Estudio de la dosis eritematosa mínima en una serie de urticaria solar / Study of Minimal Erythema Dose in a Series of Solar Urticaria

Antecedentes La dosis eritematosa mínima (DEM) reducida es una reacción anormal a la luz según el fototipo de piel y que se determina mediante fototest. La DEM es reducida o anormal en algunas fotodermatosis. Sin embargo, no hemos encontrado información sobre la DEM reducida en pacientes con urticaria solar (US), enfermedad que cursa con urticaria tras la exposición al sol. Objetivo Determinar la DEM en una serie de pacientes con US. Métodos Llevamos a cabo un estudio prospectivo de casos de US diagnosticados en nuestro departamento entre enero de 2007 y diciembre de 2017, a través de anamnesis o por provocación mediante exposición a la luz solar natural o a fuentes de luz artificial. De acuerdo con el protocolo del Grupo Español de Fotobiología, a las 24 horas se llevó a cabo la lectura del fototest en todos los pacientes. Se recopilaron las variables relativas al paciente (edad, sexo, fototipo), enfermedad (tiempo de evolución, espectro de activación) y otras relacionadas con la posible DEM reducida (autoanticuerpos, medicación fototóxica). Resultados Se estudiaron 25 pacientes, de los cuales, seis (24%) presentaron una DEM anormal, el 83% de ellos eran hombres, y el 50% mostraba el espectro de acción en el rango de la radiación UVB. Conclusión Hasta en una cuarta parte de los pacientes con US se puede observar la DEM anormal. Esta circunstancia podría tener implicaciones en la selección de los pacientes y en los protocolos para el tratamiento con fototerapia (AU)

Background Reduced minimal erythema dose (MED) is an abnormal erythematous reaction to light according to the skin phototype, which is determined by phototest. MED is reduced or abnormal in some photodermatoses. However, we have not found information about reduced MED in patients with solar urticarial (SU), a condition which causes hives after sun exposure. Objective To determine MED in a series of patients with SU. Methods We conducted a prospective study of SU cases diagnosed in our department between January 2007 and December 2017, either by anamnesis, provocation with natural sunlight or provocation with artificial light sources. In all patients, a phototest with reading at 24 h was performed according to the protocol of the Spanish Group of Photobiology. Variables related to the patient (age, sex, phototype), disease (time of evolution, action spectrum) and others related to possible reduced MED (autoantibodies, phototoxic medication) were collected. Results Twenty-five patients were studied. Six patients (24%) had abnormal MED. Eighty-three percent of patients with abnormal MED were men, and 50% had action spectrum in UVB. Conclusion Abnormal MED can be seen in up to a fourth of the patients with SU. This could have implications in the selection of patients and protocols for treatment with phototherapy (AU)

Validación del método de cuantificación del área corporal afectada por la psoriasis mediante lápiz óptico / Validation of an Optical Pencil Method to Estimate the Affected Body Surface Area in Psoriasis

INTRODUCCIÓN: La determinación de la superficie corporal afectada, Body Surface Area (BSA), es una de las escalas de medida más empleadas en la evaluación de la gravedad de la psoriasis, pero no está exenta de inconvenientes. OBJETIVO: Validación de un nuevo sistema de medida del BSA. MATERIAL Y MÉTODO: Estudio multicéntrico, prospectivo, que incluyó 56 pacientes con psoriasis. Cada paciente fue evaluado en 2 visitas por 2 dermatólogos del mismo Centro que valoraron BSA mediante 2 procedimientos: método visual «tradicional» (MT), palma mano=1%; y el método «lápiz óptico» (LO), lápiz capacitivo puntero sobre pantalla táctil con medición de la superficie mediante software específico. RESULTADOS: Se observó una concordancia aceptable entre ambos métodos, con coeficiente de correlación intraclase (CCI) de 0,87, pero con unos límites de acuerdo excesivamente grandes y un sesgo sistemático consistente en mayores medidas de BSA con MT que con LO. La concordancia entre métodos fue superior en el tronco y las extremidades inferiores (CCI > 0,8). La fiabilidad intraobservador fue excelente con ambos métodos (CCI: MT, 0,97; LO, 0,98). La fiabilidad interobservador fue elevada (CCI: MT, 0,91; LO, 0,94), pero el BSA medio difirió significativamente entre observadores. Además, el CCI se redujo drásticamente cuando se consideró la cabeza exclusivamente. CONCLUSIONES: El presente estudio valida el método LO para la medición de la superficie corporal afectada en pacientes con psoriasis. Muestra una buena concordancia con el MT, presentando menos variabilidad y mayor fiabilidad interobservador

INTRODUCTION: Body surface area (BSA) affected by psoriasis is one of the most often used measures for assessing severity, but this method has shortcomings. OBJECTIVE: To validate a new way to estimate BSA. MATERIAL AND METHOD: Prospective, multicenter study in 56 patients with psoriasis. Each patient was evaluated by 2 dermatologists in 2 visits to the same hospital. Each dermatologist used 2 methods for estimating BSA: the traditional visual estimation in which the area of the palm equals 1% of the total body surface and an optical pencil (OP) method in which the affected area is drawn on a touch screen. Software in the application then calculates the BSA. RESULTS: Overall concordance between the 2 methods was acceptable according to an intraclass correlation coefficient (ICC) of 0.87. However, the limits of agreement were unacceptably large and there was systematic bias: traditional estimates were consistently greater than OP calculations. Concordance between the methods was better (ICC > 0.8) on the trunk and lower extremities. Intraobserver reliability was excellent with both methods (ICCs, 0.97 and 0.98 for the traditional and OP estimates, respectively). Interobserver reliability was also high (ICCs, 0.91 and 0.94 for the traditional and OP methods), although the mean BSA differed significantly between observers. The ICCs were much lower for BSA estimates on the head. CONCLUSIONS: This study to validate the OP method for estimating the affected BSA in patients with psoriasis shows good agreement between the OP and traditional approaches. The OP calculations also showed less variance and better interobserver reliability

Validation of an Optical Pencil Method to Estimate the Affected Body Surface Area in Psoriasis. / Validación del método de cuantificación del área corporal afectada por la psoriasis mediante lápiz óptico.

INTRODUCTION: Body surface area (BSA) affected by psoriasis is one of the most often used measures for assessing severity, but this method has shortcomings. OBJECTIVE: To validate a new way to estimate BSA. MATERIAL AND METHOD: Prospective, multicenter study in 56 patients with psoriasis. Each patient was evaluated by 2 dermatologists in 2 visits to the same hospital. Each dermatologist used 2 methods for estimating BSA: the traditional visual estimation in which the area of the palm equals 1% of the total body surface and an optical pencil (OP) method in which the affected area is drawn on a touch screen. Software in the application then calculates the BSA. RESULTS: Overall concordance between the 2 methods was acceptable according to an intraclass correlation coefficient (ICC) of 0.87. However, the limits of agreement were unacceptably large and there was systematic bias: traditional estimates were consistently greater than OP calculations. Concordance between the methods was better (ICC>0.8) on the trunk and lower extremities. Intraobserver reliability was excellent with both methods (ICCs, 0.97 and 0.98 for the traditional and OP estimates, respectively). Interobserver reliability was also high (ICCs, 0.91 and 0.94 for the traditional and OP methods), although the mean BSA differed significantly between observers. The ICCs were much lower for BSA estimates on the head. CONCLUSIONS: This study to validate the OP method for estimating the affected BSA in patients with psoriasis shows good agreement between the OP and traditional approaches. The OP calculations also showed less variance and better interobserver reliability.

Papel del laboratorio en el control metabólico del paciente diabético / Role of laboratory in the metabolic control of the diabetic patient

Los objetivos planteados en el presente estudio son, evaluar el grado de control glucémico a largo plazo de pacientes diabéticos de nuestra área sanitaria en función de la glicohemoglobina (HbA1c), según los criterios definidos por el European NIDDM Policy Group, así como evaluar una de las complicaciones crónicas más frecuentes de los diabéticos, la afectación renal, mediante la cuantificación de microalbuminuria (MA) como marcador precoz para predecir el desarrollo de nefropatía diabética en dichos pacientes, y de esta forma permitir que se inicien tratamientos destinados a revertir o enlentecer su progresión hacia la enfermedad renal. Los resultados que se presentan se obtuvieron del análisis de HbA1c de sangre procedentes de 6374 pacientes diabéticos, y del análisis de las muestras de orina procedentes de 2961 pacientes diabéticos. De los pacientes a los que se les midió la HbA1c, 1803 (28,2 por ciento) presentaban resultados óptimos (8 por ciento). De los pacientes a los que se les midió la microalbuminuria, 1997 (67,4 por ciento) presentaban valores de microalbuminuria negativas (01,9 mg/dl), 520 (17,5 por ciento) presentaban valores altos (2,0-5,7 mg/dl) y 444 (14,9 por ciento) presentaban valores muy altos de microalbuminuria (>5,7 mg/dl). La frecuencia de microalbuminuria (32,4 por ciento) encontrada en nuestro estudio es similar a la hallada en otros estudios, por lo que habrá que incidir en este grupo de población, con una atención integral e individual de dichos pacientes en los que la determinación de microalbuminuria tiene interés pronóstico en los diabéticos tipo 1 en los que anuncia una nefropatía diabética. También permite evaluar un riesgo de naturaleza cardiovascular. En los diabéticos tipo 2, la microalbuminuria predice una mortalidad prematura, estando asociada a factores de riesgo cardiovasculares clásicos, no específicos de la diabetes, aunque frecuentemente, más precoces y más graves como hipertensión arterial y dislipemias (AU)

Comparison of manual and automatic CPAP titration in patients with sleep apnea/hypopnea syndrome.

Automatic CPAP (auto-CPAP) is engineered to automatically provide a positive pressure to the upper airway in response to apnea, hypopnea, airflow limitation, or snoring in patients with the sleep apnea/ hypopnea syndrome (SAHS). Self-adjusted CPAP has theoretical advantages over traditional fixed CPAP. We investigated the value of auto-CPAP regulation in 20 patients with SAHS in order to predict future fixed-level CPAP needs, as an alternative method to conventional polysomnographically (PSG)-controlled CPAP titration. This was accomplished through comparison of the optimal CPAP level obtained with PSG with that obtained with auto-CPAP. There were no significant differences between the optimal CPAP level achieved with full PSG or with auto-CPAP. As a secondary analysis, we analyzed auto-CPAP performance with regard to sleep-stage distribution and arousals in a group of nine male patients, and compared it with the previous group of 20 patients in which manually CPAP titration was guided by PSG. After adequate CPAP was reached, upward and downward fluctuations in the CPAP level had no significant effect on sleep architecture or fragmentation. We conclude that auto-CPAP permits the prediction of future fixed-level CPAP needs, and does so without sleep disruption.

Time-course of stepwise CPAP titration. Behavior of respiratory and neurological variables.

Because successful medical treatment of obstructive sleep apnea/hypopnea syndrome (SAHS) depends on adequate CPAP treatment, we have analyzed in nine SAHS patients the behavior of respiratory and neurological parameters during a stepwise, polysomnography-controlled CPAP titration to achieve an optimal CPAP. Particularly, we have focused on which simple variable could predict the optimal CPAP pressure and could better define a distinctive optimal-suboptimal pattern. Main parameters analyzed through the CPAP titration procedure were respiratory events (apnea, hypopnea), the contour of inspiratory flow, the pleural pressure behavior, the thoraco-abdominal motion, oximetry, arousals, and sleep stage. During the CPAP titration we observed: (1) a rounded shape in the inspiratory flow contour was associated with the lowest esophageal pressure; (2) during stepwise increases in CPAP, almost all apnea events changed to hypopnea periods, followed by prolonged periods of limited inspiratory flow with still high esophageal pressure but without arousals (probably suboptimal CPAP); and (3) as CPAP reached suboptimal levels, sleep stage moved to deeper stages without arousals. We conclude that if during CPAP titration the end point is the disappearance of arousals, most patients with SAHS will still exhibit periods of high intrathoracic pressures with limited inspiratory flow. Alternatively, if the end point to be reached is the lowest esophageal pressure, higher CPAP levels will be needed. The contour of inspiratory flow appears as the simplest variable that best correlates with lowest esophageal pressure during CPAP titration.