Cutaneous tuberculosis as a manifestation of Pott's Disease: A diagnostic challenge in patients with Non-HIV immunosuppression.

Tuberculosis (TB) is one of the most important public health issues in developing countries. The World Health Organization estimates that approximately 20%-40% of the world's population is infected. Pulmonary forms account for the majority of cases; however, it can manifest as extrapulmonary disease in 8.4%-13.7% of cases. Of these extrapulmonary forms of TB, only 1%-2% may have skin manifestations. Cutaneous tuberculosis (CTB) is relatively uncommon and is not a well-defined disease, which complicates diagnosis. We present two patients with Pott's disease that manifested as CTB, one with tuberculous gumma and the other with scrofuloderma. Both patients with non-HIV immunosuppression. The diagnosis of CTB was made by detecting Mycobacterium tuberculosis in skin samples by real-time polymerase chain reaction (Xpert MTB/RIF test) and Ziehl-Neelsen staining. The histologic findings described in these two forms of TB may vary or be absent in immunosuppressed patients, making diagnosis difficult.

Both Subjective Emotional Distress and Visual Handicap Correlate with Belin ABCD Classification in the Worse Eye as Measured with the "Keratoconus End-Points Assessment Questionnaire" (KEPAQ).

BACKGROUND: Keratoconus is a disease characterized by progressive corneal distortion and quality of vision. So far, no study using disease-specific scales has evaluated whether different stages of the disease correlate with higher quality of life (QoL) compromise. METHODS: A total of 114 patients with a confirmed diagnosis of Keratoconus were included in this retrospective study. All patients underwent a clinical and a Pentacam evaluation. They were also administered the "Keratoconus End-Points Assessment Questionnaire" (KEPAQ). Belin ABCD criteria were used for Keratoconus classification. "Better eye" was defined as the eye with the lowest maximum keratometry value. Spearman Rank Order Correlation was used to determine the correlation between the different Belin criteria and the KEPAQ scores in both subscales. RESULTS: Mean age was 28.13 ± 11.57 years, with 39.47% of patients being male. Mean score for the KEPAQ-E was 2.33 ± 3.40 Logit, while for the KEPAQ-F, it was 1.85 ± 3.61 Logit. Criteria A (anterior elevation), B (posterior elevation) and D (visual acuity) in the worse eye correlated significantly with a greater decrease in QoL (p < 0.05 for all correlations). No correlation could be found regarding the better eye. CONCLUSION: A greater corneal distortion in the worse eye, as determined by Belin ABCD, is associated with a greater decrease in patient's QoL. Surgical improvement of the worse eye should probably be performed before surgery of the better eye, as it may provide a better response regarding the quality of life improvement.

Both sub-scales of the "Keratoconus End-Points Assessment Questionnaire" (KEPAQ) are unidimensional and reliable.

BACKGROUND: Measuring quality of life in keratoconus is important and demands for well-constructed instruments and scales. To date, the Keratoconus End-Points Assessment Questionnaire (KEPAQ) is the only disease-specific scale to measure both functional and emotional compromise due to disease. Nevertheless, not much information exists regarding whether both sub-scales of the test show unidimensionality, a necessary condition in well-functioning instruments. METHODS: A sample of patients with a confirmed diagnosis of keratoconus were administered the full version of the KEPAQ. A Rasch analysis and principal component analysis were performed. RESULTS: A total of 249 patients with keratoconus were included. Their average age was 29.19 ± 10.91 years, and 51.40% were male. Mean score for the KEPAQ-E was 2.51 ± 3.29 logit while it was 2.26 ± 3.70 logit for the KEPAQ-F. For both sub-scales, Kaiser Criterion, Scree Plot Criterion, and Variability Criterion demonstrated unidimensionality. Reliability as measured by Cronbach's alpha was 0.85 for the KEPAQ-E and 0.87 for the KEPAQ-F. CONCLUSIONS: The KEPAQ is a robust, well-designed disease-specific questionnaire that shows unidimensionality. It can be reliably used to measure quality of life in keratoconus patients.

Development and Validation of the "Keratoconus End-Points Assessment Questionnaire" (KEPAQ), a Disease-Specific Instrument for Evaluating Subjective Emotional Distress and Visual Function Through Rasch Analysis.

BACKGROUND: Keratoconus is a disease characterized by progressive distortion of the corneal anatomy, coupled with a decrease in vision. Assessing quality of life (QoL) in keratoconus is essential. So far, no instrument in the world has been designed to evaluate both visual function and emotional distress in this population. The purpose of the following study is to develop and validate the "Keratoconus End-Points Assessment Questionnaire" (KEPAQ) in a population of ectatic patients, the very first disease-specific scale to measure emotional latent traits in keratoconus. METHODS: A last generation, Rasch analysis method was used for scale validation. First, a number of focus groups were carried out to create a pool of potential items. Then, a series of processes (such as "Content Validity Index") was carried out to develop a prior, 20-question version of the KEPAQ. Then, a study including 150 keratoconus patients was performed, followed by a careful Rasch analysis to validate and optimize both sub-scales (Emotional Compromise, KEPAQ-E, and Functional Compromise, KEPAQ-F). RESULTS: Initially, 86 items were considered as potential elements. After test optimization, 20 items were retained. A total of 150 patients with a confirmed diagnosis of keratoconus were included for the Rasch analysis. The mean age was 29.84 ± 9.96 years. In 150 patients, 12.6% had a history of keratoplasty, 46.0% had corneal rings, and 31.3% had crosslinking. For both sub-scales, misfitting items were removed until no misfitting was determined by repetitive Rasch runs. For the final version of the KEPAQ-E sub-scale, variance explained by the model was 62.4% with a dimensional scale. Person Separation Index and Person Number of Strata were 2.43 and 3.57, respectively. For the final version of the KEPAQ-F sub-scale, variance explained by the model was 61.3% with a unidimensional scale. Person Separation Index and Person Number of Strata were 3.19 and 4.59, respectively. Both sub-scales showed excellent Person Reliability. CONCLUSION: The KEPAQ is a robust scale, developed and validated through the latest theoretical models. It shows excellent psychometric properties, which render it extremely useful for both clinical and research use. To date, the KEPAQ is the only disease-specific scale worldwide to evaluate both functional and emotional compromise in keratoconus patients.

Cáncer de mama: la enfermedad del siglo XXI / Breast cancer: the disease of the 21st century

El cáncer de mama es considerado en la actualidad como una de las patologías más comunes en la población femenina. Su incidencia va en aumento y se asocia a factores de riesgo tales como la edad, el sexo, factores hormonales y antecedentes tanto familiares como personales. Se ha asociado también a ciertos genes (BRCA 1 y BRCA 2), pero en su patogenia están involucrados otros factores como la dieta, el consumo de alcohol y la hiperinsulinemia. El diagnóstico debe ser abordado desde tres lineamientos: clínico, imagenológico e inmunohistoquímico, pues el tratamiento y el pronóstico dependen de la clasificación definitiva del tumor.

Breast cancer is currently considered as one of the most common pathologies in female population. Incidence is increasing and is associated with risk factors such as age, sex, hormonal factors and both family and personal history. It has also been associated with certain genes (BRCA 1 and BRCA 2), but factors such as diet, alcohol consumption and hyperinsulinemia are also involved in its pathogenesis. The diagnosis must be approached from three guidelines: clinical, imaging and immunohistochemical because the treatment and prognosis depend from the definitive classification of the tumor