Studying regression of seborrheic keratosis in lichenoid keratosis with sequential dermoscopy imaging.

BACKGROUND: Lichenoid keratosis (LK) is a well-described entity that has been proposed to represent a regressive response to a pre-existent epidermal lesion. AIMS: To evaluate the natural evolution of a series of cases showing the intermediate stage of the regression of seborrheic keratosis in LK using sequential dermoscopy imaging over time. MATERIAL AND METHODS: A series of lesions with dermoscopic areas of seborrheic keratosis and LK in the same tumor were consecutively collected for over 3 years at the Dermatology Department of the Hospital de Sant Pau i Santa Tecla, Tarragona, Spain. Sequential dermoscopic images of each case were collected quarterly for 1 year. At the end of the follow-up, all the lesions were biopsied. RESULTS: A total of 22 cases were collected. At the end of the follow-up, the LK part increased in all the lesions. In 11 cases (50%), the seborrheic keratosis part disappeared completely, and in another 5 cases (22.7%), seborrheic keratosis comprised only 10% of the remaining area. CONCLUSIONS: These dermoscopic study findings support the proposal that LK represents a regressive response to a pre-existent epidermal lesion, in this case seborrheic keratosis.

Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia.

BACKGROUND: Pneumococcal diseases remain a major cause of morbidity and mortality worldwide. Updated data on drug-resistance from different populations may be important to recognize changes in disease patterns. This study assessed current levels of penicillin resistance among Streptococcus Pneumoniae causing pneumonia in Spanish middle age and older adults. METHODS: Antimicrobial susceptibility was tested for 104 consecutive isolates of Streptococcus pneumoniae recovered from patients 50 years or older with radiographically confirmed pneumonia in the region of Tarragona (Spain) between 2002 and 2007. According to the minimum inhibitory concentration of tested antimicrobials (penicillin, erythromycin, cefotaxime and levofloxacin) strains were classified as susceptible or resistant. Antimicrobial resistance was determined for early cases (2002-2004) and contemporary cases (2005-2007). RESULTS: Twenty-seven (25.9%) were penicillin-resistant strains (19 strains with intermediate resistance and 8 strains with high resistance). Penicillin-resistance was higher in 2002-2004 than in 2005-2007 (39.5% vs 18.2%, p = 0.017).Of 27 penicillin-resistant strains, 10 (37%) were resistant to erythromycin, 8 (29.6%) to cefotaxime, 2 (7.4%) to levofloxacin, and 4 (14.8%) were identified as multidrug resistant. Case-fatality rate was higher among those patients who had an infection caused by any penicillin susceptible strain (16.9%) than in those with infections due to penicillin-resistant strains. CONCLUSION: Resistance to penicillin among Streptococcus pneumoniae remains high, but such resistance does not result in increased mortality in patients with pneumococcal pneumonia.

Effects of annual influenza vaccination on winter mortality in elderly people with chronic heart disease.

AIMS: Although there is general agreement for the recommendation of the influenza vaccine to elderly and high-risk adults, the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial. In this study, we have assessed the effects of annual influenza vaccination on winter mortality in older adults with chronic heart disease. METHODS AND RESULTS: Cohort study that included 1340 Spanish community-dwelling individuals 65 years or older who had chronic heart disease (congestive heart failure or coronary artery disease) followed from January 2002 to April 2005. Annual influenza vaccine status was a time-varying condition and primary outcome was all-cause death during the study period. Multivariable Cox proportional-hazard models adjusted by age, sex, and comorbidity were used to evaluate vaccine effectiveness. Influenza vaccination was associated with a significant reduction of 37% in the adjusted risk of winter mortality during the overall period 2002-2005. The attributable mortality risk reduction in vaccinated people was 8.2 deaths per 1000 person-winters. We estimated that one death was prevented for every 122 annual vaccinations (ranging between 49 in Winter 2005 and 455 in Winter 2003). CONCLUSION: Our results suggest a benefit from the influenza vaccination and support an annual vaccination strategy for elderly people with cardiac diseases.

Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: results of the EVAN-65 study.

A prospective cohort study evaluating the clinical effectiveness of the 23-valent pneumococcal polysaccharide vaccine was conducted among 1298 Spanish older adults with chronic respiratory diseases (bronchitis, emphysema or asthma) who were followed between 2002 and 2005. Main outcomes were all-cause community-acquired pneumonia (CAP) and 30 days mortality from CAP. The association between vaccination and the risk of each outcome was evaluated by multivariable Cox proportional-hazard models adjusted for age and comorbidity pneumococcal vaccination did not alter significantly the risk of overall CAP (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.56-1.07) and 30 days mortality from CAP (HR: 0.87; 95% CI: 0.33-2.28). However, a borderline significant reduction of 30% in the risk of all-cause hospitalisation for CAP was observed among vaccinated subjects (HR: 0.70; 95% CI: 0.48-1.00; p=0.052). The effectiveness of the vaccine on the combined endpoint of pneumococcal and unknown organism infections reached 34% (HR: 0.66; 95% CI: 0.43-1.01; p=0.059). Although our findings suggest moderate benefits from the vaccination, the evidence of clinical effectiveness appears limited.