ABSTRACT
Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are described as difficult-to-treat psoriasis and require specific management. Involvement of these sites often has a significant physical and emotional impact on the patient and the lesions are difficult to control with topical treatments owing to inadequate penetration of active ingredients and the poor cosmetic characteristics of the vehicles used. Consequently, when difficult-to-treat sites are involved, psoriasis can be considered severe even though the lesions are not extensive. Scant information is available about the use of biologic therapy in this setting, and published data generally comes from clinical trials of patients who also had moderate to severe extensive lesions or from small case series and isolated case reports. In this article we review the quality of the scientific evidence for the 4 biologic agents currently available in Spain (infliximab, etanercept, adalimumab, and ustekinumab) and report level i evidence for the use of biologics to treat nail psoriasis (level of recommendation A) and a somewhat lower level of evidence in the case of scalp involvement and palmoplantar psoriasis.
Subject(s)
Biological Factors/therapeutic use , Foot Dermatoses/drug therapy , Hand Dermatoses/drug therapy , Nail Diseases/drug therapy , Psoriasis/drug therapy , Scalp Dermatoses/drug therapy , Biological Therapy , Evidence-Based Medicine , HumansABSTRACT
INTRODUCTION: Minor Surgery is an ever-increasing programmed activity in Primary Health Care Centres. The aim of this paper is to determine the relationship between the clinical diagnosis prior to Minor Surgery and its concordance with the histological results. MATERIAL AND METHODS: We carried out a retrospective study using the registered activity log in a Primary Health Care Centre in the region of Valdejalón of Aragón. SUBJECTS: A total of 1231 patients were included between April 1999 and June 2009. A total of 1391 diagnoses were given, together with the corresponding medical care. MEASUREMENTS: Clinical diagnosis and histological results, and the level of correlation between both. RESULTS: A total of 820 samples were submitted for histological study (59% of the total sample). Eleven of the main clinical and histological diagnoses were evaluated, and a contingency table was prepared. The result of the correlation gave a Kappa coefficient of 0.638. CONCLUSIONS: Once the results were analysed and compared to similar studies of Minor Surgery carried out in Primary Care, our results confirm that there is a high correlation between the clinical diagnosis and the histological results.
Subject(s)
Diagnosis , Minor Surgical Procedures/statistics & numerical data , Pathology, Clinical , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Retrospective Studies , Rural Health , Spain , Young AdultABSTRACT
Introducción. La cirugía menor forma parte de las actividades programadas en un número cada vez más creciente de nuestros centros de atención primaria. El objetivo de este trabajo es conocer el grado de correlación entre el diagnóstico clínico previo al proceso de cirugía menor y su concordancia con el resultado de anatomía patológica. Material y método. Para ello realizamos un estudio retrospectivo a partir del Registro de Actividades de Cirugía Menor de un Centro de Salud Rural de la Comarca de Valdejalón de Aragón. Sujetos. Se incluyeron 1.231 pacientes atendidos durante el periodo comprendido entre abril de 1999 y julio del año 2009 a los que se realizaron un total de 1.391 diagnósticos con sus correspondientes actuaciones. Mediciones. Diagnóstico clínico y resultado clínico-patológico. Correlaciones entre ambos Resultados Se remitieron 820 piezas para estudio clínico-patológico (el 59% de las intervenidas). Se valoraron los 11 diagnósticos clínicos y clínico-patológicos principales con los que se construyó una tabla de contingencia. Se obtuvo un coeficiente kappa de 0,638 Conclusiones. Analizados estos resultados y comparándolos con otros trabajos similares realizados en el ámbito de la cirugía menor en atención primaria, podemos afirmar que hay una buena correspondencia entre el diagnóstico clínico inicial y los resultados de anatomía patológica (AU)
Introduction. Minor Surgery is an ever-increasing programmed activity in Primary Health Care Centres. The aim of this paper is to determine the relationship between the clinical diagnosis prior to Minor Surgery and its concordance with the histological results. Material and methods. We carried out a retrospective study using the registered activity log in a Primary Health Care Centre in the region of Valdejalón of Aragón. Subjects. A total of 1231 patients were included between April 1999 and June 2009. A total of 1391 diagnoses were given, together with the corresponding medical care. Measurements. Clinical diagnosis and histological results, and the level of correlation between both. Results. A total of 820 samples were submitted for histological study (59% of the total sample). Eleven of the main clinical and histological diagnoses were evaluated, and a contingency table was prepared. The result of the correlation gave a Kappa coefficient of 0.638. Conclusions. Once the results were analysed and compared to similar studies of Minor Surgery carried out in Primary Care, our results confirm that there is a high correlation between the clinical diagnosis and the histological results (AU)
