Encuesta sobre las características y honorarios de la práctica dermatológica privada española en 2023. Actualización y cambios con respecto a 2018 / Survey on Private Dermatology Practice Characteristics and Fees in Spain in 2023. Update and Changes From 2018

El presente trabajo incluye el análisis de los datos obtenidos mediante una encuesta realizada en enero de 2023 a 235 dermatólogos que ejercen actividad asistencial privada en España. Se añade un fotograma posterior al estudio con metodología similar realizado en 2018, al mismo tiempo que se analizan los cambios y adaptaciones que tiene la práctica con los nuevos tiempos y retos emergentes. Comparado con 2018, en 2023 destacan: incrementos en la dedicación a la actividad privada, las teleconsultas, el cobro anticipado de técnicas, la aceptación de pagos con tarjeta bancaria y banca electrónica; cambios en la periodicidad de ajuste de precios; el hecho de que un 60% de los encuestados declare que ha ajustado al alza los precios en el año; un incremento de los precios que se ajusta aproximadamente al del IPC y la observación de que los dermatólogos varones declaran con más frecuencia precios extremos más altos (AU)

The present work includes the analysis of the data obtained through a survey conducted in January 2023 to 235 dermatologists practicing private healthcare activity in Spain. A subsequent frame is added to the study with similar methodology carried out in 2018, while analyzing the changes and adaptations that the practice has with the new times and emerging challenges. Compared to 2018, in 2023 the following findings stand out: increases in dedication to private activity, teleconsultations, advance payment for techniques, acceptance of payments by bank card and electronic banking; changes in the periodicity of price adjustment; the fact that 60% of respondents state that they have adjusted prices upwards in the year; a rise in prices that is approximately in line with that of the CPI, and the observation that male dermatologists more frequently state higher extreme prices (AU)

[Translated article] Private Dermatology Practice Characteristics and Fees in Spain in 2023: A Survey and Comparison With Findings for 2018 / Encuesta sobre las características y honorarios de la práctica dermatológica privada española en 2023. Actualización y cambios con respecto a 2018

This report analyzes findings from a January 2023 survey of 235 dermatologists in private practice in Spain. The data for 2023 are compared to findings from a similar survey of conditions in 2018, to provide a snapshot of each year and identify changes in clinical practice and adaptations to emerging situations and challenges. Noteworthy changes in 2023 vs. 2018 included increased dedication to private practice and teleconsultations, more use of prepayment for procedures, more acceptance of payment by credit card or other electronic means, and variation in the timing of price changes. Sixty percent of the respondents reported planning to raise prices in 2023. The planned pricing adjustments will approximate the rise in the consumer price index. We also found that male dermatologists more often reported fees at the highest end of the range (AU)

El presente trabajo incluye el análisis de los datos obtenidos mediante una encuesta realizada en enero de 2023 a 235 dermatólogos que ejercen actividad asistencial privada en España. Se añade un fotograma posterior al estudio con metodología similar realizado en 2018, al mismo tiempo que se analizan los cambios y adaptaciones que tiene la práctica con los nuevos tiempos y retos emergentes. Comparado con 2018, en 2023 destacan: incrementos en la dedicación a la actividad privada, las teleconsultas, el cobro anticipado de técnicas, la aceptación de pagos con tarjeta bancaria y banca electrónica; cambios en la periodicidad de ajuste de precios; el hecho de que un 60% de los encuestados declare que ha ajustado al alza los precios en el año; un alza de los precios que se ajusta aproximadamente a la del IPC, y la observación de que los dermatólogos varones declaran con más frecuencia precios extremos más altos (AU)

Survey on Private Dermatology Practice Characteristics and Fees in Spain in 2023. Update and Changes From 2018. / Encuesta sobre las características y honorarios de la práctica dermatológica privada española en 2023. Actualización y cambios con respecto a 2018.

The present work includes the analysis of the data obtained through a survey conducted in January 2023 to 235 dermatologists practicing private healthcare activity in Spain. A subsequent frame is added to the study with similar methodology carried out in 2018, while analyzing the changes and adaptations that the practice has with the new times and emerging challenges. Compared to 2018, in 2023 the following findings stand out: increases in dedication to private activity, teleconsultations, advance payment for techniques, acceptance of payments by bank card and electronic banking; changes in the periodicity of price adjustment; the fact that 60% of respondents state that they have adjusted prices upwards in the year; a rise in prices that is approximately in line with that of the CPI, and the observation that male dermatologists more frequently state higher extreme prices.

Impacto del confinamiento en el ejercicio físico de los pacientes con artrosis durante la pandemia COVID-19 / Impact of lockdown on physical activity of patients with osteoarthritis during the COVID-19 pandemic

Introducción: La actividad física es esencial en la población con artrosis, sin embargo, el confinamiento durante la pandemia por COVID obligó al cambio en los estilos de vida. Se llevó a cabo un estudio observacional y descriptivo con el objetivo de evaluar el ejercicio físico realizado en personas con patología osteoarticular degenerativa (POD) durante la pandemia por COVID-19. Material y métodos: Se realizó una encuesta telefónica a personas mayores de 60 años con POD atendidos previamente en el Hospital Central de la Cruz Roja, valorando el ejercicio físico durante el confinamiento por pandemia COVID-19. Se analizaron las variables (tiempo de ejercicio físico, causas si el ejercicio fue reducido, y la intensidad de dolor) y se compararon con la situación previa al confinamiento domiciliario. Resultados: Se incluyeron un total de 33 pacientes (ocho hombres, 25 mujeres), con una edad media de 75,6 años. La poliartrosis fue el diagnóstico más frecuente. El 51,5% realizaban la misma cantidad de ejercicio físico, el 21,21% realizaban más y 24,2% menos que antes. Solo el 6,1% realizaba más de una hora al día de actividad. El 36,4% tenían más dolor que previamente. Conclusiones: Aunque existe una alta adherencia a los ejercicios aprendidos en el servicio de rehabilitación, el confinamiento por COVID-19 ha tenido un efecto negativo en el nivel de ejercicio realizado por los pacientes con POD. Es recomendable incentivar el ejercicio físico durante períodos de confinamiento.(AU)

Introduction: Physical activity is essential in the osteoarthritis population, however, confinement during the COVID pandemic forced lifestyle changes. An observational and descriptive study was conducted to assess physical exercise in people with degenerative osteoarticular disease (DOD) during the COVID-19 pandemic. Material and methods: A telephone survey was conducted among people over 60 years of age with DOD previously treated at the Hospital Central de la Cruz Roja, assessing physical exercise during the COVID-19 pandemic confinement. The variables (time of physical exercise, causes if exercise was reduced, and pain intensity) were analysed and compared with the situation prior to home confinement. Results: A total of 33 patients (8 men, 25 women) were included, with a mean age of 75.6 years. Polyarthrosis was the most frequent diagnosis. 51.5% performed the same amount of physical exercise, 21.21% performed more and 24.2% less than before. Only 6.1% performed more than 1 h a day of activity. 36.4% had more pain than previously. Conclusions: Although there is a high adherence to the exercises learned in the rehabilitation service, COVID-19 confinement has had a negative effect on the level of exercise performed by POD patients. It is advisable to encourage physical exercise during periods of lockdown.(AU)

[Impact of lockdown on physical activity of patients with osteoarthritis during the COVID-19 pandemic]. / Impacto del confinamiento en el ejercicio físico de los pacientes con artrosis durante la pandemia COVID-19.

INTRODUCTION: Physical activity is essential in the osteoarthritis population, however, confinement during the COVID pandemic forced lifestyle changes. An observational and descriptive study was conducted to assess physical exercise in people with degenerative osteoarticular disease (DOD) during the COVID-19 pandemic. MATERIAL AND METHODS: A telephone survey was conducted among people over 60 years of age with DOD previously treated at the Hospital Central de la Cruz Roja, assessing physical exercise during the COVID-19 pandemic confinement. The variables (time of physical exercise, causes if exercise was reduced, and pain intensity) were analysed and compared with the situation prior to home confinement. RESULTS: A total of 33 patients (8 men, 25 women) were included, with a mean age of 75.6 years. Polyarthrosis was the most frequent diagnosis. 51.5% performed the same amount of physical exercise, 21.21% performed more and 24.2% less than before. Only 6.1% performed more than 1 h a day of activity. 36.4% had more pain than previously. CONCLUSIONS: Although there is a high adherence to the exercises learned in the rehabilitation service, COVID-19 confinement has had a negative effect on the level of exercise performed by POD patients. It is advisable to encourage physical exercise during periods of lockdown.

Efectos en vida real de la adición de semaglutida subcutánea semanal al tratamiento con insulina en diabetes mellitus tipo 2 / Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus

Objetivos: Determinar en la vida real los beneficios antropométricos y analíticos de la adición de semaglutida por vía subcutánea al tratamiento previo con insulina en pacientes con diabetes tipo 2.Métodos: Estudio descriptivo, retrospectivo y abierto en el que se describen características clínicas y antropométricas de 117 pacientes diagnosticados de diabetes tipo 2 seguidos en las consultas externas de Endocrinología y Nutrición del Hospital Universitario Central de Asturias a lo largo de 53 semanas tras el inicio de tratamiento con semaglutida subcutánea (octubre-diciembre 2019). Todos los pacientes estaban en tratamiento previo con insulina, con o sin antidiabéticos orales.Resultados: De los 117 pacientes iniciales, 17 no completaron el estudio debido a efectos adversos (náuseas, vómitos), decisión clínica y pérdida de seguimiento.A los 12 meses (semana 53) del inicio de la semaglutida se obtuvo un descenso de HbA1c de 0,74% (IC 95% 0,59-1,14, p<0,05), así como de 3,61kg de peso (IC 95% 2,30-4,92, p<0,05), y de 15,88 UI de insulina total (IC 95% 10,98-20,74, p<0,05) respecto a las cifras basales. En pacientes sin análogo del receptor de GLP-1 (arGLP-1) previo, el efecto en la disminución de HbA1c, el peso y la dosis total de insulina fue estadísticamente significativo; sin embargo, los pacientes pretratados con arGLP-1 solo tuvieron mejoría en la reducción de peso. No se observaron eventos adversos graves.Conclusiones: La adición de semaglutida subcutánea al tratamiento previo con insulina con o sin antidiabéticos orales induce una disminución de HbA1c, peso y dosis de insulina de forma segura. Este efecto es mayor en pacientes naïve para tratamiento con arGLP-1. (AU)

Objectives: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes.Methods: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics.Results: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up.Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p<0.05) as well as 3.61kg of weight loss (95% CI 2.30-4.92, p<0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p<0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed.Conclusions: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients. (AU)

Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus.

OBJECTIVES: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes. METHODS: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics. RESULTS: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up. Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p < 0.05) as well as 3.61 kg of weight loss (95% CI 2.30-4.92, p < 0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p < 0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed. CONCLUSIONS: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients.

'Rainbow pattern': a dermoscopic sign of invasive melanoma.

BACKGROUND: The 'rainbow pattern' was initially described as a highly specific dermoscopic feature of Kaposi sarcoma. Since then, it has been reported in many benign and malignant cutaneous tumours, including a few malignant melanomas (MMs). AIM: To determine the frequency and presentation of this dermoscopic pattern in primary cutaneous MMs in comparison to other cutaneous tumours. METHODS: The presence of a rainbow pattern was evaluated in a sample of 1100 dermoscopic images of different melanocytic and nonmelanocytic cutaneous neoplasms. RESULTS: The rainbow pattern was observed in 23 of 245 (9.4%) MM and 44 of 855 (5.1%) non-MM neoplasms. MMs presenting this feature were generally thicker: 82.6% > 1 mm and 43.0% > 2 mm. Compared with non-MMs, rainbow pattern in MMs was more commonly focal (82.7% vs. 36.4% nonfocal, P = 0.001) and associated with > 2 dermoscopic structures associated with MM (100% vs. 9% with fewer, P = 0.001). CONCLUSION: The rainbow pattern is a dermoscopic sign that can occasionally be observed in invasive MMs. In MMs, this feature is usually associated with other dermoscopic criteria of MM and located in a focal and eccentric area, as opposed to a diffuse and isolated presentation in non-MM neoplasms.

[Real-life efficacy and safety of PCSK9 inhibitors treatment: Experience in three hospitals in Asturias]. / Efectividad y seguridad del tratamiento con iPCSK9 en vida real: experiencia de tres hospitales asturianos.

BACKGROUND: Inhibitors of proprotein convertase subtilisin/kexin type9 (PCSK9 inhibitors) are a treatment option for those patients with familial hypercholesterolemia or in secondary prevention who do not reach the LDL-C target with other therapeutic measures. The aim of this study is to assess the effectiveness and safety of these drugs. METHODS: Retrospective, multicentric, descriptive study. We collected data from all patients that have started PCSK9 inhibitors treatment in three hospitals in Asturias since the beginning of its use in 2016. We analysed changes in lipid profile with PCSK9 inhibitors and its side effects. RESULTS: We registered 98 patients, 75 of them affected by familial hypercholesterolemia (FH) and 23 unaffected. Two months after the beginning of PCSK9 inhibitors treatment, a 61% reduction rate in LDL-C in patients with FH and 52% in those without this condition was observed. This statistically significant reduction remained stable during follow-up. A significant decrease in total cholesterol was observed, without significant changes in HDL-C and triglycerides. 96% of patients had no complications. CONCLUSIONS: PCSK9 inhibitors are safe drugs that rapidly achieve significant reductions in LDL-C after the beginning of treatment, which are maintained over time. Hence, the use of PCSK9 inhibitors is an alternative for the control of LDL-C in those patients in which the LDL-C target is not reached with other therapeutic measures.

Acute promyelocyte leukemia arose from CALR 1 mutated post essential thrombocythemia- myelofibrosis with splanchnic vein thrombosis: A case report.

Major disease complications for patients with essential thrombocythemia (ET) include thrombosis and fibrotic or leukemic transformation. Calreticulin (CALR) mutation type 1 frequencies in ET are estimated between 7% and 11% and ET patients carrying CALR type 1 mutation are associated with lower risk of thrombosis but higher risk of myelofibrosis transformation compared to ET patients with JAK2 mutation. Leukemic transformation rates at 20 years are estimated at less than 5% for ET and risk factors for leukemic transformation are advanced age, thrombosis history, leukocytosis, and anemia. Amongst the subtypes of blast phase myeloproliferative neoplasms, acute promyelocytic leukemia is extremely rare. Herein, we present a case of a promyelocytic blast crisis of post-ET myelofibrosis with associated life-threatening splanchnic vein thrombosis. This case suggests that inflammation plays a key role in thrombotic events and fibrotic/leukemic transformation in ET patients, regardless the molecular landscape.

Urgent manifestations of immunoglobulin G4-related disease.

Objective: Immunoglobulin G4-related disease (IgG4-RD) is considered a chronic condition with insidious presentation, but clinical experience suggests that disease onset prompts admission to the emergency department (ED) in a sizeable proportion of patients. We assessed the prevalence of acute manifestations associated with IgG4-RD onset requiring referral to the ED. Method: We revised our database and identified patients admitted to the ED because of symptoms latterly attributed to IgG4-RD onset (Group 1) and those who were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical region affected by IgG4-RD. Epidemiological, clinical, and serological features of Groups 1 and 2 were compared. Results: The study included 141 patients with IgG4-RD. Of these, 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%) and the nervous system (6.6%). Pancreatobiliary involvement was significantly more frequent in Group 1 than in Group 2. Head and neck, and salivary and lacrimal gland involvement was more frequent in Group 2 than in Group 1. The diagnostic delay was significantly shorter in Group 1 than in Group 2. Conclusion: Clinical manifestations associated with IgG4-RD onset require referral to the ED in most cases. This finding contrasts with the general view of IgG4-RD as a condition with non-acute presentation.