[Avances recientes en dermatología comunitaria 2016-2017. Teledermatología, un modelo de enseñanza y asistencia en atención primaria a la salud].

INTRODUCTION: Community dermatology (CD) is integrated by dermatologists, epidemiologists and interested people. It has 27 years of experience at the Guerrero State. Due to unsafety issues, the teaching and medical attention model had to be changed from presential to virtual trough telemedicine. METHOD: Transversal, descriptive, observational and analytic study, in which results from teaching-learning of the health personal that was capacitated throughout the telemedicine network at the Guerrero State were evaluated, during nine courses that reached 35 telemedicine centers. RESULTS: 2465 health workers were capacitated in basic dermatology, which were evaluated in their general knowledge of dermatology before and after every course. The utility of this modality of teaching was statistically evaluated with a random simple in 611 attendees with satisfactory results. DISCUSSION: Teaching through telemedicine network, represents an improvement for CD by reaching a higher number of attendees to several reception centers simultaneously, minimizing transportation expenses and improving the safety of the participants at the activities, with the advantage of allowing continuity of the CD purposes.

INTRODUCCIÓN: La dermatología comunitaria (DC) está integrada por dermatólogos, epidemiólogos y personal afín. Tiene 27 años de existencia en el Estado de Guerrero. Por condiciones de inseguridad se cambió el modelo presencial de enseñanza y atención dermatológica a la forma virtual, a través de teledermatología. OBJETIVO: Determinar la utilidad de la capacitación y enseñanza virtual a través de la telemedicina en DC. MÉTODO: Estudio transversal, descriptivo, observacional y analítico, en el que se evaluaron los resultados de la enseñanza-aprendizaje en el personal de salud capacitado por la red de telemedicina mediante nueve cursos que llegaron a 35 centros de telemedicina en el Estado de Guerrero. RESULTADOS: Se capacitó en dermatología básica a 2465 trabajadores de la salud, evaluando sus conocimientos antes y después de cada curso. Se validó estadísticamente la utilidad de esta modalidad de enseñanza con una muestra al azar de 611 asistentes, con resultados satisfactorios. DISCUSIÓN: La enseñanza a través de la red de telemedicina representa un avance en DC al llegar a un mayor número de asistentes en varios centros de recepción en forma simultánea, minimizando los gastos de transporte y salvaguardando la integridad de los participantes, con la ventaja de dar continuidad a los propósitos de DC.

Cervical and middle dorsal actinomycetomas from Guerrero State, Mexico.

BACKGROUND: Mycetomas are frequent subcutaneous mycoses with typical clinical characteristics such as sinuses, blood-stained, serous, or purulent exudates as well as local swelling. Even though the most commonly affected areas are the lower limbs, we report four cases affecting the neck and midback regions, of which three were young females. We draw attention to the importance of early identification of these cases for prevention and specific treatment in order to avoid severe consequences or irreversible complications such as quadriplegia. OBJECTIVE: To document the occurrence of cervical spine and middle dorsal thoracic mycetomas, as well as their severity, clinical manifestations, and secondary complications. MATERIAL AND METHODS: This was an observational and descriptive study in which we reviewed cases with neck and middle dorsal thoracic mycetomas diagnosed at the Acapulco General Hospital of Guerrero State, Mexico. We describe the cases including the mechanism of inoculation, neurological symptoms, and severity. CONCLUSIONS: We describe three cases initially diagnosed clinically as cervical mycetomas and one in the middle dorsal thoracic region. All the cases were diagnosed at the Acapulco General Hospital of Guerrero State in Mexico.

Eumycotic mycetoma caused by Madurella mycetomatis successfully treated with antifungals, surgery, and topical negative pressure therapy.

We report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. The lesion had been treated surgically at another hospital, but recurred 2 years later. Black, charcoal-like grains were observed draining through the fistulas. A biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. Culture demonstrated small white colonies of Madurella mycetomatis. The patient was treated with itraconazole for 6 months, followed by surgery. TNP was initiated in the immediate post-operative period, and copious granulation tissue was observed within 1 week. Autologous skin grafting was performed, and itraconazole was continued for an additional 3 months. Although necrosis of the graft ensued, the functional result was acceptable. The patient appeared free of disease at 18 months of follow-up. Eumycotic mycetoma is an infectious and inflammatory process that occurs after traumatic inoculation of fungi through the skin. Surgery is the treatment of choice, but successful reconstruction may be challenging and recurrence is common. Topical negative pressure (TNP) promotes the formation of granulation tissue, which facilitates closure of deep wounds and chronic ulcers. This case illustrates that eumycotic mycetoma is difficult to treat. Whether TNP contributed to the successful outcome cannot be proven but, given the generally poor response of eumycetoma to therapy, we suggest that the role of TNP in the management of this disease merits attention.