Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain: Recommendations From a Group of Experts. / Mejoras en la atención al paciente con psoriasis pustulosa generalizada en España: recomendaciones de un grupo de expertos.

This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n = 8), an expert panel (n = 15) and patients with GPP (n = 6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.

Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain: Recommendations From a Group of Experts. / Mejoras en la atención al paciente con psoriasis pustulosa generalizada en España: recomendaciones de un grupo de expertos.

This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n=8), an expert panel (n=15) and patients with GPP (n=6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.

Pharmacogenetic biomarkers for secukinumab response in psoriasis patients in real-life clinical practice.

BACKGROUND: Prediction of the response to a biological treatment in psoriasis patients would allow efficient treatment allocation. OBJECTIVE: To identify polymorphisms associated with secukinumab response in psoriasis patients in a daily practice setting. METHODS: We studied 180 SNPs in patients with moderate-to-severe plaque psoriasis recruited from 15 Spanish hospitals. Treatment effectiveness was evaluated by absolute PASI ≤3 and ≤1 at 6 and 12 months. Individuals were genotyped using a custom Taqman array. Multiple logistic regression models were generated. Sensitivity, specificity and area under the curve (AUC) were analysed. RESULTS: A total of 173 patients were studied at 6 months, (67% achieved absolute PASI ≤ 3 and 65% PASI ≤ 1) and 162 at 12 months (75% achieved absolute PASI ≤ 3 and 64% PASI ≤ 1). Multivariable analysis showed the association of different sets of SNPs with the response to secukinumab. The model of absolute PASI≤3 at 6 months showed best values of sensitivity and specificity. Four SNPs were associated with the capability of achieving absolute PASI ≤ 3 at 6 months. rs1801274 (FCGR2A), rs2431697 (miR-146a) and rs10484554 (HLCw6) were identified as risk factors for failure to achieve absolute PASI≤3, while rs1051738 (PDE4A) was protective. AUC including these genotypes, weight of patients and history of biological therapy was 0.88 (95% CI 0.83-0.94), with a sensitivity of 48.6% and specificity of 95.7% to discriminate between both phenotypes. CONCLUSION: We have identified a series of polymorphisms associated with the response to secukinumab capable of predicting the potential response/non-response to this drug in patients with plaque psoriasis.

Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar / Multidisciplinary Management of the Adverse Effects of Apremilast

En el presente artículo, en base a una revisión de la literatura y su experiencia personal, un equipo multidisciplinar de 14 profesionales sanitarios (incluyendo dermatólogos, reumatólogos, neurólogos, gastroenterólogos, farmacéuticos y enfermeras) ha elaborado una serie de recomendaciones generales y específicas (basadas en la fisiopatología) para el manejo de los efectos adversos secundarios a apremilast que con mayor frecuencia conducen a la suspensión del tratamiento (diarrea, náuseas y cefalea). Se aportan algoritmos sencillos de manejo que incluyen aspectos clínicos de evaluación y sugerencias de tratamiento farmacológico. Los efectos adversos de apremilast pueden ser abordados desde un punto de vista multidisciplinar y la optimización en su manejo pretende proporcionar un beneficio clínico a los pacientes que los sufren

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients

Multidisciplinary Management of the Adverse Effects of Apremilast. / Manejo de los efectos adversos de apremilast desde un abordaje multidisciplinar.

We present a series of general and specific recommendations based on pathophysiologic considerations for managing the most common adverse effects of apremilast that lead to treatment discontinuation: diarrhea, nausea, and headache. The recommendations are based on a review of the literature and the experience of a multidisciplinary team of 14 experts including dermatologists, rheumatologists, neurologists, gastroenterologists, pharmacists, and nurses. We propose a series of simple algorithms that include clinical actions and suggestions for pharmacologic treatment. The adverse effects of apremilast can be managed from a multidisciplinary approach. The purpose of optimizing management is to bring clinical benefits to patients.

Epidemiology, molecular characterisation and antimicrobial susceptibility of Neisseria gonorrhoeae isolates in Madrid, Spain, in 2016.

With the aim to elucidate gonococcal antimicrobial resistance (AMR)-risk factors, we undertook a retrospective analysis of the molecular epidemiology and AMR of 104 Neisseria gonorrhoeae isolates from clinical samples (urethra, rectum, pharynx and cervix) of 94 individuals attending a sexually transmitted infection clinic in Madrid (Spain) from July to October 2016, and explored potential links with socio-demographic, behavioural and clinical factors of patients. Antimicrobial susceptibility was determined by E-tests, and isolates were characterised by N. gonorrhoeae multi-antigen sequence typing. Penicillin resistance was recorded for 15.4% of isolates, and most were susceptible to tetracycline, cefixime and azithromycin; a high incidence of ciprofloxacin resistance (~40%) was found. Isolates were grouped into 51 different sequence types (STs) and 10 genogroups (G), with G2400, ST5441, ST2318, ST12547 and G2992 being the most prevalent. A significant association (P = 0.015) was evident between HIV-positive MSM individuals and having a ciprofloxacin-resistant strain. Likewise, a strong association (P = 0.047) was found between patient age of MSM and carriage of isolates expressing decreased susceptibility to azithromycin. A decrease in the incidence of AMR gonococcal strains and a change in the strain populations previously reported from other parts of Spain were observed. Of note, the prevalent multi-drug resistant genogroup G1407 was represented by only three strains in our study, while the pan-susceptible clones such as ST5441, and ST2318, associated with extragenital body sites were the most prevalent.

PET/TC con 18F-FDG en paciente con presentación atípica de angiosarcoma cardiaco / 18F-FDG PET/CT in a patient with atypical presentation of cardiac angiosarcoma

Los tumores cardíacos o pericárdicos primarios son infrecuentes siendo más habitual la afectación metastásica. El angiosarcoma cardíaco es un tumor primario infrecuente de origen mesenquimal y de mal pronóstico por presentar metástasis en el momento del diagnóstico, y por su pobre respuesta a los tratamientos oncoespecíficos. Se describe el caso de una paciente de 74 años, que presenta un angiosarcoma cardíaco primario, con una localización infrecuente a nivel de pericardio. Se revisa la literatura y la utilidad de la PET/TC con 18F-FDG en su estadificación inicial

Primary cardiac or pericardial tumors are infrequent, metastatic involvement being more common. Cardiac angiosarcoma is a rare primary malignant tumor of mesenchymal origin. It entails a poor prognosis mostly due to frequent metastases at the time of diagnosis, as well as low response to onco-specific treatments. We describe a case of a 74-year-old patient with a primary cardiac angiosarcoma with an infrequent location at pericardium level. We review the literature and the utility of 18F-FDG PET/CT in the initial staging

18F-FDG PET/CT in a patient with atypical presentation of cardiac angiosarcoma. / PET/TC con 18F-FDG en paciente con presentación atípica de angiosarcoma cardiaco.

Primary cardiac or pericardial tumors are infrequent, metastatic involvement being more common. Cardiac angiosarcoma is a rare primary malignant tumor of mesenchymal origin. It entails a poor prognosis mostly due to frequent metastases at the time of diagnosis, as well as low response to onco-specific treatments. We describe a case of a 74-year-old patient with a primary cardiac angiosarcoma with an infrequent location at pericardium level. We review the literature and the utility of 18F-FDG PET/CT in the initial staging.

Descripción de los pacientes que reciben biológicos como primer tratamiento sistémico en el registro BIOBADADERM durante el periodo 2008-2016 / Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016

INTRODUCCIÓN Y OBJETIVOS: La utilización clínica habitual de los fármacos biológicos en el tratamiento de la psoriasis es en segunda línea, es decir, tras el uso previo de un fármaco clásico. Sin embargo, en casos particulares -particularidades del paciente o criterio médico- se realiza la indicación en primera línea. No existen estudios sobre las características demográficas, clínicas y de seguridad de los pacientes que reciben fármaco biológico en primera línea. Como objetivo primario se pretende determinar dichas características de acuerdo con la iniciación de la terapia biológica en primera o segunda línea. MATERIAL Y MÉTODO: Se realizó un estudio descriptivo, multicéntrico, de 181 pacientes que iniciaron tratamiento biológico como primer fármaco sistémico para control de su psoriasis moderada-grave, y que forman parte del Registro Español de Acontecimientos Adversos Asociados con Medicamentos Biológicos en Dermatología, entre enero de 2008 y noviembre de 2016. RESULTADOS: Los pacientes de ambos grupos son muy similares, si bien se evidencia que el grupo que recibe el biológico en primera línea presenta una edad más avanzada, sin que se justifique por gravedad de la enfermedad (PASI) ni por el tiempo de evolución de esta desde el diagnóstico. En este grupo de pacientes es más frecuente la presencia de hipertensión, diabetes y hepatopatía. No hemos encontrado diferencias en motivos de suspensión ni seguridad entre ambos grupos. CONCLUSIONES: No se han encontrado diferencias relevantes entre los 2 grupos, lo cual refuerza la seguridad de los fármacos biológicos en este contexto

INTRODUCTION AND OBJECTIVES: Biologic drugs are usually prescribed as second-line treatment for psoriasis, that is, after the patient has first been treated with a conventional psoriasis drug. There are, however, cases where, depending on the characteristics of the patient or the judgement of the physician, biologics may be chosen as first-line therapy. No studies to date have analyzed the demographics or clinical characteristics of patients in this setting or the safety profile of the agents used. The main aim of this study was to characterize these aspects of first-line biologic therapy and compare them to those observed for patients receiving biologics as second-line therapy. MATERIAL AND METHOD: We conducted an observational study of 181 patients treated in various centers with a systemic biologic drug as first-line treatment for moderate to severe psoriasis between January 2008 and November 2016. All the patients were registered in the Spanish Registry of Adverse Events Associated with Biologic Drugs in Dermatology. RESULTS: The characteristics of the first- and second-line groups were very similar, although the patients receiving a biologic as first-line treatment for their psoriasis were older. No differences were observed for disease severity (assessed using the PASI) or time to diagnosis. Hypertension, diabetes, and liver disease were all more common in the first-line group. There were no differences between the groups in terms of reasons for drug withdrawal or occurrence of adverse effects. CONCLUSIONS: No major differences were found between patients with psoriasis receiving biologic drugs as first- or second-line therapy, a finding that provides further evidence of the safety of biologic therapy in patients with psoriasis

Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016. / Descripción de los pacientes que reciben biológicos como primer tratamiento sistémico en el registro BIOBADADERM durante el periodo 2008-2016.

INTRODUCTION AND OBJECTIVES: Biologic drugs are usually prescribed as second-line treatment for psoriasis, that is, after the patient has first been treated with a conventional psoriasis drug. There are, however, cases where, depending on the characteristics of the patient or the judgement of the physician, biologics may be chosen as first-line therapy. No studies to date have analyzed the demographics or clinical characteristics of patients in this setting or the safety profile of the agents used. The main aim of this study was to characterize these aspects of first-line biologic therapy and compare them to those observed for patients receiving biologics as second-line therapy. MATERIAL AND METHOD: We conducted an observational study of 181 patients treated in various centers with a systemic biologic drug as first-line treatment for moderate to severe psoriasis between January 2008 and November 2016. All the patients were registered in the Spanish Registry of Adverse Events Associated with Biologic Drugs in Dermatology. RESULTS: The characteristics of the first- and second-line groups were very similar, although the patients receiving a biologic as first-line treatment for their psoriasis were older. No differences were observed for disease severity (assessed using the PASI) or time to diagnosis. Hypertension, diabetes, and liver disease were all more common in the first-line group. There were no differences between the groups in terms of reasons for drug withdrawal or occurrence of adverse effects. CONCLUSIONS: No major differences were found between patients with psoriasis receiving biologic drugs as first- or second-line therapy, a finding that provides further evidence of the safety of biologic therapy in patients with psoriasis.

Clocking Femtosecond Collisional Dynamics via Resonant X-Ray Spectroscopy.

Electron-ion collisional dynamics is of fundamental importance in determining plasma transport properties, nonequilibrium plasma evolution, and electron damage in diffraction imaging applications using bright x-ray free-electron lasers (FELs). Here we describe the first experimental measurements of ultrafast electron impact collisional ionization dynamics using resonant core-hole spectroscopy in a solid-density magnesium plasma, created and diagnosed with the Linac Coherent Light Source x-ray FEL. By resonantly pumping the 1s→2p transition in highly charged ions within an optically thin plasma, we have measured how off-resonance charge states are populated via collisional processes on femtosecond time scales. We present a collisional cross section model that matches our results and demonstrates how the cross sections are enhanced by dense-plasma effects including continuum lowering. Nonlocal thermodynamic equilibrium collisional radiative simulations show excellent agreement with the experimental results and provide new insight on collisional ionization and three-body-recombination processes in the dense-plasma regime.

Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad / Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality

Objetivo. Determinar la prevalencia de las úlceras por presión en pacientes hospitalizados en Medicina Interna y los factores clínicos y riesgo de muerte asociados a su presencia. Pacientes y métodos. Estudio prospectivo de cohortes con pacientes ingresados en Medicina Interna. Se recogieron la edad, sexo, presencia de úlceras por presión, grado de la úlcera, índice de Barthel, escala de Norton, categoría diagnóstica mayor, duración de la estancia hospitalaria y peso del grupo relacionado de diagnóstico. Se compararon las características clínicas de los pacientes con o sin úlceras y se analizó la mortalidad al cabo de 3 años en función de la presencia de úlceras. Resultados. Se incluyeron 699 pacientes, de los que 100 (14,3%) presentaron úlceras por presión (27 de grado I, 17 de grado II, 21 de grado III, 25 de grado IV y 10 de grado no conocido). El índice de Barthel (OR 0,985 IC95% 0,972-0,998; p=0,022) y la escala de Norton (OR 0,873 IC95% 0,780-0,997; p=0,018) se asociaron de forma independiente con las úlceras. Durante el ingreso fallecieron el 23% de los pacientes con úlceras, al cabo de un año el 68% y a los 3 años el 83%. La presencia de úlceras por presión se asoció de forma independiente con la mortalidad (HR 1,531, IC95% 1,140-2,056, p=0,005). Conclusiones. Las úlceras por presión son frecuentes en los pacientes hospitalizados en Medicina Interna y su presencia se asocia con mayor mortalidad a corto, medio y largo plazo (AU)

Objective. To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. Patients and methods. Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. Results. The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). Conclusions. Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality (AU)

Pressure ulcers in patients hospitalized in Internal Medicine: associated factors and mortality. / Úlceras por presión en pacientes ingresados en Medicina Interna: factores asociados y mortalidad.

OBJECTIVE: To determine the prevalence of pressure ulcers in patients hospitalized in internal medicine and the clinical factors and risk of death associated with its presence. PATIENTS AND METHODS: Prospective cohort study with patients hospitalized in internal medicine. We recorded the age, sex, presence of pressure ulcers, degree of ulceration, Barthel index, Norton scale, major diagnostic category, length of hospital stay and weight of the diagnosis-related groups. We compared the clinical characteristics of the patients with or without ulcers and analysed the mortality after 3 years based on the presence of ulcers. RESULTS: The study included 699 patients, 100 of whom (14.3%) had pressure ulcers (27 with grade I, 17 with grade II, 21 with grade III, 25 with grade IV and 10 with unknown grade). The Barthel index (OR 0.985; 95% CI 0.972-0.998; p=.022) and Norton scale (OR 0.873; 95% CI 0.780-0.997; p=.018) are independently associated with ulcers. Twenty-three percent of the patients with ulcers died during hospitalization, 68% died within a year, and 83% died within 3 years. The presence of pressure ulcers was independently associated with mortality (HR, 1.531; 95% CI 1.140-2.056; p=.005). CONCLUSIONS: Pressure ulcers are common in patients hospitalized in internal medicine, and their presence is associated with higher short, medium and long-term mortality.

Directrices del grupo español de psoriasis (GEP) basadas en la evidencia para el uso de medicamentos biológicos en pacientes con psoriasis en localizaciones de difícil tratamiento (uñas, cuero cabelludo, palmas y plantas) / Evidence-Based Guidelines of the Spanish Psoriasis Group on the Use of Biologic Therapy in Patients With Psoriasis in Difficult-to-Treat Sites (Nails, Scalp, Palms, and Soles)

El término de psoriasis en localizaciones de difícil tratamiento se emplea para hacer referencia a la psoriasis localizada en el cuero cabelludo, las uñas, las palmas y las plantas y que requiere un manejo diferenciado. A menudo los pacientes presentan un importante impacto físico y emocional, unido a la dificultad para controlar adecuadamente sus lesiones con tratamientos tópicos, debido a una insuficiente penetración de los principios activos y la escasa cosmeticidad de los vehículos empleados. Esta circunstancia justifica que la psoriasis en estas localizaciones pueda ser considerada grave, a pesar de su extensión limitada. La experiencia con terapias biológicas en estas localizaciones es escasa, en general en el contexto de ensayos clínicos de formas extensas de psoriasis moderada y grave, junto con series limitadas o casos aislados. En el presente artículo se presenta la calidad de la evidencia científica para los 4 agentes biológicos disponibles en España (infliximab, etanercept, adalimumab y ustekinumab) siendo de nivel i en el caso de la psoriasis ungueal (nivel de recomendación A) y algo inferior en la psoriasis del cuero cabelludo y palmoplantar

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

Evidence-based guidelines of the spanish psoriasis group on the use of biologic therapy in patients with psoriasis in difficult-to-treat sites (nails, scalp, palms, and soles).

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.

Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro / Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center

Objetivos. Presentamos los resultados a corto y largo plazo de una serie de pacientes con estenosis arteriales intracraneales (EAIC) sintomáticas tratados en nuestro centro mediante angioplastia y endoprótesis. Material y métodos. Revisión de pacientes con estenosis intracraneales > 50% sintomáticas tratados en nuestro centro mediante angioplastia y/o colocación de endoprótesis. Se recogieron los datos demográficos y los factores de riesgo vascular (hipertensión, diabetes, dislipemia, cardiopatía isquémica). Todas las lesiones tratadas se caracterizaron por su localización, grado y longitud de la estenosis. El grado de estenosis se calificó como moderado (50-70%) o grave (> 70%). En el seguimiento se evaluaron los accidentes cerebrovasculares, episodios de cardiopatía isquémica o fallecimientos ocurridos durante los 30 primeros días y en el seguimiento posterior. Resultados. Entre 2006 y 2010 se trataron 26 pacientes (21 varones y 5 mujeres) con edades comprendidas entre 44 y 79 años (media: 63 años), con 29 lesiones intracraneales. El procedimiento endovascular se realizó con éxito (angioplastia + endoprótesis) en 23 casos (92,0%). En los 30 primeros días postintervención se produjeron tres (11,5%) efectos adversos de origen vascular: un ictus, una hemorragia y un fallecimiento por trombosis de la endoprótesis. El seguimiento a largo plazo se ha realizado sobre 25 pacientes (5-46 meses). No se han detectado recurrencias de la sintomatología. Conclusión. El tratamiento endovascular de las EAIC es técnicamente factible. Las complicaciones del procedimiento a corto plazo tienen una prevalencia alta. No se ha detectado recurrencia de la sintomatología a largo plazo(AU)

Objectives. We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. Material and methods. We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. Results. Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty + stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. Conclusion. Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up(AU)

Impacto de la calidad de vida relacionada con la salud en población pediátrica y adulta española con dermatitis atópica. Estudio PSEDA / Impact of Atopic Dermatitis on Health-Related Quality of Life in Spanish Children and Adults: The PSEDA Study

Introducción y objetivos: La dermatitis atópica (DA) puede afectar tanto a niños como a adultos. Su principal síntoma es el prurito, afectando la calidad de vida relacionada con la salud (CVRS) de los pacientes. El presente manuscrito pretende evaluar el impacto de la DA en la vida de los pacientes, tanto pediátricos como adultos. Pacientes y métodos: Estudio epidemiológico, prospectivo, multicéntrico, en consultas de Dermatología. Se seleccionaron pacientes pediátricos (2-17 años) y adultos (≥18 años) con DA de más de un año de evolución, sin otra patología inflamatoria crónica dermatológica. Se recogieron variables sociodemográficas, clínicas de la DA y centradas en el paciente (cuestionarios Itch Severity Scale [ISS] y Children's Dermatology Life Quality Index [cDLQI] o Dermatology Life Quality Index [DLQI]). Resultados: Se incluyeron 151 pacientes pediátricos y 172 pacientes adultos. Los pediátricos tenían una edad media (DE) de 9,4 (4,5) años y el 51,7% eran niños; los adultos tenían una edad media (DE) de 32,3 (13,4) años y el 58,7% eran mujeres. Entre los pediátricos la puntuación del ISS aumenta con la gravedad (p<0,05); el 79% presentaban dificultad para conciliar el sueño. En adultos la frecuencia e intensidad del prurito fue superior, presentando más diferencias según la gravedad (p<0,05); el 87,1% presentaba dificultades para conciliar el sueño. En ambas poblaciones se observaron diferencias en la puntuación global y por dimensiones del DLQI/cDLQI según la gravedad de la enfermedad. Conclusiones: La DA afecta la CVRS de los pacientes, tanto pediátricos como adultos, correlacionándose con la presencia e intensidad del prurito (AU)

Background and objectives: Atopic dermatitis (AD) affects both children and adults. The main symptom of this disease is pruritus, which impacts health-related quality of life (HRQOL). The aim of this study was to evaluate the impact of AD on the lives of children and adults with this disease. Patients and methods: This was a multicenter prospective epidemiological study of children (2-17 years) and adults (≥18 years) with AD selected from dermatology offices in Spain. The patients had all had AD for at least a year and had no other chronic inflammatory skin diseases. In addition to sociodemographic information, the data collected included the clinical features of AD and the results of patient-centered questionnaires: the Itch Severity Scale (ISS), the Dermatology Life Quality Index (DLQI), and the children’s version of this questionnaire (cDLQI). Results: We studied 151 children and 172 adults. The mean (SD) age of the children was 9.4 (4.5) years and 51.7% were boys. In the case of adults, the mean age was 32.3 (13.4) years and 58.7% were women. Among the children, the ISS score increased with disease severity and in the adults, both the frequency and intensity of pruritus increased with disease severity (P <0 .05 in both cases); 79%of the children and 87.1% of the adults reported difficulty sleeping. In both populations, overall and subscale DLQI and cDLQI scores varied according to disease severity. Conclusions: AD affects HRQOL in both children and adults and its impact is correlated with the presence and intensity of pruritus (AU)

[Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center]. / Tratamiento endovascular de estenosis intracraneales sintomáticas: resultados a corto y largo plazo de un único centro.

OBJECTIVES: We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. MATERIAL AND METHODS: We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. RESULTS: Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty+stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. CONCLUSION: Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up.

Impact of atopic dermatitis on health-related quality of life in Spanish children and adults: the PSEDA study.

BACKGROUND AND OBJECTIVES: Atopic dermatitis (AD) affects both children and adults. The main symptom of this disease is pruritus, which impacts health-related quality of life (HRQOL). The aim of this study was to evaluate the impact of AD on the lives of children and adults with this disease. PATIENTS AND METHODS: This was a multicenter prospective epidemiological study of children (2-17 years) and adults (≥ 18 years) with AD selected from dermatology offices in Spain. The patients had all had AD for at least a year and had no other chronic inflammatory skin diseases. In addition to sociodemographic information, the data collected included the clinical features of AD and the results of patient-centered questionnaires: the Itch Severity Scale (ISS), the Dermatology Life Quality Index (DLQI), and the children's version of this questionnaire (cDLQI). RESULTS: We studied 151 children and 172 adults. The mean (SD) age of the children was 9.4 (4.5) years and 51.7% were boys. In the case of adults, the mean age was 32.3 (13.4) years and 58.7% were women. Among the children, the ISS score increased with disease severity and in the adults, both the frequency and intensity of pruritus increased with disease severity (P<.05 in both cases); 79% of the children and 87.1% of the adults reported difficulty sleeping. In both populations, overall and subscale DLQI and cDLQI scores varied according to disease severity. CONCLUSIONS: AD affects HRQOL in both children and adults and its impact is correlated with the presence and intensity of pruritus.