¿Cuál es la calidad de vida de los adultos con vitiligo en México? / What is the quality of life of adults with vitiligo in Mexico?

Resumen Introducción: El vitiligo es incurable, lentamente progresivo, su prevalencia varía de 0.4 a 2.0 %. La calidad de vida relacionada con la salud (CVRS) se refiere al bienestar autopercibido asociado a la presencia de una enfermedad y su tratamiento. Métodos: Estudio transversal en un centro dermatológico. Se incluyeron adultos con vitiligo no segmentario (VNS), en tanto que se excluyeron pacientes con otros trastornos pigmentarios y otros tipos de vitiligo. Se aplicó el cuestionario VitiQoL (0 = sin afectación, 90 = máxima afectación), el Vitiligo Extent Score (VES) y el Vitiligo Area Scoring Index (VASI). Resultados: Participaron 492 pacientes, 63 % mujeres. Se obtuvieron 32.6 puntos de promedio en el VitiQoL (IC 95 % = 30.6-34.5). La autopercepción de gravedad y la CVRS se correlacionaron (r = 0.568, p < 0.001). La edad, el sexo femenino, la menor educación y la mayor gravedad autopercibida se asociaron a peor CVRS. La proporción de personas que reportaron una adicción fue similar en los grupos con peor y mejor CVRS (28 % versus 32 %, p = 0.23). Conclusión: La peor CVRS se explica por la autopercepción de gravedad, preocupación por la progresión de la enfermedad, aspecto de la piel y acciones necesarias para evitar la exposición al sol durante la recreación.

Abstract Introduction: Vitiligo is an incurable, slowly progressive skin condition, the prevalence of which ranges from 0.4 to 2.0%. Health-related quality of life (HRQoL) refers to self-perceived well-being associated with the presence of a disease and its treatment. Methods: Cross-sectional study at a dermatological center. Adults with non-segmental vitiligo (NSV) were included, while patients with other pigmentary disorders and other types of vitiligo were excluded. The VitiQoL questionnaire (0 = no skin involvement, 90 = maximum skin involvement), the Vitiligo Extent Score (VES) and the Vitiligo Area Scoring Index (VASI) were applied. Results: 492 patients did participate; 63% were women. An average score of 32.6 was obtained on VitiQoL (95% CI = 30.6-34.5). Self-perception of severity and HRQoL were correlated (r = 0.568, p < 0.001). Age, the female gender, lower education and higher self-perceived severity were associated with poorer HRQoL. The proportion of subjects who reported an addiction was similar in the worst and best HRQoL groups (28% vs. 32%, p = 0.23). Conclusion: Poorer HRQoL is explained by severity self-perception, concern about disease progression, appearance of the skin and necessary actions to avoid sun exposure during recreation.

Evidence based Latin American Guidelines of clinical practice on prevention, diagnosis, management and treatment of glucocorticoid induced osteoporosis. A 2022 update : This manuscript has been produced under the auspices of the Committee of National Societies (CNS) and the Committee of Scientific Advisors (CSA) of the International Osteoporosis Foundation (IOF).

Guidelines and recommendations developed and endorsed by the International Osteoporosis Foundation (IOF) are intended to provide guidance for particular pattern of practice for physicians who usually prescribe glucocorticoid (GC) therapy, and not to dictate the care of a particular patient. Adherence to the recommendations within this guideline is voluntary and the ultimate determination regarding their application should be made by the physician in light of each patient's circumstances. Guidelines and recommendations are intended to promote a desirable outcome but cannot guarantee any specific outcome. This guideline and its recommendations are not intended to dictate payment, reimbursement or insurance decisions. Guidelines and recommendations are subjected to periodic revisions as a consequence of the evolution of medicine, technology and clinical practice. A panel of Latin American (LATAM) experts specialized in osteoporosis with recognized clinical experience in managing patients with glucocorticoid-induced osteoporosis (GIO) met to produce evidence-based LATAM recommendations for the diagnosis and management of GIO. These guidelines are particularly intended to general practitioners and primary care physicians who prescribe GC treatments in LATAM to guide their daily clinical practice in terms of evaluation, prevention and treatment of GIO. These recommendations were based on systematic literature review using MEDLINE, EMBASE, SCOPUS and COCHRANE Library database during the period from 2012 to 2021. Randomized clinical trials (RCT), systematic reviews of RCT, controlled observational studies, guidelines and consensus were considered. Based on the review and expert opinion the panel members voted recommendations during two successive rounds of voting by panel members. Agreements for each statement were considered if a concordance of at least 70% was achieved following Delphi methodology. Grading of recommendations was made according to the Oxford Centre for the Evidence-based Medicine (EBM) criteria. Among five GIO guidelines and consensus initially identified, two of them (American College of Rheumatology 2017 and the Brazilian Guidelines 2021) were selected for comparison considering the latter as the most current guides in the LATAM region. Based on this methodology fifty statements were issued. All of them but four (1.20, 1.21, 1.23 and 4.2) attained agreement.

What is the quality of life of adults with vitiligo in Mexico?

INTRODUCTION: Vitiligo is an incurable, slowly progressive skin condition, the prevalence of which ranges from 0.4 to 2.0%. Health-related quality of life (HRQoL) refers to self-perceived well-being associated with the presence of a disease and its treatment. METHODS: Cross-sectional study at a dermatological center. Adults with non-segmental vitiligo (NSV) were included, while patients with other pigmentary disorders and other types of vitiligo were excluded. The VitiQoL questionnaire (0 = no skin involvement, 90 = maximum skin involvement), the Vitiligo Extent Score (VES) and the Vitiligo Area Scoring Index (VASI) were applied. RESULTS: 492 patients did participate; 63% were women. An average score of 32.6 was obtained on VitiQoL (95% CI = 30.6-34.5). Self-perception of severity and HRQoL were correlated (r = 0.568, p < 0.001). Age, the female gender, lower education and higher self-perceived severity were associated with poorer HRQoL. The proportion of subjects who reported an addiction was similar in the worst and best HRQoL groups (28% vs. 32%, p = 0.23). CONCLUSION: Poorer HRQoL is explained by severity self-perception, concern about disease progression, appearance of the skin and necessary actions to avoid sun exposure during recreation.

INTRODUCCIÓN: El vitiligo es incurable, lentamente progresivo, su prevalencia varía de 0.4 a 2.0 %. La calidad de vida relacionada con la salud (CVRS) se refiere al bienestar autopercibido asociado a la presencia de una enfermedad y su tratamiento. MÉTODOS: Estudio transversal en un centro dermatológico. Se incluyeron adultos con vitiligo no segmentario (VNS), en tanto que se excluyeron pacientes con otros trastornos pigmentarios y otros tipos de vitiligo. Se aplicó el cuestionario VitiQoL (0 = sin afectación, 90 = máxima afectación), el Vitiligo Extent Score (VES) y el Vitiligo Area Scoring Index (VASI). RESULTADOS: Participaron 492 pacientes, 63 % mujeres. Se obtuvieron 32.6 puntos de promedio en el VitiQoL (IC 95 % = 30.6-34.5). La autopercepción de gravedad y la CVRS se correlacionaron (r = 0.568, p < 0.001). La edad, el sexo femenino, la menor educación y la mayor gravedad autopercibida se asociaron a peor CVRS. La proporción de personas que reportaron una adicción fue similar en los grupos con peor y mejor CVRS (28 % versus 32 %, p = 0.23). CONCLUSIÓN: La peor CVRS se explica por la autopercepción de gravedad, preocupación por la progresión de la enfermedad, aspecto de la piel y acciones necesarias para evitar la exposición al sol durante la recreación.

Methodological quality of clinical trials of keloid scars.

BACKGROUND: There is heterogeneity in the design of clinical trials (CT) for the treatment of keloid scars that compromises the validity of their results. OBJECTIVE: To assess the methodological quality of the CT published on keloid scars, mainly the outcomes used in them. METHOD: Articles of CT for keloid scars were analyzed, their methodological quality was evaluated following the CONSORT guidelines and the risk of bias based on the Cochrane tool. All the clinical outcomes measured in CT were identified. RESULTS: Fifty-two full-text articles were evaluated, of which, only 3.84% of the CT mentioned important changes in the methodology after starting patient recruitment. Fifty-nine percent of the CT were assessed as high risk of performance bias due to mistakes in blinding participants and personnel. The most frequent outcome was the height or thickness of the keloids. CONCLUSIONS: We recommend that participants with hypertrophic scars should be excluded from keloids' clinical trials, and that the main outcome must be the scar height and flattening. The pain and quality of life of patients should also be measured.

ANTECEDENTES: Existe heterogeneidad en el diseño de los ensayos clínicos (EC) para el tratamiento de cicatrices queloides que compromete la validez de sus resultados. OBJETIVO: Evaluar la calidad metodológica de los EC publicados sobre cicatrices queloides, principalmente las medidas de eficacia utilizadas. MÉTODO: Se analizaron los EC publicados sobre tratamientos para cicatrices queloides y se evaluó su calidad metodológica siguiendo los lineamientos CONSORT y el riesgo de sesgo según la herramienta de Cochrane. Se identificaron todas las medidas de eficacia utilizadas en los EC. RESULTADOS: Se incluyeron 52 artículos, de los cuales solo en el 3.84% se mencionan los cambios importantes en la metodología después de iniciar el reclutamiento de los pacientes. El 59.6% de los EC fueron evaluados con alto riesgo de sesgo de realización por errores en el cegamiento del equipo de investigación. La variable de respuesta más frecuente fue la altura o grosor de las cicatrices. CONCLUSIONES: Se recomienda que en los EC de cicatrices queloides se excluya a los participantes con cicatrices hipertróficas, y que la variable de resultado principal sea la altura de la cicatriz. También deben medirse el dolor y la calidad de vida de los pacientes.

Educational intervention for the evaluation of nasal symmetry in cleft lip and palate operated patients.

Background: Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry. Methods: Quasi-experimental study. Results: In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD. Conclusions: The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.

Introducción: La asimetría nasal es una de las características más frecuentes de los pacientes con labio y paladar hendido; la medición antropométrica (MA) es un método accesible y confiable que puede ser utilizado por los especialistas para evaluarlo. El objetivo de este estudio fue evaluar la efectividad de una intervención educativa aplicada a especialistas que tratan pacientes con labio y paladar hendido para incrementar la precisión en las MA en la evaluación de la asimetría nasal. Métodos: Estudio cuasiexperimental. Resultados: En la primera fase del estudio, 5 de las 13 medidas antropométricas reportaron una diferencia de medias (DM) > 1.5 mm, y 12 de las 13 MA mostraron resultados mayores a dos desviaciones estándar (DE). Los resultados en la segunda fase evidenciaron 11 de las 13 MA con DM < 1 mm, y 9 de las 13 MA fueron menores a dos DE. Conclusiones: La intervención realizada con el Manual de medidas antropométricas aumentó los conocimientos de los especialistas sobre la anatomía, puntos y MA que se pueden utilizar para evaluar la asimetría nasal en pacientes con labio y paladar hendido. La intervención educativa ayuda a aumentar el acuerdo entre los evaluadores para realizar una evaluación confiable de la asimetría nasal en pacientes con estos padecimientos.

Intervención educativa para la evaluación de la simetría nasal en pacientes operados de labio y paladar hendido / Educational intervention for the evaluation of nasal symmetry in cleft lip and palate operated patients

Resumen Introducción: La asimetría nasal es una de las características más frecuentes de los pacientes con labio y paladar hendido; la medición antropométrica (MA) es un método accesible y confiable que puede ser utilizado por los especialistas para evaluarlo. El objetivo de este estudio fue evaluar la efectividad de una intervención educativa aplicada a especialistas que tratan pacientes con labio y paladar hendido para incrementar la precisión en las MA en la evaluación de la asimetría nasal. Métodos: Estudio cuasiexperimental. Resultados: En la primera fase del estudio, 5 de las 13 medidas antropométricas reportaron una diferencia de medias (DM) > 1.5 mm, y 12 de las 13 MA mostraron resultados mayores a dos desviaciones estándar (DE). Los resultados en la segunda fase evidenciaron 11 de las 13 MA con DM < 1 mm, y 9 de las 13 MA fueron menores a dos DE. Conclusiones: La intervención realizada con el Manual de medidas antropométricas aumentó los conocimientos de los especialistas sobre la anatomía, puntos y MA que se pueden utilizar para evaluar la asimetría nasal en pacientes con labio y paladar hendido. La intervención educativa ayuda a aumentar el acuerdo entre los evaluadores para realizar una evaluación confiable de la asimetría nasal en pacientes con estos padecimientos.

Abstract Background: Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry. Methods: Quasi-experimental study. Results: In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD. Conclusions: The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.

Content validity of psoriatic arthritis screening questionnaires: systematic review.

BACKGROUND: Psoriatic arthritis (PsA) is the main entity associated with psoriasis (PsO). Consequently, several PsA screening instruments have been developed, most of them are self-administered questionnaires, known as patient-reported outcome measures (PROMs). OBJECTIVE: To identify, summarize, and systematically evaluate the evidence of the content validity of PsA screening PROMs, in patients with PsO, by the dermatologist, based on COSMIN methodology. METHODS: A structured literature search was performed, until June 2019, that included development and/or validation studies of a questionnaire for the screening of PsA in patients with PsO. The evaluation was based on the PROMs' development, relevance, comprehensiveness, and comprehensibility. RESULTS: Eleven PROMs were included in the systematic review with four additional validation studies of the included instruments. Only ToPAS2 (Toronto Psoriatic Arthritis Screen) questionnaire had an adequate content validity. CONTEST (Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis), CEPPA (Center of Excellence for Psoriasis sand Psoriatic Arthritis), and SiPAS (Simple Psoriatic Arthritis Screening questionnaire) qualified as inadequate. CONCLUSIONS: Despite the existence of eleven validated PsA screening PROMs, none were supported by very high-quality evidence of their content validity, which brings the opportunity for the creation of a new proposal PROM for the screening of PsA.

[Calidad de vida en adultos con cicatrices queloides]. / Quality of life in adults with keloid scars.

INTRODUCCIÓN: Las cicatrices queloides afectan hasta el 16% de la población hispana y pueden causar un deterioro en la calidad de vida. La mayoría de los estudios previos han estudiado pacientes con cicatrices hipertróficas secundarias a quemaduras. OBJETIVO: Determinar la calidad de vida en adultos con cicatrices queloides que acuden a un centro dermatológico. MÉTODO: Se realizó un estudio transversal analítico en el Centro Dermatológico Dr. Ladislao de la Pascua, en adultos con diagnóstico de cicatrices queloides. Se midió la calidad de vida mediante el instrumento DLQI (Dermatology Life Quality Index) y se estudiaron las siguientes variables clínicas: edad, sexo, tiempo de evolución, tamaño de la cicatriz, número de cicatrices y topografía afectada. Se aplicó el cuestionario de Beck para el tamizaje de la depresión. RESULTADOS: Se reclutaron 106 adultos con cicatrices queloides (61% hombres y 39% mujeres), con una mediana de edad de 26 años (rango intercuartilar: ±18 años). El puntaje promedio del DLQI fue de 5.58 (desviación estándar [DE]: ± 5.528), con un máximo obtenido de 22 puntos; dicho puntaje se interpreta como un deterioro mínimo de la calidad de vida. La dimensión que más contribuyó al total del puntaje fue la de síntomas y sentimientos, con el 50.36%. El número de cicatrices y la edad se asociaron directamente con el puntaje del DLQI. El puntaje promedio obtenido con el cuestionario de Beck fue de 6.45 (DE: ± 6.46 puntos) y se correlacionó con el puntaje del DLQI. CONCLUSIONES: Las cicatrices queloides tienen un efecto negativo mínimo en la calidad de vida. Dicho efecto se asoció al autorreporte de síntomas depresivos; sin embargo, los resultados de este estudio no permiten atribuirle una relación casual. Se recomienda aplicar el cuestionario de calidad de vida en adultos jóvenes con cicatrices. INTRODUCTION: Keloid scars affect up to 16% of the Hispanic population and may cause deterioration in the quality of life. Most of the previous studies have focused on patients with hypertrophic scars secondary to burns. OBJECTIVE: To determine the quality of life in adults with keloid scars that go to a dermatological center. METHODS: An analytical cross-sectional study was carried out at Centro Dermatológico Dr. Ladislao de la Pascua in adults with a diagnosis of keloid scars. The quality of life was measured using the Dermatology Life Quality Index (DLQI) and the following clinical variables were studied: age, sex, evolution time, scar size, number of scars and affected topography. The Beck questionnaire for depression was also applied. RESULTS: 106 adults with keloid scars were recruited, 61% men and 39% women, with a median age of 26 years (interquartile range: ± 18 years). The average score of the DLQI was 5.58 (standard deviation [SD]: ± 5.528), with a maximum obtained of 22 points, this score is interpreted as a minimum or small deterioration of the quality of life. The dimension that contributed most to the total score was symptoms and feelings, with 50.36%. The number of scars and age were directly associated with the DLQI score. The average score obtained with the Beck questionnaire was: 6.45 (SD: ± 6.46 points) and it correlates with the DLQI score. CONCLUSIONS: Keloid scars have a minimal negative effect on the quality of life of young adults. This effect was associated with the self-report of depressive symptoms; however, the results of this study do not allow to attribute a causal relationship. It is recommended to apply the quality of life questionnaire in young adults with scars.

Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients.

OBJECTIVES: Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. DESIGN: For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. METHODS: Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant). RESULTS: At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. CONCLUSIONS: A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. PRACTITIONER POINTS: A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.