Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases-A Cohort Study.

BACKGROUND: Melanoma is the cancer with the highest risk of dissemination to the central nervous system (CNS), one of the leading causes of mortality from this cancer. OBJECTIVE: To identify patients at higher risk of developing CNS metastases and to evaluate associated prognostic factors. METHODS: A cohort study (1998-2023) assessed patients who developed CNS melanoma metastases. Multivariate logistic regression was used to identify predictive factors at melanoma diagnosis for CNS metastasis. Cox regression analysis evaluated the CNS-independent metastasis-related variables impacting survival. RESULTS: Out of 4718 patients, 380 (8.05%) developed CNS metastases. Multivariate logistic regression showed that a higher Breslow index, mitotic rate ≥ 1 mm2, ulceration, and microscopic satellitosis were significant risk factors for CNS metastasis development. Higher patient age and the location of the primary tumor in the upper or lower extremities were protective factors. In survival analysis, post-CNS metastasis, symptomatic disease, prior non-CNS metastases, CNS debut with multiple metastases, elevated LDH levels, and leptomeningeal involvement correlated with poorer survival. CONCLUSION: Predictive factors in the primary tumor independently associated with brain metastases include microscopic satellitosis, ulceration, higher Breslow index, and trunk location. Prognostic factors for lower survival in CNS disease include symptomatic disease, multiple CNS metastases, and previous metastases from different sites.

Dermoscopy of Linear Basal Cell Carcinomas, a Potential Mimicker of Linear Lesions: a Descriptive Case-series.

Introduction: Among the various widely recognized basal cell carcinoma (BCC) clinical patterns, linear basal cell carcinoma (LBCC) is an uncommon morphologic variant of BCC. Objectives: Describe the clinical and dermoscopic characteristics of LBCC. Methods: Retrospective study including LBCC cases from 5 dermatology centers in North and South America. Biopsy-proven primary BCCs, that presented with at least 3:1 length:width ratio on physical examination, irrespective of tumor subtype or location, were included. Clinical and dermoscopic analysis were performed by 2 experts in dermoscopy. Results: Eighteen cases of LBCC met our inclusion criteria and were included in the study. Median age at diagnosis was 86.0 years, 10 patients (58.8%) were males. Regarding anatomic location, 11/18 (61.1%) were located on the head and neck, 5/18 (27.7%) cases were found on the trunk, and 2 on lower extremities (11.1%). Under dermoscopy, 15/18 (83.3%) of LBCC were pigmented. All tumors displayed at least one of the BCC-specific dermoscopic criteria the most common being blue-grey globules (72.2%). Conclusions: Dermoscopy might be useful in the differentiation of LBCC from other diagnoses presenting as linear lesions such as scars, scratches/erosions, and tattoos, among others. Some of these lesions might be confused by naked eye examination alone.

Asociación entre depresión y teletrabajo durante la pandemia de COVID-19 en Chile / The association between depression and telework during the COVID-19 pandemic in Chile

Introducción: a principios del 2020, el mundo experimentó una pandemia COVID-19 que repercutió en múltiples ámbitos de la vida, entre ellos la salud mental y el área laboral. En este periodo, se han observado grandes cambios sociales, específicamente en términos del teletrabajo. Paralelamente, se han objetivado mayores niveles de depresión y ansiedad en la población. Actualmente hay escasos estudios que exploran cómo ambas variables se relacionan en conjunto y, por ello, en el presente artículo se explorará el trabajo vía telemática y la presencia de sintomatología depresiva. Métodos: datos obtenidos de un estudio longitudinal que tomó una muestra aleatoria de 1383 personas entre 21 y 68 años. Se recopilaron datos demográficos, laborales y se evaluó la presencia de síntomas depresivos mediante el Patient Health Questionnaire (PHQ9). Resultados: un 45% de las personas que mantenían un empleo con teletrabajo presentaba algún grado de sintomatología depresiva en comparación con un 30,9% de las personas ocupadas sin teletrabajo. Discusión: interpretamos que inicialmente el teletrabajo se presentaba como una forma idónea de trabajo. No obstante, se comenzaron a evidenciar factores de riesgo conocidos para desarrollar sintomatología depresiva, tales como; el sedentarismo, tiempo frente a las pantallas, insomnio y aislamiento social. Frente a dicha realidad, los resultados del presente estudio son concordantes con lo descrito en la literatura, pero aún falta profundizar su impacto a largo plazo y las medidas protectoras que se podrían implementar.

Introduction: In the early 2020s, the world experienced the COVID-91 pandemic which echoed in multiple areas of life, including mental health and employment. During this time, a great number of social changes have appeared, specifically in terms of telecommuting. Concurrently, there has been more levels of depression and anxiety in the population. Nowadays, the literature about this topic is scarce, particularly about how these two variables interact and, because of this, this article will explore the relationship between telework and the presence of depressive symptomatology. Methods: Data from a longitudinal study involving a random sample of 1383 people between 21 and 68 years of age. Demographic and occupational data were collected and the presence of depressive symptoms was assessed using the Patient Health Questionnaire (PHQ9). Results: 45% of those employed with telework presented some degree of depressive symptoms compared to 30,9% of those employed without telework. Discussion: We can conclude that at the beginning teleworking was presented as an optimal way of working. However, as it was maintained over time, certain risk factors began to become evident, perpetuating and maintaining certain risk factors for developing depressive symptoms such as sedentary lifestyle, time in front of screens, insomnia, and isolation. Given this reality, the results of the present study are consistent with what has been described in the literature, but the long-term impact and the protective measures that should be implemented still need to be studied in more detail

Clinical and dermoscopic evaluation of melanocytic nevi changes during diode laser hair removal: A prospective study.

BACKGROUND: Laser hair removal (LHR) is a common practice with increasing use worldwide. Clinical and dermoscopic changes in melanocytic nevi after LHR have been reported but prospective studies are lacking. OBJECTIVE: To describe dermoscopic changes of melanocytic nevi at different time points after LHR. METHODS: Prospective study in a cohort of female patients undergoing diode LHR. Dermoscopic follow-up of at least three nevi on the legs that underwent hair removal. We included three nonexposed nevi on the arms as controls. Two blinded investigators analyzed dermoscopic images, according to variables selected based on the available literature. RESULTS: Thirty-four patients were included with a total of 148 nevi on the legs and 112 nevi on the arms (controls). 47.9% (71/148) of the nevi on the legs had evidence of dermoscopic changes at the sixth hair removal session, compared to 9.8% (11/112) on controls (p < 0.001). The most frequent change was "bleaching" (41.9%, 62/148). Also, we observed "irregular hyperpigmented areas," and "regression structures" in 5.4% (8/148) and 4.7% (7/148) of the cases at the sixth session, respectively. Neither of these structures were observed in the controls (p < 0.05). LIMITATIONS: Only females were included; we did not perform histopathological evaluation nor reflectance confocal microscopy of changing nevi. CONCLUSION: Melanocytic nevi frequently change after diode LHR. The changes cannot always distinguish between LHR induced and melanoma, so we advise avoiding nevi during laser therapies with melanin targets.

El impacto de la resiliencia en la esquizofrenia: una revisión sistemática cualitativa / The impact of resilience in Schizophrenia: a qualitative systematic review

Resumen Introducción: la resiliencia ha sido definida como la resistencia frente a experiencias psicosociales adversas. Tiene un rol importante en varios trastornos mentales, asociándose, por ejemplo, a la severidad en el trastorno depresivo mayor y a la calidad de vida en el trastorno afectivo bipolar. La esquizofrenia es un trastorno mental severo que destaca por producir dificultades en múltiples dominios de la vida y una alta morbimortalidad. El objetivo de esta revisión fue sintetizar la evidencia disponible acerca de la importancia de la resiliencia en la esquizofrenia. Métodos: se realizó una búsqueda en las bases de datos PubMed, LILACS y SciELO, seleccionando artículos en inglés y español, que incluyeran personas con esquizofrenia y midieran la resiliencia. Veinticinco artículos cumplieron los criterios de inclusión. Resultados: las personas con esquizofrenia tenían una menor resiliencia que sujetos sanos (9 estudios). El nivel de resiliencia se asoció inversamente con los síntomas negativos (3 estudios), síntomas positivos (1 estudio), depresión (4 estudios), desesperanza (3 estudios) y suicidio (1 estudio). Por otro lado, la resiliencia se asoció positivamente con la calidad de vida (5 estudios), funcionalidad (4 estudios) y salud física (2 estudios). En dos estudios se evaluaron intervenciones orientadas a potenciar la resiliencia de pacientes con esquizofrenia, mostrando resultados poco concluyentes. Discusión: es llamativa la escasa literatura que aborda el tema de la resiliencia en esquizofrenia. Los hallazgos de la presente revisión sitúan a la resiliencia como un factor determinante de la evolución y expresión clínica de esta enfermedad.

Introduction: resilience has been defined as the resistance to adverse psychosocial experiences. It has an important role in various mental disorders, being associated, for example, with the severity in major depressive disorder and the quality of life in bipolar affective disorder. Schizophrenia is a severe mental disorder that stands out for causing difficulties in multiple domains of life and high morbidity and mortality. The objective of this review was to synthesize the available evidence about the importance of resilience in schizophrenia. Methods: a search of the PubMed, LILACS and SciELO databases was performed, selecting articles in English and Spanish that included patients with schizophrenia and measured resilience. Twenty-five articles met the inclusion criteria. Results: patient with schizophrenia had less resilience than healthy subjects (9 studies). Resilience levels were inversely associated with negative symptoms (3 studies), positive symptoms (1 study), depression (4 studies), hopelessness (3 studies), and suicide (1 study). On the other hand, resilience was positively associated with quality of life (5 studies), functionality (4 studies) and physical health (2 studies). In two studies, interventions aimed at enhancing the resilience of patients with schizophrenia were evaluated, showing inconclusive results. Discussion: there is a striking limited literature that address the topic of resilience in schizophrenia. The findings of the present review place resilience as a determining factor in the evolution and clinical expression of this disease.

Dermoscopy of primary cutaneous B- and T-cell lymphomas and pseudolymphomas presenting as solitary nodules and tumors: a case-control study with histopathologic correlation.

BACKGROUND: Primary cutaneous lymphomas (PCLs) and pseudolymphomas presenting as single pink-red nodules/tumors are highly unspecific and include a wide differential diagnosis. OBJECTIVE: To describe the dermoscopic characteristics of PCL/pseudolymphoma. METHODS: In this retrospective, case-control study, we evaluated the dermoscopic features of patients with solitary PCL/pseudolymphoma tumors and compared them to a control group of non-lymphomatous, nonpigmented, solitary tumors (e.g., basal cell carcinoma, amelanotic melanoma, etc). RESULTS: We included 14 patients with PCL/pseudolymphomas and 35 controls. T-cell and B-cell lymphoma proportions were 28.6% (n = 4) and 71.4% (n = 10), respectively. Compared to controls, most lymphomas presented dermoscopically with orange color (71.4% vs. 14.2%, P < 0.001), follicular plugs (85% vs. 2.8%, P < 0.001), and as  organized lesions (85% vs. 31.4%, P = 0.001). Coexistence of orange color and follicular plugs had an odds ratio (OR) of 2.8 (P < 0.001), highly suggestive of PCL . The kappa index for independent observers was 0.66, 0.49, 0.43 for orange background, follicular plugs, and organized lesion, respectively. Histopathologic correlation was performed in six PCL cases and showed dense diffuse and perifollicular lymphocytic infiltrate in all cases and keratin plugs in five of six cases, possibly correlating with the orange color and the follicular plugs, respectively. CONCLUSION: Primary cutaneous lymphomas/pseudolymphomas present with characteristic dermoscopic findings irrespective of immunohistochemical subtype.

Trombosis de la vena central de la retina (TVCR) bilateral asociada a síndrome de hiperviscosidad en una Macroglobulinemia de Waldenström (MW) - a propósito de un caso / Bilateral central retinal vein thrombosis (TVCR) associated with hyperviscosity syndrome in a Waldenström Macroglobulinemia (MW) - a case report

Introducción: la Macroglobulinemia de Waldenström (MW) es un tipo raro de linfoma de células B caracterizado por la proliferación de células linfoplasmocíticas que secretan altas cantidades de inmunoglobulinas M (IgM) monoclonales. Puede presentarse con una amplia gama de síntomas, entre ellos los derivados del aumento de la viscosidad plasmática. Métodos: reportamos un caso de MW que presentó una trombosis de la vena central de la retina (TVCR) bilateral en el contexto de un síndrome de hiperviscosidad (SHV). El objetivo de este trabajo fue revisar algunos aspectos clínicos de la MW, con especial énfasis en el SHV y la TVCR. Resultados: las manifestaciones clínicas y de laboratorio de la MW son inespecíficas y comunes a otras neoplasias hematológicas. El SHV se produce cuando los niveles de IgM sobrepasan los 3 mg/dL, situación que ocurre en un 15-30 por ciento de los pacientes. La TVCR es una complicación grave y rara asociada al SHV, presentándose típicamente como una pérdida de agudeza visual indolora. El fondo de ojo exhibe signos característicos, como tortuosidad venosa y hemorragias retinales hasta la periferia, y la angiografía con fluorosceína y la OCT pueden orientar al diagnóstico y guiar el manejo. El tratamiento incluye la plasmaféresis y tratamientos oftalmológicos basados en agentes antioangiogénicos. Conclusión: la MW es una enfermedad incurable. Sin embargo, es importante sospechar una TVCR en pacientes que debutan con una pérdida de agudeza visual, ya que existen tratamientos efectivos en el manejo de esta complicación. (AU)

Introduction: Waldenstrom's Macroglobulinemia (WM) is a rare type of B-cell lymphoma characterized by proliferation of lymphoplasmocitarian cells that secrete high amounts of monoclonal immunoglobulin M (IgM). It may present with a wide range of symptoms, including the ones that derivatives of the increase in plasma viscosity. Methods: we report a case of WM that presented a bilateral central retinal vein occlusion (CRVO) in the context of a hyperviscosity syndrome (HVS). The objective of this study was to review clinical aspects of the WM, with special emphasis on the HVS and the CRVO. Results: the WM laboratory and clinical manifestations are common to other hematological malignancies. The HVS occurs when levels of IgM exceed 3 mg/dL, situation that occurs in 15-30 percent of patients. The CRVO is a serious and rare complication associated with the HVS, typically presented as a painless visual acuity loss. The fundoscopic examination exhibits characteristic signs, such as venous tortuousity and retinal hemorrhages in all four quadrants and most numerous in the periphery; angiography with fluoroscein and the OCT can orientate the diagnosis and guide the management. The treatment includes plasmapheresis and other ophthlamological treatments based on antiangiogenic agents. Conclusion: the WM is an incurable disease. However, it is important to suspect a CRVO in patients who made their debut with a loss of visual acuity, since there are effective treatments in the management of this complication.(AU)