Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation. / Registro de Melanoma de la Academia Española de Dermatología y Venereología (REGESMEL): descripción y datos en el primer año de funcionamiento.

INTRODUCTION: The incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. METHODS: REGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. RESULTS: A total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. CONCLUSIONS: The distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

[Poor prognostic factors in patients hospitalized for COVID-19].

BACKGROUND: The clinical spectrum of COVID-19 varies from no or mild symptoms to pneumonia with fatal complications. The aim of the study was to find predictors of mortality and admission in the intensive care unit (ICU) in patients hospitalized for COVID-19. METHODS: Retrospective study of a cohort of patients admitted for COVID-19 between March 2020 and February 2021. Demographic, clinical, radiological and laboratory variables were described at admission. Independent predictors of mortality and ICU admission were identified by means of backward stepwise logistic regression and described in terms of odds ratio (OR) and 95% confidence interval (95%CI). RESULTS: A total of 883 patients were included, 51.8% men with a mean age of 68; 1.8% readmissions. 17.6% of patients died (n=154). The independent predictors of mortality were age (OR=1.071; 95%CI: 1.046-1.095), percentage of oxygen saturation (SatO2) (OR=0.938; 95%CI: 0.903-0.974), diastolic blood pressure (DBP, OR= 0.972; 95%CI: 0.955-0.989), creatinine (OR=1.516; 95%CI: 1.088-2.113), INR (OR=1.199; 95%CI: 1.012-1.419) and sodium (OR=1.082; 95%CI: 1.037-1.128). Eight percent of patients were admitted to ICU; the independent predictors were: male sex (OR=2.079; 95%CI: 1.099-3.935), age (OR=0.960; 95%CI: 0.942-0.979), SatO2 (OR=0.925; 95%CI: 0.889-0.962), creatinine (OR=1.551; 95%CI: 1.118-2.152) and C-reactive protein (CRP, OR=1.003; 95%CI: 1.000-1.007). CONCLUSION: The identification of independent predictors of mortality (age, SatO2, DBP, creatinine, INR, sodium) and ICU admission (sex, age, SatO2, creatinine, and CRP) allowed for the stratification of patients to adapt clinical care protocols to these findings, thereby improving medical decisions.

Factores de mal pronóstico en pacientes hospitalizados por COVID-19 / Poor prognostic factors in patients hospitalized for COVID-19

Fundamento: El espectro clínico de la COVID-19 varía entre sintomatología leve o ausente hasta neumonías con complicaciones mortales. El objetivo del estudio fue determinar los factores predictivos de mortalidad e ingreso en cuidados intensivos (UCI) en pacientes hospitalizados por COVID-19. Metodología: Estudio retrospectivo de una cohorte de pacientes ingresados por COVID-19 entre marzo de 2020 y febrero de 2021. Se describieron las variables demográficas, clínicas, radiológicas y analíticas al ingreso. Los predictores independientes de mortalidad e ingreso en UCI se identificaron mediante regresión logística por pasos hacia atrás y se describieron como odds ratio (OR) e intervalo de confianza al 95% (IC95%). Resultados: Se incluyeron 883 pacientes, 51,8% varones y edad media 68 años; el 1,8% reingresó. Fallecieron 154 pacientes (17,6%); los predictores independientes de mortalidad fueron: edad (OR=1,071; IC95%: 1,046-1,095), porcentaje de saturación de oxígeno (SatO2) (OR=0,938; IC95%: 0,903-0,974), tensión arterial diastólica (PAD, OR=0,972; IC95%: 0,955-0,989), creatinina (OR=1,516; IC95%: 1,088-2,113), INR (OR=1,199; IC95%: 1,012-1,419) y sodio (OR=1,082; IC95%: 1,037-1,128). El 8% de los pacientes ingresaron en UCI; las variables predictoras independientes fueron: sexo masculino (OR=2,079; IC95%: 1,099-3,935), edad (OR=0,960; IC95%: 0,942-0,979), SatO2 (OR=0,925; IC95%: 0,889-0,962), creatinina (OR=1,551; IC95%: 1,118-2,152) y proteína C reactiva (PCR, OR=1,003; IC95%: 1,000-1,007). Conclusiones: La identificación de predictores independientes de mortalidad (edad, SatO2, PAD, creatinina, INR, sodio) y de ingreso en UCI (sexo, edad, SatO2, creatinina y PCR) permite estratificar a los pacientes y adaptar los protocolos de atención clínica a estos hallazgos, mejorando las decisiones médicas.(AU)

Background: The clinical spectrum of COVID-19 varies from no or mild symptoms to pneumonia with fatal complications. The aim of the study was to find predictors of mortality and admis-sion in the intensive care unit (ICU) in patients hospitalized for COVID-19. Methods: Retrospective study of a cohort of patients admitted for COVID-19 between March 2020 and February 2021. Demographic, clinical, radiological and laboratory variables were described at admission. Independent predictors of mortality and ICU admission were identified by means of backward stepwise logistic regression and described in terms of odds ratio (OR) and 95% confidence interval (95%CI). Results: A total of 883 patients were included, 51.8% men with a mean age of 68; 1.8% readmissions. 17.6% of patients died (n=154). The independent predictors of mortality were age (OR=1.071; 95%CI: 1.046-1.095), percentage of oxygen saturation (SatO2) (OR=0.938; 95%CI: 0.903-0.974), diastolic blood pressure (DBP, OR= 0.972; 95%CI: 0.955-0.989), creatinine (OR=1.516; 95%CI: 1.088-2.113), INR (OR=1.199; 95%CI: 1.012-1.419) and sodium (OR=1.082; 95%CI: 1.037-1.128). Eight percent of patients were admitted to ICU; the independent predictors were: male sex (OR=2.079; 95%CI: 1.099-3.935), age (OR=0.960; 95%CI: 0.942-0.979), SatO2 (OR=0.925; 95%CI: 0.889-0.962), creatinine (OR=1.551; 95%CI: 1.118-2.152) and C-reactiveprotein (CRP, OR=1.003; 95%CI: 1.000-1.007). Conclusion: The identification of independent predictors of mortality (age, SatO2, DBP, creatinine, INR, sodium) and ICU admission (sex, age, SatO2, creatinine, and CRP) allowed for the stratification of patients to adapt clinical care protocols to these findings, thereby improving medical decisions.(AU)

[What risk factors are associated with mortality and readmissions in osteoporotic hip fracture?] / ¿Qué factores de riesgo se asocian con la mortalidad y los reingresos en la fractura de cadera osteoporótica?

INTRODUCTION AND OBJECTIVE: Hip fracture in the elderly leads to long hospital stays, readmissions and mortality. OBJECTIVE: To identify risk factors associated with mortality and readmissions in elderly with hip fracture. PATIENTS AND METHODS: Prospective observational study in people over 65years with hip fracture between October-2017 and November-2018, followed for 12months (128 patients). STATISTICAL ANALYSIS: SPSS vs27.0. RESULTS: 6 (4.7%) patients were readmitted at 1 month; at year 24 (19.4%); 55 (44.4%) consulted for emergencies; 4 (3.1%) died during admission, and 26 (20.3%) in 12months; hospital stay 6.5 (SD: 4.80) days. Those with a previous Barthel less than 85 (6 [8.5%] vs 0 [0%]; P=.037) and less EuroQol5D (6 [10.0] vs 0 [0%]; P=.011) were readmitted more at one month. Those taking anticoagulants (OR: 3.33 (1.13-9.81); P=.003) and those with high surgical risk (18 [23.4%] vs 1 [5.6%]) were readmitted more after one year; P=.038). There was higher intra-episode mortality with renal failure (OR: 34.2 [3.25-359.93]; P=.003) and decompensated heart failure (OR: 23.8 [2.76-205.25]; P=.015). Higher mortality at one year in those older than 85years (OR: 4.3 [1.48-12.49]; P=.007); in those taking benzodiazepines (OR: 2.86 [1.06-7.73]; P=.038); if Barthel was less than 85 (OR: 2.96 [1.1-7.99]; P=.027) and if EuroQol5D was low (0.249 vs 0.547; P=.025). Those operated after 72h (24 [57.1%] vs. 29 [38.2%]; P=.047) consulted more for the emergency department. CONCLUSIONS: Renal failure and cardiac decompensation increased intra-episode mortality. Older age, benzodiazepines, and previous low functionality and low EuroQol5D increased mortality at one year. They were readmitted more if higher surgical risk, previously anticoagulated and worse quality of life and functionality.

Influence of COVID-19 confinement on the size of malignant skin tumours surgically removed at a Spanish hospital.

The COVID-19 pandemic required people to confine themselves to their homes where possible, and disrupted normal hospital activities. We examine whether this lockdown generated changes in the size of the tumours. We compared the dimensions of the surgically removed malignant skin tumours from the first 150 patients treated after the confinement ended in Spain (22 May 2020) with those of the last 150 patients to receive such treatment before the confinement began (13 March 2020). Data on tumour surface area were collected from pathology reports. Overall, no significant difference was seen in the tumour sizes. However, among men, the tumours removed after confinement were significantly larger (P < 0.05). Controversy exists over how the reduction in the number of tumours diagnosed during lockdowns might have influenced the characteristics of tumours. In this study, no overall difference was seen in the size of the tumours removed, although those removed from men after confinement were larger.

[Cross-cultural adaptation and Spanish validation of Patient Satisfaction Questionnaire in dermatology (PSQ-18)]. / Validación y adaptación transcultural del cuestionario de satisfacción en Dermatología (PSQ-18).

BACKGROUND AND OBJECTIVE: Patient satisfaction has become one of the most important outcome measures of quality of care. This study aimed to present the translation, cultural adaptation and validation of a Spanish version of the Patient Satisfaction Questionnaire (PSQ-18) in a sample of Spanish dermatology patients. METHODS: Cross-cultural linguistic adaptation and translation-backtranslation processes were performed following accepted international guidelines. The psychometric properties, reliability and construct validity were evaluated with Cronbach's alpha and confirmatory factorial analysis respectively. The intraclass correlation coefficient was calculated in a test-retest study, which was conducted on randomly selected participants twice with a 14-21 days interval. RESULTS: 240 participants completed the cross-culturally adapted Spanish questionnaire agreed by the researchers. Internal consistency was high (Cronbach's alpha coefficient of 0.834) and confirmatory factorial analysis showed a good model fitting to the model proposed in the original version of the scale. The intraclass correlation coefficients for all the items on the questionnaire were higher than 0.8. CONCLUSIóN: PSQ-18 proved to be a valid and reliable instrument, with psychometric properties suitable for the assessment of satisfaction among dermatology patients.

Asociación entre trastornos neurocognitivos según MiniMental State examination y control glicémico en Diabéticos Mayores de 80 años

Es conocida la relación entre la diabetes y la demencia según numerosos estudios, siendo estas enfermedades crónicas no transmisibles de gran impacto en la salud pública. En la actualidad existen diversos estudios sobre el control glicémico en pacientes diabéticos adultos mayores, población en la cual se han encontrado controversias sobre esta temática, específicamente en el control glicémico estricto, en especial en población muy mayor. El objetivo del estudio es determinar la asociación entre trastornos neurocognitivos según MiniMental State Examination y control glicémico adecuado en adultos mayores diabéticos de 80 años en comparación a los no controlados, atendidos en el Centro Médico Naval entre 2017 y 2018. Se realizó un estudio analítico, transversal, retrospectivo, análisis secundario de base de datos. La muestra final fue de 66 participantes. Se evaluó el control glicémico y el grado de trastorno neuro cognitivo (TNC). Se realizó un análisis descriptivo de las variables principales y un análisis bivariado comparando las covariables con la variable dependiente. Finalmente, las variables significativas en el análisis bivariado fueron incluidas en el modelo de regresión de Poisson. En los resultados se observó que el 92.42% no tuvo un control glicémico adecuado y presentaron trastornos neurocognitivos el 22.73% de los participantes. El valor de glucosa promedio en el grupo sin TNC fue de 99.53 ± 16.26 y del grupo con TNC el cual fue de 117.40 ± 55.01; además el valor de hemoglobina glicosilada fue en promedio de 7.96% ± 0.55 en el grupo con TNC y de 5.81 ± 0.54% en grupo sin TNC. En el modelo de regresión ajustado se obtuvo un valor de 1.13 (1.11-1.26). Se concluye que los pacientes con mal control glicémico tuvieron más riesgo de sufrir deterioro de la función cognitiva.

The relationship between diabetes and dementia is well known according to múltiple studies. These non-transmissible chronic conditions have a great impact in public health. Nowadays there are several studies that discuss the glycemic control in elderly diabetic patients and there have been controversies about this topic, especially in the strict glycemic management in very old populations. The objective of the study is to determine the relationship between cognitive impairment according to MiniMental State Examination procedure in appropriately controlled glycemic index in 80 years old diabetic adults versus not appropriately controlled, who were monitored at the Navy Medical Center between 2017 and 2018. The research consisted of an analytical, transversal and retrospective secondary analysis of a database. The final sample consisted of 66 participants. The glycemic control and the degree of neurocognitive impairment were evaluated. A descriptive analysis of the main variables was made and a bivariate analysis comparing the covariables with the dependent variable. Finally, all the meaningful variables in the bivariate analysis were included in the Poisson regression model. In the results it was observed that 92.42% did not have and adequate glycemic control and 22.73% of those presented neurocognitive impairments (NCI). The mean glucose value in the group without NCI was 99.53 ±16.26 and the group with NCI 117.40 ± 55.01. Furthermore, the glycosylated hemoglobin was on average of 7.96% ± 0.55 in the NCI group and 5.81 ± 0.54 % in the group without NCI. In the adjusted regression model, the value obtained was 1.13 (1.11-1.26). It was concluded that the patients with an inadequate glycemic control were more at risk of suffering cognitive decline.

Redes sociales y dermatitis atópica: estudio descriptivo transversal / Social Networks and Atopic Dermatitis: Cross-Sectional Descriptive Study

ANTECEDENTES: Las redes sociales se han convertido en una herramienta clave para la búsqueda y difusión de información médica. OBJETIVO: Describir las características de las páginas relacionadas con la dermatitis atópica en las redes sociales, la temática de sus publicaciones y el grado de seguimiento que se realiza de ellas. MATERIAL Y MÉTODOS: Se seleccionaron páginas, grupos o cuentas relacionadas con la dermatitis atópica en Facebook, Twitter y Linkedin durante los meses de enero y febrero de 2020. De cada una de ellas se recogieron: el país de origen, año de creación, objetivo, presencia de enlaces a páginas web, existencia de correo electrónico y número de seguidores. Además, se realizó un análisis de las temáticas más frecuentes en las últimas publicaciones de las páginas con más seguidores de cada red social. RESULTADOS: Se incluyeron en el estudio un total de 257 páginas, grupos o cuentas (171 en Facebook, 59 en Twitter y 27 en Linkedin). Facebook obtuvo un mayor número medio (±DT) y total de seguidores (1416,71±3722,63). Los grupos de apoyo a pacientes fueron el tipo de página más frecuente (63%), aunque aquellas clasificadas como empresas o venta de productos obtuvieron un mayor número de seguidores (p < 0,035). Se analizaron 909 publicaciones, siendo «Información general sobre dermatitis atópica» la temática más frecuente (27,94% del total). CONCLUSIONES: Nuestros hallazgos ponen de manifiesto la importancia de definir claramente el papel y las limitaciones de estas plataformas para orientar futuras campañas de información y desarrollar nuevos modelos centrados en el paciente con dermatitis atópica

BACKGROUND: Social networks have become key tools for finding and disseminating medical information. OBJECTIVE: To describe the characteristics of social network postings on atopic dermatitis, the content that is posted, and the number of followers of pages, groups, or accounts. MATERIAL AND METHODS: We selected pages, groups, or accounts related to atopic dermatitis on Facebook, Twitter, and Linkedin during January and February of 2020. For each site, group, or account we recorded country of origin, year created, purpose, presence of links, provision of a contact email, and number of followers. We also analyzed the topics treated in recent content posts on the pages with the largest numbers of followers in each network. RESULTS: A total of 257 pages, groups, or accounts were included: Facebook, 171; Twitter, 59; and LinkedIn, 27. Facebook had the largest total number of pages and mean (SD) number of followers: 1416.71 (3722.63). Patient support groups accounted for most of the pages (63%), but businesses or product offers had more followers (P <.035). Of the 909 posts of informative content we analyzed, the most frequent topic was "general information about atopic dermatitis" (27.94%). CONCLUSIONS: Our findings show the importance of clearly defining the roles and limitations of social media platforms for designing future information campaigns and new patient-centered approaches to reaching patients with atopic dermatitis

Social Networks and Atopic Dermatitis: Cross-Sectional Descriptive Study. / Redes sociales y dermatitis atópica: estudio descriptivo transversal.

BACKGROUND: Social networks have become key tools for finding and disseminating medical information. OBJECTIVE: To describe the characteristics of social network postings on atopic dermatitis, the content that is posted, and the number of followers of pages, groups, or accounts. MATERIAL AND METHODS: We selected pages, groups, or accounts related to atopic dermatitis on Facebook, Twitter, and Linkedin during January and February of 2020. For each site, group, or account we recorded country of origin, year created, purpose, presence of links, provision of a contact email, and number of followers. We also analyzed the topics treated in recent content posts on the pages with the largest numbers of followers in each network. RESULTS: A total of 257 pages, groups, or accounts were included: Facebook, 171; Twitter, 59; and LinkedIn, 27. Facebook had the largest total number of pages and mean (SD) number of followers: 1416.71 (3722.63). Patient support groups accounted for most of the pages (63%), but businesses or product offers had more followers (P <.035). Of the 909 posts of informative content we analyzed, the most frequent topic was "general information about atopic dermatitis" (27.94%). CONCLUSIONS: Our findings show the importance of clearly defining the roles and limitations of social media platforms for designing future information campaigns and new patient-centered approaches to reaching patients with atopic dermatitis.

Acropustulosis infantil: a propósito de un caso / Infantile acropustulosis: A case report

La acropustulosis infantil es una entidad poco frecuente en Pediatría. Aparece habitualmente en niños menores de 2 años y se caracteriza por brotes de pápulas eritematosas muy pruriginosas que se convierten en vesículas o pústulas, fundamentalmente en zonas acrales (dorso de las manos y los pies). Habitualmente se resuelven de manera espontánea y requieren únicamente tratamiento sintomático. Presentamos el caso de un paciente varón de 6 meses diagnosticado de acropustulosis infantil con resolución espontánea (AU)

Infantile acropustulosis is a rare entity in Pediatrics. It usually appears in children under 2 years of age and it is characterized by pruritic erythematous papules that turn into vesicles or pustules; mainly in acral areas (back of the hands and feet). Acropustulosis usually resolves spontaneously and requires only symptomatic treatment. We present the case of a six-month-old boy diagnosed with childhood acropustulosis with spontaneous resolution (AU)

Tratamiento de verrugas víricas con sinecatequinas de té verde / Viral wart treatment with green tea sinecatechins

No disponible

Curas húmedas en dermatitis atópica. Nuestra experiencia / Wet wraps in atopic dermatitis. Our experience

En ocasiones, los brotes de dermatitis atópica pueden ser graves y de difícil control, resistentes a los tratamientos habituales. En estos casos podemos recurrir al empleo de curas húmedas, un procedimiento con buenos resultados y escasos efectos secundarios. Presentamos una serie de casos de cinco pacientes con brotes moderados-graves resistentes al tratamiento convencional, tratados mediante curas húmedas con betametasona o propionato de fluticasona diluidos al 10% en la crema hidratante durante un intervalo de tiempo de entre 4-6 días. Se obtuvo la resolución completa del brote en cuatro casos, continuándose en el caso restante las curas de forma domiciliaria durante 2-3 días más, con posterior resolución completa. Ningún paciente presentó efectos adversos (AU)

Occasionally, atopic dermatitis outbreaks can be severe and difficult to control, resistant to standard treatments. In these cases we can use wet wraps, a procedure with good results and few side effects. We present five patients with moderate to severe outbreaks resistant to conventional treatment treated with wet wraps with betamethasone or fluticasone propionate 10% diluted for 4-6 days. Complete resolution was obtained in four cases, the last one continued by domiciliary wet wraps for 2-3 days with final complete resolution. Any patient had adverse effects (AU)

Lycopodium clavatum exine microcapsules enable safe oral delivery of 3,4-diaminopyridine for treatment of botulinum neurotoxin A intoxication.

3,4-Diaminopyridine has shown promise in reversing botulinum intoxication, but poor pharmacokinetics and a narrow therapeutic window limit its clinical utility. Thus, we developed a pH-dependent oral delivery platform using club moss spore exines. These exine microcapsules slowed 3,4-diaminopyridine absorption, limited its seizure activity, and enabled delivery of doses which prolonged mouse survival after botulism neurotoxin A intoxication.