Protocolo asistencial clínico-psicológico para el tratamiento del tabaquismo con citisina / Clinical-psychological care protocol for the treatment of smoking with cytisine

Citisina es un tratamiento farmacológico del tabaquismo que ha sido introducido recientemente en nuestro país. Los estudios realizados con el mismo durante los últimos años muestran que es un tratamiento eficaz y seguro utilizado a dosis decrecientes durante un periodo de 25 días. Sus específicas características de dosis y tiempo de duración hacen recomendable que se diseñe un protocolo asistencial clínico-psicológico para ser desarrollado durante la utilización de citisina. Un grupo multidisciplinario de profesionales sanitarios expertos en tabaquismo han consensuado un protocolo que recomiendan para llevar a cabo en aquellos pacientes a los que se prescriba citisina como fármaco para dejar de fumar. (AU)

Cytisine is a smoking cessation medication that has appeared recently in Spain. It is effective and safe for helping smokers to quit using for 25 days. Its specific characteristicis in doses and duration recommends to desing a protocol clinical-psychological. A multidisciplinary group of health professionals experts on smoking cessation has designed a protocol to develop with patients who are receiving cytisineas medication for smoking cessation. (AU)

Citisina: nuevo fármaco para dejar de fumar en España / Cytisine: New drug for smoking cessation in Spain

Citisina es un alcaloide que se origina en las semillasde algunas plantas pertenecientes al género Legumi-nosae (Fabaceae). Recientemente ha sido aprobado enEspaña como nuevo fármaco de prescripción para eltratamiento del tabaquismo. A lo largo de esta revisiónse analiza su mecanismo de acción y los resultadosde los principales ensayos clínicos y metaanálisis quevaloran su eficacia y seguridad de uso.(AU)

Cytisine is an alkaloid that originates in the seeds ofsome plants belonging to the Leguminosae (Fabaceae)genera. It has been approved recently in Spain as a newprescription drug for the treatment of the smokinghabit. In this review, its action mechanism and theresults of the principal clinical trials as well as themeta-analyses that evaluate its efficacy and safety ofuse are analyzed.(AU)

Análisis de la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) que dejan de fumar / Analysis of quality of life in patients with Chronic Obstructive Pulmonary Disorder (COPD) who give up smoking

Objetivo: Analizar el impacto en la calidad de vida de los pacientes con EPOC, medido mediante el CAT, que dejan de fumar. Pacientes y métodos: Se incluye una serie de pacientes con EPOC que recibieron tratamiento para dejar de fumar. Todos los pacientes estaban tratados con diferentes broncodilatadores de acuerdo con el nivel de gravedad de su enfermedad. Dicho tratamiento no fue alterado en el proceso de abandono del consumo del tabaco. Los pacientes recibieron un programa de tratamiento del tabaquismo que consistió en una combinación de tratamiento farmacológico y terapia conductual. Todos los sujetos cumplimentaron el cuestionario CAT antes de iniciar el tratamiento, es decir, en fase de consumo activo y a los seis 6 de abandonar el tabaco. Todos los sujetos que se incluyen en el análisis estaban abstinentes a los 6 meses de seguimiento. Resultados: Se incluyen en la serie 59 pacientes, de los que 27 eran varones (45,8%). Edad media de 61,8 (7,5) años. El valor medio del CAT basal fue de 18,9 (7,3) puntos y del CAT a los 6 meses, de 8,1 (6,1) puntos (p=0,038. El análisis de regresión lineal múltiple mostró que: a) a igualdad de edad, sexo y nivel de gravedad de la EPOC, a mayor CAT basal, mayor es la diferencia alcanzada al dejar de fumar, a los 6 meses, y b) a mayor edad, menor es la diferencia entre el CAT basal y el CAT a los 6 meses. Conclusiones: Dejar de fumar se asocia a una mejoría en la calidad de vida de los pacientes con EPOC. Aquellos con peor calidad de vida obtienen un mayor beneficio al dejar de fumar, aunque esta diferencia puede verse atenuada por el incremento de la edad

Objective: To analyse the impact in COPD patients' quality of life who stop smoking. Patients and methods: We studied a group of COPD patients who received smoking cessation treatment. All patients were treated with bronchodilators according to the severity of their disorder. This treatment was not changed during the process of smoking cessation. Patients received a smoking cessation programme that consisted of a combination of pharmacological treatment plus cognitive-behavioural treatment. All subjects fill in CAT questionnaire before starting smoking cessation programme and after 6 months of abstinence. All subjects included had stop smoking. Results: The study included 59 patients, with 27 (45.8%) males, and a mean age of 61.8 (7.5) years. Mean CAT score before quitting was 18.9 (7.3) points, and after 6 months of abstinence was 8.1 (6.1) points, P=.038. Multiple regression analysis showed: a) the higher the baseline CAT score the greater is the difference after quitting, at 6 months, at same age, gender, and grade of severity of COPD, and b) the older the age, the lower is the difference between baseline CAT score and the 6 months CAT score. Conclusions: Smoking cessation is associated with improvement in the quality of life in COPD patients. Those with worse quality of life get the biggest benefit from quitting, although this difference can be diminished in ageing patients

[Analysis of quality of life in patients with Chronic Obstructive Pulmonary Disorder (COPD) who give up smoking]. / Análisis de la calidad de vida en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) que dejan de fumar.

OBJECTIVE: To analyse the impact in COPD patients' quality of life who stop smoking. PATIENTS AND METHODS: We studied a group of COPD patients who received smoking cessation treatment. All patients were treated with bronchodilators according to the severity of their disorder. This treatment was not changed during the process of smoking cessation. Patients received a smoking cessation programme that consisted of a combination of pharmacological treatment plus cognitive-behavioural treatment. All subjects fill in CAT questionnaire before starting smoking cessation programme and after 6 months of abstinence. All subjects included had stop smoking. RESULTS: The study included 59 patients, with 27 (45.8%) males, and a mean age of 61.8 (7.5) years. Mean CAT score before quitting was 18.9 (7.3) points, and after 6 months of abstinence was 8.1 (6.1) points, P=.038. Multiple regression analysis showed: a) the higher the baseline CAT score the greater is the difference after quitting, at 6 months, at same age, gender, and grade of severity of COPD, and b) the older the age, the lower is the difference between baseline CAT score and the 6 months CAT score. CONCLUSIONS: Smoking cessation is associated with improvement in the quality of life in COPD patients. Those with worse quality of life get the biggest benefit from quitting, although this difference can be diminished in ageing patients.

Effectiveness and safety of varenicline and nicotine replacement therapy among mental health patients: A retrospective cohort study.

OBJECTIVE: To analyse the effectiveness and safety of two smoking cessation medications (varenicline and nicotine patches) in patients with controlled psychiatric disorders in daily practice in a Smoking Cessation Service. METHODS: This is a retrospective cohort study. It was carried on at a smoking cessation clinic in Madrid and used a convenience sampling strategy. We reviewed medical records of patients diagnosed with psychiatric disorders who attended a Smoking Cessation Service. All patients received similar treatment programme: a combination of pharmacological treatment (varenicline or nicotine replacement therapy) and intensive cognitive-behavioural therapy. RESULTS: The group included 349 patients (38.4% men). Mean age (SD) 49.6 (10.5) years. 28.3 (12.8) cigarettes per day. 156 subjects achieved 9-24 weeks continuous abstinence (44.7%), in 39% of those who used nicotine patches and in 53.7% of those who used varenicline. OR: 1.64 (95% CI: 1.03-2.61; p=0.036). Success rates were higher in men; OR 1.85 (95% CI: 1.12-3.04; p=0.016). High levels of CO and high daily cigarette use were associated with poorer success rates (OR: 0.98, 95% CI: 0.96-0.99, p=0.007; and OR: 0.98, 95% CI: 0.96-1.00, p=0.045), respectively. Nausea and pruritus were the most common adverse events. No cases of suicidal ideation or behaviour were found. CONCLUSIONS: Varenicline and nicotine patches could be safe and effective smoking cessation treatments for patients with psychiatric disorders in daily clinical practice.

Telangiectasias verticalizadas y prurito en el tórax en un paciente con síndrome de cava superior inicial secundario a un timoma maligno / Vertically Orientated Telangiectasias and Pruritus on the Thorax of a Patient With Early Superior Vena Cava Syndrome Secondary to a Malignant Thymoma

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Dejar de fumar con reducción progresiva / Quit smoking with progressive reduction

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Dermatitis de contacto alérgica a hidrocortisona como complicación del cuidado local de tatuajes / Allergic Contact Dermatitis to Hydrocortisone as a Complication of Tattoo Care

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[Allergic contact dermatitis to cosmetics]. / Dermatitis alérgica de contacto por cosméticos.

INTRODUCTION: Contact dermatitis to cosmetics is a common problem in the general population, although its prevalence appears to be underestimated. We reviewed cases of allergic contact dermatitis to cosmetics diagnosed in our dermatology department over a 7-year period with a view to identifying the allergens responsible, the frequency of occurrence of these allergens, and the cosmetic products implicated. METHODS: Using the database of the skin allergy department, we undertook a search of all cases of allergic contact dermatitis to cosmetics diagnosed in our department from January 2000 through October 2007. RESULTS: In this period, patch tests were carried out on 2,485 patients, of whom 740 were diagnosed with allergic contact dermatitis and the cause was cosmetics in 202 of these patients (170 women and 32 men), who accounted for 27.3 % of all cases. A total of 315 positive results were found for 46 different allergens. Allergens most often responsible for contact dermatitis in a cosmetics user were methylisothiazolinone (19 %), paraphenylenediamine (15.2 %), and fragrance mixtures (7.8 %). Acrylates were the most common allergens in cases of occupational disease. Half of the positive results were obtained with the standard battery of the Spanish Group for Research Into Dermatitis and Skin Allergies (GEIDAC). The cosmetic products most often implicated among cosmetics users were hair dyes (18.5 %), gels/soaps (15.7 %), and moisturizers (12.7 %). CONCLUSION: Most patients affected were women. Preservatives, paraphenylenediamine, and fragrances were the most frequently detected cosmetic allergens, in line with previous reports in the literature. Finally, in order to detect new cosmetic allergens, cooperation between physicians and cosmetics producers is needed.

Dermatitis alérgica de contacto por cosméticos / Allergic Contact Dermatitis to Cosmetics

Introducción: La dermatitis de contacto por cosméticos es un problema frecuente entre la población general, sin embargo, parece ser que su prevalencia está infraestimada. Revisamos en este trabajo los casos de dermatitis de contacto alérgica por cosméticos diagnosticados en el Departamento de Dermatología en un periodo de 7 años con el objetivo de detectar los alergenos responsables, la frecuencia de los mismos, así como los productos cosméticos implicados. Métodos: Utilizando la base de datos de la sección de Alergia Cutánea se realiza una búsqueda de todos los casos de dermatitis de contacto alérgica por cosméticos diagnosticados en nuestro departamento entre enero de 2000 y octubre de 2007. Resultados: Durante este periodo se realizaron pruebas epicutáneas a 2.485 pacientes. De todos ellos, 740 fueron diagnosticados de una dermatitis de contacto alérgica, 202 pacientes (170 mujeres/32 varones), es decir, el 27,3 % lo fueron por cosméticos. Se detectaron un total de 315 parches positivos y 46 alergenos diferentes. Los alergenos que con más frecuencia produjeron una dermatitis de contacto en el usuario fueron las metilisotiazolinonas (19 %), la parafenilendiamina (15,2 %) y la mezcla de perfumes (7,8 %). Los acrilatos fueron los alergenos más frecuentes en aquellos casos que tenían un origen laboral. Con la batería estándar del Grupo Español en Investigación en Dermatitis y Alergia Cutánea (GEIDAC) se detectaron la mitad de las pruebas positivas. Los productos cosméticos implicados con mayor frecuencia en el usuario fueron los tintes capilares (18,5 %), los geles/jabones (15,7 %) y las cremas hidratantes (12,7 %). Conclusión: La mayoría de los pacientes afectados fueron mujeres. Los conservantes, la parafenilendiamina y los perfumes fueron los alergenos cosméticos más frecuentes, tal y como había sido publicado previamente en la literatura. Finalmente, con el objetivo de detectar nuevos alergenos cosméticos debe existir colaboración entre los facultativos y las casas comerciales (AU)

Introduction: Contact dermatitis to cosmetics is a common problem in the general population, although its prevalence appears to be underestimated. We reviewed cases of allergic contact dermatitis to cosmetics diagnosed in our dermatology department over a 7-year period with a view to identifying the allergens responsible, the frequency of occurrence of these allergens, and the cosmetic products implicated. Methods: Using the database of the skin allergy department, we undertook a search of all cases of allergic contact dermatitis to cosmetics diagnosed in our department from January 2000 through October 2007. Results: In this period, patch tests were carried out on 2485 patients, of whom 740 were diagnosed with allergic contact dermatitis and the cause was cosmetics in 202 of these patients (170 women and 32 men), who accounted for 27.3% of all cases. A total of 315 positive results were found for 46 different allergens. Allergens most often responsible for contact dermatitis in a cosmetics user were methylisothiazolinone (19%), paraphenylenediamine (15.2%), and fragrance mixtures (7.8%). Acrylates were the most common allergens in cases of occupational disease. Half of the positive results were obtained with the standard battery of the Spanish Group for Research Into Dermatitis and Skin Allergies (GEIDAC). The cosmetic products most often implicated among cosmetics users were hair dyes (18.5%), gels/soaps (15.7%), and moisturizing creams (12.7%). Conclusion: Most patients affected were women. Preservatives, paraphenylenediamine, and fragrances were the most frequently detected cosmetic allergens, in line with previous reports in the literature. Finally, in order to detect new cosmetic allergens, cooperation between physicians and cosmetics producers is needed (AU)

Etanercept en la psoriasis. Experiencia clínica / Clinical experience with etanercept in the treatment of psoriasis

Introducción. Etanercept es uno de los nuevos fármacos biológicos surgidos para el tratamiento de la psoriasis. Ha demostrado ser una opción eficaz en un alto porcentaje de pacientes, provocando mejoras en el PASI (Psoriasis Assessment and Severity Index) que se mantienen en el tiempo. Además, resulta igualmente adecuado para el control de la artritis psoriásica. Por otra parte, el perfil de seguridad es excelente, con una toxicidad órgano específica mucho menor que los fármacos clásicos y la aparición de escasos efectos secundarios. Muchos de los datos publicados hasta el momento proceden de los distintos estudios clínicos que se han realizado con esta medicación, pero se necesitan trabajos que reflejen la experiencia en la práctica clínica diaria con el manejo de esta terapia en condiciones normales. Métodos. Estudio observacional, retrospectivo, en el que se recogen los 36 pacientes con psoriasis a los que administramos etanercept durante el período de tiempo comprendido entre marzo de 2004 y marzo de 2006. Exponemos la experiencia de nuestro centro en la utilización de este fármaco, con la evolución clínica y los problemas a los que nos hemos enfrentado. Resultados. El PASI se evaluó antes de comenzar el tratamiento y a los tres y seis meses de seguimiento de los pacientes. A los tres meses de tratamiento 13 de los pacientes (36,11 %) habían alcanzado el PASI 50, y 16 pacientes (44,44 %) habían alcanzado el PASI 75. Dos de los pacientes (5,56 %) experimentaron una mejoría de su psoriasis, sin alcanzar el PASI 50, y sólo 4 pacientes (11,11 %) no mostraron mejoría clínica o incluso empeoraron. A los 6 meses se observó un aumento de la eficacia, con 27 pacientes (75 %) que alcanzaron el PASI75 y 6 pacientes (16,67 %) que llegaron a obtener el PASI 50, 2 pacientes (5,56 %) no mostraron ningún beneficio tras la terapia. A los 6 meses 13 de los pacientes (36,1 %) habían alcanzado el PASI 90. En ninguno de los casos se presentaron acontecimientos adversos de importancia que obligaran a suspender el tratamiento. Once de los pacientes siguen en tratamiento con etanercept en el momento actual, ya que se ha mantenido la eficacia y no han presentado efectos adversos importantes. Conclusiones. Exponemos nuestra experiencia clínica con la utilización de etanercept para el tratamiento de la psoriasis en placas, con un perfil muy favorable de eficacia y seguridad. Proponemos la estandarización de la visita clínica al paciente con psoriasis, con recogida exhaustiva de datos en cada visita y la creación de un sistema nacional de registro de datos de pacientes con tratamientos biológicos (AU)

Background. Etanercept is one of the new biologic agents available for treating psoriasis. It has proved an effective option in a high percentage of patients, leading to sustained improvements in the psoriasis are aseverity index (PASI). Likewise, it is effective at controlling psoriatic arthritis, and its safety profile is excellent, with a much lower specific organ toxicity than traditional drugs and few side effects. Many of the data published to date are derived from clinical trials with this medication, but further studies are needed on the use of this therapy to manage patients in daily clinical practice. Methods. This was a retrospective observational study of 36 patients with psoriasis who received etanercept between March 2004 and March 2006. We describe the experience of using this agent at our hospital, with the clinical outcomes and the problems we have faced. Results. The PASI score was assessed before treatment and at 3 and 6 months of patient follow-up. After 3 months of treatment, 13 patients (36.11 %) had achieved a 50 % improvement in PASI score (PASI50), and 16 patients (44 %) had achieved a 75 % improvement (PASI75). Two of the patients (5.56 %) experienced an improvement in their disease without reaching PASI50 and only 4 patients (11.11 %) did not show clinical improvement or deteriorated. After 6 months, efficacy improved, with 27 patients (75 %) achieving PASI75, 6 patients (16.67 %) achieving PASI50, and 2 patients (5.56 %) showing no benefit from treatment. After 6 months, 13 of the patients (36.1 %) had achieved a 90% improvement in PASI score. No adverse events of sufficient significance to warrant discontinuation of treatment were reported. At present, 11 of the patients remain on etanercept treatment as efficacy has been sustained and they have not experienced any adverse events of note. Conclusions. Our clinical experience with the use of etanercept for treating plaque psoriasis shows a favorable efficacy and safety profile. We propose a standardized procedure for consultations with psoriasis patients involving extensive data collection on each visit and the creation of a national surveillance system for patients under treatment with biologic agents (AU)

[Clinical experience with etanercept in the treatment of psoriasis]. / Etanercept en la psoriasis. Experiencia clínica.

BACKGROUND: Etanercept is one of the new biologic agents available for treating psoriasis. It has proved an effective option in a high percentage of patients, leading to sustained improvements in the psoriasis area severity index (PASI). Likewise, it is effective at controlling psoriatic arthritis, and its safety profile is excellent, with a much lower specific organ toxicity than traditional drugs and few side effects. Many of the data published to date are derived from clinical trials with this medication, but further studies are needed on the use of this therapy to manage patients in daily clinical practice. METHODS: This was a retrospective observational study of 36 patients with psoriasis who received etanercept between March 2004 and March 2006. We describe the experience of using this agent at our hospital, with the clinical outcomes and the problems we have faced. RESULTS: The PASI score was assessed before treatment and at 3 and 6 months of patient follow-up. After 3 months of treatment, 13 patients (36.11 %) had achieved a 50 % improvement in PASI score (PASI(50)), and 16 patients (44 %) had achieved a 75 % improvement (PASI(75)). Two of the patients (5.56 %) experienced an improvement in their disease without reaching PASI(50) and only 4 patients (11.11 %) did not show clinical improvement or deteriorated. After 6 months, efficacy improved, with 27 patients (75 %) achieving PASI(75), 6 patients (16.67 %) achieving PASI(50), and 2 patients (5.56 %) showing no benefit from treatment. After 6 months, 13 of the patients (36.1 %) had achieved a 90 % improvement in PASI score. No adverse events of sufficient significance to warrant discontinuation of treatment were reported. At present, 11 of the patients remain on etanercept treatment as efficacy has been sustained and they have not experienced any adverse events of note. CONCLUSIONS: Our clinical experience with the use of etanercept for treating plaque psoriasis shows a favorable efficacy and safety profile. We propose a standardized procedure for consultations with psoriasis patients involving extensive data collection on each visit and the creation of a national surveillance system for patients under treatment with biologic agents.

Tromboflebitis superficial migratoria: revisión clínica e histológica de 8 casos / Superficial migratory thrombophlebitis: a clinical and histologic review of 8 cases

Introducción. La tromboflebitis superficial migratoria (TSM) o tromboflebitis migrans se caracteriza por episodios recurrentes de trombosis segmentaria de las venas superficiales de los miembros y el tronco. La TSM se ha asociado con diversas enfermedades sistémicas que deben tenerse en cuenta a la hora de evaluar al paciente. Material y métodos. Desde 1997 hasta 2007, 8 pacientes con TSM fueron estudiados en el Hospital General Universitario de Valencia. Se revisaron las características clínicas e histopatológicas, así como las enfermedades asociadas. Resultados. La presentación clínica más frecuente fue en forma de nódulos dolorosos recurrentes en las extremidades inferiores, similar a un eritema nodoso. Otras localizaciones fueron el abdomen y el tronco. Sólo en un caso el diagnóstico clínico fue de TSM. Otros diagnósticos clínicos fueron celulitis, linfangitis, vasculitis nodularo panarteritis nodosa. Las características histológicas fueron compatibles con tromboflebitis superficial, yla tinción con orceína mostró ausencia de la lámina elástica interna en todos los casos. En ninguno se demostró asociación con una neoplasia oculta. En 2 casos existían antecedentes de enfermedad de Buerger y otro apareció en el contexto de una fiebre de origen desconocido. Conclusión. El reconocimiento de la TSM es importante por su posible asociación con enfermedades sistémicas, incluyendo el cáncer. En nuestra serie fuimos incapaces de encontrar una enfermedad asociada en la mayoría de los casos. Sin embargo, y dado que el cáncer se puede manifestar entre meses e incluso años después de la aparición de la TSM, es necesario el seguimiento de los pacientes (AU)

Introduction. Superficial migratory thrombophlebitis (SMT) or thrombophlebitis migrans is characterized by recurrent episodes of localized thrombosis of the superficial veins in the limbs and trunk. It has been associated with various systemic diseases that should be taken into consideration when assessing the patient. Material and methods. Between 1997 and 2007, 8 patients with SMT were seen at Hospital General Universitario de Valencia in Valencia, Spain. We review the clinical features and histopathology, along with theassociated diseases.Results. The most common clinical presentation was with painful nodules mimicking erythema nodosum on the lower extremities. Other sites were on the abdomen and trunk. Only in 1 case was SMT diagnosed clinically. In other cases, the clinical diagnoses were cellulitis, lymphangitis, nodular vasculitis, and panarteritis nodosa. The histologic characteristics were compatible with superficial thrombophlebitis, and orce in staining revealed the internal elastic lamina to be absent in all cases. No evidence of an occult tumor was found in any of the cases. Two cases had a history of Buerger disease and in another the condition presented in association with a fever of unknown origin. Conclusion. The possible association of SMT with systemic diseases, including cancer, makes its diagnosis important. In our case series we did not find evidence of associated disease in the majority of cases. However, since cancer can manifest months and even years after the appearance of SMT, follow-up is necessary in these patients (AU)

[Superficial migratory thrombophlebitis: a clinical and histologic review of 8 cases]. / Tromboflebitis superficial migratoria: revisión clínica e histológica de 8 casos.

INTRODUCTION: Superficial migratory thrombophlebitis (SMT) or thrombophlebitis migrans is characterized by recurrent episodes of localized thrombosis of the superficial veins in the limbs and trunk. It has been associated with various systemic diseases that should be taken into consideration when assessing the patient. MATERIAL AND METHODS: Between 1997 and 2007, 8 patients with SMT were seen at Hospital General Universitario de Valencia in Valencia, Spain. We review the clinical features and histopathology, along with the associated diseases. RESULTS: The most common clinical presentation was with painful nodules mimicking erythema nodosum on the lower extremities. Other sites were on the abdomen and trunk. Only in 1 case was SMT diagnosed clinically. In other cases, the clinical diagnoses were cellulitis, lymphangitis, nodular vasculitis, and panarteritis nodosa. The histologic characteristics were compatible with superficial thrombophlebitis, and orcein staining revealed the internal elastic lamina to be absent in all cases. No evidence of an occult tumor was found in any of the cases. Two cases had a history of Buerger disease and in another the condition presented in association with a fever of unknown origin. CONCLUSION: The possible association of SMT with systemic diseases, including cancer, makes its diagnosis important. In our case series we did not find evidence of associated disease in the majority of cases. However, since cancer can manifest months and even years after the appearance of SMT, follow-up is necessary in these patients.