Eczema en los pies en una consulta de alergia cutánea: estudio retrospectivo de 13 años / Foot Eczema in a Skin Allergy Unit: Retrospective Study of 13 Years

Introducción: La dermatitis de pies es un motivo frecuente de consulta en las Unidades de Alergia Cutánea. Objetivos: Conocer las características demográficas, el diagnóstico y los alérgenos más frecuentemente implicados en los pacientes a los que se les han practicado pruebas epicutáneas. Material y métodos: Estudio observacional transversal en un Servicio de Dermatología con todos los pacientes estudiados con la batería estándar española durante 13 años (2004-2016). Comparamos los resultados de las pruebas epicutáneas y los diagnósticos finales entre los distintos subgrupos de pacientes con eczema de pies. Resultados: Estudiamos un total de 3.265 pacientes; 308 (9,4%) presentaban eczema en los pies, 176 (57,9%) tenían afectación solo en los pies y 132 (42,1%) afectación concomitante en manos y pies. En el subgrupo con afectación exclusiva en los pies se observó un mayor porcentaje de pacientes con pruebas epicutáneas positivas (61,5% solo pies, 53,4% manos y pies). En el subgrupo de afectación concomitante de manos y pies se observó un menor porcentaje de pruebas epicutáneas positivas entre los menores de 18 años (51,3% en menores y 64,4% en mayores). El alérgeno con relevancia presente más frecuente en todos los subgrupos fue el dicromato potásico. La dermatitis de contacto alérgica (49,1%) fue el diagnóstico más frecuente en los pacientes con afectación exclusiva de los pies, mientras que en los pacientes con eczema en manos y pies fue la psoriasis (33,6%) en los adultos y la dermatitis atópica en los menores de 18 años (60,0%). Conclusión: La realización de pruebas epicutáneas es de gran utilidad tanto en los pacientes con eczema de afectación exclusiva de los pies como en aquellos con afectación concomitante de manos y pies

Introduction: Foot eczema is a common complaint encountered by skin allergists. Objective: To study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved. Material and methods: Cross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema. Results: Of the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients >18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%). Conclusion: Patch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement

Foot Eczema in a Skin Allergy Unit: Retrospective Study of 13 Years. / Eczema en los pies en una consulta de alergia cutánea: estudio retrospectivo de 13 años.

INTRODUCTION: Foot eczema is a common complaint encountered by skin allergists. OBJECTIVE: To study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved. MATERIAL AND METHODS: Cross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema. RESULTS: Of the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients >18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%). CONCLUSION: Patch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement.

Ectopic third molar in condylar region.

Inclusion of the third molar is relatively frequent in oral and maxillofacial surgery, but ectopic placement is quite rare. Only a few cases of third molar inclusion in the condyle region of the mandible have been reported. Presented here are two cases of ectopic location of a third molar in the condyle of the mandible. A description of the management of this pathology through open surgery and extraction of the molar is given, while preserving the anatomy of the condylar region.

[Eating habits in physical therapy students]. / Hábitos dietéticos en estudiantes de fisioterapia.

OBJECTIVE: a) To know the eating and exercising habits of undergraduate Physical Therapy students; b) To promote awareness among these future health professionals and educators of the need to foster adequate eating habits among patients and the general population. METHODS: A dietary and physical activity questionnaire, regarding a seven-day period, distributed among students of the School of Physical Therapy (University of Valladolid) in the city of Soria, Spain (n = 131; sex (m/f): 38/93). RESULTS: Results show that a high percentage of the subjects follow the recommendations of the new Nutritional Pyramid of the Spanish Nutrition Society (SEN) regarding intake of meat, fish, milk, dairy products and exercise habits. This is not the case, however, for products such as pasta, bread and cereals, vegetables, fruits, legumes and olive oil. Furthermore, fast food is taken, on average, once a week despite the recommended sporadic monthly intakes. CONCLUSIONS: According to results, formative programmes should be carried out to enable these students to encourage healthy diets. Thus, diseases related to non-healthy eating habits could be prevented, and information on the issue could be spread among the population.

Hábitos dietéticos en estudiantes de fisioterapia / Eating habits in physical therapy students

Objetivos: a) Conocer los hábitos dietéticos y de ejercicio físico de los alumnos de la EU de Fisioterapia de Soria. b) Concienciar a nuestros alumnos, como futuros profesionales de la salud y agentes de Educación Sanitaria, para que potencien y promuevan una alimentación adecuada entre la población general y entre sus pacientes. Metodología: Encuesta a los alumnos de la Escuela Universitaria de Fisioterapia de Soria sobre el consumo de alimentos y ejercicio físico realizado a lo largo de siete días (n = 131; 93 mujeres y 38 varones). Resultados: Tomando como referencia la nueva Pirámide Nutricional de la Sociedad Española de Nutrición (SEN), en cuanto a consumo de grupos de alimentos como carne, pescado, leche y derivados y práctica de ejercicio físico, hemos detectado que un porcentaje alto de nuestros alumnos consumen estos alimentos y realizan ejercicio físico de acuerdo a las recomendaciones hechas por la SEN. Para el resto de los grupos de alimentos, pasta, pan y cereales, verduras y hortalizas, frutas, legumbres, y aceite de oliva, su consumo dista mucho de cumplir las recomendaciones. El consumo de comida rápida se sitúa en una media de una vez por semana superando la recomendación de hacerlo de forma esporádica o alguna vez al mes. Conclusiones: En función de los resultados obtenidos, parece conveniente realizar algún tipo de intervención educativa entre nuestros alumnos para que ellos sean capaces de promover una alimentación saludable. De esta forma podrán prevenir enfermedades relacionadas con malos hábitos dietéticos y transmitir estos conocimientos a la población. No se puede hacer promoción de algo que no se conoce o no se practica

Objective: a) To know the eating and exercising habits of undergraduate Physical Therapy students; b) To promote awareness among these future health professionals and educators of the need to foster adequate eating habits among patients and the general population. Methods: A dietary and physical activity questionnaire, regarding a seven-day period, distributed among students of the School of Physical Therapy (University of Valladolid) in the city of Soria, Spain (n = 131; sex (m/f): 38/93). Results: Results show that a high percentage of the subjects follow the recommendations of the new Nutritional Pyramid of the Spanish Nutrition Society (SEN) regarding intake of meat, fish, milk, dairy products and exercise habits. This is not the case, however, for products such as pasta, bread and cereals, vegetables, fruits, legumes and olive oil. Furthermore, fast food is taken, on average, once a week despite the recommended sporadic monthly intakes. Conclusions: According to results, formative programmes should be carried out to enable these students to encourage healthy diets. Thus, diseases related to nonhealthy eating habits could be prevented, and information on the issue could be spread among the population

[Prevalence of osteoporosis assessed by quantitative ultrasound calcaneus measurements in institutionalized elderly population]. / Prevalencia de osteoporosis en ancianos institucionalizados, mediante ultrasonografía de calcáneo.

OBJECTIVES: To analyze using quantitative ultrasound of calcaneus (QUS) the prevalence of osteoporosis in institutionalized elderly people, in order to contribute to state reliable criteria (T-score units) for the diagnosis of osteoporosis which allow advances in bone fracture prevention. MATERIAL AND METHODS: Elderly people (n=171) were divided into separate groups according to sex and age criteria (three decades, from 70 to 90 years) and analyzed using QUS. RESULTS: Both globally and in the younger groups, women showed significantly lower values than men in all densitometry variables (p < 0.001). In the oldest group only T-score and BUA showed statistical differences (p = 0.039 y p = 0.025, respectively). The prevalence of osteoporosis in women was higher than in men whichever criteria were applied in all age groups. Applying the WHO criteria with QUS, the prevalence of osteoporosis in global population is close to that stated by DEXA using the same criteria. CONCLUSIONS: QUS could be useful to assess the bone mass evolution with age and for the diagnosis and monitoring of osteoporosis. In our elderly population, the WHO criteria for DEXA, are also the most suitable ones for QUS utilization.

Prevalencia de osteoporosis en ancianos institucionalizados, mediante ultrasonografía de calcáneo / Prevalence of osteoporosis assessed by quantitative ultrasound calcaneus measurements ininstitutionalized elderly population

Objetivos: Analizar mediante ultrasonografía cuantitativa de calcáneo (QUS) la prevalencia de osteoporosis en ancianos institucionalizados, para contribuir al establecimiento de un punto de corte en unidades de T-score en el diagnóstico de osteoporosis, lo que permitiría avanzar en la prevención de fracturas. Material y métodos: Se analizó mediante QUS a la población (n = 171) por sexos y por grupos de edad (tres décadas entre los 70 y los 90 años). Resultados: Para todas las variables densitométricas, tanto de forma global como en los grupos de edad más jóvenes, las mujeres mostraron valores significativamente más bajos que los varones (p < 0,001). En el grupo de mayor edad sólo se aprecian diferencias significativas en la T-score y en el BUA (p = 0,039 y p = 0,025, respectivamente). Bajo cualquiera de los criterios aplicados y en todos los grupos de edad, la prevalencia en las mujeres es superior a la del varón. Aplicando los criterios de la OMS con QUS, la prevalencia de osteoporosis en la población total se acerca a la establecida mediante DEXA con esos mismos criterios. Conclusión: La técnica QUS puede ser muy útil para valorar la evolución de la masa ósea con la edad y para el diagnóstico y seguimiento de la osteoporosis. En nuestra población anciana, los criterios de la OMS para la técnica DXA, son también los más adecuados para el empleo de la técnica QUS

Objectives: To analyze using quantitative ultrasound of calcaneus (QUS) the prevalence of osteoporosis in institutionalized elderly people, in order to contribute to state reliable criteria (T-score units) for the diagnosis of osteoporosis which allow advances in bone fracture prevention. Material and methods: Elderly people (n=171) were divided into separate groups according to sex and age criteria (three decades, from 70 to 90 years) and analyzed using QUS. Results: Both globally and in the younger groups, women showed significantly lower values than men in all densitometry variables (p < 0.001). In the oldest group only T-score and BUA showed statistical differences (p = 0.039 y p = 0.025, respectively). The prevalence of osteoporosis in women was higher than in men whichever criteria were applied in all age groups. Applying the WHO criteria with QUS, the prevalence of osteoporosis in global population is close to that stated by DEXA using the same criteria. Conclusions: QUS could be useful to assess the bone mass evolution with age and for the diagnosis and monitoring of osteoporosis. In our elderly population, the WHO criteria for DEXA, are also the most suitable ones for QUS utilization

Ejercicio físico en el ancianoinstitucionalizado / Physical exercise in the institutionalized elderly

El objetivo fundamental en la atención al anciano es mejorar su salud, bienestar y calidad de vida. Desde nuestra perspectiva hemos confeccionado un programa de actividad física especialmente adaptado a las necesidades del anciano. Este programa deberá incluir los siguientes tipos de ejercicios: - 30-40 por ciento del programa para el trabajo aeróbico.- 30-40 por ciento para mejorar flexibilidad y fuerza.- 10 por ciento para mejorar el equilibrio.- 10 por ciento para mejorar coordinación.- 10 por ciento para mejorar velocidad de reacción (AU)

A double-blind, placebo-controlled oral challenge study with lyophilized larvae and antigen of the fish parasite, Anisakis simplex.

BACKGROUND: The third-stage larvae of Anisakis simplex may be a hidden source of allergens in fish. The objective was to determine whether the ingestion of lyophilized A. simplex larvae, or antigen, induces clinical symptoms in a group of A. simplex-sensitized patients. METHODS: Double-blind, placebo-controlled oral challenges were conducted in 11 individuals who had experienced allergic reactions after eating fish. Another patient had chronic urticaria unrelated to the ingestion of fish. All patients had positive skin tests and specific IgE determinations for A. simplex and negative skin tests to a battery of fish species. Conjunctival tests with A. simplex extracts were conducted in all patients and in five controls. The 12 patients received capsules containing either lactose or one, five, or 25 lyophilized larvae of A. simplex at 2-h intervals in a double-blind fashion. The highest single dose was 100 larvae. ECP and tryptase levels in serum were measured before and after the last oral challenge. Lyophilized antigen was also given to five patients. RESULTS: None of the 12 patients experienced a positive reaction after the ingestion of the placebo, the lyophilized larvae, or the antigen. Tryptase and ECP levels before and after challenges did not change significantly. Conjunctival provocation tests were positive in 11 out of the 12 patients and in none of the controls. CONCLUSIONS: The ingestion of 100 lyophilized A. simplex larvae, or its equivalent in antigen, does not induce clinical symptoms in individuals with a clinical history and laboratory findings of hypersensitivity to A. simplex. The data suggest that only the ingestion of live larvae may be capable of inducing allergic manifestations.

Beer-induced anaphylaxis: identification of allergens.

BACKGROUND: We report on a 21-year-old atopic woman who developed urticaria, angioedema of the face, and wheezy dyspnea shortly after drinking beer and after eating a corn-made snack. METHODS: Skin prick tests and specific IgE determinations to beer ingredients and cereal extracts were performed. Immunoblotting inhibition assays were carried out to investigate possible common allergens shared by barley and malt with corn. RESULTS: Skin prick tests and specific IgE measurements with beer, barley, malt, wheat, corn, rye, rice, and oat flour were positive. Ten pollen-allergic patients showed negative skin tests to beer. Double-blind, placebo-controlled, oral challenge tests with sodium metabisulfite and wheat flour were negative. Immunoblotting demonstrated several IgE-binding bands at 31-56 kDa in malt and barley extracts, and a major band at 38 kDa in the beer extract. Immunoblot inhibition assays showed that malt extract was able to inhibit most of the IgE-binding bands in wheat and corn extracts, whereas corn did not produce significant inhibition to barley and malt extracts. CONCLUSIONS: This patient developed type I hypersensitivity to barley/malt and corn. Although she also showed IgE reactivity to wheat and other cereals, no symptoms were elicited upon ingestion of these cereals, probably indicating latent sensitization to them.

Galectin-3 down-regulates IL-5 gene expression on different cell types.

Galectin-3 is an animal lectin, formerly named epsilon-binding protein or Mac-2, which has been described to play an important role in some inflammatory processes by the implication of different cells and the increase in cell adhesion functions through laminin binding activity. In this work we analyzed the role of galectin-3 in the modulation of Th2 cytokines that have an important role in the development of the inflammatory response. We have found that the addition of galectin-3 to human eosinophils, the eosinophilic cell line EoL-3, PBMC, and an Ag-specific T cell line (CD4+) produced a selective inhibition of IL-5 transcription. No inhibitory effect was found on the IL-4 mRNA transcription rate. The inhibitory effect on IL-5 transcription was reversed by incubation with lactose and using specific Ab against galectin-3. Galectin-3 is able to induce inhibition of the IL-5 released in the supernatants from PBMC stimulated with phorbol 12,13-dibutyrate and anti-CD3. Similar results were obtained when a T-specific cell line was stimulated with Ag. Also, EoL-3 stimulated with anti-CD32 produced IL-5 protein, the synthesis of which was partially inhibited by galectin-3. The present results demonstrate that galectin-3 induces a selective down-regulation of IL-5 expression in different cell types, opening important new possibilities in the regulation of the allergic reactions.

Olive pollen allergy: searching for immunodominant T-cell epitopes on the Ole e 1 molecule.

BACKGROUND: The amino-acid and nucleotide sequence of Ole e 1 (the major antigen of olive pollen) has been described and the IgE antibody response to this major allergen was associated with DR7/DQ2 antigens. With this previous data we try to define the T-cell epitopes implicated in Ole e 1 reactivity. OBJECTIVES: To study the recognition of T cells (derived from allergic and non-allergic Ole e 1 patients) to Ole e 1 synthetic peptides in order to define immunodominant T-cell epitopes. METHODS: We have compared the proliferative response of the peripheral blood mononuclear cells from Ole e 1 sensitized patients vs. non-sensitized controls, induced by 14 Ole e 1 synthetic peptides. Thirty subjects were classified in two groups: group 1 (non-responders against Ole e 1, n=16) and group 2 (Ole e 1 responders, n=14), according to their clinical parameters and the presence or not in their sera of the significant Ole e 1 IgE antibody levels. RESULTS: Our results shown that it is possible to find T cells reactive to Ole e 1 peptides in patients with and without significant levels of Ole e 1 IgE antibodies. However, the percentage of response was higher in patients with IgE antibodies 71.4% vs 25%), and the recognition profile was different: the control group showed a broad reactivity pattern, in contrast, the response by the 'Ole e 1 responders' group was mainly directed against three peptides of the carboxi-terminal region, peptides 10 (91-102), 12 (109-120) and 13 (119-130), with a response frequency of 35.7, 28.5 and 28.5%, respectively. By direct and inhibition test no antibody response was found against the synthetic peptides. CONCLUSIONS: Our data suggest that the regions between 91 and 102 and 109-130 aminoacids on the Ole e 1 molecule are immunodominant T-cell epitopes. These epitopes are not recognized by IgE antibodies.