Os problemas dermatológicos afetam aproximadamente um terço da população em algum momento da sua vida e, em aproximadamente 10 a 15% de todas as consultas médicas, a queixa principal deve-se a um problema dermatológico. A despeito desta importância, diversos estudos têm demonstrado deficiências no ensino de dermatologia nos cursos de graduação em medicina. Os sistemas de educação a distância baseados na internet representam uma das alternativas para corrigir esta deficiência e oferecer um maior contato do estudante de medicina com a especialidade. Considerando este cenário, o objetivo deste estudo foi desenvolver um programa de educação a distância em dermatologia para estudantes de graduação em medicina e avaliar o impacto deste mecanismo de ensino no aprendizado dos alunos. Foi realizado um estudo prospectivo incluindo estudantes do segundo ano da Faculdade de Medicina da Universidade de Tecnologia e Ciências de Salvador Bahia Brasil. Os 44 alunos selecionados foram divididos em dois grupos; o grupo que participou de atividades presenciais apenas e o grupo que participou das atividades presenciais associado ao curso de educação a distância (curso híbrido). Todos os alunos foram submetidos a uma avaliação pré e pós curso e o desempenho foi comparado entre os dois grupos. Os estudantes que participaram do curso híbrido apresentaram escores pós-teste superiores (8,9 ± 0,8) aos obtidos pelos alunos que participaram apenas das aulas presenciais (7,75 ± 0,98). Esta diferença foi estatisticamente significante (p <0,05). Os resultados indicaram que o desempenho dos alunos de graduação , do curso de educação a distância em dermatologia associado a atividades presenciais, foi superior ao curso presencial apenas / Dermatological disorders affects approximately one third of the general population. It is estimated that 10 to 15% of all office visits are for dermatologic complaints. Despite this fact, in medical school, the available time for teaching dermatology is usually very limited. The internet based distance education represents a viable alternative to provide greater contact with medical student with this specialty and meet the current deficiencies. Given this scenario, the objective of this study was to develop a program of internet based distance education in dermatology to undergraduate medical students and evaluate the impact of this tool on student learning. This prospective study included student form the second year of School of Medicine at the University of Technology and Science of Salvador Bahia Brazil. The 44 selected students were divided into two groups: the group that participated in classroom activities and the group that participated in classroom activities associated with distance education course (blended course). Tests were applied for all students before and after the course and both scores were evaluated. Students who participated of online discussions associated with face-to face activities had statistically higher post-test scores (8.9±0.8) than those who participated of the classroom activities alone (7.75±0.98). This difference was statistically significant (p <0.05). The results indicated superior performance of undergraduate students who participated in the course of distance education in dermatology associated with classroom activities (blended course) compared to classroom activities alone

Malignant melanoma arises from the pigment producing melanocytes in epidermis and is the most aggressive type of skin cancer. The incidence of malignant melanoma is increasing faster than any other type of cancer in white population worldwide, with a doubling rate every 10-20 years. So far, the only identified external risk factor for malignant melanoma is UV exposure. Elimination of photodamaged cells by apoptosis (programmed cell death) is essential to prevent tumor formation. Melanocytes are considered relatively resistant to apoptosis, however, the regulation of apoptosis in melanocytes is still unknown. The aim of this thesis was to investigate the apoptotic process following ultraviolet (UV) irradiation in primary cultures of human melanocytes. Focus was on regulation of mitochondrial stability by Bcl-2 family proteins and the possible participation of lysosomal proteases, cathepsins. UV irradiation activated the mitochondrial pathway of apoptosis, leading to cytochrome c release, caspase activation, and nuclear fragmentation. No change in protein expression of Bax and Bcl-2 was observed in response to UV. Instead, translocation of the Bcl-2 family proteins from cytosol to mitochondia was important in the regulation of survival and death of melanocytes. The findings further demonstrated permeabilization of the lysosomal membrane to occur early in the apoptotic process, resulting in cathepsin release into the cytosol. The cathepsins were potent pro-apoptotic mediators and triggered apoptosis upstream of Bax translocation and mitochondrial membrane permeabilization. In response to both heat and UV irradiation, there was a marked increase in expression of stress-induced heat shock protein 70 (Hsp70), which inhibited apoptosis by binding lysosomal and mitochondrial membranes and counteracting the release of cathepsins and cytochrome c. Furthermore, UV irradiation activated c-jun N-terminal kinase (JNK), which triggered apoptosis upstream of cathepsins release from the lysosomes. In addition, JNK mediated apoptosis through phosphorylation of pro-apoptotic Bim, which was released from anti-apoptotic Mcl-1, by UV induced Mcl-1 depletion. This thesis illustrates that permeabilization of mitochondria and lysosomes and release of their constituents to the cytosol participates in UV induced apoptosis signaling in human melanocytes in vitro. The process is regulated by a complex network of pro- and anti-apoptotic proteins, exerting their effects through intracellular translocation and alteration of protein expression.

Polymorphic light eruption (PLE) is the most common photodermatosis, affecting ~17% of the population. PLE is a delayed-type hypersensitivity response to an antigen induced by solar ultra-violet radiation (UVR). Its effects vary between patients, but the main symptom is a non-scarring, red papular rash in areas exposed to UVR. An effective therapy is low dose ultra-violet B (NBUVB) phototherapy. It is thought that NBUVB phototherapy desensitises the skin to further UVR exposure, but the mechanism by which this happens is unknown. Current immune based studies have been unable to clarify a mechanism as to how PLE arises. However, research in other skin diseases, such as psoriasis and atopic dermatitis, has shown that the barrier function of the skin is compromised by these disorders. Furthermore, research in lesional PLE skin showed an increase in barrier permeability of the skin. Recent research has specifically linked claudin proteins of tight junctions to the barrier dysfunction. Therefore, this study used quantitative immunofluorescent staining to measure tight junction (TJ) proteins and other barrier proteins of interest. Barrier function was also measured by transepidermal water loss (TEWL); a tracer dye penetration assay was used to measure TJ barrier function specifically. All measurements were made in non-lesional PLE skin, as compared to skin from healthy human volunteers. In photoprotected PLE skin the TJ protein claudin-1 was significantly reduced compared to healthy skin. The use of a tracer dye highlighted there was a reduction in TJ barrier function in PLE skin compared to healthy individuals. PLE and healthy skin were then exposed to ultra-violet B (UVB) and 24h later TJ proteins and TJ barrier function were measured. There was no change to claudin-1 after UVB exposure in PLE skin, but claudin-7 was reduced and claudin-12 increased. In contrast, in UVB-irradiated skin in normal controls after UVB exposure claudin-7 and claudin-12 were both increased, whilst claudin-1 was reduced. In PLE patients there was no further change to TJ barrier function, however, in normal controls, skin TJ barrier function was reduced post UVB. Both in healthy and PLE skin TEWL was unchanged before and after UVB exposure. Lastly TJ proteins were investigated after NBUVB in PLE patients. There was a further reduction in claudin-1 in PLE patients as well as a reduction in the TJ protein occludin, however the stratum corneum was significantly thickened. It could be suggested that this is a compensatory measure for the reduction seen in TJ barrier proteins, however further studies are needed to understand this. These data show significant differences in the TJ skin barrier in patients with PLE as compared to healthy human volunteers before and after UVB exposure. Furthermore, in PLE skin there is a significant change to the epidermis after NBUVB phototherapy. These data demonstrate that TJ protein expression and function is altered in PLE skin and may contribute to aetiology of the disorder, however the role of TJ barrier in aetiology is yet to be firmly established.

No description available.

The aim of this thesis is to analyze the prevalence of the phenomenon of non-compliance patiens with a diagnosis of atopic dermatitis using the questionnaire survey in two selected dermatology clinics in Prague. The result obtained were tested using standard statistics methods. The results suggest the non-compliance depends mainly on attitude of physisians.

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-08-01T11:51:08Z No. of bitstreams: 1 Dissertação Galileu Bonifácio.pdf: 1876947 bytes, checksum: 040bde4c33a32b1025e2822176ae0797 (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-08-01T11:52:29Z (GMT) No. of bitstreams: 1 Dissertação Galileu Bonifácio.pdf: 1876947 bytes, checksum: 040bde4c33a32b1025e2822176ae0797 (MD5) / Approved for entry into archive by Kely Alves (kely.alves@unifenas.br) on 2018-08-01T11:53:21Z (GMT) No. of bitstreams: 1 Dissertação Galileu Bonifácio.pdf: 1876947 bytes, checksum: 040bde4c33a32b1025e2822176ae0797 (MD5) / Made available in DSpace on 2018-08-01T11:53:40Z (GMT). No. of bitstreams: 1 Dissertação Galileu Bonifácio.pdf: 1876947 bytes, checksum: 040bde4c33a32b1025e2822176ae0797 (MD5) Previous issue date: 2017-12-16 / Introduction: Diagnostic calibration can be defined as the relationship between diagnostic accuracy and the confidence in that accuracy. Reflective practice seems to be an interesting strategy to improve diagnostic calibration by improving performance insights and has been proposed to foster clinical reasoning by improving diagnostic accuracy. However, its effect on diagnostic calibration has yet to be assessed. Aim: This study seeks to evaluate the impact of structured reflection on diagnostic calibration, diagnostic accuracy, and the confidence in that accuracy while solving dermatology case vignettes. Methods: This study recruited sixth year medical students from Universidad José do Rosário Vellano, who were systematically allocated into one of two groups: reflection group (RG) or control group (CG). Students from both groups were presented the same 12 dermatology cases and were initially asked to point out the probable diagnosis and their confidence in that diagnosis. The students allocated to the RG were then told to reflect on the case using a structured tool. Those allocated to the CG engaged in a time-filler activity before providing their final diagnosis for each case and their final confidence in that diagnosis. Both groups were compared as to their diagnostic accuracy, confidence, and diagnostic calibration overall as well as stratified by dermatological syndrome and case difficulty. Results: Sixty-one students were included (33 in the RG and 28 in the CG). Age and self-assessed perception of knowledge/previous experience were similar in both groups. Gender was significantly different among the groups. Students from the RG showed a better diagnostic accuracy for both melanocytic and non-melanocytic lesions (p=0.025 and p=0.022, respectively). Regarding diagnostic calibration, both RG and CG showed better calibration for melanocytic lesions than for non-melanocytic lesions. Calibration for non-melanocytic lesions was more distant from zero, in a positive direction (i.e. greater overconfidence). It was observed that calibration was worse among more difficult cases, with students showing greater overconfidence when solving such cases. Reflection did not impact significantly on confidence nor on calibration (p=0.228 and p=0.197, respectively). It is worth noting that a significant difference was observed in the calibration in both groups when solving easier cases; students from the RG had a greater diagnostic accuracy, but their confidence did not differ from those in the CG, resulting in an opposite direction of calibration (i.e. among students in the RG, diagnostic accuracy was slightly greater than their confidence). Conclusion: Reflective practice increased the overall diagnostic accuracy, but it did not significantly change overall confidence and calibration. Calibration was worse when solving more difficult cases, and reflection was not enough to improve it. / Introdução: A calibragem diagnóstica pode ser definida como a relação entre acurácia e confiança do profissional em relação a esta acurácia. A prática reflexiva é uma potencial estratégia para melhorar a calibragem diagnóstica, pois pode aumentar o insight sobre a performance. O uso da reflexão estruturada para melhoria da calibragem diagnóstica ainda não foi avaliado. Objetivo: Avaliar o impacto da reflexão estruturada na calibragem diagnóstica, acurácia e confiança na resolução de casos dermatológicos. Métodos: estudo realizado entre alunos do 6º ano do curso de medicina da universidade José do Rosário Vellano (UNIFENAS-BH). Os alunos foram divididos em dois grupos (grupo reflexão (GR) e grupo controle (GC)). Os dois grupos avaliaram as mesmas 12 lesões dermatológicas, apontando diagnóstico inicial mais provável e a confiança diagnóstica. Em seguida, os alunos foram orientados a refletirem de maneira estruturada sobre o diagnóstico (GR) ou engajarem em atividade distratora (GC) e então fornecerem o diagnóstico final e o grau de confiança. Foram comparadas acurácia diagnóstica, confiança e calibragem diagnóstica globalmente, por síndrome dermatológica e por grau de dificuldade. Resultados: Foram incluídos 61 alunos, alocados 33 para GR e 28 para GC. Houve predominância de mulheres no GR, mas não houve diferença significativa de idade ou de auto-percepção do conhecimento/experiência prévios entre os grupos. Observou-se uma maior acurácia diagnóstica dos alunos do GR em relação ao GC tanto para síndromes melanocíticas (p=0,025) quanto para não-melanocíticas (p=0,022). Em relação à calibragem diagnóstica, tanto o GC (p=0,017) quanto o GR (p=0,001) apresentaram melhor calibragem para síndromes melanocíticas, sendo que para síndromes não-melanociticas o aluno apresenta maior excesso de confiança. A calibragem foi pior para os casos difíceis com os alunos apresentando excesso de confiança em relação ao seu real desempenho. A reflexão não impactou de maneira significativa em relação à confiança e calibragem de maneira global. Nos casos fáceis, houve diferença de calibragem entre GR e GC, observando-se no GR maior acurácia diagnóstica, mas com confiança semelhante à observada do GC, ocorrendo inversão do sinal da calibragem com os alunos tendo um desempenho levemente superior à sua confiança. Conclusão: A atividade reflexiva aumentou a acurácia diagnóstica de maneira global para as lesões dermatológicas testadas, mas não alterou globalmente a confiança e calibragem diagnóstica. A calibragem piorou nos casos mais difíceis e a reflexão não foi capaz de melhorar esta situação.

Made available in DSpace on 2016-07-18T17:54:14Z (GMT). No. of bitstreams: 1 DEUSITA_DISSERTACAO_20_06_2011.pdf: 12528804 bytes, checksum: a875980e4f2e37beb9f92e8ce1102385 (MD5) Previous issue date: 2011-04-28 / This research involves the investigation of Supervised Internship Course in the Dermatology Department in the Course of Medicine UNOESTE. There is need to develop medical training, so that the theory underlying the practice and this, in turn, question the theory in a dialectical movement to drive pedagogical changes. The search for competent medical professionals surrounds this issue, because the practice of medicine includes knowledge, skills, human relations and culture, therefore, what pedagogical strategies could meet this challenge? This research sought to contribute to theme a few scientific studies, the Supervised Practices in the Dermatology Department at the medical school. Aimed to identify and describe situations, experiences and expectations of students, and the intervening factors, assess the pedagogical aspects of the course and the development plan of Training in Dermatology. The methodology chosen was qualitative, structured on a case study, employing observation, interviews and testimonials from students of the 9th and 10th term of the Course of Medicine, Discipline of Dermatology. Reached the following conclusions: the stage in Dermatology focuses on the technical approach, the observation of cases, the curriculum has little involvement of students in theoretical and practical construction, with a fragile living space for a cultural and civic education. / Esta pesquisa compreende a investigação do Estagio Curricular Supervisionado na disciplina de Dermatologia no Curso de Medicina da UNOESTE. Há necessidade de que se desenvolva a formação do médico, de maneira que a teoria pedagógica embase a prática e esta, por sua vez, questione essa teoria, num movimento dialético, para impulsionar transformações pedagógicas. A busca de profissionais médicos competentes envolve essa questão, pois o exercício da medicina compreende conhecimentos, habilidades, relacionamento humano e cultura. Esta pesquisa procurou contribuir para um tema pouco trabalhado cientificamente, o Estágio Curricular Supervisionado na disciplina de Dermatologia no Curso de Medicina. Teve como objetivos identificar e descrever situações, experiências e expectativas dos alunos e, os fatores intervenientes, avaliar aspectos do plano de ensino de Dermatologia. A metodologia eleita foi a de natureza qualitativa, estruturada a partir de um estudo de caso, com emprego de observações, entrevistas e depoimentos dos alunos do 9º e 10º termo do Curso de Medicina, disciplina de Dermatologia. Chegou-se às seguintes conclusões: o Estágio em Dermatologia acontece na observação de casos; o currículo apresenta pouca participação dos alunos, tanto na construção teórica como na prática, com uma frágil vivência cultural e espaço para uma formação cidadã.

Orientador: Juliano Vilaverde Schmitt / Resumo: Fundamentos: As unhas são anexos cutâneos queratinizados tendo um ritmo de crescimento de até 3 mm/mês nos quirodáctilos. Biotina é vitamina hidrossolúvel de fonte exógena, que provou aumentar a espessura da lâmina ungueal, sob regime de 2,5mg oral por 6-15 meses. O minoxidil tópico 5% 2x/dia, que tem ação comprovada no folículo piloso, foi pouco estudado na velocidade do crescimento ungueal. Não há estudos comparativos com biotina oral, ou de sua associação ao minoxidil tópico. Este estudo objetiva avaliar a eficácia do minoxidil tópico e biotina oral no aumento da velocidade de crescimento das unhas das mãos. Casuística e métodos: Ensaio clínico quasi-experimental com desenho fatorial, aberto e paralelo, envolvendo 37 voluntários adultos saudáveis, alocados em 4 grupos: controle, minoxidil 5% tópico 2x ao dia exclusivo, biotina 2,5mg oral exclusiva e uso combinado, que foram comparados quanto à velocidade do crescimento ungueal do 2o e 4o quirodáctilos, quanto ao status basal, após 14 e 28 dias de tratamento. Todos os indivíduos foram observados, sem intervenções, 14 dias após a inclusão, iniciando o tratamento após esse período, com duração de 28 dias, e reavaliações em 28 e 42 dias após a inclusão no estudo. A idade, sexo, dominância da mão, onicofagia dos pacientes foram levados em conta para comparação da velocidade de crescimento ungueal nos períodos de tratamento e no período sem intervenção, durante todo o estudo. Pré-tratamento, evidenciou-se crescimento basal mais ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: The nails are keratinized cutaneous attachments, their growth rate reaches up to 3 mm / month in the chirodactyls. Biotin is a water-soluble vitamin from an exogenous source that has been shown to increase the thickness of the nail plate under oral 2.5mg regimen for 6-15 months. Similarly to topical minoxidil 5% 2x / day, with proven action on the hair follicle, which has been poorly studied at the rate of nail growth. There are no comparative studies with oral biotin, or its association with other treatments. This study aims to evaluate the efficacy of topical minoxidil and oral biotin in increasing the growth velocity of fingernails. Methods: Quasi-experimental, factorial, open and parallel clinical trial involving 37 healthy adult volunteers, allocated into 4 groups: control, minoxidil 5% topical 2x daily exclusive, oral 2.5mg exclusive oral and combined use, which were compared for nail growth velocity of the 2nd and 4th chirodactyls, as to basal status, after 14 and 28 days of treatment. All subjects were observed without intervention for 14 days after inclusion, starting treatment after this period, lasting 28 days, and reassessments at 28 and 42 days after inclusion in the study. Patients' age, gender, hand dominance, onychophagy were taken into account when comparing nail growth velocity in the treatment and non-intervention periods throughout the study. Results: Pretreatment showed more pronounced basal growth in the dominant hands and among the onychopha... (Complete abstract click electronic access below) / Mestre

Atopic Dermatitis (AD), a chronic inflammatory skin disease causing lesions, often causes decreased quality of life (Kapur, 2018). Segmentation, a method of illustrating the difference between lesioned and non-lesioned areas of interest (AOIs) has been the primary method for which AD has been studied (Ranteke & Jain, 2013). Manual segmentation is prone to subjectivity (Ning et al., 2014) and automatic segmentation, while reliable and efficient, poses challenges such as light reflections and color variations (Lu et al., 2013). Yet, AD can be classified from color and texture (Hanifin et al., 2001; Nisar et al., 2013), as well as through machine learning methods. The purpose of this study was to determine the optimal method for segmentation of images of atopic dermatitis on subject arms in a novel and standardized photography lightbox (Lightbox) and of images of subjects' self-acquired at-home photos. The goals of this study were to determine the accuracy and reliability of photo acquisition of arms of subjects with AD in a novel standardized photography lightbox, compared to photo acquisition by subjects at home, and determine the accuracy and reliability of automated segmentation of AD lesions with combined color-based segmentation and the U-Net CNN.

Lipodystrophic syndromes encompass a wide range of both inherited and acquired conditions whereby adipose tissue is lost or absent. We report a rare case of acquired localized, pressure-induced lipodystrophy whereby continuous elbow pressure to the distal thighs led to marked tissue disfigurement. Pressure-induced lipodystrophy is a condition that likely results from protracted, localized pressure which ultimately decreases blood flow to the surrounding tissues. Overtime, the decreased perfusion is thought to induce adipocyte degeneration and eventual tissue deformation. Our findings resemble those described in the case reports of leg crossers’ dimples and lipoatrophia semicircularis and support current literature suggesting that prolonged pressure can indeed lead to significant adipose tissue loss and local architectural distortion. Our findings are significant because pressure-induced lipodystrophy represents an avoidable condition that can be circumvented if patients and physicians are knowledgeable of the underlying causes. We highlight a rare case report to educate the public as well as physicians about the causes of pressure-induced lipodystrophy and ultimately prevent future cases of unnecessary and unintended disfigurement.