RESUMO
BACKGROUND: There are few studies of teledermatology focused on the pediatric age group. The aim of this study was to assess the validity and reliability of store-and-forward teledermatology (STD) as a diagnostic tool for pediatricians and to reduce face-to-face consultations. MATERIAL AND METHODS: A retrospective, observational study of 383 children and adolescents under 15 years of age, referred from primary care to Dermatology Department of University Hospital of La Coruña, Spain, between 2011 and 2013, using a STD consult system. RESULTS: Diagnoses concordance between pediatricians and teledermatologists was 39.2% of cases and partial concordance 16.7%. Agreement for global diagnosis was κ = 0.78 (p = 0.000) and for specific diagnosis was κ = 0.73 (p = 0.000). Management was concordant in 28.7% and partially concordant in 15.4%. Lower reliability was statistically associated with modification of the lesions by inappropriate treatments, incomplete clinical data or bad-quality photographic images included in the referral consultation, diagnosis of infectious diseases and rare dermatoses. The filtering percentage (as the percentage of avoided clinic-based evaluations) was 64.5%. The mean response time of the consultant dermatologists was 3.62 days. Referrals for live consultations due to poor clinical information or insufficient quality of pictures were necessary in only 10% of the cases. CONCLUSION: The degree of diagnostic accuracy for the pediatric population using STD as a diagnostic tool was similar to that achieved in adults. Its usefulness for filtering dermatologic referral was also demonstrated in the study, so it could be suitable for integration into the routine practice of pediatricians.
Assuntos
Dermatologia/métodos , Encaminhamento e Consulta , Consulta Remota/métodos , Dermatopatias/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Estudos RetrospectivosAssuntos
Erupções Acneiformes/induzido quimicamente , Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Pele/patologia , Erupções Acneiformes/diagnóstico , Idoso , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Antineoplásicos/uso terapêutico , Biópsia , Cetuximab , Neoplasias Colorretais/tratamento farmacológico , Diagnóstico Diferencial , Toxidermias/diagnóstico , Receptores ErbB/antagonistas & inibidores , Humanos , MasculinoRESUMO
El empleo del láser en urología ha presentado un avance significativo y en la actualidad es empleado en una gran variedad de patologías. El desarrollo de los diferentes tipos de láser, el empleo de diferentes tipos de longitudes de onda, los sistemas de fibra óptica, la precisión y la reducción del coste han hecho mejorar la tecnología del láser, y extender y potenciar sus indicaciones. Los diversos tipos de láser de los que disponemos en la actualidad, suponen una excelente alternativa terapéutica en el tratamiento de diversas patologías benignas, pre-malignas y malignas localizadas en los genitales, con excelentes resultados estéticos y funcionales, y con una reducida morbilidad. El objetivo de esta trabajo es proporcionar las indicaciones clínicas más importantes y aplicaciones con el láser más novedosas en las lesiones genitales (AU)
The use of laser applications in urology has undergone significant advances and is now used in a wide variety of procedures. Improvements in types of lasers, the wavelength of energy used, optical fiber delivery systems, precision of laser applications and cost reduction have served to further improve laser technology and extend the potential applications. The different types of lasers available at the present time appear to be an alternative treatment modality with excellent cosmetic and functional results and low morbidity in the treatment of benign, pre-malignant and malignant lesions in the genital area. The objective of this article is to provide an update on the most important clinical and experimental advancements therapeutic applications of lasers in genital lesions (AU)
Assuntos
Humanos , Masculino , Terapia a Laser/métodos , Lasers/uso terapêutico , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/cirurgia , Balanite (Inflamação)/diagnóstico , Balanite (Inflamação)/cirurgia , Imunoterapia , Ceratose/cirurgia , Genitália Masculina/lesões , Genitália Masculina/patologia , Genitália Masculina , Condiloma Acuminado/terapia , Papulose Linfomatoide/cirurgia , Carcinoma de Células Escamosas/cirurgia , Eritroplasia/cirurgia , Osteíte Deformante/cirurgia , Angioceratoma/patologia , Angioceratoma/cirurgiaRESUMO
The use of laser applications in urology has undergone significant advances and is now used in a wide variety of procedures. Improvements in types of lasers, the wavelength of energy used, optical fiber delivery systems, precision of laser applications and cost reduction have served to further improve laser technology and extend the potential applications. The different types of lasers available at the present time appear to be an alternative treatment modality with excellent cosmetic and functional results and low morbidity in the treatment of benign, pre-malignant and malignant lesions in the genital area. The objective of this article is to provide an update on the most important clinical and experimental advancements therapeutic applications of lasers in genital lesions.
Assuntos
Doenças dos Genitais Masculinos/cirurgia , Terapia a Laser , Humanos , MasculinoAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Bandagens/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Fitoterapia/efeitos adversos , Preparações de Plantas/efeitos adversos , Rosmarinus/efeitos adversos , Thymus (Planta)/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Testes do EmplastroAssuntos
Grupo Borrelia Burgdorferi , Eritema Migrans Crônico , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Grupo Borrelia Burgdorferi/genética , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Eritema Migrans Crônico/diagnóstico , Eritema Migrans Crônico/tratamento farmacológico , Eritema Migrans Crônico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Espanha/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
La presentación clínica de un pénfigo vulgar con lesiones cutáneas localizadas y sin afectación de mucosas es poco frecuente. Presentamos el caso de un varón de 37 años que consultaba por una placa en la espalda, inflamatoria y con pústulas en superficie. El estudio histopatológico demostró una espongiosis eosinofílica y la inmunofluorescencia directa depósitos de IgG entre los queratinocitos epidérmicos. El tratamiento con sulfona hizo desaparecer las lesiones en tres semanas y tras varios años de seguimiento no ha habido recidiva de las mismas. La espongiosis eosinofílica es un hallazgo histológico que puede encontrarse con cierta frecuencia en los pénfigos en estadios iniciales, pero además es un marcador de una presentación clínica e histológica peculiar de pénfigo vulgar (AU)
