Validation of the CORB75 (confusion, oxygen saturation, respiratory rate, blood pressure, and age ≥ 75 years) as a simpler pneumonia severity rule.

PURPOSE: This study compares the ability of two simpler severity rules (classical CRB65 vs. proposed CORB75) in predicting short-term mortality in elderly patients with community-acquired pneumonia (CAP). METHODS: A population-based study was undertaken involving 610 patients ≥ 65 years old with radiographically confirmed CAP diagnosed between 2008 and 2011 in Tarragona, Spain (350 cases in the derivation cohort, 260 cases in the validation cohort). Severity rules were calculated at the time of diagnosis, and 30-day mortality was considered as the dependent variable. The area under the receiver operating characteristic curves (AUC) was used to compare the discriminative power of the severity rules. RESULTS: Eighty deaths (46 in the derivation and 34 in the validation cohorts) were observed, which gives a mortality rate of 13.1 % (15.6 % for hospitalized and 3.3 % for outpatient cases). After multivariable analyses, besides CRB (confusion, respiration rate ≥ 30/min, systolic blood pressure <90 mmHg or diastolic ≤ 60 mmHg), peripheral oxygen saturation (≤ 90 %) and age ≥ 75 years appeared to be associated with increasing 30-day mortality in the derivation cohort. The model showed adequate calibration for the derivation and validation cohorts. A modified CORB75 scoring system (similar to the classical CRB65, but adding oxygen saturation and increasing the age to 75 years) was constructed. The AUC statistics for predicting mortality in the derivation and validation cohorts were 0.79 and 0.82, respectively. In the derivation cohort, a CORB75 score ≥ 2 showed 78.3 % sensitivity and 65.5 % specificity for mortality (in the validation cohort, these were 82.4 and 71.7 %, respectively). CONCLUSIONS: The proposed CORB75 scoring system has good discriminative power in predicting short-term mortality among elderly people with CAP, which supports its use for severity assessment of these patients in primary care.

Dermoscopy of apocrine hidrocystomas: a morphological study.

BACKGROUND: The dermoscopic morphology of apocrine hidrocystomas remains to be elucidated. OBJECTIVE: To evaluate the morphological findings of apocrine hidrocystomas under dermoscopic observation. METHODS: Dermoscopic examination of 22 cases of apocrine hidrocystomas was performed to evaluate specific dermoscopic criteria and patterns. RESULTS: The most frequently occurring dermoscopic features were found to be: (i) A translucent to opaque, homogeneous area which occupies the whole lesion in all apocrine hidrocystomas (100%). The colour of this homogeneous area was skin-colored in 31.8% of our cases; yellow, in 31.8% and blue, in 22.7% of apocrine hidrocystomas. (ii) Vascular structures were identified in 81.8% of our cases; arborizing vessels, in 68.2% and linear-irregular vessels in 9.1% of our cases; and (iii) Whitish structures were identified in 22.7% of the lesions. The results of our study reveal that the presence of a homogeneous area that occupies the whole lesion and arborizing vessels is the most common dermoscopic pattern in apocrine hidrocystomas (68.2%). CONCLUSION: Apocrine hidrocystomas, above all in its pigmented variant, may represent a dermoscopic pitfall, being difficult to differentiate clinically and dermoscopically from basal cell carcinomas.

Comparison of three predictive rules for assessing severity in elderly patients with CAP.

AIM: This study compares the ability of the Pneumonia Severity Index (PSI) and the British Thoracic Society CURB-65 and CRB-65 rules in predicting short-term mortality among elderly patients with community-acquired pneumonia (CAP). METHODS: It is a population-based study including all people over 65 years old with a radiographically confirmed CAP in the region of Tarragona (Spain) between 2002 and 2008. Treatment setting and clinical variables were considered for each patient. PSI, CURB-65 and CRB-65 scores were calculated at the moment of diagnosis and 30-day mortality was considered as a main dependent variable. The rules were compared based on sensitivity, specificity and area under the receiver operating characteristic curve (AUC). RESULTS: Of the total 590 CAP cases, mortality rate was 13.6% (15.3% in hospitalised and 1.4% in outpatient cases; p = 0.001). Mortality increased with increasing PSI score (None in class II, 6,9% in class III, 14,4% in class IV and 29,5% in class V), CURB-65 score (7.5%, 14.5%, 26.7%, 53.3% and 100% for scores 1,2,3,4 and 5 respectively) and CRB-65 score (6.6%, 26.1%, 40.5% and 50% for scores 1,2,3 and 4 respectively). The three rules performed too similarly to predict 30-day mortality, with a ROC area of 0.727 [95% confidence interval (CI): 0.67-0.79] for the PSI, 0.672 (95% CI: 0.61-0.74) for the CURB-65, and 0.719 (95% CI: 0.65-0.78) for the CRB-65. CONCLUSION: Our data shows that the analysed rules perform equally well among elderly people with CAP which supports the recommendation for using the simplified CRB-65 severity score among elderly patients in primary care or emergency visits.

Dermoscopic pattern of intermediate stage in seborrhoeic keratosis regressing to lichenoid keratosis: report of 24 cases.

BACKGROUND: Lichenoid keratosis (LK) is a well-described entity which has been proposed to represent an immunological or regressive response to pre-existing epidermal lesions such as solar lentigines or seborrhoeic keratoses. OBJECTIVES: To evaluate the dermoscopic criteria of a series of cases of LK with remaining areas of seborrhoeic keratosis which were both dermoscopically and histologically diagnosed. METHODS: Pigmented lesions with dermoscopic areas of seborrhoeic keratosis and LK in the same tumour were consecutively diagnosed and prospectively included in the study. All pigmented lesions were examined and registered using DermLite Foto equipment (3Gen, LLC, Dana Point, CA, U.S.A.), at 10-fold magnification, at the Dermatology Department of Hospital de Sant Pau i Santa Tecla (Tarragona, Spain), between 1 January 2003 and 31 December 2005. RESULTS: In total, 24 cases of lesions with dermoscopic areas of seborrhoeic keratosis and LK were collected. In four lesions (17%), the clinical differential diagnosis without dermoscopy included malignant melanoma and in seven lesions (29%), basal cell carcinoma. The diagnosis of LK was clinically considered without dermoscopy in only six cases (25%). A granular pattern was observed to be distributed throughout the LK areas of the lesions. This pattern consisted of the presence of brownish-grey, bluish-grey or whitish-grey coarse granules that formed, in 11 cases (46%), globules and/or short lines. In one lesion, located on the face, these short lines produced annular or rhomboid structures as seen in lentigo maligna melanoma. CONCLUSIONS: Dermoscopy is a useful tool which assists in the correct clinical recognition of LK, which may also potentially illuminate the pathogenesis of these tumours, showing the intermediate stage of regressing epidermal lesions in an LK.

Las manifestaciones cutáneas asociadas a hemorragia gastrointestinal

La piel y el tracto gastrointestinal son dos aparatos en estrecha relación. Existen numerosas enfermedades que afectan primariamente al tracto gastrointestinal con manifestaciones cutáneas que, en muchos casos, pueden ser la clave diagnóstica del proceso digestivo subyacente. La hemorragia digestiva es un problema cuya incidencia en nuestro medio supera los 150 casos por 100.000 habitantes y cuya mortalidad estimada es del 10 por ciento de los casos. En el presente artículo revisaremos las enfermedades vasculares del tracto gastrointestinal y otros procesos digestivos que cursan con hemorragia, que presentan manifestaciones cutáneas características, destacando su descripción e importancia clínicas y su tratamiento. (AU)

Los queloides y las cicatrices hipertróficas

Las cicatrices hipertróficas y los queloides son respuestas hiperproliferativas del tejido conectivo frente a diferentes estímulos, entre los que se incluyen la inflamación, la infección y los traumatismos cutáneos (sobre todo las quemaduras y las heridas quirúrgicas). Su diagnóstico es clínico y no son raros en los postoperatorios de la cirugía menor cutánea. En el presente artículo trataremos las modalidades terapéuticas actuales y daremos algunos consejos prácticos para su prevención (AU)