Development of a clinical-dermoscopic model for the diagnosis of urticarial vasculitis.

The clinical criteria for the diagnosis of urticarial vasculitis lack accuracy, according to previous studies. The aim of the study was to assess the accuracy of a clinical and a clinical-dermoscopic model for the differential diagnosis of chronic spontaneous urticaria (CSU) and urticarial vasculitis (UV). Dermoscopic images of lesions with histopathologically confirmed diagnosis of CSU and UV were evaluated for the presence of selected criteria (purpuric patches/globules (PG) and red linear vessels). Clinical criteria of CSU and UV were also registered. Univariate and adjusted odds ratios were calculated. Multivariate regression analyses were conducted separately for clinical variables (clinical diagnostic model) and for both clinical and dermoscopic variables (clinical-dermoscopic diagnostic model). 108 patients with CSU and 27 patients with UV were included in the study. The clinical-dermoscopic model notably showed higher diagnostic sensitivity than the clinical approach (63% vs. 44%). Dermoscopic purpuric patches/globules (PG) was the variable that better discriminated UV, increasing by 19-fold the odds for this diagnosis. In conclusion, dermoscopy helps the clinical discrimination between CSU and UV. The visualization of dermoscopic PG may contribute to optimize decisions regarding biopsy in patients with urticarial rashes.

Tratamiento de la diabetes tipo 2 en el paciente anciano: la seguridad es una prioridad / Treatment for type 2 diabetes in elderly patients: safety is a priority

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Siringomas acrales múltiples / Multiple Acral Syringomas

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Tumor fibroso solitario cutáneo: una neoplasia fusocelular con una inmunohistoquímica particular / Cutaneous Solitary Fibrous Tumor: A Spindle Cell Neoplasm With Distinctive Immunohistochemical Features

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La fragilidad: un nuevo reto para el médico rehabilitador / Frailty: a new challenge for physical medicine and rehabilitation specialists

El síndrome geriátrico de fragilidad física es un síndrome médico de causas y agentes múltiples, caracterizado por pérdida de fuerza/resistencia y disminución de la función fisiológica, que aumenta la vulnerabilidad individual para desarrollar dependencia o muerte. La fragilidad es considerada la antesala de la discapacidad, lo que supone un reto para los servicios de rehabilitación, que deberán adaptarse a este síndrome y formular programas de detección e intervención temprana. El médico rehabilitador, ante cualquier proceso del anciano, debe conocer los principales cribados de fragilidad, identificar la fragilidad como un estado tratable con potencial pronóstico y establecer programas de ejercicio según unos objetivos individualizados (AU)

Frailty syndrome is a complex clinical syndrome produced by multiple causes and agents, characterised by loss of strength/tolerance for exertion, and a decrease in physiological functioning that increases individual vulnerability to dependency or death. Frailty is considered a stage prior to disability and has therefore become a new challenge for rehabilitation services as they will have to set up screening and early intervention strategies to prevent and treat this syndrome. Physical medicine and rehabilitation specialists should be familiar with the main screening tools to detect frailty and to identify this syndrome as a potentially treatable state with a potential prognosis in order to establish individual exercise programmes (AU)

Aggregation of European storm-petrel (Hydrobates pelagicus ssp. melitensis) around cage fish farms. Do they benefit from the farms resources?

Cage aquaculture aggregates wild fauna due to food provision. Several seabirds frequent fish farms, including the European storm-petrel (Hydrobates pelagicus melitensis). This work investigates the presence of storm-petrels around two aquaculture areas interspersed between breeding colonies in western Mediterranean Sea. Contribution of aquaculture-derived resources to their diet was assessed. Storm-petrels were mist-netted at the colonies and marked by bleaching feathers. Density around aquaculture areas was estimated through visual counts. Marks recognition was conducted visually and by photo-capture. Storm-petrel regurgitates were used as target tissue to estimate diet sources contribution. Contribution of surface zooplankton, ichthyoplankton and aquaculture wastes was estimated through Bayesian mixing modelling combining carbon and nitrogen stable isotopes and fatty acids as biomarkers. Storm-petrel density was high in open-sea aquaculture area, but not observed around near shore farms. Temporal variability of storm-petrels density during the breeding season was linked to their reproductive phenology. Within the open-sea aquaculture area, bluefin tuna farm was more attractive for storm-petrels than seabream/seabass farms. Visual identification of bleaching marks was not useful. Photo-capture showed that 8.3% of the storm-petrels watched around farms were firstly trapped in some of the nearby colonies, and 91.7% were unmarked. Qualitative evidence of aquaculture-derived wastes utilization was obtained. However, its estimated contribution was low (4.3%) when compared to ichthyoplankton (61.1%) or zooplankton (34.6%). The studied open-sea farms significantly aggregated storm-petrels along their entire breeding season. Storm-petrels got a slight profit from aquaculture resources. Nevertheless, some concerns arise regarding the cost/benefit balance of the interaction.

Dosis de radiación producida por los pacientes durante la incorporación del radiofármaco en las pruebas diagnósticas de medicina nuclear / Radiation dose produced by patients during radiopharmaceutical incorporation in nuclear medicine diagnostic procedures

Objetivos. Evaluar la dosis que pueden recibir los miembros del público debido al contacto con pacientes de medicina nuclear durante la incorporación del radiofármaco y compararla con la dosis impartida una vez finalizado el estudio, con el fin de establecer recomendaciones. Material y métodos. Se estudiaron 194 pacientes de forma prospectiva. Se midió la tasa de dosis H*(10) a 0,1; 0,5 y 1 m tras la administración del radiofármaco, antes de la imagen y finalizada la prueba diagnóstica. Se calcularon las dosis efectivas para diferentes circunstancias de contacto, mediante el percentil-95 (gammagrafías óseas) y el valor máximo (resto de los estudios). Resultados. La dosis máxima que recibe el paciente por compartir sala de espera con otro paciente, durante la incorporación del radiofármaco, es 0,59 mSv. Si acudiese a una consulta médica, a un restaurante o a una cafetería las dosis a terceros alcanzarían los 23, 43 y 22 μSv. Estas dosis se reducen en un factor 3 cuando dicha actividad tiene lugar una vez finalizada la prueba. En la mayoría de los estudios, el uso del transporte privado, frente al público, reduce la dosis en un factor superior a 6. Conclusiones. Durante la incorporación del radiofármaco se recomienda maximizar la distancia entre pacientes y hacer una distribución de los mismos en función del tipo de estudio. Debe fomentarse que los pacientes hagan uso del transporte privado frente al público. Dependiendo del número de pacientes de medicina nuclear por año que reciba un médico en su consulta, puede ser necesario aplicar restricciones (AU)

Objectives. The aim of this study was to assess the dose received by members of the public due to close contact with patients undergoing nuclear medicine procedures during radiopharmaceutical incorporation, and comparing it with the emitted radiation dose when the test was complete, in order to establish recommendations. Material and methods. A prospective study was conducted on 194 patients. H*(10) dose rates were measured at 0.1, 0.5, and 1.0 m after the radiopharmaceutical administration, before the image acquisition, and at the end of the nuclear medicine procedure. Effective dose for different close contact scenarios were calculated, according to 95th percentile value (bone scans) and the maximum value (remaining tests). Results. During the radiopharmaceutical incorporation, a person who stays with another injected patient in the same waiting room may receive up to 0.59 mSv. If the patient had a medical appointment, or went to a restaurant or a coffee shop, members of the public could receive 23, 43, and 22 μSv, respectively. After finishing the procedure, these doses are reduced by a factor 3. In most of the studies, the use of private instead of public transport may reduce the dose by more than a factor 6. Conclusion. It is recommended to increase the distance between the patients during the radiopharmaceutical incorporation and to distribute them according to the diagnostic procedure. Patients should be encouraged to use private instead of public transport. Depending on the number of nuclear medicine outpatients per year attended by a physician, it could be necessary to apply restrictions (AU)

Radiation dose produced by patients during radiopharmaceutical incorporation in nuclear medicine diagnostic procedures.

OBJECTIVES: The aim of this study was to assess the dose received by members of the public due to close contact with patients undergoing nuclear medicine procedures during radiopharmaceutical incorporation, and comparing it with the emitted radiation dose when the test was complete, in order to establish recommendations. MATERIAL AND METHODS: A prospective study was conducted on 194 patients. H*(10) dose rates were measured at 0.1, 0.5, and 1.0m after the radiopharmaceutical administration, before the image acquisition, and at the end of the nuclear medicine procedure. Effective dose for different close contact scenarios were calculated, according to 95th percentile value (bone scans) and the maximum value (remaining tests). RESULTS: During the radiopharmaceutical incorporation, a person who stays with another injected patient in the same waiting room may receive up to 0.59 mSv. If the patient had a medical appointment, or went to a restaurant or a coffee shop, members of the public could receive 23, 43, and 22 µSv, respectively. After finishing the procedure, these doses are reduced by a factor 3. In most of the studies, the use of private instead of public transport may reduce the dose by more than a factor 6. CONCLUSION: It is recommended to increase the distance between the patients during the radiopharmaceutical incorporation and to distribute them according to the diagnostic procedure. Patients should be encouraged to use private instead of public transport. Depending on the number of nuclear medicine outpatients per year attended by a physician, it could be necessary to apply restrictions.

Preliminary insights into the incorporation of rosemary extract (Rosmarinus officinalis L.) in fish feed: influence on performance and physiology of gilthead seabream (Sparus aurata).

Gilthead seabream (Sparus aurata) were fed a basal (control) diet and four experimental diets (R600, R1200, R1800 and R2400), containing 600, 1200, 1800 and 2400 mg kg(-1), respectively, of rosemary extract (Rosmarinus officinalis L.). At 4 and 12 weeks from the beginning of the ongrowing period, the fish were sacrificed, blood was drawn to obtain plasma and the liver and intestines were dissected. Growth and feed intake were unaffected by rosemary extract addition. A histological examination of the intestine revealed no differences among the dosages, while the liver showed a sharp decrease in hepatic steatosis in diets supplemented with rosemary extract. Furthermore, plasma alanine aminotransferase was lower with these diets at the end of the ongrowing period. Rosemary extract reduced the plasma levels of glucose and triglycerides on week 4 and glucose and HDL/LDL cholesterol ratio on week 12, suggesting better transport and energy metabolism of the lipids. Overall, the most evident effect of rosemary extract was observed with the 600 mg kg(-1) dose.

Dermoscopy in general dermatology: practical tips for the clinician.

In addition to its well-documented value in improving the diagnosis of skin tumours, dermoscopy is continually gaining appreciation in the field of general dermatology. Dermoscopy has been shown to facilitate the clinical recognition of several inflammatory and infectious diseases, as well as their discrimination from skin tumours. Moreover, recent data indicate that it might also be profitable in assessing the outcome and adverse effects of various treatments. Application of dermoscopy should follow the standard procedure of acquiring information from patient history and clinically evaluating the number, location and morphology of the lesion(s). Four parameters should be assessed when applying dermoscopy in the realm of inflammatory and infectious diseases: (i) morphological vascular patterns; (ii) arrangement of vascular structures; (iii) colours; and (iv) follicular abnormalities, while the presence of other specific features (clues) should also be evaluated. It must be underlined that dermoscopic findings should always be interpreted within the overall clinical context of the patient, integrated with information from the history and the macroscopic examination. With new evidence continuously being gathered, the dermatoscope gradually acquires a role similar to the stethoscope of general practitioners, becoming an irreplaceable clinical tool for dermatologists. In this article, we provide a succinct summary of existing data on dermoscopy in general dermatology. Practical tips are suggested, which can assist clinicians in profitably utilizing and applying the available knowledge in their everyday practice.

Psoriasis, psoriatic arthritis and type 2 diabetes mellitus: a systematic review and meta-analysis.

Several observational studies have assessed the association between psoriasis, psoriatic arthritis (PsA) and type 2 diabetes mellitus, with inconclusive results. We set out to investigate the association between psoriasis, PsA and type 2 diabetes mellitus. Observational studies assessing the relationship between psoriasis or PsA and type 2 diabetes mellitus up to December 2012 were identified by electronic and hand searches in Medline, Embase, PubMed, the Cochrane Database of Systematic Reviews and Google Scholar. For each study we collected the first author's last name, publication year, country of origin, study design, characteristics of participants (sample size, age and sex), the variables incorporated into the multivariable analyses, and the odds ratios (ORs) of psoriasis associated with diabetes along with the corresponding 95% confidence intervals (CIs). From the data provided in each article, the crude OR was also calculated. Forty-four observational studies (in 37 articles) were identified for the final analysis. The pooled OR from random-effects analysis was determined to be 1·76 (95% CI 1·59-1·96). The highest risk was for patients suffering from PsA (OR 2·18, 95% CI 1·36-3·50). We also observed a dose effect in the risk of suffering from type 2 diabetes mellitus, as patients considered as having severe psoriasis had higher risk (OR 2·10, 95% CI 1·73-2·55) than the pooled OR. We perform meta-regression and sensitivity analyses to explore sources of heterogeneity among the studies and to determine how they would influence the estimates, and found no significant influence in the results of the meta-analyses. The findings support the association between psoriasis, PsA and type 2 diabetes mellitus. Some caution must be taken in the interpretation of these results because there may be heterogeneity between studies.

Lesiones vesiculosas y erosivas en el cuero cabelludo / Vesicular and Erosive Lesions on the Scalp

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Benthic recovery after fish farming cessation: a "beyond-BACI" approach.

The development of a benthic environment after fish-farming cessation was examined. To ascertain whether recovery occurred, several abiotic (granulometry, acid-volatile sulfides, total phosphorus and redox potential) and biotic (polychaete abundance) variables were monitored using a "beyond-BACI" approach. Before the cessation of farming, the geochemical conditions and polychaete assemblages differed among the impacted and control sites. After cessation, an improvement of the geochemical conditions was achieved. A significant tendency toward a recovery of the polychaete assemblage in the impacted area was observed, but significant differences still remained compared with the control sites. The acid-volatile sulfide level was responsible for these differences. The abundance of polychaete families associated with organically enriched sediments diminished at the impacted site after cessation, whereas the abundance of some sensitive and omnivorous families increased. The "beyond-BACI" approach provided a wider framework than other approaches, enabling us to differentiate the natural variability from those changes induced by the fish farm and farming cessation.