ABSTRACT
BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
Subject(s)
Dermatology , Humans , Spain , Cross-Sectional StudiesABSTRACT
BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.
Subject(s)
Dermatology , Humans , Spain , Cross-Sectional StudiesABSTRACT
Transposition flaps are some of the most commonly used flaps for reconstructing scalp defects. Limberg first described his rhomboid transposition flap in 1946. Dufourmentel flap was an improved version of the Limberg flap published in 1962 in which the base of the flap is widened to improve vascularisation. Transposition flaps are one of the best known and most widely used transposition flaps in reconstructive surgery. They have proven successful in different types of reconstructive and aesthetic situations as a full-thickness random transposition flap. Combination of three Dufourmentel flaps to reconstruct hexagonal defects has not been reported in the literature. It is a modification of the triple Limberg flap, in which, after removing a hexagonal defect, we reconstruct the primary defect with a triple Dufourmentel flap. This flap is very useful for reconstructing large scalp defects as it provides a large amount of skin tissue with high viability; however, given its versatility, it could be used in other anatomical areas. Ann Med Surg (Lond) 2021 7:102544; Plast Reconstr Surg 2015 136:163-164; Atlas Oral Maxillofac Surg Clin North Am 2020 28:17-22.
Subject(s)
Ectodermal Dysplasia , Plastic Surgery Procedures , Humans , Scalp , Surgical FlapsABSTRACT
BACKGROUND: Methotrexate (MTX) is frequently used in the treatment of moderate-to-severe psoriasis, however, there is limited data on health-related quality-of-life (HRQoL), psoriasis clinical outcomes and hepatic fibrosis in MTX-treated patients in routine clinical practice. OBJECTIVES: To investigate the impact of moderate-to-severe psoriasis in MTX-treated patients in Spain regarding to HRQoL, psoriasis clinical data and risk of hepatic fibrosis. METHODS: Observational, non-interventional, cross-sectional, retrospective, multicentre study, performed in Spain in moderate-to-severe plaque psoriasis patients treated with MTX > 16 weeks prior to inclusion. RESULTS: Despite ongoing treatment, 17.1% of 457 evaluable patients reported moderate-to-extreme impact on HRQoL (DLQI > 5); 21.4% BSA > 5 and 35.2% moderate-to-severe pruritus (VAS ≥ 4). Persistent severe psoriasis (PASI ≥ 10 and/or DLQI ≥ 10) was observed in 10.7%. Hepatic steatosis was identified in 64.1% of patients (HSI ≥ 36) and 37.2% of the patients were at-risk of advanced fibrosis which was associated to the MTX treatment duration. CONCLUSIONS: The study identified unmet needs in moderate-to-severe plaque psoriasis patients treated with MTX, revealing a significant proportion of sub-optimally controlled patients in terms of HRQoL and different domains of the disease. This study also found patients at-risk of advanced fibrosis, with evidence suggesting a correlation between longer exposures to MTX and higher risk of advanced fibrosis.
Subject(s)
Dermatologic Agents , Psoriasis , Cross-Sectional Studies , Dermatologic Agents/adverse effects , Humans , Liver Cirrhosis , Methotrexate/therapeutic use , Psoriasis/chemically induced , Psoriasis/drug therapy , Quality of Life , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
ANTECEDENTES Y OBJETIVO: El ácido tranexámico por vía intravenosa ha demostrado que disminuye el sangrado y la necesidad de transfusiones en la artroplastia total de cadera, aunque tiene un riesgo teórico de producir fenómenos tromboembólicos. Recientemente, se han publicado algunos trabajos con la aplicación del ácido tranexámico tópico, sin haberse definido todavía cuál es el protocolo de administración ideal. El objetivo de este trabajo fue demostrar que nuestro protocolo de administración tópica de ácido tranexámico es eficaz y seguro. MATERIALES Y MÉTODOS: Recogida de datos de una serie prospectiva de 80 artroplastias primarias de cadera, en las que se utilizó un protocolo de ácido tranexámico tópico: se prepararon 1,5 g diluidos en un volumen total de 60ml, administrando 20ml tras fresar el cotilo, 20ml en el canal femoral y 20ml a través del redón, manteniéndolo cerrado durante 20 min. RESULTADOS: Se intervino a 80 pacientes. Hemoglobina preoperatoria 14,26g/dl; hematocrito preoperatorio 42,39%. Se observó una pérdida media de 2,74g/dl de hemoglobina y del 8% de hematocrito. Precisaron transfusión el 11% de los pacientes, de los cuales el 67% tenía una anemia previa conocida; solo 3 pacientes sin anemia previa precisaron transfusión (4%). No hubo ninguna complicación tromboembólica en nuestra serie. CONCLUSIONES: La utilización de ácido tranexámico tópico fue eficaz y segura en la artroplastia total primaria de cadera, reduciendo la necesidad de transfusión sanguínea respecto a lo descrito en la literatura en pacientes no tratados
BACKGROUND AND AIM: Intravenous tranexamic acid has been shown to reduce bleeding and the need for transfusions in total hip arthroplasty, although it has a theoretical risk of producing thromboembolic phenomena. Recently some papers have been published using the topical application of tranexamic acid, but the ideal administration protocol has not yet been clearly defined. The aim of this paper was to demonstrate that our protocol of topical tranexamic acid is effective and safe. MATERIALS AND METHODS: Prospective data collection from a case series of 80 primary hip arthroplasties, in which the following topical tranexamic acid protocol is used: 1.5 grams diluted to a total volume of 60ml were administered, applying 20ml in the acetabular bed, 20ml in the femoral canal and 20ml through the Redon drain, keeping it closed for 20minutes. RESULTS: Eighty patients were operated. Preoperative haemoglobin 14.26g / dL; preoperative haematocrit 42.39%. An average loss of 2.74g / dL of haemoglobin and 8% of haematocrit was obtained. Eleven percent of the patients required transfusion, of whom 67% had known previous anaemia; only 3 patients without prior anaemia required transfusion (4%). There were no thromboembolic complications in our series. CONCLUSIONS: The use of topical tranexamic acid was safe and effective in primary total hip arthroplasty, reducing the need for blood transfusion compared to that described in the literature in untreated patients
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Antifibrinolytic Agents/administration & dosage , Arthroplasty, Replacement, Hip , Blood Loss, Surgical/prevention & control , Tranexamic Acid/administration & dosage , Administration, Topical , Antifibrinolytic Agents/therapeutic use , Blood Loss, Surgical/statistics & numerical data , Blood Transfusion/statistics & numerical data , Clinical Protocols , Prospective Studies , Tranexamic Acid/therapeutic use , Treatment OutcomeABSTRACT
ANTECEDENTES Y OBJETIVO: La tendinitis calcificante del manguito de los rotadores es una de las causas frecuentes de dolor en el hombro. El objetivo fue dar a conocer una presentación poco habitual de la tendinitis calcificante de hombro, la expansión intraósea, que en muchos casos puede ser confundida con una lesión tumoral o infecciosa, y de esta manera evitar biopsias o tratamientos innecesarios, y presentar nuestra experiencia con el tratamiento artroscópico. MATERIAL Y MÉTODOS: Se presentan 2 casos clínicos de tendinitis calcificante de hombro con extensión intraósea y una revisión de las series publicadas. RESULTADOS: En ambos casos se observó erosión de la cortical, una lesión osteolítica en la tuberosidad mayor y un edema perilesional. Se obtuvieron buenos resultados con el tratamiento mediante artroscopia de hombro con desbridamiento de la lesión y reinserción del supraespinoso en la tuberosidad mayor mediante un arpón. CONCLUSIONES: Ante una lesión osteolítica con edema perilesional en la tuberosidad mayor, hay que valorar, dentro del diagnóstico diferencial, la expansión intraósea de una tendinitis calcificante. En nuestros casos el tratamiento artroscópico fue eficaz
BACKGROUND AND AIM: Calcific tendinitis of the rotator cuff is a common cause of shoulder pain. The aim of the present study was to show a rare presentation of calcific tendinopathy of the shoulder, the intraosseous extension, which can be mistaken for a bone tumour or an infectious disease. MATERIAL AND METHODS: Two clinical cases of calcific tendinopathy of the shoulder with intraosseous extension and a review of the literature are presented. RESULTS: Cortical erosion, osteolytic lesion in the greater tuberosity and perilesional oedema were observed in both cases. Good results were achieved with shoulder arthroscopy including lesion debridement and reinsertion of the tendon in the greater tuberosity with an anchor. CONCLUSIONS: In the presence of an osteolytic lesion with perilesional oedema in the greater tuberosity, the intraosseous expansion of a calcifying tendinopathy should be included in the differential diagnosis. In our cases the arthroscopic treatment was successful
Subject(s)
Humans , Female , Middle Aged , Arthroscopy/methods , Calcinosis/surgery , Rotator Cuff/surgery , Tendinopathy/surgery , Arthrography , Calcinosis/diagnostic imaging , Debridement/methods , Rotator Cuff/diagnostic imaging , Shoulder/diagnostic imaging , Tendinopathy/diagnostic imagingABSTRACT
BACKGROUND AND AIM: Intravenous tranexamic acid has been shown to reduce bleeding and the need for transfusions in total hip arthroplasty, although it has a theoretical risk of producing thromboembolic phenomena. Recently some papers have been published using the topical application of tranexamic acid, but the ideal administration protocol has not yet been clearly defined. The aim of this paper was to demonstrate that our protocol of topical tranexamic acid is effective and safe. MATERIALS AND METHODS: Prospective data collection from a case series of 80 primary hip arthroplasties, in which the following topical tranexamic acid protocol is used: 1.5 grams diluted to a total volume of 60ml were administered, applying 20ml in the acetabular bed, 20ml in the femoral canal and 20ml through the Redon drain, keeping it closed for 20minutes. RESULTS: Eighty patients were operated. Preoperative haemoglobin 14.26g / dL; preoperative haematocrit 42.39%. An average loss of 2.74g / dL of haemoglobin and 8% of haematocrit was obtained. Eleven percent of the patients required transfusion, of whom 67% had known previous anaemia; only 3 patients without prior anaemia required transfusion (4%). There were no thromboembolic complications in our series. CONCLUSIONS: The use of topical tranexamic acid was safe and effective in primary total hip arthroplasty, reducing the need for blood transfusion compared to that described in the literature in untreated patients.
Subject(s)
Antifibrinolytic Agents/administration & dosage , Arthroplasty, Replacement, Hip , Blood Loss, Surgical/prevention & control , Tranexamic Acid/administration & dosage , Administration, Topical , Adult , Aged , Antifibrinolytic Agents/therapeutic use , Blood Loss, Surgical/statistics & numerical data , Blood Transfusion/statistics & numerical data , Clinical Protocols , Female , Humans , Male , Middle Aged , Prospective Studies , Tranexamic Acid/therapeutic use , Treatment OutcomeABSTRACT
BACKGROUND AND AIM: Calcific tendinitis of the rotator cuff is a common cause of shoulder pain. The aim of the present study was to show a rare presentation of calcific tendinopathy of the shoulder, the intraosseous extension, which can be mistaken for a bone tumour or an infectious disease. MATERIAL AND METHODS: Two clinical cases of calcific tendinopathy of the shoulder with intraosseous extension and a review of the literature are presented. RESULTS: Cortical erosion, osteolytic lesion in the greater tuberosity and perilesional oedema were observed in both cases. Good results were achieved with shoulder arthroscopy including lesion debridement and reinsertion of the tendon in the greater tuberosity with an anchor. CONCLUSIONS: In the presence of an osteolytic lesion with perilesional oedema in the greater tuberosity, the intraosseous expansion of a calcifying tendinopathy should be included in the differential diagnosis. In our cases the arthroscopic treatment was successful.
Subject(s)
Arthroscopy/methods , Calcinosis/surgery , Rotator Cuff/surgery , Tendinopathy/surgery , Arthrography , Calcinosis/diagnostic imaging , Debridement/methods , Female , Humans , Middle Aged , Rotator Cuff/diagnostic imaging , Shoulder/diagnostic imaging , Tendinopathy/diagnostic imagingABSTRACT
La lepra (enfermedad de Hansen) es una enfermedad granulomatosa crónica que afecta a la piel y a los nervios, fundamentalmente, producida por Mycobacterium leprae. Se considera un proceso preerradicado en España, con una prevalencia de 0,1 casos por 10.000 habitantes. Se ha visto un discreto incremento debido al fenómeno de inmigración desde países con mayor prevalencia de este proceso. El tratamiento que se emplea es una combinación de fármacos como rifampicina, dapsona y clofazimina (AU)
Leprosy (Hansen's disease) is a chronic granulomatous disease affecting the skin and nerves that is mainly produced by Mycobacterium leprae. It is considered a pre-eradicated condition in Spain, with a prevalence rate of 0.1 cases per 10,000 inhabitants. A slight increase has been observed due to the phenomenon of immigration from countries with higher prevalence of this condition. Current treatments used share a common base made up of several combined drugs, particularly rifampicin, dapsone, and clofazimin (AU)
Subject(s)
Humans , Leprosy/diagnosis , Mycobacterium leprae/isolation & purification , Leprosy/drug therapy , Emigrants and Immigrants , Anti-Bacterial Agents/therapeutic useABSTRACT
La lepra (enfermedad de Hansen) es una enfermedad granulomatosa crónica que afecta a la piel y a los nervios, fundamentalmente, producida por Mycobacterium leprae. Se considera un proceso preerradicado en España, con una prevalencia de 0,1 casos por 10.000 habitantes. Se ha visto un discreto incremento debido al fenómeno de inmigración desde países con mayor prevalencia de este proceso. El tratamiento que se emplea es una combinación de fármacos como rifampicina, dapsona y clofazimina (AU)
Leprosy (Hansen's disease) is a chronic granulomatous disease affecting the skin and nerves that is mainly produced by Mycobacterium leprae. It is considered a pre-eradicated condition in Spain, with a prevalence rate of 0.1 cases per 10,000 inhabitants. A slight increase has been observed due to the phenomenon of immigration from countries with higher prevalence of this condition. Current treatments used share a common base made up of several combined drugs, particularly rifampicin, dapsone, and clofazimin (AU)
Subject(s)
Humans , Leprosy/drug therapy , Drug Combinations , Emigrants and Immigrants/statistics & numerical data , Leprosy/epidemiology , Anti-Bacterial Agents/therapeutic use , Antiparasitic Agents/therapeutic useSubject(s)
Adrenal Cortex Hormones/adverse effects , Dermatitis, Allergic Contact/etiology , Histamine Antagonists/adverse effects , Spirostans/adverse effects , Adrenal Cortex Hormones/administration & dosage , Dermatitis, Allergic Contact/drug therapy , Dermatitis, Allergic Contact/immunology , Female , Histamine Antagonists/administration & dosage , Humans , Middle Aged , Ointments/administration & dosage , Ointments/adverse effects , Patch Tests , Spirostans/therapeutic useABSTRACT
El nevus comedoniano es un proceso infrecuente, hamartomatoso, de la unidad pilosebácea. Generalmente aparece como un grupo asintomático decomedones, que se distribuyen con un patrón lineal. Ocasionalmente se han descrito asociaciones con anomalías sistémicas. Presentamos una serie decinco pacientes con lesiones clínica y/o histología compatibles con nevus comedoniano. Se analiza la edad de los pacientes, edad de comienzo, la localizaciónde las lesiones, asociación a cuadros sistémicos y el tratamiento realizado (AU)
Naevus comedonicus represents an uncommon hamartomatous disorder of pilo-sebaceous unit. It appears as a usually asymptomatic group of comedones,wich may be arranged in a linear pattern. An occasional association with systemic abnormalities has been reported. A serie of five patients withlesions clinically and/or histologically consistent with naevus comedonicus is reported. The age of patients, the age of presentation, localization of thelesions, noncutaneous abnormalities associated treatment are analized (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Laser Therapy , Retinoids/administration & dosage , Nevus/therapy , Nevus/diagnosis , Treatment OutcomeABSTRACT
Los ligandos selectivos del receptor retinoide X se utilizan actualmente en el tratamiento de estadios avanzados del linfoma cutáneo de células T resistentes a otros tratamientos sistémicos, siendo el bexaroteno el primer fármaco de este grupo aprobado en Europa. Se han descrito numerosos efectos adversos asociados a su utilización, entre los que destacan las alteraciones endocrino-metabólicas. Presentamos a 2 pacientes con linfoma cutáneo de células T, tratados con bexaroteno, que desarrollaron hipotiroidismo central y dislipemia de forma precoz tras su inicio. Se describen también la respuesta de estas alteraciones al tratamiento y su remisión completa tras suspender el bexaroteno (AU)
The retinoid X receptor-selective ligands has been used for advanced stages of cutaneous T-cell lymphoma refractory to previous systemic therapy, being bexarotene the first drug in this group approved in Europe. Multiple drug-related adverse events has been reported such as endocrine-metabolic disorders. We report 2 patients with cutaneous T-cell lymphoma, treated with bexarotene, that developed central hypothyroidism and dyslipidaemia immediately after the beginning of this treatment. We also showed the successfully treatment response of these alterations and the total clinical remission after discontinuing the drug (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Lymphoma, T-Cell, Cutaneous/diagnosis , Retinoids/agonists , Lymphoma, T-Cell, Cutaneous/drug therapy , Lymphoma, T-Cell, Cutaneous/genetics , Blood Glucose/metabolism , Clinical EvolutionABSTRACT
Describimos el caso de un paciente varón de 50 años de edad que presentaba leiomioma cutáneo zosteriforme de región facial izquierda, intensamente doloroso, y que obtuvo mejoría clínica espectacular tras la administración diaria de 4 mg de doxazosina oral. Este tratamiento fue bien tolerado y no presentó ningún efecto adverso asociado. En la literatura médica de habla inglesa se han publicado sólo dos casos tratados con doxazosina que demostraron excelente resultado terapéutico
We report a 50-year-old man that presented a zosteriform cutaneous leiomyoma in the left facial region, intensely painful, that showed great improvement after the administration of a daily dose of 4 mg of oral doxasozine. The therapy was well tolerated and did not present any associated adverse effect. In the English medical literature only two cases successfully treated with doxasozine have been reported
Subject(s)
Male , Middle Aged , Humans , Leiomyoma/drug therapy , Adrenergic alpha-Antagonists/administration & dosage , Skin Neoplasms/drug therapy , Treatment OutcomeABSTRACT
We report a 50-year-old man that presented a zosteriform cutaneous leiomyoma in the left facial region, intensely painful, that showed great improvement after the administration of a daily dose of 4 mg of oral doxasozin. The therapy was well tolerated and did not present any associated adverse effect. In the English medical literature only two cases successfully treated with doxasozin have been reported.
Subject(s)
Adrenergic alpha-Antagonists/therapeutic use , Doxazosin/therapeutic use , Facial Neoplasms/drug therapy , Leiomyoma/drug therapy , Skin Neoplasms/drug therapy , Administration, Oral , Adrenergic alpha-Antagonists/pharmacology , Diagnosis, Differential , Doxazosin/pharmacology , Facial Neoplasms/diagnosis , Herpes Zoster/diagnosis , Humans , Leiomyoma/diagnosis , Male , Middle Aged , Piloerection/drug effects , Skin Neoplasms/diagnosisABSTRACT
El síndrome de Stevens-Johnson es una enfermedad inflamatoria aguda originada por una hipersensibilidad que incluye la piel y las membranas mucosas.Puede ser inducida por muchos factores precipitantes, desde agentes farmacológicos hasta una infección. La incidencia de reacciones cutáneasseveras secundarias a amifostina es inferior al 1%, siendo el síndrome de Stevens-Johnson una de ellas. Nosotros comunicamos un caso de síndromede Stevens-Johnson en probable relación con la administración subcutánea de amifostina subcutánea durante radioterapia
The Stevens-Johnson syndrome is an acute inflammatory disease, caused by hipersensitivity of the skin and mucous membrane. It can be induced bymany precipitant factors, including pharmacological agents and infections. The incidence rate of severe secondary cutaneous reactions is less than1%, the Stevens-Johnson syndrome being one of them. We report a case of Stevens-Johnson syndrome probably related to subcutaneous amifostineadministration during radiotherapy procedure
Subject(s)
Humans , Male , Middle Aged , Stevens-Johnson Syndrome/chemically induced , Amifostine/adverse effects , Radiotherapy/adverse effects , Tonsillar Neoplasms/radiotherapyABSTRACT
No disponible
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Subject(s)
Male , Adult , Humans , Dental Amalgam/adverse effects , Gingivitis/etiology , Hyperpigmentation/etiologyABSTRACT
El síndrome de Bazex es una dermatosis paraneoplásica caracterizada por lesiones acrales psoriasiformes que se asocia a una neoplasia subyacente. Presentamos el caso de un paciente varón de 72 años, con lesiones queratósicas, simétricas, en los pabellones auriculares, las manos y los pies, compatibles con síndrome de Bazex. En el estudio que se le realizó, se detectó una recidiva de carcinoma epidermoide de paladar blando y carcinoma de esófago poco diferenciado
Bazex syndrome is a paraneoplastic dermatosis characterized by acral psoriasiform lesions associated with an underlying neoplasm. We present the case of a 72 year old male patient with keratosic, symmetric lesions in the auricular external ears, hands and feet, consistent with Bazex Syndrome. The study conducted detected recurrent squamous cell carcinoma of soft palate and undifferentiated esophageal carcinoma
