BACKGROUND: Teledermatology is seldom used in Brazil, although some incipient initiatives have been implemented in the state of Amazonas. Further studies are still required to confirm the feasibility and efficacy of this diagnostic tool. Objectives: To evaluate the efficacy of an asynchronous method of teledermatology using simple, inexpensive technological resources. Methods: One hundred and seventy-four patients were examined by four dermatologists, two clinic-based dermatologists, who diagnosed the patients following live examination (A1 and A2), and two consultant specialists in image dermatology, who reached diagnoses by examining images of the lesions and the patients' clinical histories (B1 and B2). The agreement between live examination and examination of images was evaluated. Results: Agreement between the two live examiners (A1 and A2) with respect to the principal diagnosis was 83.3% compared to 81.0% between the physicians who diagnosed by examining images (B1 and B2). Agreement between the principal diagnosis established by live examination and that obtained from examining images ranged from 78.2% to 83.9%, Conclusion: Agreement between diagnoses of dermatological diseases reached following examination of digital images and those reached following live examination of the patient was excellent. Keywords: Clinical diagnosis; Dermatology; Telemedicine Resumo: FUNDAMENTOS: A teledermatologia, pouco utilizada no Brasil e com iniciativas incipientes no Amazonas, necessita de estudos para demonstrar sua factibilidade e eficácia. OBJETIVOS: Avaliar a eficácia de um método assíncrono de teledermatologia, utilizando recursos tecnológicos simples e de baixo custo. MÉTODOS: Cento e setenta e quatro pacientes foram examinados por quatro dermatologistas; dois efetuaram diagnóstico presencial (A1 e A2) e dois por meio de imagens das lesões e história clínica (B1 e B2). Foi investigada a concordância entre as avaliações presenciais e por imagens. RESULTADOS: A concordância do diagnóstico principal entre os examinadores presenciais (A1 e A2) foi de 83,3% e entre os de imagens (B1 e B2), de 81%. A concordância entre o diagnóstico principal estabelecido pelo método presencial e o obtido por meio de imagens variou de 78,2% a 83,9%. CONCLUSÃO: O diagnóstico de doenças dermatológicas realizado por imagens digitais demonstrou concordância ótima quando comparado àquele realizado com a presença física do paciente.
FUNDAMENTOS: Doenças Sexualmente Transmissíveis em crianças permanecem um problema de saúde pública pouco estudado, sendo ainda necessários esclarecimentos sobre seu manejo e a relação destas com o abuso sexual infantil. OBJETIVOS: Descrever o perfil clínico-epidemiológico das Doenças Sexualmente Transmissíveis em crianças atendidas em centro de referência na cidade de Manaus. MÉTODOS: Realizou-se estudo descritivo exploratório para verificar características clínicas, epidemiológicas e laboratoriais das Doenças Sexualmente Transmissíveis em crianças atendidas durante o período de janeiro/2003 a dezembro/2007. RESULTADOS: Foram incluídas no estudo 182 crianças que apresentavam DST. A maioria era do sexo feminino (65,4%) e de cor parda; a média de idade foi de 8,5 anos; 89% eram procedentes da cidade de Manaus; os pais foram os principais acompanhantes na consulta; verruga genital foi o principal diagnóstico em ambos os sexos; e, 90,1% apresentavam apenas uma DST. CONCLUSÃO: As frequências e características clínicas das DST nas crianças do estudo não diferiram do encontrado na literatura. Embora, com base em sinais e sintomas referentes tão somente às DST nas crianças, não se tenham parâmetros fidedignos de confirmação de abuso, deve-se sempre estar alerta para esta possibilidade, visto que estas doenças podem ser sinalizadoras de ofensas sexuais, por vezes, dissimuladas e repetidas.
Scabies is an ectoparasitosis caused by Sarcoptes scabiei var. hominis , characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.
HISTORY OF THE DISEASEECSS, an 18-year old female born and living in Manaus in the Brazilian state of Amazonas presented with a single, well-defined erythematous, desquamative plaque with a maximum diameter of 4 cm, situated in the abdominal region, which had been present for the past year (Figure 1). The patient stated that she had not used any medication previously. A skin biopsy was performed for diagnostic evaluation.At histopathology, the hematoxylin-eosinstained sections showed the presence of a group of mononuclear cells containing atypical lymphocytes and mild spongiosis. In the papillary dermis an infiltrate of perivascular lymphoid cells was found reaching the epidermis. No further alterations were identified in the rest of the dermis or hypodermis (Figures 2 and 3). The paraffin block was sent for immunohistochemical evaluation, which showed that the majority of the lymphoid cells present were CD3-positive in addition to being CD20 negative; CD45RO-positive; CD30-negative; and AE1/AE3-negative. The set of histopathological and immunohistochemical findings were conclusive for a diagnosis of unilesional mycosis fungoides.An Bras Dermatol. 2010;85(6):927-9.The patient was submitted to laboratory evaluation (full blood count, glucose and clinical chemistry) and systemic evaluation (chest x-ray, bone xray, a magnetic resonance imaging scan of the head and computed tomography).No abnormalities were found.
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