Adaptación y validación de la versión española del cuestionario Actinic Keratosis Quality of Life(AKQoL) / Adaptation and validation of the Spanish version of the Actinic Keratosis Quality of Life questionnaire

INTRODUCCIÓN Y OBJETIVO: Actualmente existen cuestionarios para valorar el impacto en la calidad de vida en pacientes con cáncer cutáneo. Sin embargo, no se cuenta con un instrumento específico aplicable a casos con queratosis actínica. El objetivo de este estudio ha sido la traducción y adaptación transcultural del cuestionario Actinic Keratosis Quality of Life (AKQoL) al español. PACIENTES Y MÉTODOS: El cuestionario original se tradujo al español de acuerdo con el modelo metodológico para la adaptación transcultural de medidas autoadministradas. Se han calculado diversos índices para la fiabilidad general y la validez, incluyendo el coeficiente alfa de Cronbach y test-retest (correlación de rango de Spearman y prueba de Bland-Altman), mientras que para la validez concurrente se utilizó el coeficiente de correlación de Pearson entre los resultados de los cuestionarios AKQoL y Skindex-29. RESULTADOS: La versión final se administró a un total de 621 sujetos con queratosis actínica con una puntuación media ±desviación estándar de 5,25±4,73 (0 a 25 puntos). El análisis de fiabilidad mostró una alfa de Cronbach de 0,84. La correlación entre el Skindex-29 (1,87±4,07) y AKQoL (1,97±2,98) fue de 0,344 (p = 0,002; rho de Spearman), con una proporción de varianza compartida del 11,8%. CONCLUSIONES: Mediante los distintos procesos de traducción, adaptación transcultural y validación en distintos grupos hemos generado una herramienta comprensible y fiable para valorar el impacto de la queratosis actínica en la calidad de vida de pacientes de nuestro entorno

BACKGROUND AND OBJECTIVE: While there are questionnaires for evaluating the effects of skin cancer on patient quality of life, there are no specific questionnaires available in Spanish for evaluating quality of life in patients with actinic keratosis. The aim of this study was to translate and culturally adapt the Actinic Keratosis Quality of Life (AKQoL) questionnaire into Spanish. PATIENTS AND METHODS: The original questionnaire was translated into Spanish following the guidelines for the cross-cultural adaptation of self-report measures. Several measures of general reliability and validity were calculated, including Cronbach α for internal consistency and the Spearman rank-order correlation coefficient and a Bland-Altman plot for test-retest reliability. To test concurrent validity, we used the Pearson correlation coefficient to measure the correlation between AKQoL and Skindex-29 scores. RESULTS: The final version of the questionnaire was administered to 621 patients with actinic keratosis, who scored a mean (SD) of 5.25 (4.73) points (total possible score, 0-25). The Cronbach α reliability coefficient analysis was 0.84. The correlation between the mean (SD) score on the Skindex-29 (1.87 [4.07]) and on the AKQoL (1.97 [2.98] was 0.344 (P=.002, Spearman's rho), with a proportion of shared variance of 11.8%. CONCLUSIONS: The translation, cross-cultural adaptation, and validation of the original AKQoL produced a reliable, easily understandable questionnaire for evaluating the impact of actinic keratosis on the quality of life of patients in our setting

Adaptation and validation of the Spanish version of the Actinic Keratosis Quality of Life questionnaire. / Adaptación y validación de la versión española del cuestionario Actinic Keratosis Quality of Life (AKQoL).

BACKGROUND AND OBJECTIVE: While there are questionnaires for evaluating the effects of skin cancer on patient quality of life, there are no specific questionnaires available in Spanish for evaluating quality of life in patients with actinic keratosis. The aim of this study was to translate and culturally adapt the Actinic Keratosis Quality of Life (AKQoL) questionnaire into Spanish. PATIENTS AND METHODS: The original questionnaire was translated into Spanish following the guidelines for the cross-cultural adaptation of self-report measures. Several measures of general reliability and validity were calculated, including Cronbach α for internal consistency and the Spearman rank-order correlation coefficient and a Bland-Altman plot for test-retest reliability. To test concurrent validity, we used the Pearson correlation coefficient to measure the correlation between AKQoL and Skindex-29 scores. RESULTS: The final version of the questionnaire was administered to 621 patients with actinic keratosis, who scored a mean (SD) of 5.25 (4.73) points (total possible score, 0-25). The Cronbach α reliability coefficient analysis was 0.84. The correlation between the mean (SD) score on the Skindex-29 (1.87 [4.07]) and on the AKQoL (1.97 [2.98] was 0.344 (P=.002, Spearman's rho), with a proportion of shared variance of 11.8%. CONCLUSIONS: The translation, cross-cultural adaptation, and validation of the original AKQoL produced a reliable, easily understandable questionnaire for evaluating the impact of actinic keratosis on the quality of life of patients in our setting.

Mesenchymal contribution to recruitment, infiltration, and positioning of leukocytes in human melanoma tissues.

To understand factors that regulate leukocyte entry and positioning within human melanoma tissues, we performed a multiparametric quantitative analysis of two separated regions: the intratumoral area and the peritumoral stroma. Using two mesenchymal markers, fibroblast activation protein (FAP) and CD90, we identified three subsets of mesenchymal cells (MCs): (i) intratumoral FAP(+)CD90(low/-) MC, (ii) peritumoral FAP(+)CD90(+) MC, and (iii) FAP(-)CD90(+) perivascular MC. We characterized CD90(+) MCs, which showed a stable CCL2-secretory phenotype when long-term expanded ex vivo, and heavily surrounded peritumoral Duffy antigen receptor for chemokine(+) (DARC) postcapillary venules, supporting a role for these vessels in peritumoral inflammatory leukocyte recruitment. Conversely, the intratumoral area was variably invaded by FAP(+)CD90(low/-) MCs that colocalized with a distinct extracellular matrix (ECM) network. A positive correlation was observed between intratumoral stromal cell/ECM networks and leukocyte infiltration among tumor cells (TCs), as well as in a stroma-dependent xenograft tumor model. Adoptively transferred T lymphocytes preferentially infiltrated tumors composed of TC+MC, compared with TCs only. Altogether, our results suggest that a variety of MCs contribute to regulate different steps of leukocyte tumor infiltration, that is, CD90(+) cells surrounding peritumoral vessels secrete CCL2 to recruit CCR2(+) leukocytes at the tumor periphery, whereas intratumoral FAP(+) cells organize a stromal scaffold that contact guide further invasion among densely packed tumor cells.

Metastatic Crohn's disease mimicking genital pyoderma gangrenosum in an HIV patient.

The differential diagnosis of ulcerative genital lesions in patients with high risk sexual habits can be a challenge even for dermatologists. We present the case of a 27-year-old HIV-positive male with a history of recalcitrant genital ulcers. Microbiology studies were negative. A skin biopsy and a sample from a perineal fistula showed granulomatous infiltrates. The patient was treated with prednisone, metronidazole and aminosalicylates, showing complete resolution of the lesions in a few weeks. The clinical picture and histological findings are consistent with the diagnosis of cutaneous metastatic Crohn's disease. Although infrequent, metastatic Crohn's disease should be suspected in cases of recalcitrant ulcerative conditions, even in the absence of intestinal disease.