Saint Paul's Thorn in the Flesh: a Dermatological Weakness?

Saint Paul's thorn in the flesh has been the subject of much controversy in medical, historical and religious literature. It was crucial for the development of Paul's theology and, therefore, its study is important for a better understanding of early Christianity. The purpose of this article is to review the available evidence on this issue, perform a historical and medical critical analysis and suggest plausible diagnosis that have not been previously published in scientific literature. Our research on primary sources seem to indicate that in 41-42 AD Paul of Tarsus developed a clinical picture with a pain similar to that of a thorn injury and bad physical appearance. It could also have a chronic course with a limited number of relapses and few global. It could remind Job's illness and provoke humiliation in Paul and repulse in his audience. Multiple diseases could explain some of these data, but fewer explain all of them. Though a definitive diagnosis cannot be achieved, we think that cutaneous disorders are the most obvious candidates for a humiliating and painful disease which, however, would permit long journeys during more than a decade. Disorders with cutaneous involvement like lupus erythematosus, dermatomyositis, urticaria/angioedema, herpes simplex leukocytoclastic vasculitis or nodular vasculitis should be added to other possibilities previously reported

Bienestar psicológico, salud y calidad de vida percibida en personas mayores institucionalizadas

Según los datos publicados por el Instituto Nacional de Estadística (INE), a 1 de enero de 2017 había 1.307.395 personas residiendo en Aragón, 1.168 menos que un año atrás, lo que supone una disminución del 0,1% de la población, siendo una de las menores del país. Es de gran importancia conocer la salud y bienestar psicológico en personas mayores que están institucionalizadas para mejorar su calidad de vida en la última etapa vital. El objetivo general es conocer la Salud Percibida, el Bienestar Psicológico y la Calidad de vida percibida en personas mayores de 65 años residentes en los centros geriátricos “Hogar Doz” de Tarazona y el IASS de Borja durante el primer trimestre de 2018 y la relación de cada una de ellas con las variables sexo, edad, estado civil y estudios académicos. Se realizó un estudio descriptivo de corte transversal de personas mayores residentes en ambos centros geriátricos durante el primer trimestre de 2018 a través de un cuestionario diseñado para este estudio. En el cual se preguntó sobre cuestiones sociodemográficas, Salud Percibida, Calidad de Vida Percibida y se aplicó la escala de Bienestar Psicológico de Ryff. De los 49 residentes entrevistados, existió una elevada proporción de personas mayores institucionalizadas que presentaron una Salud y Calidad de Vida Percibida buena. La percepción de forma positiva de la salud fue mayor en mujeres, los individuos de edades entre 65-75 años y mayores de 86 años, las personas viudas y aquellas sin estudios académicos. Además, la percepción de la calidad de vida de forma positiva por sexos fue mejor entre las mujeres y en cuanto a la edad, los mayores de 86 años. Según el estado civil las personas solteras y aquellos individuos sin estudios. También se afirma que a medida que aumenta la edad aumenta también el conocimiento y la aceptación del yo y por tanto los aspectos positivos y negativos sobre la propia vida, es decir, aumenta la autoaceptación de cada persona. Para concluir, la mayoría de las personas mayores institucionalizadas de las Residencias “Hogar Doz” de Tarazona e IASS de Borja presentaron una buena Salud y calidad de vida percibida además de un bienestar psicológico satisfactorio. De este modo se manifiesta que los cuidados profesionales en ambos centros residenciales son los adecuados. Palabras clave: personas mayores, institucionalización, bienestar psicológico, salud percibida, calidad de vida percibida

Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization

Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses

Amphilimus- vs. zotarolimus-eluting stents in patients with diabetes mellitus and coronary artery disease: the SUGAR trial

Aim: Patients with diabetes mellitus are at high risk of adverse events after percutaneous revascularization, with no differences in outcomes between most contemporary drug-eluting stents. The Cre8 EVO stent releases a formulation of sirolimus with an amphiphilic carrier from laser-dug wells, and has shown clinical benefits in diabetes. We aimed to compare Cre8 EVO stents to Resolute Onyx stents (a contemporary polymer-based zotarolimus-eluting stent) in patients with diabetes. Methods and results: We did an investigator-initiated, randomized, controlled, assessor-blinded trial at 23 sites in Spain. Eligible patients had diabetes and required percutaneous coronary intervention. A total of 1175 patients were randomly assigned (1:1) to receive Cre8 EVO or Resolute Onyx stents. The primary endpoint was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target-lesion revascularization at 1-year follow-up. The trial had a non-inferiority design with a 4% margin for the primary endpoint. A superiority analysis was planned if non-inferiority was confirmed. There were 106 primary events, 42 (7.2%) in the Cre8 EVO group and 64 (10.9%) in the Resolute Onyx group [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.44 to 0.96; pnon-inferiority <0.001; psuperiority = 0.030]. Among the secondary endpoints, Cre8 EVO stents had significantly lower rate than Resolute Onyx stents of target-vessel failure (7.5% vs 11.1%, HR 0.67, 95% CI 0.46 to 0.99; p = 0.042). Probable or definite stent thrombosis and all-cause death were not significantly different between groups. Conclusions: In patients with diabetes, Cre8 EVO stents were non-inferior to Resolute Onyx stents with regard to target-lesion failure composite outcome. An exploratory analysis for superiority at 1 year suggests that the Cre8 EVO stents might be superior to Resolute Onyx stents with regard to the same outcome

Incidence of co-infections and superinfections in hospitalised patients with COVID-19: a retrospective cohort study

Objectives: To describe the burden, epidemiology and outcomes of co-infections and superinfections occurring in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods: We performed an observational cohort study of all consecutive patients admitted for ≥48 hours to the Hospital Clinic of Barcelona for COVID-19 (28 February to 22 April 2020) who were discharged or dead. We describe demographic, epidemiologic, laboratory and microbiologic results, as well as outcome data retrieved from electronic health records. Results: Of a total of 989 consecutive patients with COVID-19, 72 (7.2%) had 88 other microbiologically confirmed infections: 74 were bacterial, seven fungal and seven viral. Community-acquired co-infection at COVID-19 diagnosis was uncommon (31/989, 3.1%) and mainly caused by Streptococcus pneumoniae and Staphylococcus aureus. A total of 51 hospital-acquired bacterial superinfections, mostly caused by Pseudomonas aeruginosa and Escherichia coli, were diagnosed in 43 patients (4.7%), with a mean (SD) time from hospital admission to superinfection diagnosis of 10.6 (6.6) days. Overall mortality was 9.8% (97/989). Patients with community-acquired co-infections and hospital-acquired superinfections had worse outcomes. Conclusions: Co-infection at COVID-19 diagnosis is uncommon. Few patients developed superinfections during hospitalization. These findings are different compared to those of other viral pandemics. As it relates to hospitalized patients with COVID-19, such findings could prove essential in defining the role of empiric antimicrobial therapy or stewardship strategies

Amphilimus- vs. zotarolimus-eluting stents in patients with diabetes mellitus and coronary artery disease: the SUGAR trial.

AIM: Patients with diabetes mellitus are at high risk of adverse events after percutaneous revascularization, with no differences in outcomes between most contemporary drug-eluting stents. The Cre8 EVO stent releases a formulation of sirolimus with an amphiphilic carrier from laser-dug wells, and has shown clinical benefits in diabetes. We aimed to compare Cre8 EVO stents to Resolute Onyx stents (a contemporary polymer-based zotarolimus-eluting stent) in patients with diabetes. METHODS AND RESULTS: We did an investigator-initiated, randomized, controlled, assessor-blinded trial at 23 sites in Spain. Eligible patients had diabetes and required percutaneous coronary intervention. A total of 1175 patients were randomly assigned (1:1) to receive Cre8 EVO or Resolute Onyx stents. The primary endpoint was target-lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, and clinically indicated target-lesion revascularization at 1-year follow-up. The trial had a non-inferiority design with a 4% margin for the primary endpoint. A superiority analysis was planned if non-inferiority was confirmed. There were 106 primary events, 42 (7.2%) in the Cre8 EVO group and 64 (10.9%) in the Resolute Onyx group [hazard ratio (HR): 0.65, 95% confidence interval (CI): 0.44-0.96; Pnon-inferiority < 0.001; Psuperiority = 0.030]. Among the secondary endpoints, Cre8 EVO stents had significantly lower rate than Resolute Onyx stents of target-vessel failure (7.5% vs. 11.1%, HR: 0.67, 95% CI: 0.46-0.99; P = 0.042). Probable or definite stent thrombosis and all-cause death were not significantly different between groups. CONCLUSION: In patients with diabetes, Cre8 EVO stents were non-inferior to Resolute Onyx stents with regard to target-lesion failure composite outcome. An exploratory analysis for superiority at 1 year suggests that the Cre8 EVO stents might be superior to Resolute Onyx stents with regard to the same outcome. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT03321032

X chromosome inactivation does not necessarily determine the severity of the phenotype in Rett syndrome patients

Rett syndrome (RTT) is a severe neurological disorder usually caused by mutations in the MECP2 gene. Since the MECP2 gene is located on the X chromosome, X chromosome inactivation (XCI) could play a role in the wide range of phenotypic variation of RTT patients; however, classical methylation-based protocols to evaluate XCI could not determine whether the preferentially inactivated X chromosome carried the mutant or the wild-type allele. Therefore, we developed an allele-specific methylation-based assay to evaluate methylation at the loci of several recurrent MECP2 mutations. We analyzed the XCI patterns in the blood of 174 RTT patients, but we did not find a clear correlation between XCI and the clinical presentation. We also compared XCI in blood and brain cortex samples of two patients and found differences between XCI patterns in these tissues. However, RTT mainly being a neurological disease complicates the establishment of a correlation between the XCI in blood and the clinical presentation of the patients. Furthermore, we analyzed MECP2 transcript levels and found differences from the expected levels according to XCI. Many factors other than XCI could affect the RTT phenotype, which in combination could influence the clinical presentation of RTT patients to a greater extent than slight variations in the XCI pattern

Intervenciones para el tratamiento de la neoplasia intraepitelial anal y la prevención de conductas sexuales de riesgo

La prevalencia de neoplasia intraepitelial del canal anal (NICA) está incrementándose, principalmente en hombres que tienen sexo con hombres VIH+. No hay consenso sobre el manejo óptimo de la NICA, ni se ha procedido a un estudio global sobre la evidencia disponible del efecto preventivo que puedan tener las distintas intervenciones conductuales (IC). Objetivos: Sintetizar y analizar cualitativamente la evidencia disponible sobre la eficacia de las intervenciones terapéuticas en la NICA y de las IC para su prevención. Métodos: se procedió a una revisión sistemática con el respaldo del Colorectal Cancer Cochrane Group incluyendo ensayos clínicos aleatorizados sobre intervenciones en NICA. Se diseñó una "revisión de revisiones" seleccionando revisiones sistemáticas que cumpliesen unos criterios de calidad mínimos, comparando los resultados obtenidos al evaluar los efectos de las intervenciones mediante criterios objetivos con los obtenidos al evaluarlos mediante criterios subjetivos (autoinforme), así como en función de si se trataba o no de una revisión Cochrane. Se estudiaron conjuntamente ambas revisiones desde la perspectiva de la Medicina Basada en la Evidencia. Resultados: Se identificó un ECA que no halló diferencias estadísticamente significativas entre imiquimod y placebo en el tratamiento de la NICA. Se identificaron 55 revisiones sistemáticas sobre intervenciones conductuales. Se halló ausencia de efecto global en el 72.5% de revisiones que evaluaron las intervenciones mediante variables objetivas; 47.3% de las que lo hicieron mediante variables subjetivas; 86.6% de las revisiones Cochrane que utilizaron variables objetivas y 64.7% de las revisiones Cochrane que emplearon variables subjetivas. Conclusión: No hay evidencia suficiente sobre la eficacia de las intervenciones terapéuticas en la NICA. No hay evidencia de que las IC modifiquen las conductas sexuales que constituyen el principal factor de riesgo de contraer la enfermedad, sobre todo cuando se evalúan mediante resultados biológicos objetivos. Es necesario realizar más estudios bien diseñados sobre la NICA y reevaluar las estrategias de prevención primaria en las infecciones de transmisión sexual