated into an overall schema. Choice of therapy for an individual should ideally address all disease domains active in that patient, supporting shared decision-making. As safety issues often affect potential therapeutic choices, additional consideration was given to relevant comorbidities. These GRAPPA treatment recommendations provide up-to-date, evidence-based guidance on PsA management for clinicians and people with PsA