[Translated article] Approach to the Epidemiology, Disease Management, and Current Challenges in the Management of Generalized Pustular Psoriasis Through a Survey Conducted Among Spanish Dermatologists.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain. METHODS: An electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges. RESULTS: A total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients' perspective on the management of the disease. CONCLUSION: Our study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

[Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain.

BACKGROUND AND OBJECTIVE: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.

Psoriasis Severity, Health-Related Quality of Life, Work Productivity, and Activity Impairments Among Patients With Moderate to Severe Psoriasis Receiving Systemic Treatment: Real-World Data From Clinical Practice in Spain. / [Artículo traducido] Gravedad de la psoriasis, calidad de vida relacionada con la salud, productividad laboral y deterioro de la actividad en pacientes con psoriasis moderada a grave que reciben tratamiento sistémico: datos de la vida real de la práctica clínica en España.

BACKGROUND AND OBJECTIVE: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL. MATERIAL AND METHODS: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction. RESULTS: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001). CONCLUSIONS: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction.

Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. / Condicionantes de acceso a nuevos medicamentos dermatológicos en España: resultados del proyecto EQUIDAD.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Approach to the Epidemiology, Disease Management, and Current Challenges in the Management of Generalized Pustular Psoriasis Through a Survey Conducted Among Spanish Dermatologists. / Aproximación a la epidemiología, manejo de la enfermedad y retos actuales en la gestión de la psoriasis pustulosa generalizada en España a través de un cuestionario dirigido a dermatólogos.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory skin disease characterised by recurrent or intermittent flares. Epidemiological and disease management data in Spain are limited. Our goal was to estimate the epidemiology of GPP, explore its management, and reach consensus on the current challenges faced in Spain. METHODS: An electronic survey was submitted to dermatologists from the Spanish Academy of Dermatology and Venereology Psoriasis Working Group. This group is experienced in the management of GPP. It included a Delphi consensus to establish the current challenges. RESULTS: A total of 33 dermatologists responded to the survey. A 5-year prevalence and incidence of 13.05 and 7.01 cases per million inhabitants, respectively, were estimated. According to respondents, the most common GPP symptoms are pustules, erythema, and desquamation, while 45% of patients present > 1 annual flares. A total of 45% of respondents indicated that flares often require a length of stay between 1 and 2 weeks. In the presence of a flare, 67% of respondents often or always prescribe a non-biological systemic treatment as the first-line therapy [cyclosporine (55%); oral retinoid (30%)], and 45% a biological treatment [anti-TNFα (52%); anti-IL-17 (39%)]. The dermatologists agreed that the main challenges are to define and establish specific therapeutic goals to treat the disease including the patients' perspective on the management of the disease. CONCLUSION: Our study describes the current situation on the management of GPP in Spain, increasing the present knowledge on the disease, and highlighting the current challenges faced at the moment.

Evolving etiologies, comorbidities, survival, and costs of care in adult encephalitis.

Encephalitis is a central nervous system disorder, often caused by infectious agents or aberrant immune responses. We investigated causes, comorbidities, costs, and outcomes of encephalitis in a population-based cohort. ICD-10 codes corresponding to encephalitis were used to identify health services records for all adults from 2004 to 2019. Data were cross-validated for identified diagnoses based on laboratory confirmation using univariate and multivariate statistical analyses. We identified persons with a diagnosis of encephalitis and abnormal cerebrospinal fluid (CSF) results (n = 581) in whom viral genome was detected (n = 315) in a population of 3.2 million adults from 2004 to 2019. Viral genome-positive CSF samples included HSV-1 (n = 133), VZV (n = 116), HSV-2 (n = 34), enterovirus (n = 4), EBV (n = 5), and CMV (n = 3) with the remaining viruses included JCV (n = 12) and HHV-6 (n = 1). The mean Charlson Comorbidity Index (2.0) and mortality rate (37.6%) were significantly higher in the CSF viral genome-negative encephalitis group although the mean costs of care were significantly higher for the CSF viral genome-positive group. Cumulative incidence rates showed increased CSF VZV detection in persons with encephalitis, which predominated in persons over 65 years with a higher mean Charlson index. We detected HSV-2 and VZV more frequently in CSF from encephalitis cases with greater material-social deprivation. The mean costs of care were significantly greater for HSV-1 encephalitis group. Encephalitis remains an important cause of neurological disability and death with a viral etiology in 54.2% of affected adults accompanied by substantial costs of care and mortality. Virus-associated encephalitis is evolving with increased VZV detection, especially in older persons.

Effectiveness and safety of brodalumab in the treatment of plaque, scalp and palmoplantar psoriasis: A multicentre retrospective study in a Spanish population.

BACKGROUND AND OBJECTIVE: The data in clinical practice regarding the effectiveness and safety of brodalumab in psoriasis are scarce, especially at scalp and palmoplantar locations. The main objective was the percentage of patients achieving absolute PASI ≤3/ ≤1/ =0 for plaque psoriasis and the percentage of patients achieving an IGA 0-1/IGA 0 for the special locations at Week 52 of treatment. PATIENTS AND METHODS: Observational retrospective multicentre study in 28 Spanish Hospitals that included adult patients with plaque psoriasis treated with brodalumab, from September 2018 until March 2021. RESULTS: A total of 200 patients were included. The mean baseline PASI was 10.97 (±6.28) with a mean basal scalp (n = 58) and palmoplantar (n = 40) IGA of 2.10 (±0.97) and 2.15 (±1.26), respectively. At Week 52, 93.98%/75.90%/68.67% of patients reached an absolute PASI ≤3/ ≤1/ =0 in plaque psoriasis (n = 83), with a percentage of patients achieving scalp (n = 27) and palmoplantar (n = 19) IGA 0-1/IGA 0 of 96.3%/88.9% and 100%/88.9%, respectively. Fifteen per cent of patients reported any adverse events with candidiasis being the most reported (6%), but only 6% of the adverse events required the withdrawal. CONCLUSIONS: Brodalumab demonstrated high PASI and IGA responses and was well tolerated in clinical practice in plaque, scalp and palmoplantar psoriasis.

From preventive eugenics to slippery eugenics: Population control and contemporary sterilisations targeted to indigenous peoples in Mexico.

Eugenic ideas in Mexico were popularised after the Mexican Revolution (1910-1920) as a way of 'modernising' and 'civilising' the nation. As a result, eugenic ideas were able to linger and be maintained through different departments, institutions, and individuals from all disciplines. After eugenics was considered a pseudoscience, its practices and ideas continued through population control measures that targeted indigenous populations for sterilisation, a trend that still prevails. The purpose of this article is to explore the legacies of eugenics in current sterilizations procedures mostly targeted at indigenous communities in Mexico. I offer the term 'slippery eugenics' to account for the legacies of eugenics in Mexico which, in this specific case, resurface in the systematic forced and coerced sterilisation procedures targeted at indigenous communities.

Adaptación transcultural del cuestionario motion sickness susceptibility questionnaire form short (MSSQ-SHORT) para la población adulta chilena / Cross-cultural adaptation of the motion sickness susceptibility questionnaire form short (MSSQ-SHORT) for the chilean adult population

Resumen Introducción: La cinetosis se relaciona con la presencia de una serie de síntomas que comúnmente son inducidos por situaciones cotidianas de viajes en medios de transporte. Una forma utilizada por décadas para determinar el grado de susceptibilidad a la cinetosis ha sido con la aplicación del cuestionario en su versión acortada Motion Sickness Suscep-tibility-short (MSSQ-short). Objetivo: Adaptar lingüística y transculturalmente al español el cuestionario MSSQ-short. Material y Método: Se llevaron a cabo cuatro etapas: Traducción directa, traducción inversa (retrotraducción), consolidación por un comité de expertos y pretest (aplicabilidad/viabilidad). En la etapa de pre-test 51 personas respondieron el cuestionario. Resultados: La discrepancias encontradas en las primeras etapas fueron resueltas por un tercer traductor, el cual concluyó en un documento final en español que fue analizado y revisado por el comité de expertos. Se determinaron los percentiles del 0 al 100, percentil 50 con 9,0 puntos, percentil 25 con 2,13 puntos y el percentil 75 con 17,4 puntos. La consistencia interna del cuestionario fue de 0,889. Conclusión: La traducción y adaptación transcultural fue aceptada por un comité de expertos y participantes con distintas características demográficas y educacionales. El cuestionario obtuvo buena consistencia interna y resultados concordantes con la versión original.

Abstract Introduction: Motion sickness is related to the presence of a series of symptoms that are typically induced by everyday situations of travel in means of transport. A way used for decades to determine the degree of susceptibility to motion sickness has been with the application of the questionnaire in its shortened version Motion Sickness Susceptibility-short (MSSQ-short). Aim: Linguistically and cross-culturally adapt the MSSQ-short questionnaire to Spanish. Material and Method: Four stages were carried out: direct translation, reverse translation (back translation), consolidation by a committee of experts, and pretest (applicability/feasibility). In the pre-test stage, 51 people answered the questionnaire. Results: The discrepancies found in the early stages were resolved by a third translator, which concluded in a final document in Spanish that was analyzed and reviewed by the expert committee. The percentiles from 0 to 100 were determined, 50th percentile with 9.0 points, 25th percentile with 2.13 points, and 75th percentile with 17.4 points. The internal consistency of the questionnaire was 0.889. Conclusion: The cross-cultural translation and adaptation were accepted by a committee of experts and participants with different demographic and educational characteristics. The questionnaire obtained good internal consistency and results consistent with the original version.

On-surface products from de-fluorination of C60F48 on Ag(111): C60, C60Fx and silver fluoride formation.

By employing diverse surface sensitive synchrotron radiation spectroscopies we demonstrate that the fluorine content of initial C60F48 deposited at room temperature on Ag(111) varies with molecular coverage. At the very early stages of deposition, C60F48 fully de-fluorinates and transforms into C60. Strong indications of silver fluoride formation are provided. The chemical footprint of fluorinated fullerenes emerges at relatively low molecular coverage indicating that the degree of fullerene de-fluorination decreases (from total to partial de-fluorination) as molecules are deposited. Full de-fluorination stops well before the substrate surface is completely covered by fullerenes. At the molecular level, the fluorine loss observed by spectroscopic techniques is supported by scanning tunneling microscopy imaging. Both molecules and metal surface are importantly involved in the process.

Evaluación electrofisiológica del procesamiento auditivo

Resumen En la actualidad existen distintas herramientas para la evaluación del procesamiento auditivo y sus alteraciones. Además de las pruebas conductuales y de las mediciones electroacústicas, se ha establecido que la batería mínima de evaluación del procesamiento auditivo debe incluir exámenes electrofisiológicos que permitan dar cuenta del estado funcional de las estructuras anatómicas a nivel de tronco cerebral, la corteza auditiva y del sistema nervioso auditivo central en general. Las pruebas electrofisiológicas más descritas en la literatura corresponden a las respuestas auditivas complejas de tronco cerebral, potenciales evocados auditivos de latencia media, potenciales evocados auditivos de latencia tardía, y los potenciales auditivos asociados a eventos como el potencial de disparidad y el P300. A pesar de que diversos organismos internacionales como la American Speech-Language-Hearing Association y la American Academy of Audiology han recomendado su utilización en el proceso diagnóstico del trastorno del procesamiento auditivo y han mencionado su utilidad en la diferenciación de cuadros asociados, no existe evidencia concluyente en relación con sus aplicaciones clínicas. Esto último ha llevado a organizaciones como la British Society of Audiology a poner en duda su verdadera utilidad en estos casos.

Abstract Currently, there are different tools for the assessment of auditory processing and its disorders. In addition to behavioral tests and electroacoustic measurements, it has been established that the minimum battery for auditory processing assessment must include electrophysiological examinations that allow to verify the functional state of anatomical structures at the brainstem, the auditory cortex and, broadly, the central auditory nervous system. In literature, the most described electrophysiological tests correspond to complex auditory brainstem responses, auditory middle latency evoked responses, auditory late latency evoked responses and event related evoked potentials, such as mismatch negativity and P300. Although several international organizations such as the American Speech-Language-Hearing Association and the American Academy of Audiology have recommended its use in the diagnostic process of auditory processing disorder and have mentioned its usefulness in the differentiation of associated conditions, there is no conclusive evidence in relation to its clinical applications. The latter has led organizations such as the British Society of Audiology to question its true usefulness in these cases.

A grapevine leaves dataset for early detection and classification of esca disease in vineyards through machine learning.

Esca is one of the most common disease that can severely damage grapevine. This disease, if not properly treated in time, is the cause of vegetative stress or death of the attacked plant, with the consequence of losses in production as well as a rising risk of propagation to the closer grapevines. Nowadays, the detection of Esca is carried out manually through visual surveys usually done by agronomists, requiring enormous amount of time. Recently, image processing, computer vision and machine learning methods have been widely adopted for plant diseases classification. These methods can minimize the time spent for anomaly detection ensuring an early detection of Esca disease in grapevine plants that helps in preventing it to spread in the vineyards and in minimizing the financial loss to the wine producers. In this article, an image dataset of grapevine leaves is presented. The dataset holds grapevine leaves images belonging to two classes: unhealthy leaves acquired from plants affected by Esca disease and healthy leaves. The data presented has been collected to be used in a research project jointly developed by the Department of Information Engineering, Polytechnic University of Marche, Ancona, Italy and the STMicroelectronics, Italy, under the cooperation of the Umani Ronchi SPA winery, Osimo, Ancona, Marche, Italy. The dataset could be helpful to researchers who use machine learning and computer vision algorithms to develop applications that help agronomists in early detection of grapevine plant diseases. The dataset is freely available at http://dx.doi.org/10.17632/89cnxc58kj.1.

Definition of minimal disease activity in psoriasis.

OBJECTIVE: To generate an operational definition to adequately reflect the construct 'Minimal Disease Activity (MDA)' in psoriasis. METHODS: A systematic review of domains included in clinical trials of psoriasis was presented to a panel of dermatologists and patients. Further domains were elicited by panel discussions. Domains (and instruments measuring these) were items of two consecutive Delphi rounds targeting dermatologists from the Psoriasis Group of the Spanish Academy of Dermatology and Venereology and patients from the Acción Psoriasis association. The instruments selected were used to generate 388 patient vignettes. The expert group then classified these vignettes as 'No MDA/MDA/Unclassifiable'. The items were further reduced by factorial analysis. Using the classification variable as gold standard, several operational constructions were tested in regression models and ROC curves and accuracy was evaluated with area under the curve (AUC). RESULTS: The following domains were included: itching, scaling, erythema and visibility by 0-10 scales, extension by BSA, impact on quality of life by DLQI, special location and presence of arthritis as yes/no. The definition with the highest AUC and best balance between sensitivity and specificity was the one including no presence of arthritis plus at least three others below the upper limit of the 95% confidence interval (AUC, 0.897; sensitivity, 95.2%, specificity, 84.1%). CONCLUSION: This study provides, for the very first time, the construct of 'Minimal Disease Activity' in psoriasis as agreed by dermatologists and patients. MDA is defined as absence of active arthritis plus 3 out of 6: itching ≤ 1/10; scaling ≤ 2/10; redness ≤ 2/10; visibility ≤ 2/10; BSA ≤ 2; DLQI ≤ 2; and no lesions in special locations. By design, domains are representative of disease impact. This MDA definition may be used as a measure of adequate management and replace other subjective or restrictive tools.

Changing Trends in Drug Prescription and Causes of Treatment Discontinuation of First Biologic Over Ten Years in Psoriasis in the Spanish Biobadaderm Registry. / Cambios en las tendencias de la prescripción y causas de la interrupción en los tratamientos biológicos indicados en la psoriasis durante los primeros 10 años. Datos obtenidos del registro español Biobadaderm.

BACKGROUND AND OBJECTIVES: Current psoriasis guidelines do not usually include recommendations about first line classical or biologic treatment. The objectives of this study were: to describe shifts in the prescription of the first biological treatment, and to compare treatment withdrawal and rates of adverse events over ten years. MATERIAL AND METHODS: Biobadaderm registry was analyzed to describe: first biological prescription in bio-naïve patients, adverse events rate and reasons for drug withdrawal comparing three periods of time (2008-2010, 2011-2014, 2015-2018). RESULTS: Anti-TNF drugs were the most prescribed biological drug from 2008 to 2010. Ustekinumab has become the most prescribed first biologic since 2014. The main reasons for drug discontinuation were adverse events, lack of efficacy and remission. In each period any treatment was less likely to be discontinued due to any of these three reasons comparing to the previous period. CONCLUSIONS: The present study identifies trends in prescription of the first biological antipsoriatic drug in clinical practice from 2008 to 2018. It suggests that we have become more comfortable with the safety profile and more exigent with the efficacy of the drugs.

Excess mortality in the United States during the first three months of the COVID-19 pandemic.

Deaths are frequently under-estimated during emergencies, times when accurate mortality estimates are crucial for emergency response. This study estimates excess all-cause, pneumonia and influenza mortality during the coronavirus disease 2019 (COVID-19) pandemic using the 11 September 2020 release of weekly mortality data from the United States (U.S.) Mortality Surveillance System (MSS) from 27 September 2015 to 9 May 2020, using semiparametric and conventional time-series models in 13 states with high reported COVID-19 deaths and apparently complete mortality data: California, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania and Washington. We estimated greater excess mortality than official COVID-19 mortality in the U.S. (excess mortality 95% confidence interval (CI) 100 013-127 501 vs. 78 834 COVID-19 deaths) and 9 states: California (excess mortality 95% CI 3338-6344) vs. 2849 COVID-19 deaths); Connecticut (excess mortality 95% CI 3095-3952) vs. 2932 COVID-19 deaths); Illinois (95% CI 4646-6111) vs. 3525 COVID-19 deaths); Louisiana (excess mortality 95% CI 2341-3183 vs. 2267 COVID-19 deaths); Massachusetts (95% CI 5562-7201 vs. 5050 COVID-19 deaths); New Jersey (95% CI 13 170-16 058 vs. 10 465 COVID-19 deaths); New York (95% CI 32 538-39 960 vs. 26 584 COVID-19 deaths); and Pennsylvania (95% CI 5125-6560 vs. 3793 COVID-19 deaths). Conventional model results were consistent with semiparametric results but less precise. Significant excess pneumonia deaths were also found for all locations and we estimated hundreds of excess influenza deaths in New York. We find that official COVID-19 mortality substantially understates actual mortality, excess deaths cannot be explained entirely by official COVID-19 death counts. Mortality reporting lags appeared to worsen during the pandemic, when timeliness in surveillance systems was most crucial for improving pandemic response.

Primary resistance to integrase strand transfer inhibitors in Spain using ultrasensitive HIV-1 genotyping.

BACKGROUND: Transmission of resistance mutations to integrase strand transfer inhibitors (INSTIs) in HIV-infected patients may compromise the efficacy of first-line antiretroviral regimens currently recommended worldwide. Continued surveillance of transmitted drug resistance (TDR) is thus warranted. OBJECTIVES: We evaluated the rates and effects on virological outcomes of TDR in a 96 week prospective multicentre cohort study of ART-naive HIV-1-infected subjects initiating INSTI-based ART in Spain between April 2015 and December 2016. METHODS: Pre-ART plasma samples were genotyped for integrase, protease and reverse transcriptase resistance using Sanger population sequencing or MiSeq™ using a ≥ 20% mutant sensitivity cut-off. Those present at 1%-19% of the virus population were considered to be low-frequency variants. RESULTS: From a total of 214 available samples, 173 (80.8%), 210 (98.1%) and 214 (100.0%) were successfully amplified for integrase, reverse transcriptase and protease genes, respectively. Using a Sanger-like cut-off, the overall prevalence of any TDR, INSTI-, NRTI-, NNRTI- and protease inhibitor (PI)-associated mutations was 13.1%, 1.7%, 3.8%, 7.1% and 0.9%, respectively. Only three (1.7%) subjects had INSTI TDR (R263K, E138K and G163R), while minority variants with integrase TDR were detected in 9.6% of subjects. There were no virological failures during 96 weeks of follow-up in subjects harbouring TDR as majority variants. CONCLUSIONS: Transmitted INSTI resistance remains rare in Spain and, to date, is not associated with virological failure to first-line INSTI-based regimens.

Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. / El papel del dermatólogo en el diagnóstico precoz de la artritis psoriásica: recomendaciones de un grupo de expertos.

Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.