Prevalence of actinic keratosis among dermatology outpatients in Spain / Prevalencia de queratosis actínica en pacientes ambulatorios de dermatología en España

BACKGROUND: Actinic keratoses (AKs) are common skin lesions associated with an increased risk of developing squamous cell carcinoma. Few studies in Europe have focused on AK prevalence. AIM: To determine the point prevalence of AKs in a dermatology outpatient population in Spain, to describe the clinical characteristics of these lesions and to characterise the profile of AK patients. METHODS: Observational, cross-sectional, multicentre study conducted in 19 hospitals (dermatology outpatient services) around Spain. A total of 204 consecutive patients per hospital who were 45 years old were screened for the presence of AKs. RESULTS: 3877 patients were assessed and the overall AKs prevalence was 28.6%. Prevalence was significantly higher in men than women (38.4% vs. 20.8%, p < 0.0001) and increased with age for both sexes (45.2% in 71---80 years). Scalp and ear lesion locations were significantly more frequent in men (51.9% vs. 2.7% and 16.9% vs. 2.4%, respectively, p < 0.0001 both cases) and the cheek, nose and neckline in women (46.3% vs. 34.0% [p < 0.0001], 43.0% vs. 24.8% [p < 0.0001] and 5.3% vs. 1.8% [p = 0.002]). Men showed a significantly higher frequency of 2 affected areas than women (42.7% vs. 20.3%, p < 0.0001). Among patients with AK lesions, only 65% confirmed that they were the reason for the visit to the clinic. CONCLUSIONS: Approximately a quarter of the dermatology outpatient population in Spain aged 45 years old have AKs, with the prevalence rate being highest in men and in older age groups. AK is underdiagnosed and a proactive strategy is needed for the diagnosis and early treatment of these lesions

ANTECEDENTES: Las queratosis actínicas (QA) son lesiones cutáneas comunes asociadas a un mayor riesgo de desarrollar carcinoma de células escamosas. Hay pocos estudios en Europa sobre la prevalencia de QA. OBJETIVOS: Determinar la prevalencia de QA en una población de pacientes ambulatorios dermatológicos en España y describir las características clínicas de los pacientes con QA. MÉTODOS: Estudio observacional, transversal, multicéntrico (19 hospitales, servicios de consultas externas de dermatología) en España. Se incluyeron 204 pacientes consecutivamente por centro, edad 45 años y se determinó la presencia de QA. RESULTADOS: Se evaluaron 3.877 pacientes. La prevalencia de QA fue de 28,6% y esta fue más alta en hombres que en mujeres (38,4% vs. 20,8%, p < 0,0001), incrementándose con la edad en ambos sexos (45,2%, 71-80 años). Las lesiones en el cuero cabelludo y en la oreja fueron más frecuentes en hombres (51,9% vs. 2,7% y 16,9% vs. 2,4%, respectivamente, p < 0,0001 ambos casos) y la mejilla, la nariz y el escote en mujeres (46,3% vs. 34,0% [p < 0,0001], 43,0% vs. 24,8% [p < 0,0001] y 5,3% vs. 1,8% [p = 0,002]). Los hombres presentaron una mayor frecuencia de 2 zonas afectadas vs. mujeres (42,7% vs. 20,3%, p < 0,0001). Entre los pacientes con QA solo el 65% confirmó que esta era el motivo de la visita. CONCLUSIONES: Aproximadamente una cuarta parte de la población ambulatoria de dermatología en España 45 años presenta alguna QA, con una prevalencia más alta en los hombres y los grupos de mayor edad. La QA está infradiagnosticada y se requiere de una estrategia proactiva para el diagnóstico precoz y el tratamiento

Prevalence of actinic keratosis among dermatology outpatients in Spain.

BACKGROUND: Actinic keratoses (AKs) are common skin lesions associated with an increased risk of developing squamous cell carcinoma. Few studies in Europe have focused on AK prevalence. AIM: To determine the point prevalence of AKs in a dermatology outpatient population in Spain, to describe the clinical characteristics of these lesions and to characterise the profile of AK patients. METHODS: Observational, cross-sectional, multicentre study conducted in 19 hospitals (dermatology outpatient services) around Spain. A total of 204 consecutive patients per hospital who were ≥45 years old were screened for the presence of AKs. RESULTS: 3877 patients were assessed and the overall AKs prevalence was 28.6%. Prevalence was significantly higher in men than women (38.4% vs. 20.8%, p<0.0001) and increased with age for both sexes (45.2% in 71-80 years). Scalp and ear lesion locations were significantly more frequent in men (51.9% vs. 2.7% and 16.9% vs. 2.4%, respectively, p<0.0001 both cases) and the cheek, nose and neckline in women (46.3% vs. 34.0% [p<0.0001], 43.0% vs. 24.8% [p<0.0001] and 5.3% vs. 1.8% [p=0.002]). Men showed a significantly higher frequency of ≥2 affected areas than women (42.7% vs. 20.3%, p<0.0001). Among patients with AK lesions, only 65% confirmed that they were the reason for the visit to the clinic. CONCLUSIONS: Approximately a quarter of the dermatology outpatient population in Spain aged ≥45 years old have AKs, with the prevalence rate being highest in men and in older age groups. AK is underdiagnosed and a proactive strategy is needed for the diagnosis and early treatment of these lesions.

Percepción de los profesionales médicos respecto la adherencia terapéutica de los pacientes con osteoporosis / Medical professionals’ perceptions regarding therapeutic adherence in patients with osteoporosis

Introducción: La adherencia al tratamiento oral del paciente con osteoporosis es baja, con un alto porcentaje de abandonos durante el primer año. La consecuencia más notable es la falta de respuesta terapéutica. Objetivo: Conocer la percepción de los facultativos involucrados en el abordaje del paciente osteoporótico en relación a la adherencia terapéutica de estos pacientes. Material y métodos: Estudio descriptivo transversal realizado mediante una encuesta de opinión dirigida a médicos de Atención Primaria y Atención Especializada involucrados en el tratamiento de la osteoporosis. Los participantes fueron seleccionados mediante muestreo intencionado. Resultados: El cuestionario fue contestado por 235 especialistas de Reumatología (54,5%), Traumatología (10,6%) y Atención Primaria (18,7%). En opinión del 43,8% de los encuestados, más de un 25% de los pacientes olvida alguna vez tomar el tratamiento. Según el 34,9%, más de 75% de los pacientes están concienciados con el tratamiento. Los efectos secundarios y la complejidad de la administración son las razones mayoritarias que propician un cambio de medicación, con una importancia media de 7,94±2,06 y 6±2,01 puntos respectivamente en una escala 0-10. Conclusiones: Los facultativos percibieron baja adherencia terapéutica asociada fundamentalmente a los efectos secundarios, a la polimedicación y a la falta de comunicación entre profesionales. Espaciar la dosificación y el uso de formas galénicas solubles podrían ser opciones para facilitar la adherencia del paciente al tratamiento con bisfosfonatos orales. Mejorar la educación sobre la importancia de la enfermedad o aumentar el seguimiento del paciente serían algunos de los aspectos que podrían favorecer la adherencia terapéutica (AU)

Introduction: Adherence to oral treatment of patients with osteoporosis is low, with a high dropout rate in the first year. The most noteworthy result is the lack of therapeutic response. Objective: To ascertain the perception of physicians working with osteoporotic patients regarding adherence of these patients. Methods: Cross-sectional study conducted by opinion survey aimed at primary care physicians and specialists involved in osteoporosis treatment. Participants were selected by purposive sampling. Results: The questionnaire was answered by 235 specialists encompassing rheumatology (54.5%), orthopedics (10.6%) and primary care (18.7%). In 43.8% of participants, more than 25% of patients sometimes forget to take their treatment. According to 34.9%, more than 75% of patients are aware of treatment. Side effects and management complexity are the majority reasons that lead to a change in medication, mean value of 7.94±2.06 6±2.01 points respectively on a 0-10 scale. Conclusions: Overall, medical specialists attributed low adherence to side effects, polypharmacy and lack of communication between professionals. Dosage and space use of soluble dosage forms may be options to facilitate patient adherence to treatment with oral bisphosphonates. Improved education concerning the importance of the disease or increased patient monitoring could foster adherence (AU)

Sonochemical assisted synthesis of SrFe12O19 nanoparticles.

We present the synthesis of M-type strontium hexaferrite by sonochemistry and annealing. The effects of the sonication time and thermal energy on the crystal structure and magnetic properties of the obtained powders are presented. Strontium hexagonal ferrite (SrFe12O19) was successfully prepared by the ultrasonic cavitation (sonochemistry) of a complexed polyol solution of metallic acetates and diethylene glycol. The obtained materials were subsequently annealed at temperatures from 300 to 900 °C. X-ray diffraction analysis shows that the sonochemical process yields an amorphous phase containing Fe(3+), Fe(2+) and Sr(2+) ions. This amorphous phase transforms into an intermediate phase of maghemite (γ-Fe2O3) at 300 °C. At 500 °C, the intermediate species is converted to hematite (α-Fe2O3) by a topotactic transition. The final product of strontium hexaferrite (SrFe12O19) is generated at 800 °C. The obtained strontium hexaferrite shows a magnetization of 62.3 emu/g, which is consistent with pure hexaferrite obtained by other methods, and a coercivity of 6.25 kOe, which is higher than expected for this hexaferrite. The powder morphology is composed of aggregates of rounded particles with an average particle size of 60 nm.

Síndrome metabólico y complicaciones perioperatorias durante cirugías programadas con anestesia general / Metabolic Syndrome and Perioperative Complications During Elective Surgery Using General Anesthesia

Introducción: El síndrome metabólico es un conjunto de alteraciones asociadas a un alto riesgo de enfermedades cardiovasculares. Aunque representa un problema de salud pública, poco se conoce de su impacto en situaciones como la anestésica-quirúrgica. Objetivo: Analizar la correlación entre síndrome metabólico y complicaciones perioperatorias en pacientes de cirugía programada con anestesia general en Cartagena, Colombia. Material y métodos: Se diseñó un estudio de casos y controles, con 300 pacientes: 150 casos y 150 controles. Se registraron variables sociodemográficas, hemodinámicas, respiratorias,complicaciones perioperatorias (hipotensión, hipertensión, hipoxemia, sangrado, dolor moderado-severo y náuseas o vómitos postoperatorios). Se emplearon la prueba exacta de Fisher o la de la χ², según fuera apropiado, para la comparación de grupos. Se aplicó un modelo de regresión logística univariable, para estimar el grado de correlación entre las variables. Resultados: Las complicaciones perioperatorias fueron más frecuentes en el grupo de casos (p < 0,001). Hubo diferencias significativas en edad y estado físico según la Asociación Americana de Anestesiólogos (ASA) (p < 0,05). El síndrome metabólico se correlacionó con complicaciones perioperatorias (odds ratio [OR] = 3,31). El estado físico ASA III fue factor de riesgo de complicaciones postoperatorias (OR = 4,01). Conclusiones: El síndrome metabólico es un factor de riesgo de complicaciones perioperatorias. El estudio indica que hay que implementar estrategias de intervención sanitarias con vistas a la prevención y el manejo del síndrome metabólico en el ámbito quirúrgico, lo que conlleva reducción de las complicaciones perioperatorias asociadas.

Introduction: Metabolic Syndrome (MS) is a cluster of alterations associated to high risk of cardiovascular diseases and diabetes mellitus. Although Metabolic Syndrome is a public health issue, little has been studied about its impact in the anesthetic-surgical scene. Aims: To analyze the correlation level between MS and perioperative complications, in patients under programmed surgery with general anesthesia technique in Cartagena, Colombia. Materials and methods: A case control study was designed, where 300 patients were enrolled: 150 cases and 150 controls. Socio-demographic, hemodynamics and respiratory variables, as well as surgical complications (hypotension, hypertension, hypoxemia, bleeding, moderated-severe pain and post chirurgical nausea-vomiting) were registered. Fisher’s exact test and X2, where appropriated were employed to compare categorical data. A logistic regression model was applied to calculate correlation between variables. Results: Surgical complications were more frequent in cases group (P<.001). Differences in age and ASA physical status were also found (P<.05). MS was correlated to perioperative complications (OR: 3.31; P<.05). ASA III physical status was another risk factor to post chirurgical complications development (OR: 4.01; P<.05). None mortality case was reported. Conclusions: In a comparison with healthy population, Metabolic Syndrome represented a risk factor to perioperative complications development. According to results, further prevention and approach guidelines in order to reduce perioperative complications associated to Metabolic Syndrome.

Interrelationship between skin sensitization, rhinitis, and asthma in patients with allergic rhinitis: a study of Spain and Portugal.

OBJECTIVE: Allergic rhinitis can determine the presence and type of asthma. The main aim of this study was to evaluate the link between allergic rhinitis, asthma, and skin test sensitization in patients with allergic rhinitis. METHODS: Patients with allergic rhinitis, aged 10 to 50 years, were consecutively enrolled at different allergy centers in Spain and Portugal. All the patients underwent skin prick tests with a panel of 20 biologically standardized aeroallergens. Allergic rhinitis was classified according to etiology and the Allergic Rhinitis and its Impact on Asthma guidelines and asthma was classified according to the Global Initiative for Asthma guidelines. RESULTS: A total of 3225 patients, with a mean age of 27 years, were evaluated. House dust mites and grass and olive tree pollens were the most common aeroallergens. The mean (SD) number of positive skin tests per patient was 6.5 (4), the mean wheal size was 42.3 (28) mm2, and the mean atopy index was 6.5 (2). Forty-nine percent of the patients had concomitant asthma. Asthma severity was associated with a longer time since onset (P < .04) and allergic rhinitis severity (P < .001). Patients with concomitant asthma had a significantly higher number of aeroallergens and sensitization intensity than those without asthma (P < .001). CONCLUSIONS: In this broad population sample, the presence and type of asthma was influenced by skin sensitization and both time since onset and severity of allergic rhinitis.

Estudio de los efectos de la dilución de anestésico local para técnica regional subaracnoidea en procedimientos quirúrgicos abdominales ambulatorios / Study of the effects of the dilution of local anesthesic for regional technology(skill) subaracnoidea in surgical abdominal ambulatory procedures

Este estudio fue diseñado para evaluar diferencias hemodinámicas y eventos adversos de la dilución de un anestésico local hiperbárico (clorhidrato de levobupivacaína pesada 0,75 por cien más citrato de fentanilo en solución salina normal al 0,9 por cien) comparada con la técnica estándar para anestesia regional subaracnoidea. Métodos: Estudio experimental multicéntrico, prospectivo aleatorio, abierto y controlado, en el cual fueron incluidos 98 pacientes de ambos sexos programados para procedimientos quirúrgicos abdominales; las variables analizadas fueron tensión arterial media (TAM), tiempo de bloqueo motor y sensitivo, uso de líquidos endovenosos en el acto operatorio, drogas vasoactivas y duración en la unidad de recuperación postanestésica. Resultados: Fueron evaluadas las variables para ambos grupos, encontrándose diferencias significativas en: descenso de la TAM al minuto (grupo tratado 71,96±5,99 mm Hg IC: 1,69 Vs. grupo control 58,15 ±3,70 mm Hg, IC: 1,02) con relación a la media basal inicial (76,07±6,01 Vs.76,02±6,01 mm Hg) respectivamente, posterior a la inyección del anestésico en el espacio subaracnoideo; la duración del bloqueo motor (grupo tratado 18,04 ± 7,21 minutos IC: 2,03 Vs. grupo control 89,61±23,88 minutos IC: 6,6); uso de líquidos endovenosos (grupo tratado 78,39 ± 301,24 ml IC: 22,45 Vs. grupo control 2.115 ± 339 ml IC :94,07); estancia en unidad de cuidados postanestésicos (grupo tratado 27,76±6,60 minutos IC:1,86 Vs. grupo control 105,96 ± 30,07 minutos, IC: 27,74), náuseas (grupo tratado 7 pacientes, 14,58 por cien Vs. grupo control 21 pacientes, 42 por cien), vómito (grupo tratado 5 pacientes, 10,41 por cien Vs. grupo control 16 pacientes, 32 por cien), drogas vasoactivas (grupo tratado 0 pacientes, 0 por cien Vs. grupo control 34 pacientes 68 por cien). No existió diferencia significativa en la duración del bloqueo sensitivo (grupo tratado 77±17,56 minutos, IC: 2,59 Vs. grupo control 74,80±18,24 minutos, IC: 5,05) y tiempo quirúrgico (grupo tratado 40,4±13,19 minutos, IC: 3,73 Vs. grupo control 39,42 ± 8,76 minutos, IC: 2,42). Conclusión: La dilución de anestésico local hiperbárico para técnica de anestesia regional subaracnoidea es segura, efectiva y puede recomendarse como una técnica estándar en pacientes programados para cirugía abdominal con duración máxima de una hora.

Iberian study of aeroallergens sensitisation in allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is a prevalent allergic disease in Iberian countries, but there are no recent epidemiological studies that characterize this pathology according to clinical classification and aeroallergens sensitisation. This is a clinical study, representative of each country METHODS: Descriptive, observational cross-sectional, population-based study carried-out in Portugal and Spain. 3397 consecutive patients (5 regions in Spain and 3 regions in Portugal) were selected for clinical observation and skin prick tests were carried out using the same panel of standardized aeroallergens. RESULTS: 3225 patients (aged 10-50 years old) completed the study (IC 95%, SE 15). Intermittent rhinitis makes up 36% of the entire sample. Of them, intermittent AR mild forms represented 82% in Spain and 92% in Portugal that is, 87% for Iberian countries. Persistent types of rhinitis showed exactly the same rate of severity in Portugal and Spain, 44% mild and 56% moderate/severe. Seasonal forms represent 37% while 63% were perennial. BA was present in 49% of AR patients. There were significant differences between aeroallergens according to the different regions considered. Mites and grass pollens are the most relevant aeroallergens in Spanish and Portuguese AR patients, while Alternaria showed higher positive rates among 10-20 year old patients. CONCLUSIONS: This study characterizes the AR patients in Iberian countries according to the ARIA classification. No correlation was observed between this classification and the conventional (seasonal/perennial). Our results also characterize the allergic cutaneous pattern of aeroallergen sensitisation using the same panel of standardized allergens and show differences between the different regions analysed.

Optical characterization of titania thin films produced by the solgel method and doped with co(2+) at different concentrations.

We report some preliminary results on the fabrication and optical characterization of high-refractive-index thin films of titania doped with Co(2+). These films were supported on silica platesthat were chemically activated to attach both phases. The titania films were produced by the solgel method at room temperature and slowly annealed from room temperature to 230 degrees C; their thickness was approximately 600 ?. The optical characterizations were obtained by the use of spectroscopic ellipsometry, where the dielectric function of the material was obtained as a function of the wavelength. Additionally, the ellipsometric function was modeled to obtain the porosity of the films and their thickness.

Prediction of right ventricular ejection fraction by Doppler determination of right systolic time intervals.

OBJECTIVES: This study was designed to evaluate the right ventricular function by means of the determination of right ventricular systolic time intervals measured in pulmonary artery flow detected by Doppler. BACKGROUND: Left ventricular systolic time intervals have been used to evaluate left ventricular performance. There is, however, no information as to whether right ventricular systolic time intervals may be useful in the evaluation of right ventricular function. METHODS: Simultaneous measurements of right ventricular ejection fraction and Doppler determination of right systolic time intervals were made in four pigs in 47 different hemodynamic conditions that permit the modification of the right ventricular ejection fraction from 15% to 68%. The preejection time, the ratio of right preejection time to right ventricular ejection time, with and without correction by the heart rate, were correlated simultaneously to invasively determined right ventricular ejection fraction and other hemodynamic parameters, measured with a modified pulmonary artery catheter with a rapidly responding thermistor. RESULTS: There was a significant linear correlation between Doppler determination of right systolic time intervals and right ventricular ejection fraction. A similar correlation was found for preejection time (r = .80, p < .0001) and the ratio of right preejection time to right ventricular ejection time with correction by the heart rate (r = .83, p < .0001). When we used a preejection time > 70 msec as a criterion to detect a ejection fraction < 40% we found a sensitivity of 89% and specificity of 88%. A preejection time > 80 msec, as criterion of more severe ventricular disfunction (ejection fraction < 30%), displayed a sensitivity of 76% and specificity of 100%. CONCLUSION: These results show that right ventricular systolic time intervals determined by Doppler study correlate significantly with the right ventricular ejection fraction. In view of its simplicity and its accuracy in the prediction of right ventricular ejection fraction, this method may provide useful non-invasive alternative in the prediction of right ventricular ejection fraction.

Pressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow.

OBJECTIVE: To ascertain whether pressure-controlled ventilation offers any advantage with respect to conventional controlled mechanical ventilation with decelerating flow. DESIGN: Prospective, comparative study. SETTING: Intensive care unit. PATIENTS: Eleven consecutive critically ill adult patients. MEASUREMENTS AND MAIN RESULTS: Study of respiratory mechanics and arterial blood gases after 30 mins of pressure-controlled ventilation. Repetition of the same measurements after 30 mins of controlled mechanical ventilation with decelerating flow waveform, with equal tidal volumes, using a commercially available mechanical ventilator. Student's t-test for paired comparisons. A lesser maximum inspiratory flow rate was required for pressure-controlled ventilation (55.7 +/- 16 L/sec) than for controlled mechanical ventilation (72 +/- 2 L/sec) (p < .001). Nevertheless, the peak pressures measured in the orotracheal tubes of the patients were higher in pressure-controlled ventilation (20.4 +/- 3.5 cm H2O) than in controlled mechanical ventilation (18.4 +/- 4.8 cm H2O) (p < .05). This model measured pressure in the inspiratory line, providing erroneous information regarding the behavior of pressures in the airway. The peak pressure measured by the ventilator was significantly higher in controlled mechanical ventilation than in pressure-controlled ventilation and was, in addition, reached at initiation of inspiration in ten of 11 patients with controlled mechanical ventilation, while peak pressure measured in the orotracheal tube was invariably reached at the end of the inspiration, both in pressure-controlled ventilation and controlled mechanical ventilation. The rest of the parameters analyzed, including end-inspiratory pressure, mean pressure, intrinsic positive end-expiratory pressure, and arterial blood gases, showed no differences. The difference between quasi-static compliances almost reached statistical significance (72 +/- 25.4 mL/cm H2O in pressure-controlled ventilation vs. 68.8 +/- 24.3 mL/cm H2O in controlled mechanical ventilation; p = .052). CONCLUSIONS: Our study failed to demonstrate any important difference between pressure-controlled ventilation and controlled mechanical ventilation with decelerating inspiratory flow waveform. The differences in the airway pressures detected by the ventilator are spurious and are due to the place (inspiratory line) where these pressures were measured. The difference between the peak pressure measured in the orotracheal tube has statistical, but not clinical, value and is lower in controlled mechanical ventilation. Based on the limited number of variables we studied and unless the tendency indicated in the quasi-static compliance is demonstrated in the future, we do not believe that pressure-controlled ventilation contributes any uniqueness to the theory or practice of mechanical ventilation.