[Translated article] Reticulate Skin Lesions: Practical Color-Based Algorithm for Initial Clinical Assessment

Reticular patterns are observed in a great variety of skin diseases. While these morphologic patterns are often highly distinctive, they are seldom discussed or studied in clinical contexts or recognized as a diagnostic category in their own right. Diseases presenting with reticulate skin lesions have multiple etiologies (tumors, infections, vascular disorders, inflammatory conditions, and metabolic or genetic alterations) and can range from relatively benign conditions to life-threatening ones. We review a selection of these diseases and propose a clinical diagnostic algorithm based on predominant coloring and clinical features to aid in their initial assessment.

Reticulate Skin Lesions: Practical Color-Based Algorithm for Initial Clinical Assessment

Reticular patterns are observed in a great variety of skin diseases. While these morphologic patterns are often highly distinctive, they are seldom discussed or studied in clinical contexts or recognized as a diagnostic category in their own right. Diseases presenting with reticulate skin lesions have multiple etiologies (tumors, infections, vascular disorders, inflammatory conditions, and metabolic or genetic alterations) and can range from relatively benign conditions to life-threatening ones. We review a selection of these diseases and propose a clinical diagnostic algorithm based on predominant coloring and clinical features to aid in their initial assessment.

Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care

Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment of basic specifiers such as ICD-Diagnosis, therapeutic suggestions, and diagnostic suggestions, among others. This article aims to evaluate the teledermatology system of the Chilean public health service by analyzing 243 randomly extracted consultations, representative of the 20,716 electronic consultations performed during 2020. Compliance with basic specifiers is evaluated. From these, fulfillment of core teledermatology functions, such as diagnostic and therapeutic suggestions, is observed in most consultations. There are statistically significant relationships between the patient's destination (primary health center [PHC] or face-to-face referral), pharmacological prescription, coverage of the drug prescribed by the public system, and the education received by the consulting physician. If the consultation is resolved in the PHC, there is a higher chance for pharmacological prescription, prescribing mostly drugs that are covered by the government. This is less likely to occur when patients are referred for face-to-face evaluation. A targeted evaluation of education, pharmacological prescriptions, and their applicability is key to improving the quality of teledermatology systems.

Specific gel-cream as adjuvant to oral isotretinoin improved hydration and prevented TEWL increase--a double-blind, randomized, placebo-controlled study

BACKGROUND

Hydrating and emollient products are often recommended to patients under isotretinoin therapy to control the most frequent mucocutaneous side effects and to improve adherence to treatment.

AIMS

To assess, using noninvasive biophysical tests, the clinical and instrumental effectiveness of a hydrating gel-cream compared with placebo as an adjuvant to isotretinoin for treatment of facial skin in patients with inflammatory acne.

METHODS

Prospective, double-blind, randomized study, using MULTI SKIN MC750, on the adjuvant effect of a hydrating gel-cream for acne (active product) vs. a gel-cream without active substances (placebo). Follow-up lasted 3 months.

RESULTS

Sixty-six patients were included. Thirty-four were administered the active product, and 32 placebo. Though the number of lesions fell significantly in both groups, the mean number of papules on day 30 was significantly lower in the active product group. The active product group showed a significant increase in hydration, while the placebo group showed a significant increase in transepidermal water loss (TEWL). Seborrhoea decreased significantly in both groups; there were no differences between them.

CONCLUSIONS

Compared with placebo, the specific gel-cream with active products as an adjuvant to oral isotretinoin improved hydration, prevented TEWL increase, and reduced inflammatory acne lesions after 30 days.

Ozone and UV Radiation over Southern South America: Climatology and Anomalies

Ozone and UV radiation were analyzed at eight stations from tropical to sub-Antarctic regions in South America. Ground UV irradiances were measured by multichannel radiometers as part of the Inter American Institute for Global Change Radiation network. The irradiance channels used for this study were centered at 305 nm (for UV-B measurements) and 340 nm (for UV-A measurements). Results were presented as daily maximum irradiances, as monthly averaged, daily integrated irradiances and as the ratio of 305 nm to 340 nm. These findings are the first to be based on a long time series of semispectral data from the southern region of South America. As expected, the UV-B channel and total column ozone varied with latitude. The pattern of the UV-A channel was more complex because of local atmospheric conditions. Total column ozone levels of < 220 Dobson Units were observed at all sites. Analysis of autocorrelations showed a larger persistence of total column ozone level than irradiance. A decreasing cross-correlation coefficient between 305 and 340 nm and an increasing cross-correlation coefficient between 305 nm and ozone were observed at higher latitudes, indicating that factors such as cloud cover tend to dominate at northern sites and that ozone levels tend to dominate at southern sites. These results highlight the value of long-term monitoring of radiation with multichannel radiometers to determine climatological data and evaluate the combination of factors affecting ground UV radiation.

An increased intraovarian synthesis of nerve growth factor and its low affinity receptor is a principal component of steroid-induced polycystic ovary in the rat

A form of polycystic ovary (PCO) resembling some aspects of the human PCO syndrome can be induced in rats by a single injection of estradiol valerate (EV). An increase in sympathetic outflow to the ovary precedes, by several weeks, the appearance of cysts, suggesting the involvement of a neurogenic component in the pathology of this ovarian dysfunction. The present study was carried out to test the hypotheses that this change in sympathetic tone is related to an augmented production of ovarian nerve growth factor (NGF), and that this abnormally elevated production of NGF contributes to the formation of ovarian cysts induced by EV. Injection of the steroid resulted in increased intraovarian synthesis of NGF and its low affinity receptor, p75 NGFR. The increase was maximal 30 days after EV, coinciding with the elevation in sympathetic tone to the ovary and preceding the appearance of follicular cysts. Intraovarian injections of the retrograde tracer fluorogold combined with in situ hybridization to detect tyrosine hydroxylase (TH) messenger RNA-containing neurons in the celiac ganglion revealed that these changes in NGF/p75 NGFR synthesis are accompanied by selective activation of noradrenergic neurons projecting to the ovary. The levels of RBT2 messenger RNA, which encodes a beta-tubulin presumably involved in slow axonal transport, were markedly elevated, indicating that EV-induced formation of ovarian cysts is preceded by functional activation ofceliac ganglion neurons, including those innervating the ovary. Intraovarian administration of a neutralizing antiserum to NGF in conjunction with an antisense oligodeoxynucleotide to p75 NGFR, via Alzet osmotic minipumps, restored estrous cyclicity and ovulatory capacity in a majority of EV-treated rats. These functional changes were accompanied by restoration of the number of antral follicles per ovary that had been depleted by EV and a significant reduction in the number of both precystic follicles and follicular cysts. The results indicate that the hyperactivation of ovarian sympathetic nerves seen in EV-induced PCO is related to an overproduction of NGF and its low affinity receptor in the gland. They also suggest that activation of this neurotrophic-neurogenic regulatory loop is a component of the pathological process by which EV induces cyst formation and anovulation in rodents. The possibility exists that a similar alteration in neurotrophic input to the ovary contributes to the etiology and/or maintenance of the PCO syndrome in humans.

Bioethics in Ibero-America and the Caribbean

Bioethics has become a field of new challenges for Ibero-America and the Caribbean. A seeming uniformity in the region hides a rich heterogeneous society. A brief survey of bioethical developments in different Ibero-American countries is provided as well as the bioethical problems and approaches peculiar to the region. Some of the unique features of bioethics in this region, it is suggested, could infuse new life into the U.S. and European bioethics discussion. Finally, a bibliography of Ibero-American bioethics literature is provided for North American and European readers.

Variations in UV radiation in Chile

The first observations of UV global radiation in Chile with a portable multichannel radiometer are reported. Four UV wavelengths are included: 305, 320, 340 and 380 nm. Observation latitudes spanning from 18 degrees to 53 degrees S allow an estimation of latitudinal variations in daily maxima for both summer and winter. Measurements over Santiago deviate from a smooth latitudinal profile, probably as a consequence of urban air pollution. The main effect of this is to prevent UV solar radiation from reaching the ground, especially during winter. Altitudinal increments in UV radiation are estimated by comparing observations along the coast and valleys with others on the Andes and one isolated summit. Diurnal variations in the height increment support an increase from morning to evening. The results indicate that in rural areas the altitudinal increment is lower (4%-10% per kilometre) than that reported for Europe, reaching very low magnitudes (2% or less) in the Andean summits of desert regions.