The impact of skin diseases on quality of life: a multicenter study / El impacto de las enfermedades cutáneas en la calidad de vida: un estudio multicéntrico

INTRODUCTION: To date, no formal study has been published regarding how Colombian patients with skin disorders could be affected according to their perception of disease. OBJECTIVE: To determine the impact in quality of life of skin diseases in a Colombian population. METHODS: This multicenter study included patients with skin disease from almost the whole country. Individuals >18 years old; of any gender; with any skin disease and who signed informed consent, were included. We applied the Colombian validated version of the Skindex-29 instrument. RESULTS: A total of 1896 questionnaires had sufficient information for the analyses. No significant differences in sociodemographic characteristics of patients who returned the questionnaire incomplete vs. complete, were found. Participants mean age was 41.5 years. There were no statistical differences in men vs. women regarding the global (p = 0.37), symptoms (p = 0.71) and emotions (p = 0.32) domains, whereas statistical differences were found in the function domain (p = 0.04; Mann-Whitney U test). Psoriasis, contact dermatitis, atopic dermatitis, urticaria, hair disorders, Hansen's disease, scars, hyperhidrosis and genital human papillomavirus disease scored the highest. Limitations. Skindex-29 score variability as a result of differences in the location of the skin lesions, their inflammatory or non-inflammatory nature, and the start of therapy. CONCLUSIONS: Even the most localized or asymptomatic skin lesion in our population leads to a disruption at some level of patient's wellness. This study adds well supported scientific data of the burden of skin diseases worldwide

INTRODUCCIÓN: En Colombia se carece de estudios que hayan evaluado formalmente el impacto de las enfermedades dermatológicas en la calidad de vida de los pacientes que las padecen. OBJETIVO: Determinar el impacto en la calidad de vida de las enfermedades cutáneas en una población colombiana. MÉTODOS: Estudio multicéntrico que incluyó a individuos>18 años de edad; de cualquier sexo, con cualquier trastorno cutáneo y que firmaron el consentimiento informado. Se aplicó la versión validada en Colombia del instrumento Skindex-29. RESULTADOS: Un total de 1.896 cuestionarios se incluyeron en el análisis. No se observaron diferencias significativas en las características sociodemográficas entre los que devolvieron el cuestionario incompleto vs. completo. La edad promedio fue de 41,5 años. No hubo diferencias significativas entre hombres y mujeres con respecto al puntaje global del instrumento, ni de los dominios sintomático o emocional, mientras que sí las hubo en el dominio funcional. Entre las enfermedades que más afectaron la calidad de vida se incluyen: psoriasis, dermatitis de contacto, dermatitis atópica, urticaria, trastornos capilares, lepra, cicatrices, hiperhidrosis y las verrugas genitales. Limitaciones. Las puntuaciones del Skindex-29 mostraron una gran variabilidad explicable por diferencias en la localización de las lesiones de la piel, su naturaleza inflamatoria/no inflamatoria, y la iniciación o no del tratamiento. CONCLUSIONES: Cualquier lesión dermatológica por más localizada o asintomática que sea, condujo a una alteración en algún grado de la calidad de vida dermatológica. Este estudio añade soporte científico a la carga de enfermedad que generan los trastornos cutáneos en el mundo

The impact of skin diseases on quality of life: A multicenter study.

INTRODUCTION: To date, no formal study has been published regarding how Colombian patients with skin disorders could be affected according to their perception of disease. OBJECTIVE: To determine the impact in quality of life of skin diseases in a Colombian population. METHODS: This multicenter study included patients with skin disease from almost the whole country. Individuals >18 years old; of any gender; with any skin disease and who signed informed consent, were included. We applied the Colombian validated version of the Skindex-29 instrument. RESULTS: A total of 1896 questionnaires had sufficient information for the analyses. No significant differences in sociodemographic characteristics of patients who returned the questionnaire incomplete vs. complete, were found. Participants mean age was 41.5 years. There were no statistical differences in men vs. women regarding the global (p=0.37), symptoms (p=0.71) and emotions (p=0.32) domains, whereas statistical differences were found in the function domain (p=0.04; Mann-Whitney U test). Psoriasis, contact dermatitis, atopic dermatitis, urticaria, hair disorders, Hansen's disease, scars, hyperhidrosis and genital human papillomavirus disease scored the highest. LIMITATIONS: Skindex-29 score variability as a result of differences in the location of the skin lesions, their inflammatory or non-inflammatory nature, and the start of therapy. CONCLUSIONS: Even the most localized or asymptomatic skin lesion in our population leads to a disruption at some level of patient's wellness. This study adds well supported scientific data of the burden of skin diseases worldwide.

New kinetic model for predicting the photoreactivation of bacteria with sunlight.

Exposure to ultraviolet radiation is a disinfection process that is used worldwide for the treatment of wastewater in order to minimize microbial contamination caused by wastewater discharge to natural waters. Once organisms have been exposed to ultraviolet radiation, they are able to repair the damage through two processes - dark repair and photoreactivation. In the work described here, the photoreactivation process after ultraviolet disinfection has been studied in pure culture of Escherichia coli ATCC 11229, ATCC 15597 and in real wastewater, using both a laboratory plant and a pilot plant. A new kinetic model is proposed that is a modification of the model proposed by Kashimada et al. [15] including a first order decay phase. This model was applied to the photoreactivation process with sunlight. The new model incorporates a decay rate constant (M(s)) for solar reactivation in order to explain correctly the decay phase detected in the experimental data for photoreactivation with sunlight. The new model fits the data obtained in reactivation experiments, thus allowing the interpretation of the kinetic parameters S(m), S(m)-S(o), k(s), and M(s) and their relationship with UV dose.

Metástasis pleural de un osteosarcoma: imagen gammagráfica / Pleural metastasis of an osteosarcoma: scintigraphic image

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[Ochronotic arthropathy: the value of bone scintigraphy in alkaptonuria]. / Artropatía ocronótica: utilidad diagnóstica de la gammagrafía ósea en la alcaptonuria.

We report the case of a 62 year old man diagnosed of alkaptonuria who was referred to our department to undergo bone scintigraphy for polyarthralgia. The patient had a history of pain in lumbar and thoracic spine, right shoulder and left knee. Bone scintigraphy showed multiple joint disease with increased uptake in both shoulders, knees and spine. Higher uptake stood out in painful right shoulder and left knee joints. Ochronotic arthropathy that is developed in alkaptonuric patients is a degenerative joint disease. X-ray studies in this patient showed marked degenerative arthrosis in knees and shoulders, without more intense involvement in the symptomatic joints. Lumbar spine X-rays showed intervertebral disk calcification with disk collapse and fusion of the vertebral bodies with relative sparing of sacroiliac joint, which is a classic feature of ochronotic arthropathy. This case highlights the utility of bone scintigraphy in the evaluation of joint involvement as well as its correlation with clinical course and potential usefulness in the follow-up of this disease.

[Diuretic renography in the diagnostic approach of prenatal hydronephrosis]. / El renograma diurético en la estrategia diagnóstica de la hidronefrosis prenatal.

OBJECTIVE: To verify the utility of diuretic renography using 99mTc-MAG3 in the evaluation of the urinary tract obstruction in patients with prenatal diagnosis of hydronephrosis. In a neonate with upper urinary tract dilatation, it is difficult to differentiate a true obstruction from a dilated non-obstructed system. MATERIAL AND METHODS: The retrospective study (january 1993-december 1998) included 40 consecutive patients selected from 181 newborns with a prenatal diagnosis of hydronephrosis. The mean age of the performance of the first renography was 2.6 months. RESULTS: The final diagnosis (once the vesicoureteral reflux was ruled out) was: ureteropelvic junction obstruction (UPJ) 16, megaureter 15, ureterocele 3 and stasis 6. Conservative treatment was applied in most of the patients. Nevertheless, 17 of them needed surgical treatment due to the high risk of the permanent renal damage. CONCLUSIONS: 1) UPJ is the most frequent cause of neonatal hydronephrosis (NH) and consequently, of the request for diuretic renographies. The renography with 99mTc-MAG3 has the greatest influence in the therapeutic decision (identifying who should be operated on and when this should be done), due to the fact that it is the disease with the highest rate of surgical interventions. 2). The surgical indication in NH is based on the diuretic renography parameters and/or on the presence of symptomatology. In our series of surgical patients, none of those who had a differential renal function <20% with regard to the contralateral one showed recuperation after surgery (control 6 months later).

Cost and Appropriateness of Treating Plasmodium falciparum Infections in the United States.

Background: Although approximately 1000 U.S. citizens per year are reported to the Centers for Disease Control and Prevention as having acquired malaria infection during foreign travel, little information exists with regard to the cost and appropriateness of malaria therapy received in the United States. Methods: Data on treatment of U.S. citizens reported to the Centers for Disease Control and Prevention (CDC) as having acquired Plasmodium falciparum malaria in 1988-1989 while traveling in subSaharan Africa were collected by phone interview. These data were used to derive a relative index of illness severity, to estimate the costs of malaria-specific therapy, and to assess adherence to existing therapy recommendations. All monetary values throughout this study will be expressed in U.S. dollars. Results: Of 142 patients, 110 (77%) were classified as having mild, 21 (15%) as having moderate, and 11 (8%) as having severe infections. Two (1.4%) deaths were reported. Overall, the mean (6 standard deviation) cost of treatment per case was $2743.51 (6 8416.82; range $191.75 to $79,801.73). Estimated with relation to severity, the median cost for treatment per case was $467.54 for mild, $2701.16 for moderate, and $12,515.52 for severe infections. Forty-two (30%) of these patients had at least one element of therapy that was inconsistent with recommendations current at the time of the study; 27(19%) received chloroquine; 12 (9%) received primaquine unnecessarily; eight (6%) received inappropriate dosages of pyrimethamine/sulfadoxine (Fansidar)*; and three (2%) received potentially inappropriate dosing regimens of quinine. Conclusions: The relatively low fatality rate, and the fact that 70% of patients received appropriate therapy suggests that the overall standard of care for what is a relatively infrequent disease in the United States is good. However, because of rapidly changing drug resistance patterns, both physicians and travelers need to remain informed to avoid the costs and risks of this potentially severe, but easily preventable infectious disease. (J Travel Med 2:16-21, 1995)

The relation between urinary 5-hydroxyindoleacetic acid levels and the ratio of tryptophan to other large neutral amino acids placed in the stomach.

We assayed 5-hydroxyindoleacetic acid (5-HIAA) in urine samples (3- or 6 1/2-hr collection) after individual rats received 6-8 ml of water, of amino acids in solution, or of glucose by stomach tube. Tryptophan (Trp) solutions caused dose-related increases in urinary 5-HIAA; these were blocked when animals received carbidopa, an inhibitor of peripheral aromatic amino acid decarboxylase. The concurrent administration of a large neutral amino acid (LNAA; valine or isoleucine) with oral Trp, in high doses probably sufficient to compete with Trp for transport into gut cells, blocked the Trp-induced rise in urinary 5-HIAA. Concurrent administration of glycine (not a LNAA) in equivalent doses did not. Pretreatment with pyridoxine blocked the Trp-induced rise in urinary 5-HIAA but not that in brain serotonin (5-hydroxytryptamine, 5HT). These observations confirm the previous suggestion that while brain serotonin synthesis depends on the plasma Trp/LNAA ratio (which varies inversely with the proportion of protein to total calories in the diet), gut serotonin synthesis depends largely on the Trp/LNAA ratio in the dietary protein itself (and, probably, within the gut lumen postprandially). The range of molar Trp/LNAA ratios at which free LNAAs significantly diminish the effects of ingested Trp on gut serotonin synthesis (as reflected by urinary 5-HIAA) is similar to the range found in dietary proteins.

Failure of decreased serotonin uptake or monoamine oxidase inhibition to block the acceleration in brain 5-hydroxyindole synthesis that follows food consumption.

The acceleration in brain serotonin synthesis produced by injecting rats with tryptophan or allowing them to consume a carbohydrate diet was not blocked by the prior elevation of brain serotonin levels (by administration of a MAO inhibitor: Lilly 51641) or by a treatment (chlorimipramine administration) that decreases impulse flow along serotoninergic neurons.