Angioedema: diagnosis and treatment

El angioedema es una tumefacción de dermis de la piel y tejido conjuntivo de mucosas debido a vasodilatación y edema. El hecho de que el angioedema interese al tejido conjuntivo de distintas mucosas tiene el riesgo vital de afectar a la vía aérea superior. Por tanto, nos encontramos con un síndrome de máximo interés como objeto de estudio por parte del clínico. Por una parte, es una entidad que puede tener consecuencias fatales, por otra, su exploración clínica es altamente inespecífica para orientar su etiología. De esta manera, en esta revisión se propone exponer las diferentes causas que pueden conducir a un angioedema para ayudar en la orientación diagnóstica al clínico en su práctica habitual y el manejo terapéutico del mismo.Angioedema is a swelling of the dermis and connective tissue of mucous due to vasodilatation and edema. The fact that angioedema interests mucosal tissues is a risk of affecting the upper airway. Therfore we have a syndrome of great interest as study object by the clinician. On the one hand, it is an entity that can have fatal consequences, on the other, the clinician examination is highly unspecific to guide its etiology. Thus, in this review we try to expose the main different causes that can lead to angioedema to help clinician in diagnostic practice and management thereof

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

What Proportion of the Caseload at Dermatology Outpatient Clinics in Spain Do SkinTumors Account for? Results from the DIADERM National Random Sampling Project

El estudio DIADERM fue promovido por la Fundación Piel Sanade la Academia Espa˜nola de Dermatología y Venereología,que recibió ayuda económica de Novartis. La compa˜nía far-macéutica no participó en la recogida de datos, ni en elanálisis de estos, ni en la interpretación de los resultados.Introducción y objetivo: La patología tumoral conforma una parte esencial de la actividad dermatológica. El presente estudio pretende analizar la carga de los tumores cutáneos en la actividad dermatológica pública y privada del sistema de salud espa˜nol. Material y método: Estudio observacional de corte transversal de 2 períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología tumoral (165 diagnósticos codificados en los 2 períodos), que se clasificó en 24 grupos, posteriormente subclasificada en patología benigna y maligna, melanocítica y no melanocítica. cutáneasResultados: El 46,2% de los diagnósticos fueron de patología tumoral. El 18,5% de los diagnós-ticos globales se debió a tumores malignos (incluyendo entre estos diagnósticos los tumoresqueratinocíticos in situ). De los primeros 10 diagnósticos de patología tumoral en frecuen-cia, 4 eran malignos: tumores queratinocíticos in situ, carcinoma basocelular, melanoma ycarcinoma espinocelular. Se encontraron algunas diferencias significativas entre tumores benig-nos y malignos atendiendo al ámbito de su asistencia (público/privado), así como a factoresgeográficos.Conclusión: El cáncer cutáneo tiene un peso importante en la asistencia dermatológicaen Espa˜na. Se pueden observar algunas diferencias en función del ámbito de atenciónpúblico/privado y de otros factores.Introduction and objective: A significant part of a dermatologist’s activity involves the diagno-sis and management of tumors. The aim of this study was to analyze the caseload at public andprivate dermatology outpatient clinics in Spain to determine the proportion of tumor diagnoses.Material and method: Observational cross-sectional study of diagnoses made in dermatologyoutpatient clinics during 2 data-collection periods in the DIADERM study, an anonymous surveyof a random, representative sample of dermatologists across Spain. Diagnoses made during the2 periods were coded according to the CIE-10. There were 165 tumor-related codes, classifiedinto 24 groups. For the purpose of this study, these groups were then reduced to benign mela-nocytic lesions, malignant melanocytic lesions, benign nonmelanocytic lesions, and malignantnonmelanocytic lesions.Results: Tumors accounted for 46.2% of all diagnoses; 18.5% of the tumors were malignant (acategory that included in situ forms of keratinocyte cancers). Four of the 10 most commondiagnoses were of malignant tumors: in situ keratinocyte cancers, basal cell carcinoma, mela-noma, and squamous cell carcinoma. Significant differences were observed between malignantand benign tumors according to type of practice (public vs. private) and geographic region.Conclusion: Skin cancer accounts for a significant part of the dermatologist’s caseload in Spain.Differences can be observed depending on the public/private healthcare setting and other factors.Novarti

Fig 12 -

A) RMSF B) Rg C) SASA of VEGFR-2 enzyme in apo state.</p

The colors, yields, and meting points of the new compounds.

The colors, yields, and meting points of the new compounds.</p

Different theoretical ADMET characters of the tested compounds.

Different theoretical ADMET characters of the tested compounds.</p

The docked pose of sorafenib against VEGFR-2.

The docked pose of sorafenib against VEGFR-2.</p

IC₅₀ results of 10a, b and 14a-c against Vero cell line.

IC50 results of 10a, b and 14a-c against Vero cell line.</p