ABSTRACT
Pernio (chilblains) is an inflammatory condition classically characterized by localized erythema and swelling of acral sites upon exposure to cool and damp conditions. It is reported a case of a 59-year-old otherwise healthy woman with acute primary perniosis. She had a 3-day history of lesions on the toes brought on by cold, damp weather. On initial presentation, a biopsy sample was taken of a hallux lesion, and the patient was given a trial course of oral pentoxifylline, topical corticoid and nifedipine therapy. Follow-up at 2 weeks showed complete relief of symptoms and the biopsy results confirmed the diagnosis. Pentoxifylline therapy has been shown to be effective and should be considered the standard of care in the treatment of perniosis along with conservative environmental measures.The etiology and pathogenesis of perniosis are reviewed and discussed, as well as differential diagnoses and treatment options. (AU)
Subject(s)
Humans , Female , Middle Aged , Chilblains/drug therapy , Chilblains/diagnosis , Chilblains/prevention & controlABSTRACT
Introducción: Las infecciones de transmisión sexual (ITS) son una prioridad en salud pública, por su alta prevalencia, impacto en la calidad de vida y repercusiones económicas. Actualmente, no existen publicaciones que analicen la concordancia diagnóstica de las ITS entre el nivel primario y el nivel secundario de atención. Objetivo: Analizar la concordancia diagnóstica entre profesionales de atención primaria de salud (APS) y especialistas de la UNACESS en el diagnóstico de las ITS. Metodología: Se analizaron retrospectivamente las fichas de 627 pacientes derivados desde APS de la zona norte de Santiago a la UNACESS (Unidad de Atención y Control en Salud Sexual) del Hospital San José entre enero de 2015 y enero de 2016, según diagnóstico de referencia y contrarreferencia. Además, se analizó: el profesional derivador, sexo, edad y nacionalidad del paciente. El grado de concordancia diagnóstica se determinó mediante el coeficiente kappa de Cohen. Resultados: El 74% de las interconsultas desde APS fueron emitidas por matronas y el 26% por médicos. Los diagnósticos de referencia más prevalentes fueron: Condiloma acuminado (64.43%), molusco contagioso (8.13%), sífilis (7.34%), uretritis (7.02%) y herpes genital (3.67%). Los diagnósticos de contrarreferencia más prevalentes fueron: Condiloma acuminado (51.20%), sífilis (10.85%), molusco contagioso (10.37%), uretritis (6.86%) y herpes genital (3.51%). La concordancia diagnóstica global del estudio fue moderada (54%). Los médicos de APS lograron una concordancia sustancial (62%) y las matronas una concordancia moderada (49.19%) respecto a los diagnósticos realizados por el especialista. Conclusión: De los resultados, podemos concluir que existe una concordancia diagnóstica moderada entre los profesionales APS y los médicos especialistas de la UNACESS. Es fundamental reforzar la formación en ITS y elaborar estrategias de capacitación dirigido a médicos generales y matronas de APS.
Introduction: Sexually transmitted infections (STI) are a public health priority because of its high prevalence, economic repercussions and impact on a person's quality of life. Currently, there are no reports that analyse the diagnostic agreement of STI between primary and secondary health care professionals. Objective: To analyse the diagnostic concordance of STI amongst primary and secondary health care professionals. Methodology: Data is from 627 patients that were referred according to: referral and counter-referral diagnosis from Primary Health Care (PHC) of the northern zone of Santiago to San José Hospital´s Sexual Health Attention and Control Unit (UNACESS) during January 2015 until January 2016. It was also taken into consideration; the referring physician, patients sex and age. The level of diagnostic concordance was determined by the Cohen's kappa coefficient. Results: From the PHC consultations, 74% of the consultations were issued by midwives and 26% by doctors. The predominant referral diagnoses were: Condyloma acuminatum (64.43%), molluscum contagiosum (8.13%), syphilis (7.34%), urethritis (7.02%) and genital herpes (3.67%). The prevalent counter-referral diagnoses were: condylomas (51.20%), syphilis (10.85%), molluscum contagiosum (10.37%), urethritis (6.86%), and genital herpes (3.51%). The study's overall diagnostic concordance was moderate (54%). PHC physicians achieved a substantial concordance (62%) and midwives had a moderate concordance (49.19%) to the diagnoses made by the specialist. Conclusions: There is a moderate diagnostic concordance between the PHC professionals and the specialists' doctors of UNACESS. It is crucial to reinforce STI training and develop training strategies for general physicians and PHC midwives.