La memoria frágil. Algunas experiencias de estudio e inventario del patrimonio etnográfico de la Comunidad de Madrid

Ponencia en el congreso internacional de rehabilitación organizado por CICOP en Chile

Lesión ósea en calota craneal

Historia clínica: Mujer de 53 años diagnosticada de carcinoma de mama en 1999 tratada con quimioterapia, radioterapia y cirugía. En la actualidad, presenta extensión tumoral y fallece. En la autopsia se observan lesiones en la calota de las que aportamos la radiografía y foto macroscópica

Psoriasis: a skin disease associated with increased cardiovascular risk

La psoriasis y la artritis psoriásica se asocian con un mayor riesgo de eventos cardiovasculares y de mortalidad cardiovascular. Además de los factores clásicos de aterosclerosis, la gravedad de la afección cutánea influye en el aumento del riesgo cardiovascular en estos pacientes. En ambos procesos se observa la presencia de disfunción endotelial y un grosor aumentado de la íntima-media de la arteria carótida, como expresión de enfermedad cardiovascular subclínica. El tratamiento activo de la enfermedad y el manejo de los factores de riesgo cardiovascular clásicos son fundamentales para disminuir la morbilidad cardiovascular en estos pacientes. El establecimiento de guías clínicas para el manejo del riesgo cardiovascular abrirá, en el futuro, un nuevo abordaje clínico integral del paciente con psoriasis y la artritis psoriásicaPsoriasis and psoriatic arthritis are associated with increased risk of cardiovascular events and cardiovascular mortality. Alongside classic risk factors such as atherosclerosis, the severity of psoriatic skin disease also influences cardiovascular risk in these patients. In both cases, endothelial dysfunction and increased intima-media thickness in the carotid artery are indicators of subclinical cardiovascular disease. Active treatment of the psoriasis and management of traditional cardiovascular risk factors are essential in order to reduce cardiovascular morbidity in these patients. Clinical practice guidelines on the management of cardiovascular risk will define a new integrated approach to the care of patients with psoriasis and psoriatic arthritis

COVID-19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy versus apremilast in North Spain

Immunosuppressive and immunomodulatory treatments are critical for the management of inflammatory and autoimmune conditions such as psoriasis or psoriatic arthritis. Similar to those illnesses, the lung injury and acute respiratory distress shown in coronavirus disease 2019 (COVID‐19) patients are the result of a disruption in the balance of pro‐ and anti‐inflammatory cytokines. This hyperinflammatory response to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), associated with the severity of the coronavirus disease, is called the cytokine storm. There is a growing concern regarding how patients on immunosuppressant biologic therapies might be at higher risk of being infected and whether they need to discontinue their treatment preemptively. Clinical data on COVID‐19‐infected patients with psoriasis or psoriatic arthritis are still scarce. Here, we presented seven cases of these type of patients. The patient infected with COVID‐19 on apremilast and the one on apremilast with infected spouse showed the best safety profile and mildest symptoms. One of the secukinumab patients also presented a relatively good outcome. Infliximab patients and the one with serious comorbidities showed the worst outcome. Even though more clinical data are yet needed to draw strong conclusions, apremilast could be a safer alternative for dermatology and rheumatology patients in case of clinically important active infection

Infección cutánea por Alternaria triticina en un paciente con trasplante bilateral de pulmón

We report the case of a 60-year-old man who was receiving immunosuppressive therapy for a bilateral lung transplant and presented with a crusted, violaceous plaque on the left hand. Based on histopathology and microbiological culture the patient was diagnosed with infection by Alternaria species. Treatment with itraconazole led to complete resolution of the skin lesion. Forty months later he developed four reddish, nodular, skin lesions on the left leg. Analysis of a biopsy from one of these lesions using histopathologic and molecular techniques identified a mold that shared 98% homology with a strain of Alternaria triticina. Alternaria species belong to a group of dematiaceous fungi that cause opportunistic infections in humans. The incidence of these infections is increasing, mainly in transplant centers. To the best of our knowledge, this is the first reported case of a human infection caused by A. triticinaPresentamos el caso de un hombre de 60 años en tratamiento inmunosupresor por un trasplante pulmonar bilateral que presentó una placa violácea costrosa en la mano. Se diagnosticó de infección por Alternaria spp mediante estudio histopatológico y cultivo microbiológico. El tratamiento con itraconazol condujo a la resolución completa de la lesión cutánea. Cuarenta meses más tarde el paciente desarrolló 4 lesiones nodulares rojizas en la pierna izquierda. Las muestras obtenidas de una de las lesiones fueron estudiadas mediante histopatología y técnicas moleculares. La secuencia de ADN que se obtuvo del germen causal mostraba una homología del 98% con una cepa de Alternaria triticina. Las especies de Alternaria forman parte del grupo de hongos que componen las feohifomicosis susceptibles de causar infecciones oportunísticas humanas. La incidencia de estas infecciones está aumentando, sobre todo en centros de trasplante. De acuerdo con nuestra información el presente caso es el primero en el que A. triticina es causante de una infección humanaAcknowledgement: We thank Manuel Cuenca Estrella and Emilia Mellado of the Instituto Nacional de Salud Carlos III in Madrid for confirmation of the identity of the fungus

DUSP22-rearranged anaplastic lymphomas are characterized by specific morphological features and a lack of cytotoxic and JAK/STAT surrogate markers

This work was supported by grants from the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Economy and Competence (MINECO, RTICC ISCIII and CIBERONC) (SAF2013-47416- R, RD06/0020/0107-RD012/0036/0060 and Plan Nacional I+D+I: PI16/01294 and PIE15/0081), AECC and the Madrid Autonomous Community

Prevention of Unplanned Hospital Admissions in Multimorbid Patients Using Computational Modeling: Observational Retrospective Cohort Study

Background: Enhanced management of multimorbidity constitutes a major clinical challenge. Multimorbidity shows well-established causal relationships with the high use of health care resources and, specifically, with unplanned hospital admissions. Enhanced patient stratification is vital for achieving effectiveness through personalized postdischarge service selection. Objective: The study has a 2-fold aim: (1) generation and assessment of predictive models of mortality and readmission at 90 days after discharge; and (2) characterization of patients' profiles for personalized service selection purposes. Methods: Gradient boosting techniques were used to generate predictive models based on multisource data (registries, clinical/functional and social support) from 761 nonsurgical patients admitted in a tertiary hospital over 12 months (October 2017 to November 2018). K-means clustering was used to characterize patient profiles. Results: Performance (area under the receiver operating characteristic curve, sensitivity, and specificity) of the predictive models was 0.82, 0.78, and 0.70 and 0.72, 0.70, and 0.63 for mortality and readmissions, respectively. A total of 4 patients' profiles were identified. In brief, the reference patients (cluster 1; 281/761, 36.9%), 53.7% (151/281) men and mean age of 71 (SD 16) years, showed 3.6% (10/281) mortality and 15.7% (44/281) readmissions at 90 days following discharge. The unhealthy lifestyle habit profile (cluster 2; 179/761, 23.5%) predominantly comprised males (137/179, 76.5%) with similar age, mean 70 (SD 13) years, but showed slightly higher mortality (10/179, 5.6%) and markedly higher readmission rate (49/179, 27.4%). Patients in the frailty profile (cluster 3; 152/761, 19.9%) were older (mean 81 years, SD 13 years) and predominantly female (63/152, 41.4%, males). They showed medical complexity with a high level of social vulnerability and the highest mortality rate (23/152, 15.1%), but with a similar hospitalization rate (39/152, 25.7%) compared with cluster 2. Finally, the medical complexity profile (cluster 4; 149/761, 19.6%), mean age 83 (SD 9) years, 55.7% (83/149) males, showed the highest clinical complexity resulting in 12.8% (19/149) mortality and the highest readmission rate (56/149, 37.6%). Conclusions: The results indicated the potential to predict mortality and morbidity-related adverse events leading to unplanned hospital readmissions. The resulting patient profiles fostered recommendations for personalized service selection with the capacity for value generation

Evaluation of serum omentin-1 and apelin concentrations in patients with hidradenitis suppurativa

Introduction: Recent studies suggest a role of adipokines in the pathogenesis of hidradenitis suppurativa (HS). Omentin-1 and apelin are two recently identified adipokines that have been involved in the regulation of metabolic and inflammatory responses. Aim: To investigate serum omentin-1 and apelin levels in patients with HS and to assess their associations with metabolic parameters, disease severity and HS risk. Material and methods: This case-control study included 139 non-diabetic individuals (78 HS patients and 61 ageand sex-matched controls). Serum concentrations of omentin-1 and apelin and the homeostasis model assessment of insulin resistance (HOMA-IR) were measured in all participants. Results: Serum omentin-1 concentrations were significantly higher in HS patients compared to controls, whereas apelin serum levels did not significantly differ between both groups. These differences in omentin-1 concentrations remained significant even after adjusting for age, sex, and body mass index (BMI). The results of logistic regression analysis showed that increased omentin-1 plasma levels were an independent risk factor for HS. However, we found no association between serum levels of both omentin-1 and apelin with HS severity. Conclusions: Our results show that patients with HS have raised omentin-1 serum levels, which are associated with HS risk