Liquen aureus: ¿un caso congénito? / Lichen Aureus: A Congenital Case?

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Morfea en una paciente con psoriasis en tratamiento con ustekinumab: ¿coexistencia o efecto adverso? / Morphea in a Patient With Psoriasis on Treatment With Ustekinumab: Comorbidity or Adverse Effect?

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La piel sensible: un síndrome complejo / Sensitive Skin: A Complex Syndrome

Los estudios epidemiológicos ponen de manifiesto que cada vez son más las personas que dicen poseer una piel sensible, presumiéndose una prevalencia del 50% en la población europea. Se trata de una condición cutánea de hiperreactividad cuya manifestación depende de gran variedad de factores y cuya patogénesis no es del todo conocida, aunque diferentes estudios señalan un origen biofísico para este desorden. El diagnóstico objetivo de piel sensible es difícil, ya que la mayoría de los síntomas que presentan los pacientes son subjetivos. Además, no existen pruebas diagnósticas realmente eficaces y con un fuerte componente predictivo, pues la sensibilidad de la piel varía mucho de unas personas a otras. Por otra parte existen numerosas variaciones entre los compuestos que desencadenan respuestas del tipo de piel sensible. Las repercusiones sobre la calidad de vida son importantes y frecuentemente se acompañan de sintomatología psiquiátrica, por lo que el médico dermatólogo debe explorar este campo en la anamnesis. En el tratamiento de esta condición se hace imprescindible la colaboración del paciente y altas dosis de tenacidad por parte del médico (AU)

Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin (AU)

[Sensitive skin: a complex syndrome]. / La piel sensible: un síndrome complejo.

Epidemiologic studies indicate that ever larger numbers of people report having sensitive skin, for which a European prevalence of 50% is estimated. Sensitive skin is characterized by hyperreactivity, with manifestations varying in relation to many factors. The pathogenesis of this disorder is poorly understood, although studies point to a biophysical mechanism. Objective diagnosis of sensitive skin is difficult, as information comes mainly from the patient's report of symptoms in the absence of effective, strongly predictive tests because of great interindividual variability in skin sensitivity. Substances that trigger a reaction in hypersensitive skin also vary greatly. The impact of this syndrome on quality of life is considerable and patients often present psychiatric symptoms; therefore, dermatologists should explore this possibility when taking a patient's history. Patient cooperation and physician persistence are both essential for treating sensitive skin.

[Clinical management of psoriatic arthritis in Spain: the CALIPSO study]. / Manejo clínico de la artritis psoriásica en España: estudio Calipso.

OBJECTIVE: To describe the clinical management of psoriatic arthritis for patients being treated by dermatologists and rheumatologists in Spain. METHODS: Multicenter, retrospective, naturalistic observational study in which demographic and clinical variables were recorded for patients diagnosed with psoriatic arthritis. Data referred to the previous 12 months and were collected during a single visit with the physician. RESULTS: A total of 266 patients were enrolled; 78.1% were being treated by rheumatologists and 21.9% by dermatologists. The data covered 1138 visits. The main reason for consulting a physician was to monitor psoriatic arthritis (82.7% of the visits). The most widely used examination was to determine the tender- and swollen-joint count (73.1%). The tests most frequently ordered were acute-phase reactants: erythrocyte sedimentation rate (79.8%) and C reactive protein level (74.5%). Affected body surface area and the Psoriasis Area and Severity Index were the main assessments used by dermatologists. Rheumatologists tended to examine the joints and record biochemical markers. A disease-modifying antirheumatic drug was prescribed for 71.1% of the patients; 51.8% were prescribed a biologic agent (61.5% in combination with another treatment). Treatment approach differed by specialty and was modified if response was nil or partial (the rationale for 45.1% of all changes). CONCLUSION: Differences in the management of psoriatic arthritis in dermatology and rheumatology were evident in both diagnostic and treatment approaches. These 2 specialties should cooperate to establish common practice guidelines for use in Spain.

Manejo clínico de la artritis psoriásica en España: estudio Calipso / Clinical Management of Psoriatic Arthritis in Spain: The CALIPSO Study

Objetivo: Conocer el manejo clínico de los pacientes con artritis psoriásica atendidos en consultas de dermatología y reumatología en España. Método: Estudio observacional, multicéntrico, naturalístico, retrospectivo, en el que se recogieron parámetros demográficos y clínicos de pacientes diagnosticados de artritis psoriásica. Se realizó una única visita; los datos se refirieron a los 12 meses anteriores. Resultados: Participaron 266 pacientes, 78,1% procedentes de consultas de reumatología y 21,9% de dermatología. Se registró información de 1.138 visitas. El principal motivo de consulta fue el control de la artritis psoriásica (82,7% de las visitas). La exploración más utilizada fue el recuento de articulaciones dolorosas e inflamadas (73,1%) y las pruebas complementarias más frecuentes fueron la determinación de reactantes de fase aguda (velocidad sedimentación y proteína C reactiva) (79,8%; 74,5%). En dermatología destacó el uso del body surface area y el psoriasis area severity index como pruebas de evaluación habituales. En reumatología se utilizaron sobretodo criterios de evaluación articular y bioquímicos. El 71,1% de pacientes fueron tratados con algún fármaco modificador de la enfermedad, y el 51,8% con terapia biológica (61,5% con tratamiento combinado), observándose diferencias según la especialidad. La obtención de respuesta parcial o nula al tratamiento fue el principal motivo de modificación del mismo (45,1% de pacientes en los que hubo cambios). Conclusión: Se evidencian diferencias en el manejo de la artritis psoriásica según especialidad, tanto en el diagnóstico como el tratamiento de la enfermedad, considerándose imprescindible la colaboración entre dermatólogos y reumatólogos para establecer protocolos de actuación comunes en el ámbito asistencial español (AU)

Objective: To describe the clinical management of psoriatic arthritis for patients being treated by dermatologists and rheumatologists in Spain. Methods: Multicenter, retrospective, naturalistic observational study in which demographic and clinical variables were recorded for patients diagnosed with psoriatic arthritis. Data referred to the previous 12 months and were collected during a single visit with the physician. Results: A total of 266 patients were enrolled; 78.1% were being treated by rheumatologists and 21.9% by dermatologists. The data covered 1138 visits. The main reason for consulting a physician was to monitor psoriatic arthritis (82.7% of the visits). The most widely used examination was to determine the tender- and swollen-joint count (73.1%). The tests most frequently ordered were acute-phase reactants: erythrocyte sedimentation rate (79.8%) and C reactive protein level (74.5%). Affected body surface area and the Psoriasis Area and Severity Index were the main assessments used by dermatologists. Rheumatologists tended to examine the joints and record biochemical markers. A disease-modifying antirheumatic drug was prescribed for 71.1% of the patients; 51.8% were prescribed a biologic agent (61.5% in combination with another treatment). Treatment approach differed by specialty and was modified if response was nil or partial (the rationale for 45.1% of all changes). Conclusion: Differences in the management of psoriatic arthritis in dermatology and rheumatology were evident in both diagnostic and treatment approaches. These 2 specialties should cooperate to establish common practice guidelines for use in Spain (AU)

Clinical Management of Psoriatic Arthritis in Spain: The CALIPSO Study. / Manejo clínico de la artritis psoriásica en España: estudio Calipso.

OBJECTIVE: To describe the clinical management of psoriatic arthritis for patients being treated by dermatologists and rheumatologists in Spain. METHODS: Multicenter, retrospective, naturalistic observational study in which demographic and clinical variables were recorded for patients diagnosed with psoriatic arthritis. Data referred to the previous 12 months and were collected during a single visit with the physician. RESULTS: A total of 266 patients were enrolled; 78.1% were being treated by rheumatologists and 21.9% by dermatologists. The data covered 1138 visits. The main reason for consulting a physician was to monitor psoriatic arthritis (82.7% of the visits). The most widely used examination was to determine the tender- and swollen-joint count (73.1%). The tests most frequently ordered were acute-phase reactants: erythrocyte sedimentation rate (79.8%) and C reactive protein level (74.5%). Affected body surface area and the Psoriasis Area and Severity Index were the main assessments used by dermatologists. Rheumatologists tended to examine the joints and record biochemical markers. A disease-modifying antirheumatic drug was prescribed for 71.1% of the patients; 51.8% were prescribed a biologic agent (61.5% in combination with another treatment). Treatment approach differed by specialty and was modified if response was nil or partial (the rationale for 45.1% of all changes). CONCLUSION: Differences in the management of psoriatic arthritis in dermatology and rheumatology were evident in both diagnostic and treatment approaches. These 2 specialties should cooperate to establish common practice guidelines for use in Spain.

Dramatic decline in acute hepatitis B infection and disease incidence rates among adolescents and young people after 12 years of a mass hepatitis B vaccination programme of pre-adolescents in the schools of Catalonia (Spain).

The aim of the study was to describe the impact of hepatitis B vaccination and disease incidence in adolescents and young people 12 years after the launching of a mass hepatitis B vaccination of pre-adolescents in schools. Vaccination coverage was assessed using administrative and serological data. Infection trends were evaluated by means of seroepidemiological surveys. High levels of vaccination coverage and vaccine-induced immunity were achieved. The resulting low proportions of susceptible adolescents and young people have undoubtedly contributed to the substantial reduction in the prevalence of hepatitis B infection in the 15-24 years age group (0.9 per 100 in 2001 versus 9.3 per 100 in 1986) and in the reported incidence of hepatitis B cases (80% reduction). Over the last 3 years, the declining trend seems to have been halted, although 35% of cases reported during this period corresponded to immigrants.

Seroepidemiology of varicella-zoster virus infection in Catalonia (Spain). Rationale for universal vaccination programmes.

With the aim of designing a strategy for vaccination against varicella-zoster virus (VZV), the results of a seroepidemiological survey on VZV infection carried out in a sample of the population of Catalonia are presented. Representative samples from schoolchildren (30 schools) and adults (97 municipal areas) were obtained by random cluster sampling. In the study, 883 children and 1253 adults were included. Age, gender, place of birth, place of residence, educational level and occupation were investigated in the study subjects. An ELISA test was used to measure varicella antibodies. The prevalence of varicella antibodies increased with age, being 85% in the 5-9 years age group, 92% in the 10-14 years age group, 94% in the 15-34 years age group and almost 100% in people over 35. No association was found between sociodemographic variables studied and prevalence levels of antibodies. These results suggest that the best vaccination strategy in Catalonia would be to add a temporary vaccination programme of pre-adolescents at 12 years to routine vaccination at 15 months.

Role of sialylation in determining the pharmacokinetics of neutrophil inhibitory factor (NIF) in the Fischer 344 rat.

1. Recombinant neutrophil inhibitory factor (NIF) is a glycoprotein. Its amino acid sequence remains constant and has a molecular weight of 28.9 kD. However, approximately 40% of the total molecular weight consists of glycans with variable structure. 2. The pharmacokinetics of 11 different NIF batches with varying extents and patterns of sialylation have been investigated in the Fischer 344 rat following intravenous administration. These data indicate that reducing the extent of NIF sialylation reduces the half-life of the molecule due to an increase in the systemic clearance. Also, an increase in the number of unsialylated or neutral glycans may increase the volume of distribution of NIF, although this effect is marginal. 3. Isolated perfused rat liver (IPRL) investigations have shown that sialylated NIF has a low hepatic extraction (< 1%), while asialo NIF has an extraction that is > 20-fold higher. Co-administration of asialo NIF with asialo fetuin (a protein cleared by hepatic asialoglycoprotein receptor (possibly galactose)-mediated uptake reduced the hepatic extraction of asialo NIF. 4. These data suggest that NIF molecules that have free sugar moieties (possibly galactose) interact with an asialoglycoprotein receptor (possibly galactose-mediated) in the liver (parenchymal cells/hepatocytes). Interaction with this receptor leads to cellular internalization and degradation.

Structural periodicity in human articular cartilage: comparison between magnetic resonance imaging and histological findings.

OBJECTIVE: To relate the vertical striations visualized in the deeper layers of articular cartilage by Magnetic Resonance Imaging (MRI) to histological features. METHODS: Two knee joints recovered at post-mortem from males in their seventies with no history or visual evidence of joint disease were examined. MR images were obtained in a 4.7 T 400 mm-bore magnet, after which the knees were fixed, sectioned, and examined histologically. RESULTS: High resolution MR showed vertical high/low signal striations with a two to three-fold variation in signal intensity and a periodicity of 0.56 (+/-0.16 mm), most prominent in weight bearing areas. Histological sections revealed alternating light and dark staining areas with a periodicity of 1.01+/-0.54 mm in the lower zones of the cartilage, some, but not all of which clearly represented folding. Given that MR will only visualize vertical structures in cartilage aligned at 90 degrees, whereas histology will cut them at varying angles, it is likely that the vertical structures seen by each modality correspond, and that they represent structural heterogeneity in cartilage; perhaps the presence of plates of high collagen and proteoglycan content. CONCLUSION: The vertical striations seen routinely in the deep zones of hyaline articular cartilage on histological sections are not artefactual; they are likely to represent structural heterogeneity due to the presence of areas of high collagen and high proteoglycan content that exist in weight-bearing areas. This structural heterogeneity may be of great importance to the integrity and function of the cartilage.

[Changes in seroepidemiology of hepatitis A virus infection in Catalonia in the period 1989-1996. Implications for new vaccination strategy]. / Cambios en la seroepidemiología de la infección por el virus de la hepatitis A en Cataluña en el período 1989-1996. Implicaciones para una nueva estrategia vacunal.

BACKGROUND: The aim of this study was to investigate the prevalence of the risk factors of hepatitis A virus infection (HAV) in a representative sample of a Catalonian population obtained from 1995 to 1996 and the changes in the prevalence of this infection over the period of 1989-1996. SUBJECTS AND METHODS: The prevalence of anti-HAV was determined by an ELISA test in a randomized sample of 2,142 individuals, 884 from 6 to 14 years of age and 1,248 over the age of 15 years. The results were related to sociodemographic variables and multiple logistic regression analysis was performed to establish which variables were related to the risk of infection. RESULTS: The global prevalence of HAV infection was 67.8%. The prevalence of HAV infection increased from 3.5% in the group from 5-14 years of age to 99% in that over the age of 64 years (p < 0.001). A higher prevalence was observed in those born outside of Catalonia (odds ratio [OR] = 3.97; 95% CI, 2.4-6.4) and in those with a lower level of education (OR = 2.60; 95% CI, 1.9-3.5). In the period 1989-1996 the prevalence of the infection has decreased in the population under the age of 45, the differences being statistically significant in the age groups 10-14 (p < 0.0001) and 25-34 (p < 0.0001). CONCLUSIONS: The prevalence of HAV infection has progressively decreased in Catalonia while it proportionally increases the susceptible population under the age of 45 years. These findings may be important in the design of strategies for the prevention of HAV infection with universal vaccination programs against this disease.

Passive smoking and risk of pulmonary tuberculosis in children immediately following infection. A case-control study.

SETTING: Passive smoking-related respiratory disorders in children. OBJECTIVES: To assess the effect of passive smoking on the development of active pulmonary tuberculosis (PTB) in children immediately following infection by Mycobacterium tuberculosis within the family. DESIGN: An unmatched case-control study in which 93 contacts who became cases (active PTB diagnosed) and 95 contacts who did not became cases (tuberculin-positive children without evidence of active disease) were included. All were household contacts of a new case of pulmonary bacillary tuberculosis. Smoking habits were investigated by a questionnaire. Urinary cotinine was analysed. Odds Ratio (OR) was adjusted for age and socio-economic status using multiple logistic regression analysis. RESULTS: Passive smoking was a risk factor for PTB (OR: 5.29; 95% confidence interval (CI): 2.33-12.82; P < 0.00005). The adjusted OR was 5.39 (95% CI: 2.44-11.91; P < 0.00001). The risk increased when contacts were passive smokers both at home and outside the home within the family (OR: 6.35; 95% CI: 3.20, 12.72; P < 0.00001). Contacts 0-4 and 5-9 years old showed a significantly higher risk than those aged > or = 10. There was a dose-response relationship between the risk of developing active PTB immediately following infection and the number of cigarettes smoked daily by the household adults (P < 0.001). Mean (SD) urinary continine detectable concentrations (ng/ml) were different between disease contacts (119.46 [68.61]) and non diseased contacts (91.87 [73.10]). The difference was statistically significant (P < 0.001). CONCLUSIONS: Passive exposure to tobacco smoke in children was associated with an increased risk of developing pulmonary tuberculosis immediately following infection. This is an association of great concern requiring health education programmes and antitobacco medical advice.