RESUMO
Antecedentes: El tratamiento tópico es fundamental en el manejo de la psoriasis y la adherencia al mismo contribuye a su eficacia en el tratamiento prolongado. Objetivos: Establecer un consenso sobre la adherencia al tratamiento tópico en la psoriasis y recomendaciones para mejorarla, así como evaluar las características de los diferentes vehículos. Método: Se elaboró un cuestionario sobre adherencia al tratamiento tópico de la psoriasis que se sometió a Consenso Delphi por un panel de expertos, al igual que un cuestionario sobre las características de los principales vehículos utilizados, que también fue sometido a consenso por los miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología. Resultados: Se alcanzó consenso en que: a) la adherencia al tratamiento tópico aumenta su eficacia en la psoriasis; b) para aumentar la adherencia es necesario mejorar la comunicación con el personal sanitario, proporcionar instrucciones escritas, simplificar el tratamiento, con preparados de aplicación cómoda, preferiblemente diaria, y agradables; y c) la satisfacción con el tratamiento aumenta la adherencia y tiende a mejorar la calidad de vida relacionada con la salud de los pacientes. La pomada fue el vehículo peor valorado, mientras que los mejor considerados fueron las espumas y las soluciones. Las cremas y el gel lipofílico tuvieron valoraciones superiores a la pomada en diversos parámetros. Conclusión: Para aumentar la adherencia al tratamiento tópico y la eficacia del mismo en la psoriasis hay que proporcionar más información, simplificar el tratamiento y prescribir preparados cómodos de aplicar y que aseguren la satisfacción del paciente (AU)
Background: Topical therapy is key to the successful management of psoriasis, and patient adherence to treatment contributes to its effectiveness in the long-term. Objectives: To establish consensus on adherence to topical treatment in psoriasis, draw up recommendations on how adherence could be improved, and evaluate the properties of the main vehicles used. Method: We designed a questionnaire on adherence to topical treatments in psoriasis and another on the properties of the main vehicles used; the 2 questionnaires were evaluated using the Delphi method by a panel of experts and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology, respectively. Results: Consensus was reached on the following statements: a) treatment adherence increases the effectiveness of topical treatments in psoriasis; b) to improve adherence, it is necessary to improve communication between patients and health care staff, provide written instructions, and simplify treatment with easy-to-use, pleasant products that are preferably applied only once a day; c) treatment satisfaction increases adherence and tends to improve the health related quality of life of the patient. Ointment was rated the worst vehicle, while foams and solutions were rated the best. Creams and lipophilic gels were considered to be better than ointment in several respects. Conclusion: To improve adherence to topical regimens in psoriasis and the effectiveness of such therapy, we need to give patients more information, simplify treatment regimens, and prescribe easy-to-use products that will ensure satisfaction (AU)
Assuntos
Humanos , Masculino , Feminino , Satisfação do Paciente/legislação & jurisprudência , Psoríase/epidemiologia , Psoríase/prevenção & controle , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Sociedades Médicas/tendências , Sociedades Médicas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Topical therapy is key to the successful management of psoriasis, and patient adherence to treatment contributes to its effectiveness in the long-term. OBJECTIVES: To establish consensus on adherence to topical treatment in psoriasis, draw up recommendations on how adherence could be improved, and evaluate the properties of the main vehicles used. METHOD: We designed a questionnaire on adherence to topical treatments in psoriasis and another on the properties of the main vehicles used; the 2 questionnaires were evaluated using the Delphi method by a panel of experts and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology, respectively. RESULTS: Consensus was reached on the following statements: a) treatment adherence increases the effectiveness of topical treatments in psoriasis; b) to improve adherence, it is necessary to improve communication between patients and health care staff, provide written instructions, and simplify treatment with easy-to-use, pleasant products that are preferably applied only once a day; c) treatment satisfaction increases adherence and tends to improve the health-related quality of life of the patient. Ointment was rated the worst vehicle, while foams and solutions were rated the best. Creams and lipophilic gels were considered to be better than ointment in several respects. CONCLUSION: To improve adherence to topical regimens in psoriasis and the effectiveness of such therapy, we need to give patients more information, simplify treatment regimens, and prescribe easy-to-use products that will ensure satisfaction.
Assuntos
Adesão à Medicação/estatística & dados numéricos , Satisfação do Paciente , Psoríase/tratamento farmacológico , Administração Tópica , Técnica Delphi , Humanos , Veículos Farmacêuticos , Sensação/efeitos dos fármacos , Inquéritos e QuestionáriosRESUMO
Introducción: La psoriasis ocasiona un elevado coste terapéutico debido a la creciente utilización de los fármacos biológicos. La fototerapia ha demostrado ser un tratamiento seguro y coste-efectivo para la psoriasis, aunque presenta la limitación del desplazamiento del paciente varios días en semana a un centro hospitalario. Objetivos: Evaluar la eficiencia de la fototerapia domiciliaria con ultravioleta B de banda estrecha frente a los fármacos biológicos en el tratamiento de la psoriasis moderada-grave en condiciones reales de nuestro entorno. Métodos: Estudio de evaluación económica de coste-efectividad, con carácter retrospectivo, sobre 12 pacientes con psoriasis moderada-grave. La mitad recibió tratamiento con fármacos biológicos -dos etanercept, dos adalimumab y dos infliximab- y la otra mitad recibió fototerapia en su domicilio con una lámpara Waldmann UV100L-T. La medida de efectividad clínica fue la obtención de un PASI-75 antes de la semana 16 de tratamiento. Resultados: En 5 de 6 pacientes (83%) con terapia biológica y en 4 de 6 pacientes (66%) con fototerapia domiciliaria el tratamiento fue efectivo. Los costes directos por PASI-75 alcanzado fueron de 8.256 euros para los biológicos y de 903 euros para la fototerapia domiciliaria. Con el coste requerido para que un fármaco biológico fuera efectivo en un único paciente podía obtenerse respuesta en 9,1 pacientes tratados con fototerapia domiciliaria. Limitaciones Número reducido de pacientes, horizonte temporal limitado a 16 semanas, grupo de comparación heterogéneo, con fármacos de perspectivas de respuesta diferente. Conclusiones: A pesar de que los fármacos biológicos presentaron una mayor efectividad, la fototerapia domiciliaria fue más eficiente para el tratamiento de la psoriasis moderada-grave. La fototerapia domiciliaria representa una alternativa terapéutica coste-efectiva para los pacientes con psoriasis con potencial aplicación en nuestro sistema sanitario (AU)
Background: Psoriasis is associated with high treatment costs due to the increasing use of biologic drugs. Phototherapy has been demonstrated to be safe and cost effective for the treatment of psoriasis, although it is limited by the requirement for patients to visit a hospital various times week. Objectives: To evaluate the efficieny of home-based phototherapy with narrow-band UV-B radiation compared with biologic drugs for the treatment of moderate to severe psoriasis under normal practice conditions in our setting. Methods: A retrospective cost-effectiveness study was undertaken in 12 patients with moderate to severe psoriasis. Half of the patients were treated with biologic drugs (2 with etanercept, 2 with adalimumab, and 2 with infliximab) and the other half with home-based phototherapy using a Waldmann UV100L-TL01 lamp. Clinical effectiveness was determined on the basis of achieving a 75% improvement in Psoriasis Area and Severity Index (PASI 75) within 16 weeks of treatment. Results: Treatment was considered to be effective in 5 out of 6 patients (83%) treated with biologics and 4 out of 6 patients (66%) treated with home-based phototherapy. The direct costs required to achieve PASI 75 were 8256€ per patient for biologics and 903€ per patient for home-based phototherapy. The costs associated with effective treatment using biologic drugs in a single patient would provide effective home-based phototherapy for 9.1 patients. Limitations: The study included a limited number of patients analyzed over a short time period (16 weeks) and the comparison group included multiple treatments with different predicted responses. Conclusion: Although biologic drugs exhibited greater efficacy, home-based phototherapy was more efficient for the treatment of moderate to severe psoriasis. Home-based phototherapy represents a cost-effective treatment option for patients with psoriasis and may be appropriate for use in the Spanish health care system (AU)
Assuntos
Humanos , Masculino , Feminino , 50303 , Fototerapia/instrumentação , Fototerapia/métodos , Psoríase/radioterapia , Anticorpos Monoclonais/uso terapêutico , Fototerapia , Fototerapia/tendências , Terapia Ultravioleta , Psoríase/economiaRESUMO
BACKGROUND: Psoriasis is associated with high treatment costs due to the increasing use of biologic drugs. Phototherapy has been demonstrated to be safe and cost effective for the treatment of psoriasis, although it is limited by the requirement for patients to visit a hospital various times a week. OBJECTIVES: To evaluate the efficiency of home-based phototherapy with narrow-band UV-B radiation compared with biologic drugs for the treatment of moderate to severe psoriasis under normal practice conditions in our setting. METHODS: A retrospective cost-effectiveness study was undertaken in 12 patients with moderate to severe psoriasis. Half of the patients were treated with biologic drugs (2 with etanercept, 2 with adalimumab, and 2 with infliximab) and the other half with home-based phototherapy using a Waldmann UV100L-TL01 lamp. Clinical effectiveness was determined on the basis of achieving a 75% improvement in Psoriasis Area and Severity Index (PASI 75) within 16 weeks of treatment. RESULTS: Treatment was considered to be effective in 5 out of 6 patients (83%) treated with biologics and 4 out of 6 patients (66%) treated with home-based phototherapy. The direct costs required to achieve PASI 75 were 8256 per patient for biologics and 903 per patient for home-based phototherapy. The costs associated with effective treatment using biologic drugs in a single patient would provide effective home-based phototherapy for 9.1 patients. LIMITATIONS: The study included a limited number of patients analyzed over a short time period (16 weeks) and the comparison group included multiple treatments with different predicted responses. CONCLUSIONS: Although biologic drugs exhibited greater efficacy, home-based phototherapy was more efficient for the treatment of moderate to severe psoriasis. Home-based phototherapy represents a cost-effective treatment option for patients with psoriasis and may be appropriate for use in the Spanish health care system.
Assuntos
Assistência Domiciliar/economia , Psoríase/radioterapia , Terapia Ultravioleta/economia , Adalimumab , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Análise Custo-Benefício , Etanercepte , Feminino , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Psoríase/tratamento farmacológico , Psoríase/patologia , Receptores do Fator de Necrose Tumoral/uso terapêutico , Estudos Retrospectivos , Índice de Gravidade de Doença , Espanha , Resultado do Tratamento , Terapia Ultravioleta/métodosRESUMO
Commercially available serological methods for serodiagnosis of human anisakiasis either are poorly specific or do not include some of the most relevant Anisakis allergens. The use of selected recombinant allergens may improve serodiagnosis. To compare the diagnostic and clinical values of enzyme-linked immunosorbent assay (ELISA) methods based on Ani s 1 and Ani s 7 recombinant allergens and of the UniCAP 100 fluorescence enzyme immunoassay (CAP FEIA) system, we tested sera from 495 allergic and 25 non-food-related allergic patients. The decay in specific IgE antibodies in serum was also investigated in 15 positive patients over a period of 6 to 38 months. Considering sera that tested positive by either Ani s 1 or Ani s 7 ELISA, the CAP FEIA classified 25% of sera as falsely positive, mainly in the group of patients with the lowest levels of anti-Anisakis IgE antibodies, and 1.28% of positive sera as falsely negative. Considering allergens individually, the overall sensitivities of Ani s 7 ELISA and Ani s 1 ELISA were 94% and 61%, respectively. The results also showed that anti-Anisakis IgE antibodies can be detected in serum for longer with Ani s 1 ELISA than with Ani s 7 ELISA and CAP FEIA (P < 0.01). Our findings suggest that ELISA methods with Ani s 7 and Ani s 1 allergens as targets of IgE antibodies are currently the best option for serodiagnosis of human anisakiasis, combining specificity and sensitivity. The different persistence of anti-Ani s 1 and anti-Ani s 7 antibodies in serum may help clinicians to distinguish between recent and old Anisakis infections.
Assuntos
Alérgenos , Anisaquíase/diagnóstico , Anisakis/imunologia , Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos , Imunoglobulina E/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Técnicas Imunoenzimáticas/métodos , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes , Sensibilidade e Especificidade , Adulto JovemRESUMO
Among the Trichinella TSL-1 antigens, whose antigenicity is generally due mainly to tyvelose-containing epitopes, gp53 is unusual in that its antigenicity is due mainly to protein epitopes. In the present study we mapped two of these epitopes, recognized by monoclonal antibodies (mAbs) that specifically recognize gp53 from all encysting Trichinella species (mAb US9), or gp53 from Trichinella spiralis alone (mAb US5). Based on previously published sequences of this glycoprotein [Mol. Biochem. Parasitol. 72 (1995) 253], in this study, we cloned the full gp53 cDNA from a new strain, Trichinella britovi (ISS 11; AN: ), and from another T. spiralis isolate (ISS 115; AN: ). The gp53 sequence comprised an ORF of 1239bp, coding for 412 amino acids, with 61 nucleotide differences (resulting in 38 residue changes) between the two species. Mapping of US5- and US9-recognized epitopes was undertaken through the construction and expression in the pGEX4T vector of truncated gp53 peptides, and by the construction of peptides derived from the antigenic regions. The epitope recognized by mAb US9 was a linear peptide of 8 residues, 33Met- 40Ser, located in the amino-terminal region, while the corresponding epitope recognized by mAb US5 was a 47-amino acid sequence containing two alpha-helix regions flanked by random coils, 290Thr- 336Lys. Molecular modeling of these peptides seems to indicate that recognition of the US9 epitope depends on the presence of two available hydroxyl groups provided by one methionine and one serine on T. spiralis gp53 (not present on Trichinella pseudospiralis gp53). Additionally, the stability of the US5 epitope seems to depend on correct folding of the 47-amino acid sequence (only present in T. spiralis). The relevance of these findings for understanding the antigenic recognition of Trichinella TSL-1 antigens, and for further studies to investigate possible function(s) of gp53 in Trichinella, is discussed.
Assuntos
Antígenos de Helmintos/imunologia , Epitopos Imunodominantes/imunologia , Trichinella/imunologia , Tirosina Quinase da Agamaglobulinemia , Sequência de Aminoácidos , Animais , Anticorpos Anti-Helmínticos/imunologia , Anticorpos Monoclonais/imunologia , Antígenos de Helmintos/química , Antígenos de Helmintos/genética , DNA Complementar/genética , DNA de Helmintos/genética , Larva , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos CBA , Camundongos Knockout , Modelos Moleculares , Dados de Sequência Molecular , Fases de Leitura Aberta , Polissacarídeos/química , Polissacarídeos/imunologia , Conformação Proteica , Dobramento de Proteína , Proteínas Tirosina Quinases/deficiência , Proteínas Tirosina Quinases/genética , Proteínas Recombinantes de Fusão/imunologia , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Especificidade da Espécie , Trichinella/classificação , Trichinella/crescimento & desenvolvimento , Trichinella spiralis/crescimento & desenvolvimento , Trichinella spiralis/imunologiaRESUMO
Recently, several cases of skin injuries have been detected in patients undergoing cardiac radiofrequency catheter ablation. These procedures were performed on a biplane X-ray system used in a large Spanish hospital for interventional cardiology procedures. Interventional procedures performed and radiation lesions produced on patients are described. The radiation lesions were mainly erythematous lesions and chronic radiodermatitis. Results of the dosimetric evaluations and an analysis of the operational aspects of radiological protection are discussed. Poor image quality could have influenced the length of the procedures. Dose rate at the image intensifier entrance was within usual reported values in literature. However, the focus-to-skin distance for the horizontal X-ray beam was too short, resulting in a high skin dose rate. Additionally, X-ray beams are of fixed orientation, and accumulated skin dose in the patient's right side has been estimated as 11-15 Gy per procedure. In conclusion, practical radiation protection considerations to avoid further incidents of this sort are proposed, concerning the use of X-ray systems specially designed for interventional radiology, the improvement of cardiologists' training in radiation protection and routine patient dose measurements for complex interventional procedures.
