Pityriasis Rubra Pilaris: A Multicentric Case Series of 65 Spanish Patients.

INTRODUCTION: PRP is a rare entity of unknown etiopathogenesis. Lack of clinical practice guidelines makes management challenging for clinicians. OBJECTIVE: To add our experience to the corpus evidence on PRP. METHODS: This was a retrospective, descriptive, and multicentric study of 65 patients with PRP, the largest European case series of patients with PRP ever reported. RESULTS: PRP was more prevalent in men with a mean age of 51 years, yet erythrodermic forms presented in older patients (mean age, 61 years).Six (75%) pediatric patients and 10 (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. However, 26 (68%) erythrodermic patients required biologic therapy as the last and effective therapy for a mean 6.5 months to achieve complete response. CONCLUSION: Our study showed a statistical difference in terms of outcome and response to treatment between children, or patients with limited disease and patients who develop erythroderma.

Development of a care protocol in pregnancy and chronic inflammatory arthritis, in a multidisciplinary work group.

OBJECTIVE: To design a care protocol in Chronic Inflammatory Arthritis during the pre-conceptional period, pregnancy, postpartum and lactation. This protocol aims to be practical and applicable in consultations where patients with chronic inflammatory rheumatological diseases are treated, thus helping to better control these patients. Likewise, recommendations are offered on when patients could be consulted/referred to a specialized center by the physician. METHODS: A multidisciplinary panel of expert physicians from different specialties identified the key points, analyzed the scientific evidence, and met to develop the care protocol. RESULTS: The recommendations prepared have been divided into three blocks: rheumatology, gynecology and pediatrics. The first block has been divided into pre-pregnancy, pregnancy and postpartum visits. CONCLUSIONS: This protocol tries to homogenize the follow-up of the patients from the moment of the gestational desire until the year of life of the infants. It is important to perform tests in patients of childbearing age and use drugs compatible with pregnancy. If appropriate, the patient should be referred to specialized units. Multidisciplinarity (rheumatology, gynecology and pediatrics) is essential to improve the control and monitoring of these patients and their offspring.

The role of a mindful movement-based program (Movimento Biologico) in health promotion: results of a pre-post intervention study.

Introduction: Mindful movement is a comprehensive approach that integrates various bodily, emotional and cognitive aspects into physical activity, promoting overall well-being. This study assessed the impact of a mindful movement program, known as Movimento Biologico (MB), on participants psychological well-being (PWB), positive mental health (PMH), sense of coherence (SOC), and interoceptive awareness. Methods: MB program was conducted for students attending the bachelor's degree in Kinesiology and Sport Sciences of University of Perugia over 8 weeks (from October 16 to November 27, 2022). Participants were requested to fill in four questionnaires before and after the MB program: (1) 18-item PWB scale; (2) 9-item PMH scale; (3) 13-item SOC scale; (4) 32-item scale for Multidimensional Assessment of Interoceptive Awareness (MAIA). Wilcoxon signed-rank tests were used to assess changes, with significance set at p < 0.05. Results: Thirty-eight students (mean age 21.2, 60.5% male) participated. Several MAIA subscales, including noticing (p = 0.003), attention management (p = 0.002), emotional awareness (p = 0.007), self-regulation (p < 0.001), body listening (p = 0.001), and trusting (p = 0.001), showed significant improvements. PMH increased significantly (p = 0.015), and there was a significant enhancement in the autonomy subscale of PWB (p = 0.036). SOC and overall PWB also improved, though not significantly. Conclusion: The MB program significantly improved participants' positive mental health and interoceptive awareness. This likely resulted from better recognition and management of positive physiological sensations, a stronger link between physical sensations and emotions, enhanced confidence in one's body, and increased autonomy.

Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort.

INTRODUCTION: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. METHODS: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). RESULTS: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. CONCLUSIONS: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.

Adherence to Life's Essential 8 is associated with delayed biological aging: a population-based cross-sectional study.

INTRODUCTION AND OBJECTIVES: The aim of this study was to explore the potential of adhering to the American Heart Association's updated Life's Essential 8 (LE8) scores in delaying biological aging amid growing concerns about aging populations and related diseases. METHODS: A total of 18 261 adults (≥ 20 years old) were examined using National Health and Nutrition Examination Survey data from 2005-2010 and 2015-2018. The LE8 includes 8 components, covering health behaviors and factors. Acceleration of biological aging was defined as an excess of biological/phenotypic age over chronological age, assessed by using clinical biomarkers. The association between LE8 score and biological aging was explored through regression analyses. RESULTS: Each 10-point increase in LE8 scores was associated with a 1.19-year decrease in biological age and a 1.63-year decrease in phenotypic age. Individuals with high cardiovascular health (CVH) had a 90% reduction in their risk of accelerated aging based on biological age and an 81% reduction based on phenotypic age compared with individuals with low CVH. Bootstrap-based model estimates and weighted quantile sum regression suggested that health factors, particularly blood glucose, had strong impact on delaying aging. The association between smoking and biological aging seemed to differ depending on the definition of aging used. Among all subgroups, LE8 consistently correlated negatively with biological aging, despite observed interactions. Three sensitivity analyses confirmed the robustness of our conclusions. CONCLUSIONS: A higher CVH is associated with a lower risk of biological aging. Maintaining elevated LE8 levels across demographics, regardless of cardiovascular history, is recommended to delay aging and promote healthy aging, with significant implications for primary health care.

Pityriasis Rubra Pilaris: A Multicentric Case Series of 65 Spanish Patients.

INTRODUCTION: PRP is a rare entity of unknown etiopathogenesis. Lack of management guidelines makes it a challenge for clinicians. OBJECTIVE: To add our experience to increase evidence about PRP. METHODS: We performed a retrospective, descriptive and multicentric study of 65 patients with PRP, being the largest European case series of patients with PRP. RESULTS: PRP was more frequent in male patients with an average age of 51 years, but erythrodermic forms presented in older patients (average age 61 years). Six (75%) paediatric patients and ten (60%) non-erythrodermic adults controlled their disease with topical corticosteroids. On the contrary, 26 (68%) erythrodermic patients required biologic therapy as last and effective therapy line requiring an average of 6.5 months to achieve complete response. CONCLUSION: Our study showed a statistical difference in terms of outcome and response to treatment between children or patients with limited disease and patients who develop erythroderma.

Biological Identification of Skulls in Indonesian and Thai Populations: Ancestry Estimation, Sex Determination, Stature Estimation, and Age Estimation / Identificación Biológica de Cráneos en Poblaciones de Indonesia y Tailandia: Estimación de Ascendencia, Determinación del Sexo, Estimación de Estatura y Estimación de Edad

SUMMARY: This review article will present an overview of biological profiles in forensic utilities. The biological profile of the skull in the existing literature can help to identify humans, especially if the condition of the victim found is a result of mutilation or a bomb explosion. When it comes to the precision of identifying skeletal remains, the human skull is frequently cited as being first in the estimation of age and ancestry and second in terms of sex and stature. It can be an alternative to assessing the following biological parameters: sex, age, stature, and ancestry. The implementation of biological profiles in the identification process is very important considering that some cases require the assistance of forensic anthropology. This review article shows the importance of the value of skulls. The method that can be applied is craniometry which can be used to determine sex, age, stature, and estimated ancestry. Different results will occur depending on the completeness of the skull. Therefore, estimation formulas have different accurate results. Discriminant function analysis has been performed on various measurement sets and its discriminant power has been validated by many researchers. Geometric morphometric analysis has become the main tool for shape analysis and many attempts have been made to use it in analyzing skulls. Several methods supported by technology have also been developed. It is hoped that the review article will show significant differences in results between studies in Thailand and Indonesia, even though they are in the same racial group.

Este artículo presenta una descripción general de los perfiles biológicos en las utilidades forenses. El perfil biológico del cráneo en la literatura existente puede ayudar a identificar a los humanos, especialmente si la condición en la que se encuentra la víctima es el resultado de una mutilación o la explosión de una bomba. Cuando se trata de la precisión en la identificación de restos óseos, el cráneo humano se cita con frecuencia como el primero en la estimación de edad y ascendencia y el segundo en términos de sexo y estatura. Puede ser una alternativa para evaluar los siguientes parámetros biológicos: sexo, edad, estatura y ascendencia. La implementación de perfiles biológicos en el proceso de identificación es importante considerando que algunos casos requieren la asistencia de la antropología forense. Este artículo de revisión muestra la importancia del valor de las cnezas óseas. El método que se puede aplicar es la craneometría para determinar el sexo, la edad, la estatura y la ascendencia estimada. Se pueden obtener diferentes resultados dependiendo de la integridad del cráneo. Por lo tanto, las fórmulas de estimación tienen resultados precisos diferentes. Se ha realizado un análisis de función discriminante en varios conjuntos de medidas y muchos investigadores han validado su poder discriminante. El análisis a través de la morfometría geométrica se ha convertido en la principal herramienta para el análisis de formas y se ha utilizado frecuentemente en el análisis de cráneos. También se han desarrollado varios métodos apoyados en la tecnología. Se espera que este trabajo muestre diferencias significativas en los resultados entre los estudios realizados en Tailandia e Indonesia, aunque pertenezcan al mismo grupo racial.

Real-world apremilast use in biologic-naïve psoriatic arthritis patients. Data from Spanish clinical practice / Uso real de apremilast en pacientes con artritis psoriásica sin tratamiento biológico. Datos de la práctica clínica española

Introduction: Apremilast is approved for treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on apremilast effectiveness in clinical practice is limited. Methods: Observational study enrolling adult patients, across 21 Spanish centres, who had initiated apremilast in the prior 6 (±1) months and were biologic naive. Data were collected at routine follow-up visits 6 and 12 months after apremilast initiation. Primary outcome was 6 and 12-month persistence to apremilast. Secondary outcomes included Disease Activity for PsA (DAPSA), joint erosions, enthesitis, dactylitis, and patient-reported quality of life (QoL, measured using the PsA impact of disease [PsAID] questionnaire). Results: We included 59 patients. Most had oligoarticular PsA, moderate disease activity, and high comorbidity burden. Three-quarters were continuing apremilast at 6 months and two-thirds at 12 months; mean (SD) apremilast treatment duration was 9.43 (1.75) months. DAPSA scores showed improved disease activity: one-third of patients in remission or low activity at apremilast initiation versus 62% and 78% at 6 and 12 months, respectively. Eleven of 46 patients with radiographic assessments had joint erosions at apremilast initiation and none at month 12. Median (Q1, Q3) number of swollen joints was 4.0 (2.0, 6.0) at apremilast initiation versus 0.0 (0.0, 2.0) at 12 months. Incidence of dactylitis and enthesitis decreased between apremilast initiation (35.6% and 28.8%, respectively) and month 12 (11.6% and 2.4%, respectively). Over two-thirds of patients had a PSAID-9 score <4 (cut-off for patient-acceptable symptom state) at month 12. Conclusions: In Spanish clinical practice, two-thirds of PsA patients continued apremilast at 12 months, with clinical benefits at the joint level, no radiographic progression of erosions, and a positive impact on patient-reported QoL.(AU)

Introducción: Apremilast está aprobado para el tratamiento de la psoriasis y la artritis psoriásica (APs). La evidencia sobre la efectividad de apremilast en la práctica clínica es limitada. Métodos: Estudio observacional en el que se incluyó a pacientes adultos, de 21 centros españoles, que habían iniciado apremilast en los 6 (± 1) meses previos y no habían recibido biológicos. Los datos se recogieron en visitas rutinarias de seguimiento a los 6 y 12 meses del inicio de apremilast. El objetivo primario fue la persistencia de apremilast a los 6 y 12 meses. Los objetivos secundarios incluyeron la actividad de la enfermedad para APs (DAPSA), erosiones articulares, entesitis, dactilitis y la calidad de vida informada por el paciente (CdV, medida mediante el cuestionario “PsA Impact of disease [PsAID]”). Resultados: Se incluyó a 59 pacientes. La mayoría presentaba APs oligoarticular, actividad moderada de la enfermedad y alta comorbilidad. Tres cuartas partes continuaban con apremilast a los 6 meses y 2 tercios a los 12 meses; la duración media (DE) del tratamiento con apremilast fue de 9,43 (1,75) meses. Las puntuaciones DAPSA mostraron una mejora de la actividad de la enfermedad: un tercio de los pacientes en remisión o baja actividad al inicio de apremilast frente al 62 y el 78% a los 6 y 12 meses, respectivamente. Once de 46 pacientes con evaluaciones radiográficas presentaban erosiones articulares al inicio de apremilast y ninguno en el mes 12. La mediana (Q1, Q3) del número de articulaciones inflamadas fue de 4,0 (2,0, 6,0) al inicio de apremilast frente a 0,0 (0,0, 2,0) a los 12 meses. La incidencia de dactilitis y la entesitis disminuyeron entre el inicio de apremilast (el 35,6 y el 28,8%, respectivamente) y el mes 12 (el 11,6 y el 2,4%, respectivamente). Más de 2 tercios de los pacientes tenían una puntuación PSAID-9 < 4 (punto de corte del estado sintomático aceptable para el paciente) en el mes 12.(AU)

Efectos adversos cutáneos inmunomediados por los anti-TNF: revisión de 30 casos / Immune-Mediated Skin Reactions to Tumor Necrosis α Inhibitors: A Review of 30 Cases

Introducción Los fármacos biológicos inhibidores del factor de necrosis tumoral (TNF) alfa son usados para tratar diferentes enfermedades inflamatorias. A pesar de su adecuado perfil de seguridad, se han descrito reacciones paradójicas asociadas a estos tratamientos. Material y método Se ha realizado una revisión retrospectiva de los pacientes en tratamiento con un anti-TNF que hubiesen presentado una reacción paradójica con afectación cutánea visitados en el Servicio de Dermatología del Hospital Universitari Parc Taulí de Sabadell. Resultados Registramos 30 pacientes en tratamiento con un anti-TNF que desarrollaron un efecto adverso cutáneo inmunomediado en forma de psoriasis (90%), alopecia (6,7%) o dermatitis neutrofílica (3,3%). Adalimumab fue el fármaco más implicado (56,7%), seguido de infliximab (40%). La morfología de la reacción psoriasiforme más descrita es la generalizada en placas (62,9%), seguida de la pustulosis palmo-plantar (37%). El 43,3% de los pacientes mantuvieron el anti-TNF, y de ellos el 92,3% obtuvieron una resolución total y parcial. De los 5 pacientes que iniciaron otro anti-TNF, ninguno obtuvo una resolución total. De los 8 pacientes que cambiaron a un tratamiento biológico diferente al anti-TNF, el 62,5% obtuvieron una resolución total o parcial. Discusión La aparición de una reacción paradójica no siempre obliga al cambio de tratamiento biológico, puesto que se ha observado la resolución de las lesiones cutáneas con un tratamiento tópico y/o sistémico adicional en más de la mitad de los pacientes, sin necesidad de suspender el anti-TNF. Si la afectación es grave, se debe plantear el cambio de tratamiento biológico, siendo más eficaz iniciar un fármaco dirigido a una diana terapéutica distinta al anti-TNF (AU)

Background Tumor necrosis factor α (TNF) inhibitors are used to treat different inflammatory diseases. Although these biologics have an adequate safety profile, they have been associated with paradoxical reactions. Material and methods Retrospective review of patients on TNF inhibitor therapy who developed a paradoxical skin reaction and were seen at the dermatology department of Hospital Universitari Parc Taulí in Sabadell, Spain. Results We collected data on 30 patients under treatment with a TNF inhibitor who developed an immune-mediated skin reaction in the form of psoriasis (90%), alopecia (6.7%), or neutrophilic dermatitis (3.3%). The most common drugs involved were adalimumab (56.7%) and infliximab (40%). Psoriasiform reactions mostly manifested as generalized plaques (62.9%) or palmoplantar pustulosis (37%). Thirteen patients (43.3%) continued on the same TNF inhibitor and 12 of them (92.3%) achieved partial or complete resolution of lesions. Five patients were switched to a different TNF inhibitor, but none of them achieved complete resolution. Eight patients were switched to a biologic with a different target, and 5 of them (62.5%) achieved partial or complete resolution. Conclusions Paradoxical reactions during TNF inhibitor therapy do not always require a change of treatment. In our series, the addition of a topical and/or systemic treatment resolved the skin lesions in more than half of the patients, and switching to a drug with a different target was more effective. A change of strategy should be contemplated in more serious cases (AU)

[Translated article] Immune-Mediated Skin Reactions to Tumor Necrosis α Inhibitors: A Review of 30 Cases / Efectos adversos cutáneos inmunomediados por los anti-TNF: revisión de 30 casos

Background Tumor necrosis factor α (TNF) inhibitors are used to treat different inflammatory diseases. Although these biologics have an adequate safety profile, they have been associated with paradoxical reactions. Material and methods Retrospective review of patients on TNF inhibitor therapy who developed a paradoxical skin reaction and were seen at the dermatology department of Hospital Universitari Parc Taulí in Sabadell, Spain. Results We collected data on 30 patients under treatment with a TNF inhibitor who developed an immune-mediated skin reaction in the form of psoriasis (90%), alopecia (6.7%), or neutrophilic dermatitis (3.3%). The most common drugs involved were adalimumab (56.7%) and infliximab (40%). Psoriasiform reactions mostly manifested as generalized plaques (62.9%) or palmoplantar pustulosis (37%). Thirteen patients (43.3%) continued on the same TNF inhibitor and 12 of them (92.3%) achieved partial or complete resolution of lesions. Five patients were switched to a different TNF inhibitor, but none of them achieved complete resolution. Eight patients were switched to a biologic with a different target, and 5 of them (62.5%) achieved partial or complete resolution. Conclusions Paradoxical reactions during TNF inhibitor therapy do not always require a change of treatment. In our series, the addition of a topical and/or systemic treatment resolved the skin lesions in more than half of the patients, and switching to a drug with a different target was more effective. A change of strategy should be contemplated in more serious cases (AU)

Introducción Los fármacos biológicos inhibidores del factor de necrosis tumoral (TNF) alfa son usados para tratar diferentes enfermedades inflamatorias. A pesar de su adecuado perfil de seguridad, se han descrito reacciones paradójicas asociadas a estos tratamientos. Material y método Se ha realizado una revisión retrospectiva de los pacientes en tratamiento con un anti-TNF que hubiesen presentado una reacción paradójica con afectación cutánea visitados en el Servicio de Dermatología del Hospital Universitari Parc Taulí de Sabadell. Resultados Registramos 30 pacientes en tratamiento con un anti-TNF que desarrollaron un efecto adverso cutáneo inmunomediado en forma de psoriasis (90%), alopecia (6,7%) o dermatitis neutrofílica (3,3%). Adalimumab fue el fármaco más implicado (56,7%), seguido de infliximab (40%). La morfología de la reacción psoriasiforme más descrita es la generalizada en placas (62,9%), seguida de la pustulosis palmo-plantar (37%). El 43,3% de los pacientes mantuvieron el anti-TNF, y de ellos el 92,3% obtuvieron una resolución total y parcial. De los 5 pacientes que iniciaron otro anti-TNF, ninguno obtuvo una resolución total. De los 8 pacientes que cambiaron a un tratamiento biológico diferente al anti-TNF, el 62,5% obtuvieron una resolución total o parcial. Discusión La aparición de una reacción paradójica no siempre obliga al cambio de tratamiento biológico, puesto que se ha observado la resolución de las lesiones cutáneas con un tratamiento tópico y/o sistémico adicional en más de la mitad de los pacientes, sin necesidad de suspender el anti-TNF. Si la afectación es grave, se debe plantear el cambio de tratamiento biológico, siendo más eficaz iniciar un fármaco dirigido a una diana terapéutica distinta al anti-TNF (AU)

Real-world apremilast use in biologic-naïve psoriatic arthritis patients. Data from Spanish clinical practice.

INTRODUCTION: Apremilast is approved for treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on apremilast effectiveness in clinical practice is limited. METHODS: Observational study enrolling adult patients, across 21 Spanish centres, who had initiated apremilast in the prior 6 (±1) months and were biologic naive. Data were collected at routine follow-up visits 6 and 12 months after apremilast initiation. Primary outcome was 6 and 12-month persistence to apremilast. Secondary outcomes included Disease Activity for PsA (DAPSA), joint erosions, enthesitis, dactylitis, and patient-reported quality of life (QoL, measured using the PsA impact of disease [PsAID] questionnaire). RESULTS: We included 59 patients. Most had oligoarticular PsA, moderate disease activity, and high comorbidity burden. Three-quarters were continuing apremilast at 6 months and two-thirds at 12 months; mean (SD) apremilast treatment duration was 9.43 (1.75) months. DAPSA scores showed improved disease activity: one-third of patients in remission or low activity at apremilast initiation versus 62% and 78% at 6 and 12 months, respectively. Eleven of 46 patients with radiographic assessments had joint erosions at apremilast initiation and none at month 12. Median (Q1, Q3) number of swollen joints was 4.0 (2.0, 6.0) at apremilast initiation versus 0.0 (0.0, 2.0) at 12 months. Incidence of dactylitis and enthesitis decreased between apremilast initiation (35.6% and 28.8%, respectively) and month 12 (11.6% and 2.4%, respectively). Over two-thirds of patients had a PSAID-9 score <4 (cut-off for patient-acceptable symptom state) at month 12. CONCLUSIONS: In Spanish clinical practice, two-thirds of PsA patients continued apremilast at 12 months, with clinical benefits at the joint level, no radiographic progression of erosions, and a positive impact on patient-reported QoL. Trial registration number Clinicaltrials.gov: NCT03828045.

Immune-Mediated Skin Reactions to Tumor Necrosis α Inhibitors: A Review of 30 Cases. / Efectos adversos cutáneos inmunomediados por los anti-TNF: revisión de 30 casos.

BACKGROUND: Tumor necrosis factor α (TNF) inhibitors are used to treat different inflammatory diseases. Although these biologics have an adequate safety profile, they have been associated with paradoxical reactions. MATERIAL AND METHODS: Retrospective review of patients on TNF inhibitor therapy who developed a paradoxical skin reaction and were seen at the dermatology department of Hospital Universitari Parc Taulí in Sabadell, Spain. RESULTS: We collected data on 30 patients under treatment with a TNF inhibitor who developed an immune-mediated skin reaction in the form of psoriasis (90%), alopecia (6.7%), or neutrophilic dermatitis (3.3%). The most common drugs involved were adalimumab (56.7%) and infliximab (40%). Psoriasiform reactions mostly manifested as generalized plaques (62.9%) or palmoplantar pustulosis (37%). Thirteen patients (43.3%) continued on the same TNF inhibitor and 12 of them (92.3%) achieved partial or complete resolution of lesions. Five patients were switched to a different TNF inhibitor, but none of them achieved complete resolution. Eight patients were switched to a biologic with a different target, and 5 of them (62.5%) achieved partial or complete resolution. CONCLUSIONS: Paradoxical reactions during TNF inhibitor therapy do not always require a change of treatment. In our series, the addition of a topical and/or systemic treatment resolved the skin lesions in more than half of the patients, and switching to a drug with a different target was more effective. A change of strategy should be contemplated in more serious cases.

[Translated article] Immune-Mediated Skin Reactions to Tumor Necrosis α Inhibitors: A Review of 30 Cases.

BACKGROUND: Tumor necrosis factor α (TNF) inhibitors are used to treat different inflammatory diseases. Although these biologics have an adequate safety profile, they have been associated with paradoxical reactions. MATERIAL AND METHODS: Retrospective review of patients on TNF inhibitor therapy who developed a paradoxical skin reaction and were seen at the dermatology department of Hospital Universitari Parc Taulí in Sabadell, Spain. RESULTS: We collected data on 30 patients under treatment with a TNF inhibitor who developed an immune-mediated skin reaction in the form of psoriasis (90%), alopecia (6.7%), or neutrophilic dermatitis (3.3%). The most common drugs involved were adalimumab (56.7%) and infliximab (40%). Psoriasiform reactions mostly manifested as generalized plaques (62.9%) or palmoplantar pustulosis (37%). Thirteen patients (43.3%) continued on the same TNF inhibitor and 12 of them (92.3%) achieved partial or complete resolution of lesions. Five patients were switched to a different TNF inhibitor, but none of them achieved complete resolution. Eight patients were switched to a biologic with a different target, and 5 of them (62.5%) achieved partial or complete resolution. CONCLUSIONS: Paradoxical reactions during TNF inhibitor therapy do not always require a change of treatment. In our series, the addition of a topical and/or systemic treatment resolved the skin lesions in more than half of the patients, and switching to a drug with a different target was more effective. A change of strategy should be contemplated in more serious cases.

Compatibilidad de un bioinsecticida a base de Beauveria bassiana con agroquímicos: efecto en la germinación y la actividad insecticida sobre Diatraea saccharalis

Los barrenadores del tallo del género de Diatraea spp. (Lepidoptera:Crambidae) han sido reconocidos por ser la plaga de mayor impacto en el cultivo de caña de azúcar, en el que causan importantes pérdidas económicas. Para su control, una cepa colombiana de Beauveria bassiana (Bals.) Vuill (aislamiento Bv062) que demostró alta virulencia frente a larvas de D. saccharalis (Fabricius), fue utilizada para el desarrollo de un bioinsecticida formulado como un concentrado emulsionable (CE). Con el fin de integrar este bioinsecticida en un esquema de manejo integrado de plagas, es necesario evaluar su compatibilidad con los agroquímicos utilizados comúnmente en el cultivo de caña de azúcar. Para tal fin se evaluó el efecto in vitro de 11 agroquímicos (fungicidas, insecticidas y herbicidas) sobre la germinación y actividad insecticida de conidios formulados. Inicialmente el CE y los agroquímicos fueron ajustados al doble de la concentración recomendada y mezclados en proporción 1:1, se incubaron durante dos horas, y se determinó el porcentaje de germinación. Los conidios expuestos a los agroquímicos fueron también purificados y utilizados para un bioen-sayo frente a larvas de segundo instar de D. saccharalis. El CE resultó ser compatible con los herbicidas e insecticidas evaluados, manteniendo una germinación y eficacia superior al 80%. Por el contrario, el CE fue incompatible con todos los fungicidas evaua-dos. Estos resultados permiten sugerir recomendaciones de aplicación del bioplaguicida a base de B. bassiana Bv062, junto con insecticidas y herbicidas empleados en el cultivo de caña, pero se recomienda no aplicarlo de manera simultánea con fungicidas como el benomil y del grupo de triazoles. Se recomienda validar estos resultados en condiciones de campo.

Sugarcane stem borers of the genus Diatraea spp. (Lepidoptera:Crambidae) have been recognized as the pest of the greatest impact on sugarcane crops causing significant economic losses. For its control, a colombian strain of Beauveria bassiana (Bals.) Vuill (code Bv062) that showed a high virulence against D. saccharalis (Fabricius) larvae was used for a biopesticide development, formulated as emulsifiable concentrate (EC). In order to include the EC into an integrated pest management (IPM) scheme, it is necessary to evaluate its compatibility with the agrochemicals commonly used in sugarcane crops. For this purpose, the in vitro effect of 11 agrochemicals (fungicides, insecticides and herbicides) on the germination and insecticidal activity of Bv062 formulated conidia was evaluated. Initially, the EC and agrochemicals were adjusted to double the recommended concentration and mixed in a 1:1 ratio. The mixes were incubated for two hours, and the germination percentage was calculated. The conidia exposed to the agrochemicals were also purified and used for a bioassay against second instar larvae of D. saccharalis. The EC was compatible with the herbicides and insecticides, maintaining germination and efficacy higher than 80%. In contrast, EC was incompatible with all the fungicides evaluated. These results allow us to suggest recommendations for the application of the biopesticide based on B. bassiana Bv062 with insecticides and herbicides used in sugarcane crops, but it is not recommended to apply it simultaneously with fungicides such as benomyl and the triazole group. It is recommended to validate these results under field conditions.

Trichoderma spp., una alternativa para la agricultura sostenible: una revisión

En la actualidad uno de los retos a los que se enfrentan los agricultores es producir alimentos bajo las inclemencias climáticas. Para el 2050, se estima un aumento en la demanda en producción de alimentos básicos a causa del incremento demográfico, aumentando con ello el detrimento de los recursos naturales. Dentro de las alternativas biológicas está el uso de insumos a base de microorganismos benéficos, como el género Trichoderma. Los cuales se han utilizado en los campos agrícolas para el control biológico contra un gran número de fitopatógenos. Sin embargo, aún son poco conocidas otras propiedades benéficas de este género para las plantas que coloniza y el ecosistema. Se realizó una búsqueda de artículos científicos en Academic Search Ultimate, BioOne, Acsess, Esmerald, Fuente Académica, ScienceDirect y Springer, entre 2015 y 2023, con dos excepciones de años anteriores. Se utilizó la palabra clave "Trichoderma" y aquellas relacionadas con interacciones microbianas y su aplicación agrícola. Esta revisión resume los hallazgos bibliográficos actuales de este género que muestran su alta capacidad hacia el desarrollo sostenible de los agroecosistemas. Varias investigaciones reportan su capacidad de inducir la defensa vegetal, la promoción del crecimiento y desarrollo radicular, así como la estimulación y síntesis de sustancias que contribuyen a fortalecer la fertilidad del suelo. Con ello mejora los rendimientos de los cultivos a los que se encuentra asociado. En definitiva, la aplicación de Trichoderma puede coadyuvar a disminuir los efectos negativos ocasionados por el uso de agroquímicos y fertilizantes sintéticos, contribuyendo a una producción más sostenible.

Currently, one of the most critical challenges facing farmers is the production of food under adverse weather conditions. By 2050, an increase in the production of staple foods is estimated due to demographics, thereby increasing the depletion of natural resources. Among the biological alternatives is the use of inputs based on beneficial microorganisms such as the Trichoderma genus, which have been used in agricultural fields for biological control against a large number of phytopathogens. However, other beneficial properties of this genus for the plants it colonizes, and the ecosystem are still little known. Therefore, a search for scientific articles was carried out in Academic Search Ultimate, BioOne, Acsess, Esmerald, Fuente Academic, ScienceDirect and Springer, between 2015 and 2023, with two exceptions from previous years. The keyword "Trichoderma" was used and those related to microbial interactions and their agricultural application. Therefore, this review summarizes the current bibliographic findings of this genus, that shows its high capacity towards the sustainable development of agroecosystems. Several investigations report its ability to induce plant defense, promote growth and root development, and stimulate and synthesize substances that help strengthen soil fertility. This improves the yields of the crops to which they are associated. With this, the application of Trichoderma can reduce the negative effects caused by the use of agrochemicals and synthetic fertilizers, contributing to a more sustainable production.

[Perfilamiento del paciente con asma grave eosinofílica para el tratamiento biológico con Mepolizumab y su efectividad en el control de la enfermedad].

Background: Management of severe eosinophilic asthma includes typing to identify allergic, eosinophilic and non-HT2 phenotypes. Elevated eosinophil levels are associated with higher IL-5 levels. Eosinophils during their migration to target tissues secrete proteins that damage the activated bronchial epithelium and correlate with asthma severity. Mepolizumab, a humanized monoclonal antibody that binds and neutralizes IL-5. Objectives: To describe experience with the use of biological anti interleukin 5 Mepolizumab. Methods: Case report, descriptive study. We included patients with severe uncontrolled asthma, a history of rhinosinusitis with nasal polyposis and/or EREA. Eosinophils 150 cells/µL, FeNO 25 ppb and spirometry with obstructive pattern. Results: 6 women with a diagnosis of severe asthma were included. Initial eosinophil values of 180 - 630 cél/µL, IgE 176 - 2500 Ui/ml, FENO 23 -39, ACT at 2, 4 and 6 months of use, minimum of 9 and maximum end of 25. Significant improvement in the ACT test from the first two months of use, decreased inhaled steroid and 0 to 2 exacerbations in 6 months. Conclusions: There are multiple studies, there are no statistically significant reports to demonstrate superiority with the use of a specific biological, together with the different economic limitations that exist in the country. It is necessary to identify target populations with phenotypes In Mexico there are few hospitals with these therapies, it is necessary to continue with the constant evaluation and contribution of information to find the right treatment for the Mexican population. that will respond to a specific therapy and direct treatment.

Antecedentes: El manejo del asma grave eosinofílica incluye tipificación para identificar fenotipos alérgicos, eosinofílicos y no TH2. Niveles elevados de eosi- nófilos se asocia a mayor nivel de IL-5. Los eosinófilos durante su migración a los tejidos diana, secretan proteínas que dañan el epitelio bronquial activado y se correlacionan con la gravedad del asma. Mepolizumab, anticuerpo monoclonal humanizado que se une y neutraliza la IL-5. Métodos: Describir experiencia con el uso de biológico anti-interleucina 5 Mepolizumab. Objetivos: Reporte de casos, estudio descriptivo. Se incluyeron pacientes con asma grave descontrolada, antecedente de Rinosinusitis con poliposis nasal y/o EREA. Eosinófilos ≥150 células/µL, FeNO ≥25 ppb y espirometría con patrón obstructivo. Resultados: Se incluyeron 6 pacientes mujeres con diagnóstico de Asma grave. Valores iniciales de eosinófilos de 180 ­ 630 cél/µL, IgE 176 ­ 2500 Ui/ml, FENO 23 -39, ACT a los 2, 4 y 6 meses de uso, mínima de 9 y final máxima de 25. Mejoría considerable en la prueba ACT desde los primeros dos meses de uso, dismi- nucion de esteroide inhalado y 0 a 2 exacerbaciones en 6 meses. Conclusiones: Existen múltiples estudios, no se cuenta con reportes estadísticamente significativos para demostrar superioridad con el uso de algún biológico en específico, aunado a las diferentes limitantes económicas que existen en el país. Es necesario identificar poblaciones objetivo con los fenotipos que responderán a una terapia específica y dirigir el tratamiento. En México hay pocos centros hospitalarios con estas terapias, es necesario continuar con la evaluación constante y aporte de información para poder encontrar el tratamiento idóneo para la población mexicana.

Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry.

INTRODUCTION: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients. METHOD: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups. RESULT: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation. CONCLUSION: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.

Safety and effectiveness of bDMARDs during pregnancy in patients with rheumatic diseases: Real-world data from the BIOBADASER registry / Seguridad y efectividad de los FAME biológicos durante el embarazo en pacientes con enfermedades reumáticas: datos del mundo real procedentes del registro BIOBADASER

Introduction: Inflammatory rheumatic diseases usually affect women of childbearing age treated with biologic drugs. However, there is a lack of literature on the efficacy and toxicity of biologic disease-modifying drugs during pregnancy. The aim of this study was to determine the presence of pregnant patients treated with bDMARDs in a real-world dataset and to examine the impact of pregnancy and lactation on the evolution of rheumatic disease in a registry of Spanish patients.Method: This was a multicentre prospective study with a real-world setting. Information was obtained from BIOBADASER registry. Patients included are women who got pregnant until November 2020 from 19 rheumatology units. We conducted proportions, means, and standard deviations (SD) to describe the study population and the use of treatments. T-test and Chi-square test were applied to assess differences between groups.Result: Ninety cases of pregnancy were registered (n=68 full-term pregnancies; n=22 spontaneous miscarriages). Most of the cases discontinued bDMARDs during pregnancy (78.9%) but 13 cases continued treatment during pregnancy, mainly using certolizumab pegol. These cases were obtaining better management of rheumatic disease, although the differences were not statistically significant [DAS28-CRP, 2.9 (SD: 1.6) vs. 2.0 (1.2), p=.255; DAS28-ESR, 2.2 (1.0) vs. 1.7 (.5), p=.266]. No serious adverse events were reported during pregnancy and lactation.Conclusion: Being pregnant is still an uncommon condition in patients with rheumatic diseases and using bDMARDs. Our results show that rheumatic disease tended to progress better during pregnancy in patients who continued to take bDMARDs.(AU)

Introducción: Las enfermedades reumáticas inflamatorias afectan normalmente a mujeres en edad fértil tratadas con fármacos biológicos. Sin embargo, escasea la literatura sobre la eficacia y la toxicidad de los fármacos modificadores de la enfermedad (FAME) biológicos durante el embarazo. El objetivo de este estudio fue determinar la presencia de pacientes embarazadas tratadas con FAME biológicos en un conjunto de datos del mundo real y examinar el impacto del embarazo y la lactancia en la evolución de la enfermedad reumática en un registro de pacientes españoles.Método: Estudio prospectivo multicéntrico en un entorno del mundo real. La información se obtuvo del registro BIOBADASER. Los pacientes fueron mujeres embarazadas hasta el mes de noviembre del 2020, de 19 unidades de Rreumatología. Obtuvimos proporciones, medias y desviaciones estándar (DE) para describir la población de estudio y el uso de tratamientos. Se realizaron las pruebas t y χ2 para evaluar las diferencias entre grupos.Resultado:Se registraron 90 casos de embarazo (n=68 embarazos a término; n=22 abortos espontáneos). La mayoría de los casos suspendieron el tratamiento con FAME biológicos durante el embarazo (78,9%), pero 13 casos prosiguieron el tratamiento durante el embarazo, utilizando principalmente certolizumab pegol. Dichos casos obtuvieron un mejor manejo de la enfermedad reumática, aunque las diferencias no fueron estadísticamente significativas (DAS28-CRP, 2,9 [DE 1,6] vs. 2 [1,2], p=0,255; DAS28-ESR, 2,2 [1] vs. 1,7 [0,5], p=0,266). No se reportaron episodios adversos graves durante el embarazo y la lactancia.Conclusión: La situación de embarazo sigue siendo infrecuente en las pacientes con enfermedades reumáticas que utilizan FAME biológicos. Nuestros resultados reflejan que la enfermedad reumática tendió a progresar mejor durante el embarazo en las mujeres tratadas con FAME biológicos.(AU)

Desarrollo de funciones de la enfermería del trabajo en la vigilancia de la salud laboral por exposición a tóxicos: el tolueno como ejemplo / Occupational Health Nurses' Role in the Occupational Health Surveillance of Exposure to Toxics: Toluene as a Case Study

Introducción: El tolueno, hidrocarburo aromático presente en varios productos, se absorbe principalmente por vía respiratoria y afecta diferentes sistemas corporales. Los enfermeros/as del trabajo son clave para detectar exposiciones agudas y crónicas. Además, son responsables de recolectar y procesar las muestras para su biomonitorización. Sin embar-go, la información sobre los requisitos de recogida y manipulación, así como de intervencio-nes enfermeras es escasa y heterogénea. Objetivo: Revisar la bibliografía disponible sobre el tolueno y la enfermería del trabajo, iden-tificar requisitos de recogida y procesamiento de muestras, así como los signos y síntomas de exposición y relacionarlos con diagnósticos e intervenciones enfermeras.Métodos: Se realizó una revisión bibliográfica aplicando la estrategia PICO, no limitada por tipo de documento, fecha o idioma en PubMed, Web of Science y Scopus. Se clasificaron los signos y síntomas según sistema y prueba de enfermería realizada durante el examen de salud, identificando diagnósticos e intervenciones enfermeras.Resultados: No se encontraron estudios sobre tolueno y enfermería del trabajo. De 60 citas identificadas, 6 artículos señalaban requisitos de recogida de muestras. Se identificaron signos y síntomas de acuerdo a las pruebas de enfermería y se relacionaron con diagnósti-cos e intervenciones de enfermería.Conclusiones: La presencia de la enfermería del trabajo en la literatura científica sobre to-lueno es escasa. Los criterios de recogida de muestras son heterogéneos y limitados. No se han encontrado estudios que relacionen signos y síntomas de exposición al tolueno con diagnósticos e intervenciones enfermeras. Se propone un cuadro relacional novedoso. Son necesarios estudios de toxicología laboral desde la perspectiva de la enfermería del trabajo (AU)

ntroduction: Toluene, an aromatic hydrocarbon present in various products, is primarily absorbed through the respiratory tract and can affect different body organs. Occupational health nurses play a key role in detecting acute and chronic exposures. They are also re-sponsible for collecting and processing samples for biomonitoring. However, information on the collection and handling requirements, as well as nursing interventions, is scarce and heterogeneous.Aims: We reviewed the existing literature linking toluene and occupational health nursing, identified sample collection and processing requirements, as well as signs and symptoms of exposure, and related them to diagnoses and nursing interventions.Methods: We conducted a literature search using the PICO strategy, without limitations on document type, date, or language, in PubMed, Web of Science, and Scopus databases. Signs and symptoms were classified according to the system and nursing test performed during the health examination, identifying possible diagnoses and nursing interventions.Results: We found no studies linking toluene and occupational health nursing. Seven out of 60 identified documents were selected, which provided information on sample collection requirements. Signs and symptoms were identified based on nursing tests and related to diagnoses and nursing interventions.Conclusions: The presence of occupational health nursing in studies on toluene is scarce. Sample collection criteria are heterogeneous and limited. There were no studies relating signs and symptoms of toluene exposure to diagnoses and nursing interventions. Further studies on occupational toxicology are needed from a nursing perspective. (AU)

Evolution and disease.

This essay questions evolutionary or Darwinian medicine for its uncritical adherence to evolutionary theory to explain diseases, which leaves aside the very vital process that transformed an "inert planet" into a "living one" where the nascent biological order subordinated the physicochemical one to prevail. The biological order is comparable to an "infinitely diverse harmonic concert", which has created and recreated, for eons, the environments conducive to its own permanence and evolution. The arrival of homo sapiens meant the cultural order emergence, which progressively supplanted, in its effects, the biological order by causing drastic and vertiginous changes in the planetary ecosystem that silenced the evolutionary process "without time to manifest". Adaptation as an ability to overcome adverse situations is a non-sense in the "harmonic concert"; instead, it is characteristic of the cultural order that imposes inhospitable and stressful environments on humans as inescapable adaptive demands. The vital quality of the biological order is the sequential anticipation of situations of interaction with significant objects in the environment, which enables the consummation of basic vital activities, emblematic of the state of maturity of living beings. To think that evolution explains chronic diseases is not only illusory but counterproductive because it covers up the root of our problems: a humanity in constant disharmony between bellicose ethnocentrisms, perpetrator of planetary devastation, whose supreme value is profit without limits.

Este ensayo cuestiona a la medicina evolutiva o darwiniana por su adhesión acrítica a la teoría evolucionista para explicar las enfermedades, que deja de lado el propio proceso vital que transformó un planeta "inerte" en uno "viviente", donde el orden biológico naciente subordinó al fisicoquímico imperante para prevalecer. El orden biológico es equiparable a un "concierto armónico infinitamente diverso", que ha creado y recreado, por eones, los ambientes propicios para su propia permanencia y evolución. El arribo del homo sapiens significó el surgimiento del orden cultural que suplantó progresivamente en sus efectos, al orden biológico, al provocar cambios drásticos y vertiginosos en el ecosistema planetario que silenciaron el proceso evolutivo "sin tiempo para manifestarse". La adaptación como aptitud para sobreponerse a situaciones adversas, es un contrasentido en el "concierto armónico"; en cambio, es característica del orden cultural que impone a los humanos ambientes inhóspitos y estresantes como exigencias adaptativas ineludibles. La cualidad vital propia del orden biológico es la anticipación secuencial de las situaciones de interacción con los objetos significativos del ambiente, que posibilita la consumación de las actividades vitales básicas, emblema del estado de madurez de los seres vivos. Pensar que la evolución explica las enfermedades crónicas no solo es ilusorio, sino contraproducente, porque encubre la raíz de nuestros problemas: una humanidad en constante disarmonía entre etnocentrismos belicosos, perpetradora de la devastación planetaria, cuyo valor supremo es el lucro sin límites.