Real-world effectiveness and safety of apremilast in psoriasis at 52 weeks: a retrospective, observational, multicentre study by the Spanish Psoriasis Group.

BACKGROUND: Little has been published on the real-world effectiveness and safety of apremilast in psoriasis. OBJECTIVES: To evaluate the effectiveness, safety and drug survival of apremilast at 52 weeks in patients with moderate to severe plaque psoriasis or palmoplantar psoriasis in routine clinical practice. METHODS: Retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis or palmoplantar psoriasis treated with apremilast from March 2016 to March 2018. RESULTS: We studied 292 patients with plaque psoriasis and 85 patients with palmoplantar psoriasis. The mean (SD) Psoriasis Area and Severity Index (PASI) score was 10.7 (7.0) at baseline and 3.0 (4.2) at 52 weeks. After 12 months of treatment, 73.6% of patients had a PASI score of 3 or less. In terms of relative improvement by week 52, 49.7% of patients achieved PASI-75 (≥75% reduction in PASI score) and 26.5% achieved PASI-90. The mean physician global assessment score for palmoplantar psoriasis fell from 4.2 (5.2) at baseline to 1.3 (1.3) at week 52. Overall drug survival after 1 year of treatment with apremilast was 54.9 %. The main reasons for treatment discontinuation were loss of efficacy (23.9%) and adverse events (15.9%). Almost half of the patients in our series (47%) experienced at least one adverse event. The most common events were gastrointestinal problems. CONCLUSIONS: Apremilast may be a suitable alternative for the treatment of moderate to severe psoriasis and palmoplantar psoriasis. Although the drug has a good safety profile, adverse gastrointestinal effects are common.

La enfermedad de Castleman: entidad poco frecuente en pediatría y de presentación variable / Castleman’s disease: a rare entity and variable presentation in children

La enfermedad de Castleman (EC) es un trastorno linfoproliferativo infrecuente. Su etiología es desconocida, pero se cree que en ella pueden estar implicados procesos autoinmunes, inflamaciones crónicas, infecciones e inmunodeficiencias. Afecta a pacientes jóvenes y se diferencian clínicamente dos formas, una localizada, que se presenta como una masa única, asintomática, de buen pronóstico, más prevalente en pediatría, y otra multicéntrica, con afectación sistémica y peor pronóstico. Histológicamente, existen dos variantes: la hialinovascular, que suele corresponder a las formas localizadas, y la de células plasmáticas, que suele ser multicéntrica. La resección es curativa en las formas localizadas; sin embargo, en las formas multicéntricas se ha ensayado multitud de tratamientos sin éxito. Presentamos el caso de un paciente de 7 años de edad con una forma localizada de EC en la región cervical, en la que la resección quirúrgica resultó ser diagnóstica y terapéutica. Tras 2 años de seguimiento, se mantiene asintomático (AU)

Castleman's disease (CD) is an uncommon lymphoproliferative disorder. The etiology is unknown, but autoimmune processes, chronic inflammations, infections and immunodeficiencies are postulated to be involved. CD usually affects young patients and is classified into two clinical groups: a localized variant, the more frequent type in children, presented as a solitary asymptomatic mass, with good prognosis; and the multicentric variant, associated with systemic symptoms and a more aggressive clinical evolution. There are two histological variants, the hyaline-vascular type, which usually appears as localized forms, and the plasma-cell type, which is often multicentric. Resection is curative in localized forms; however, several treatments have been tried in multicentric forms without success. We report the case of a 7-year-old boy with the localized form of CD in the neck, in which the excision was both diagnostic and therapeutic. He remains asymptomatic after 2 years of follow-up (AU)

Improvement of a dry formulation of Pseudomonas fluorescens EPS62e for fire blight disease biocontrol by combination of culture osmoadaptation with a freeze-drying lyoprotectant.

AIMS: To study the effect of lyoprotectants and osmoadaptation on viability of Pseudomonas fluorescens EPS62e during freeze-drying and storage and to evaluate the formulation in terms of efficacy in biocontrol and fitness on pear flowers. METHODS AND RESULTS: A wettable powder formulation of a biocontrol agent of fire blight was optimized by means of lyoprotectants and culture osmoadaptation. Freeze-drying was used to obtain dehydrated cells, and the best viability (70% of survival) was obtained using lactose as lyoprotectant. Survival during lyophilization was additionally improved using physiological adaptation of cells during cultivation under salt-amended medium (osmoadaptation). The procedure increased the survival of cells after freeze-drying attaining viability values close to a 100% in the lactose-formulated product (3 × 10(11) CFU g(-1) ), and through the storage period of 1 year at 4°C. The dry formulation showed also an improved biocontrol efficacy and survival of EPS62e on pear flowers under low relative humidity conditions. CONCLUSIONS: Cell viability after freeze-drying was improved using lactose as lyoprotectant combined with a procedure of osmoadaptation during cultivation. The powder-formulated product remained active for 12 months and retained biocontrol levels similar to that of fresh cells. The formulation showed an improved survival of EPS62e on flowers and an increase of the efficacy of biocontrol of fire blight at low relative humidity. SIGNIFICANCE AND IMPACT OF THE STUDY: The results have a potential value for commercial application in biocontrol agents not only of fire blight but also of other plant diseases.

Postinfection Activity of Synthetic Antimicrobial Peptides Against Stemphylium vesicarium in Pear.

Brown spot of pear is a fungal disease of economic importance caused by Stemphylium vesicarium that affects the pear crops in Europe. Due to the characteristics of this disease and the moderate efficacy of available fungicides, the effectiveness of control measures is very limited; however, synthetic antimicrobial peptides (AMPs) may be a complement to these fungicides. In the present study, 12 AMPs of the CECMEL11 library were screened for fungicidal activity against S. vesicarium. In vitro experiments showed that eight AMPs significantly reduced the germination of conidia. The most effective peptides, BP15, BP22, and BP25, reduced fungal growth and sporulation at concentrations below 50 µM. Leaf assays showed that preventive application of BP15 and BP22 did not reduce infection; however, when the peptides were applied curatively, infection was significantly reduced. The use of a BP15 fluorescein 5-isothiocyanate conjugate revealed that the peptide binds to hyphae and germ tubes and produces malformations that irreversibly stop their development.

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Prospects and limitations of microbial pesticides for control of bacterial and fungal pomefruit tree diseases.

The tree constitutes an ecosystem in which microorganisms play an essential role in its functionality. Interactions that microorganisms establish with plants may be beneficial or detrimental and are of extreme importance in the exploitation of trees in agriculture as crop production systems. Fruit trees, especially pomefruit trees including apple, pear and several ornamentals are of great economic importance but its production is affected by several diseases. Fungal and bacterial fruit tree diseases are mainly controlled with chemical fungicides and bactericides, but health and environmental concerns about the use of chemical pesticides have result in strong regulatory actions and have stimulated the development of beneficial microorganisms as microbial pesticides. Up to now, several microorganisms have been registered in different countries and in the EU as biocontrol agents (BCA) covering mainly fire blight, soil-borne fungal diseases and postharvest fruit fungal rot. The key aspects in the success of this technology for disease control are related to biosafety and environmental impact of biocontrol agents, the traceability and fate in the environment and food chain, the improvement by physiological, genetic engineering or the use of mixtures or formulations as well as the industrial production and development of delivery systems for treatment application to trees.

Improvement of fitness and efficacy of a fire blight biocontrol agent via nutritional enhancement combined with osmoadaptation.

The efficacy of Pseudomonas fluorescens EPS62e in the biocontrol of Erwinia amylovora was improved by a procedure of physiological adaptation to increase colonization and survival in the phytosphere of rosaceous plants. The procedure consisted of osmoadaptation (OA) and nutritional enhancement (NE). OA was based on saline stress and osmolyte amendment of the growth medium during inoculum preparation. NE consisted of addition of glycine and Tween 80 to the formulation. NE and OA increased the growth rate and carrying capacity of EPS62e under high-relative-humidity (RH) conditions and improved survival at low RH on flowers under controlled environmental conditions. NE did not promote growth or affect infection capacity of E. amylovora. The effect of both methods was tested in the field by following the population of EPS62e using quantitative PCR (Q-PCR) (total population) and CFU counting (culturable population) methods. Following field application, EPS62e colonized blossoms, but it was stressed, as indicated by a sharp decrease in culturable compared to total population levels. However, once established in flowers and at the end of bloom, almost all the total population was culturable. The physiological adaptation treatments increased population levels of EPS62e over those of nonadapted cells during the late stage of the flowering period. Control of fire blight infections in flowers and immature fruits was tested by field application of EPS62e and subsequent inoculation with E. amylovora under controlled-environment conditions. The efficacy of fire blight control increased significantly with the combination of nutritional enhancement and osmoadaptation, in comparison with the absence of physiological adaptation.

Neumonía adquirida en la comunidad. Factores que predisponen al desarrollo de derrame pleural / Community acquired pneumonia. Factors that predispose to pleural effusion

Objetivo: Describir nuestra experiencia en el diagnóstico y el tratamiento de niños que precisan ingreso por neumonía adquirida en la comunidad (NAC), y analizar los factores que predisponen al desarrollo de derrame pleural paraneumónico (DPP). Material y métodos: Estudio observacional de una cohorte prospectiva. Muestreo consecutivo de niños de 2-14 años de edad ingresados por NAC entre julio de 2007 y febrero de 2008.Variables independientes: edad, sexo, días de estancia, patología previa, antibioterapia previa, administración de vacuna antineumocócica conjugada heptavalente (VCN7v), sintomatología, recuento de leucocitos y neutrófilos, proteína C reactiva, antígeno de neumococo en orina, hemocultivo, serología para Mycoplasma, test de tuberculina, radiología al diagnóstico y antibioterapia. Variables de resultado principal: evolución a DPP y su tratamiento. Ajustamos un modelo de regresión logística (RL) multivariable. Resultados: Se estudió a un total de 102 pacientes con una mediana de edad de 4,8 años; un 13% tenía antecedentes de broncoespasmo; en 26 la vacunación con VCN7v era completa, en 29 incompleta, y 46 niños no habían sido vacunados; 23 pacientes desarrollaron un derrame pleural, 10 precisaron un drenaje pleural y urocinasa, y uno exclusivamente drenaje; en el resto se instauró tratamiento conservador. Describimos una incidencia de DPP con un intervalo de confianza del 95% de 13,95-31,15. Tras el análisis estadístico (RL), apreciamos que tanto la vacunación completa con VCN7v (p= 0,01) como la serología indicativa de infección aguda por Mycoplasma (p= 0,01) predicen independientemente la evolución a DPP. Conclusión: El tratamiento evacuador, asociado o no a fibrinolisis, fue eficaz en todos los casos. Nuestros datos permiten conjeturar un posible papel causal de la VCN7v y de la coinfección por Mycoplasma pneumoniae en el desarrollo de DPP (AU)

Objective: To describe our experience in the diagnosis and treatment of children with community-acquired pneumonia (CAP) that need hospitalization, and to analyze the factors that influence the development of parapneumonic pleural effusion(PPE). Material and methods: Observational study of a prospective cohort. Consecutive sample of children aged 2 to 14 years admitted with CAP between July 2007 and February 2008. Independent variables: age, sex, days of stay, previous pathology, previous antibiotic therapy, vaccination with heptavalent pneumococcal conjugated vaccine (PCV7), symptomatology, white blood cells and neutrophils, C reactive protein, pneumococcal antigen in urine, blood culture, serology of Mycoplasma, tuberculin test, chest radiology, antibiotic therapy. Primary outcomes: pleural effusion development and its treatment. We fit a multivariable logistic regression (LR) model. Results: 102 patients. Median age 4.8 years, 13% had a history of bronchospasm. In 26 vaccinations with PCV7 was complete, incomplete in 29, and 46 cases had not been vaccinated. 23 patients developed PPE, 10 needed pleural drainage and urokinase, 1 exclusively drainage, the rest of the patients conservative treatment. We report an incidence of PPE 95% (CI= 13.95-31.15). After the statistical analysis (LR) we see that both PCV7 complete vaccination (p= 0.01) and serology evidence of acute Mycoplasma infection (p= 0.01) independently predict the development of PPE. Conclusion: Treatment with drainage with or without effective fibrinolysis in all cases. Our data allows us to guess estimate a possible causal role of PCV7 and Mycoplasma pneumonia ecoinfection in PPE development (AU)

Deficiencia de hierro en la infancia (II). Etiología, diagnóstico, prevención y tratamiento / Iron deficiency during childhood (II). Etiology, diagnosis, prevention and treatment

Se revisa la etiología de la ferropenia, especialmente las causas de origen nutricional. Se describe la sistemática diagnóstica, en especial las pruebas de laboratorio y el diagnóstico diferencial. Se indican las poblaciones de riesgo y las recomendaciones nutricionales para la prevención tanto en lactantes como en escolares y adolescentes, y se dan las pautas para el tratamiento farmacológico oral y parenteral, con indicación de los preparados actuales, su coste y su composición (AU)

Etiology of iron deficiency of anemia is examined, especially nutritional causes. An approach to its diagnosis is made with special reference to laboratory findings and differential diagnosis. The risk populations are indicated and the nutritional recommendations for the prevention both in breast-fed babies as scholars and adolescents are given. A guideline about pharmacological treatment, including oral and parenteral iron therapy, its costs and preparation follow-up is proposed (AU)

Deficiencia de hierro en la infancia (I). Concepto, prevalencia y fisiología del metabolismo férrico / Lack of iron during childhood (I). Concept, prevalence and physiology of the ferric metabolism

Se revisa la prevalencia de la deficiencia de hierro en la población, especialmente en los niños. Se analizan los datos disponibles sobre la repercusión neuropsicológica y las consecuencias potenciales de la ferroterapia sobre el crecimiento en pacientes que no la requieren. Se exponen las recomendaciones actuales de ingesta media diaria de hierro y los aspectos más relevantes del metabolismo férrico desde el punto de vista clínico (AU)

The prevalence of iron deficiency in the population, especially in children is checked. The available data is analyzed about the neuropsychological repercussion and the possible consequences of iron deficiency on the growth in patients that do not require it. The actual recommendations are exposed of a daily intake of iron and the most relevant aspects of iron metabolism from a clinician perspective are delineated (AU)

Need for lung resection in patients with intact or ruptured hydatid cysts.

BACKGROUND: Lung hydatid cyst caused by Echinococcus granulosus is endemic in many areas of the world. We aimed to compare the outcome of surgical treatment in intact and ruptured (infected or noninfected) cysts. METHODS: We reviewed the medical records of 115 patients with lung hydatid disease who were surgically treated between 2001 and 2005 in a tertiary hospital in Lima, Peru. Patients were divided into 3 groups based on cyst characteristics: intact cysts (n = 41), ruptured noninfected cysts (n = 47) and ruptured infected cysts (n = 27). If a patient had more than one type of cyst, the most severe form of disease was recorded. Data related to symptoms, morbidity and mortality were recorded and compared. We also calculated direct patient costs. RESULTS: Mean age of patients was 23.6 +/- 15.1 years old. Ruptured cysts were present in 64 % of patients and giant cysts (> 10 cm diameter) were present in 26 % of patients. Hemoptysis was present in 47.0 % of patients and was more frequent in patients with ruptured infected cysts. Lung resection was performed in 58 % of patients. The most common postoperative complication was infection of the operative wound (6.08 %). Perioperative mortality was zero. Patients with ruptured cysts had a longer hospitalization time and higher total cost (12.28 +/- 0.92 days, US$ 890.34 +/- 303.35) than patients with intact cysts (10.17 +/- 0.79 days, US$ 724.81 +/- 14.38). CONCLUSION: Surgical treatment of lung hydatid disease is safe, with a good outcome and a low mortality rate. The lung resection rate was higher than most published series and reflects the relatively high proportion of patients with giant and ruptured infected cysts.

Evaluation of ISO enrichment real-time PCR methods with internal amplification control for detection of Listeria monocytogenes and Salmonella enterica in fresh fruit and vegetables.

AIMS: To provide with a quick method for qualitative detection, in less than three days, of Salmonella enterica and Listeria monocytogenes in fresh fruit and vegetables. METHODS AND RESULTS: The method was based on coupling International Standard Organization (ISO) enrichment to a real-time PCR with internal amplification control (IAC), in a duplex format, without additional DNA purification. The performance was tested on different plant products. Both bacterial pathogens were consistently detected with a limit of detection (LOD) of 1 CFU in 25 g after enrichment, except for soybean sprouts. Levels of S. enterica, ranging from 1 to 10 CFU in 25 g after enrichment were detected with different enrichment broths. CONCLUSIONS: For both pathogens, the LOD was similar to that of the corresponding ISO method, while decreasing the analysis time and handling needs. SIGNIFICANCE AND IMPACT OF THE STUDY: The agreement between standard ISO and the enrichment real-time PCR(IAC)-based methods make the latter method as a promising alternative for quick and reliable detection of food-borne pathogens in fresh fruit and vegetables in routine laboratories.

Pleural empyema as a late complication of liver cystectomy for hydatid cyst.

Cystectomy without capitonnage is a widely used surgical technique for liver hydatid disease. A residual cavity can be left during the procedure, which can turn into an abscess. We report the case of a patient who developed right pleural empyema as a late complication of this procedure. She was successfully managed with antibiotics and a right thoracotomy.

Xantomas eruptivos en el debut de diabetes mellitus / Eruptive Xanthomas After Onset of Diabetes Mellitus

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