Study of Risk Factors for the Presence of Interdigital Nevi of the Feet. / Estudio de los factores de riesgo de la presencia de los nevus interdigitales de los pies.

BACKGROUND AND OBJECTIVES: No studies focused on counting the interdigital acquired melanocytic nevi (AMN) of the foot (IDNf) have ever been conducted. Therefore, our objective was to study the relationship between the presence of IDNf and the total number of AMN in the feet and the rest of the body, the racial phenotypic characteristics, and other risk factors for melanoma. MATERIAL AND METHODS: We conducted a cross-sectional observational study with 255 patients ≥18 years old who attended our Dermatology Unit from September 2020 through February 2021, and included all AMN ≥1mm from the feet and ≥2mm from the rest of the bod. The association between the variables was studied using univariate and multivariate logistic regression models. RESULTS: The presence of IDNf was significantly and independently associated with the presence of plantar AMN and body counts ≥50 AMN. However, no significant differences were observed regarding sex, age, personal history of melanoma, presence of nevi on the dorsum of the foot, history of sunburn or UV rays, or racial phenotypic characteristics. CONCLUSIONS: The presence of IDNf is associated with a higher count of plantar nevi and total AMN in the body, meaning that interdigital spaces of the foot-anatomical expansions of the sole and other possibly genetic causes-could be responsible for the number of AMN found in this location, as these regions are not photoexposed.

Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. / [Artículo traducido] Tratamientos tópicos e intralesionales en hidradenitis supurativa. Una revisión sistemática de la literatura.

BACKGROUND AND OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.

Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review.

BACKGROUND AND OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and EMBASE databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.

Exposure to biologic therapy before and during pregnancy in patients with psoriasis: Systematic review and meta-analysis.

Biologicals have transformed the management of severe disease phenotypes in psoriasis and are often prescribed in women of childbearing age. However, information on safety of biologicals in pregnancy are lacking. We conducted a systematic review and meta-analysis aimed to describe the characteristics and pregnancy outcomes in women with psoriasis exposed to biologics within 3 months before or during pregnancy, and to estimate the pooled prevalence of spontaneous, elective and total abortions, and congenital malformations in their newborns. Bibliographic searches were performed in the PubMed, Embase, Scopus and Web of Science databases up to 14 April 2022. No restrictions on sample size or publication date were applied. Review performance complied with PRISMA guidelines, and two reviewers assessed randomized controlled trials and nonrandomized studies reporting pregnancy outcomes in women exposed to biologics indicated for psoriasis during the pre-gestational and/or gestational period. Studies focusing on rheumatologic or gastroenterological immune-mediated inflammatory diseases were excluded. Regardless of data heterogeneity, a random-effects model was used to pool prevalence estimates. We included 51 observational studies, involving 739 pregnancies exposed to approved biologics for psoriasis. Administration was mostly (70.4%) limited to the first trimester, and the most common drug was ustekinumab (36.0%). The estimated prevalence of miscarriage was 15.3% (95% confidence interval [CI] 12.7-18.0) and elective abortions, 10.8% (95% CI 7.7-14.3). Congenital malformations occurred in about 3.0% (95% CI 1.6-4.8) of live births exposed to biologics during pregnancy. Altogether, exposure to biologics for psoriasis during pregnancy and/or conception does not seem to be associated with an increased risk of miscarriage/abortion or congenital malformations, showing similar rates to the general population. These results suggest that biologic drugs are safe and pose an acceptable risk to the foetuses/neonates.

Are the chilblain-like lesions observed during the COVID-19 pandemic due to severe acute respiratory syndrome coronavirus 2? Systematic review and meta-analysis.

The expansion of the COVID-19 pandemic has been accompanied by numerous reports of chilblain-like lesions (CLL) in different countries; however, the pathogenesis of these lesions is still unclear. This systematic review and meta-analysis aimed to assess the prevalence of COVID-19 (diagnosed using PCR and/or serology) in patients with CLL. We undertook a literature search in PubMed, Embase, and Scopus (to 15 March 2021), including studies that reported on the number of patients with CLL with positive PCR and/or serology for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or with a clinical suspicion of COVID-19. Regardless of data heterogeneity, a random-effects model was used to pool prevalence estimates. The meta-analysis included 63 original studies, involving 2919 cases of CLL. A subgroup of these patients underwent diagnostic tests for COVID-19 (PCR: n = 1154, 39.5%; serology: n = 943, 32.3%). The pooled prevalence of COVID-19 in the overall sample and in the subgroup who were tested for COVID-19 was, respectively: (i) positive PCR: 2.6% [95% confidence interval (CI) 1.9% to 3.4%] and 5.5% (95% CI, 3.7-7.7%); (ii) positive serology for SARS-CoV-2: 7.2% (95% CI, 4.7-10.2%) and 11.8% (95% CI, 7.9-16.3%); and (iii) positive PCR and/or serology, 15.2% (95% CI, 10.4-20.7%) and 7.5% (95% CI, 5.1-10.3%). Altogether, a small proportion of diagnostic tests for SARS-CoV-2, both PCR and serologies, show positive results in patients with CLL.

[Cerebrospinal fluid drainage and deep systemic hypothermia with total absence of circulation for spinal cord protection during surgery on the thoracic aorta]. / Drenaje de líquido cefalorraquídeo e hipotermia profunda sistémica con parada circulatoria total como método de protección medular durante la cirugía de aorta torácica.

A 53-yearold man with a dissecting aneurysm of Stanford's type-B or Crawford's type I measuring 8.5 cm in diameter underwent replacement of the distal descending aorta and the thoracic aorta using techniques for spinal cord protection involving deep hypothermia at 17 degrees C and lasting 38 minutes with total absence of circulation. A subarachnoid catheter was inserted at the lumbar level to monitor spinal fluid pressure as well as to provide drainage if pressure exceeded 10 mm Hg. During surgery 60 ml was drained, followed by 95 ml after surgery on the same day and 325, 262 and 169 ml on the following three days. No signs of neurological deficit were observed during the postoperative period. Clinical course was good until hypovolemic shock developed 27 days after the operation due to upper digestive tract bleeding caused by two duodenal ulcers that perforated the gastroduodenal artery. Emergency antrectomy and vagotomy were performed. The patient died from multiple organ failure. Spinal cord injury continues to be one of the most feared complications after excision of thoracic and thoracoabdominal aorta aneurysm. Currently, various ways of protecting the spinal cord are practiced, including drainage of cerebrospinal fluid, partial bypass of the femoral artery, intercostal artery reimplantation, drug therapy and local spinal and/or systemic hypothermia. These methods, together with shorter clamping time have achieved a reduction in the incidence of spinal cord injuries.

Drenaje de líquido cefalorraquídeo e hipotermia profunda sistémica con parada circulatoria total como método de protección medular durante la cirugía de aorta torácica / Cerebrospinal fluid drainage and deep systemic hypothermia with total absence of circulation for spinal cord protection during surgery on the thoracic aorta

A un paciente de 53 años con aneurisma disecante tipo B de Stanford o tipo I de Crawford de 8,5 cm de diámetro se le realizó recambio de cayado aórtico distal y aorta torácica, usando como métodos de protección medular hipotermia profunda de 17 °C durante 38 min y parada circulatoria total, además de un catéter subaracnoideo lumbar para la monitorización de la presión del líquido cefalorraquídeo y drenaje del mismo cuando la presión superaba los 10 mmHg. El día de la intervención se drenaron 60 ml intraoperatoriamente y 95 ml en el postoperatorio y en los 3 días siguientes 325, 262 y 169 ml, sucesivamente. No se objetivó ningún déficit neurológico durante el postoperatorio. La evolución del paciente fue buena hasta que 27 días después de la intervención sufrió un shock hipovolémico por una hemorragia digestiva alta debida a 2 úlceras duodenales que perforaban la arteria gastroduodenal; se realizó antrectomía y vagotomía de urgencia. El paciente falleció 4 días después por fallo multiorgánico. La lesión de la médula espinal continúa siendo una de las complicaciones más temidas tras resecciones de aneurisma de aorta torácica y toracoabdominales. En la actualidad se utilizan diferentes métodos de protección medular como drenaje del líquido cefalorraquídeo, derivación parcial a la arteria femoral, reimplantación de arterias intercostales, fármacos e hipotermia medular local y/o sistémica que junto a un tiempo de pinzamiento corto han logrado reducir la incidencia de alteraciones medulares (AU)

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[Prolonged neurologic deficiency after accidental spinal anesthesia]. / Déficit neurológico prolongado tras anestesia espinal accidental.

A case of severe prolonged neurological deficit following inadvertent spinal anesthesia is presented. Intradural block occurred after a test dose of Bupivacaine and vasoconstrictor when inserting an epidural catheter for post-thoracotomy pain-relief treatment. The likely triggering and etiological factors responsible for the neurological damage after spinal anesthesia were studied and evaluated, mainly those toxic and traumatic. Special mention of the local anesthetics and sodium bisulfite used is made. Preventive measures for this sort of complication are suggested.