Endoprótesis autoexpandibles en el tratamiento de la obstrucción de colon. Análisis dosimétrico

Objetivos: Realizar un análisis dosimétrico y comparar los resultados con las dosis de referencia de la colocación de endoprótesis autoexpandibles en el tratamiento de obstrucciones de colon y evaluar los efectos no estocásticos derivados de la radiación. Material y métodos: Estudio descriptivo retrospectivo unicéntrico de 109 procedimientos de colocación de endoprótesis autoexpandibles de colon. Incluye todas las obstrucciones de colon, la mayoría de causa maligna y alguna de causa benigna. Se realiza un análisis dosimétrico, comparándolo con las dosis de referencia y un seguimiento para evaluar complicaciones. Resultados: El tiempo medio de intervención fue de 55,84 minutos y el producto kerma por área medio de 339600,64 mGy.cm2. Se observó una correlación estadísticamente significativa entre dichas variables y el grado de complejidad de la intervención. Los valores obtenidos fueron superiores a los valores de referencia. Sólo en un 8,3% de los pacientes que superaron el umbral de kerma se observaron complicaciones dérmicas. Conclusiones: Esta intervención supone un tiempo de fluoroscopia y dosis de radiación considerable, observando una correlación estadísticamente significativa según el grado de dificultad de la intervención. Los radiólogos intervencionistas toman gran conciencia del problema, adoptando todas las medidas preventivas necesarias para lograr el éxito con la mínima dosis de radiación posible. En la mayoría de los casos, los beneficios clínicos y la mejora en la calidad de vida del paciente justifica el riesgo de la radiación. A pesar de las altas dosis recibidas, la incidencia de efectos no estocásticos es mínima.<br /

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer

BackgroundWhile skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. ObjectiveTo compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. MethodsMulticentre case-control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. ResultsOf the 254 cases (56.2% female; mean age, 62.67 +/- 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p = 21, and the majority SPF > 50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. ConclusionsWe describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation

Eficacia de la reeducación vocal en diez sesiones clínicas

El programa de rehabilitación vocal debe basarse en un diagnóstico funcional siendo indispensable la información que la estroboscopia proporciona para diseñar un programa de terapia específico. Los equipos de Foniatría y Logopedia colaboran en este diseño e intervención, lo que reduce la duración del tratamiento con un mejor rendimiento y menor coste para el sistema sanitario

Fully home-based methyl aminolevulinate daylight photodynamic therapy for actinic keratosis of the face or scalp: A real life open study

Methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) is highly effi-cacious for the treatment of nonhyperkeratotic actinic keratosis (AK), even when par-tially performed at home. To evaluate the long-term effectiveness, safety, andpatient-reported outcomes of MAL DL-PDT performed completely by the patient inreal life conditions. An open prospective study was conducted in Spain amongpatients diagnosed with at least five AK lesions on the face or the scalp. Patientsreceived instruction and information in infographic format to perform MAL DL-PDTat home. All had been treated with 30% urea daily for 7 days before the day of MALDL-PDT. Meteorological conditions on the day of the treatment and adverse effectswere recorded. Patients underwent follow-up, and a second session of home-basedMAL DL-PDT if deemed necessary, 3, 6, and 12 months after the initial treatmentsession. The study population consisted of 22 patients (19 men and three women,mean [standard deviation, SD] age, 72.05 [6.96] years). A complete response wasobserved in 47.7% of AK lesions at 3 months (p< 0.001) and 65.9% (n=199) at12 months (p< 0.001). Olsen grade II lesions showed the highest rate of response(76.07% at 12 months). The mean (SD) actinic keratosis area and severity index scoredecreased significantly from 4.99 (2.43) at baseline to 2.33 (1.01) at 12 months(p=0.0234). Adverse effects were mild and expected. A majority of patients were“satisfied”or“very satisfied”with the treatment instruction provided (90.9%) andthe treatment outcome (72.7%). MAL DL-PDT can be applied at home like any othertopical treatment for AK. Our results indicate good long-term effectiveness, a highlevel of patient satisfaction, and no significant side effect

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer

Melanoma; Photoprotection measures; Squamous cell carcinomaMelanoma; Mesures de fotoprotecció; Carcinoma de cèl·lules escamosesMelanoma; Medidas de fotoprotección; Carcinoma de células escamosasBackground While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. Objective To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. Methods Multicentre case–control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. Results Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p  50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. Conclusions We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation

Experience with Cutaneous Manifestations in COVID-19 Patients during the Pandemic

After the beginning of the SARS-CoV-2 pandemic, our dermatology department created a multidisciplinary unit to manage patients with cutaneous manifestations associated with COVID-19. With the objective of identifying skin lesions in patients with suspected COVID-19 and evaluating possible associations with systemic involvement, other infectious agents and coagulation disorders, we carried out a prospective observational study that included all patients that attended our COVID-19 dermatology clinic with a multidisciplinary protocol. A total of 63 patients (mean 34.6 years) were enrolled between May 2020 and February 2021. Overall, 27 patients (42.9%) had a positive COVID-19 test, and 74.6% had COVID-19 clinical signs. The most common skin lesion was maculopapular rash (36.5%), predominantly seen in male (54.2%) and older patients (42 vs. 30 years), followed by chilblain-like lesions (20.6%) in younger patients (13.9 vs. 20.9 years) who were predominantly barefoot at home (69.2%); these patients exhibited a tendency towards a negative COVID-19 test. A total of 12 patients (19.1%) had positive serology for herpesvirus 6 (IgM or IgG). We conclude that the COVID-19-associated skin lesions we observed were similar to those previously described. Questions as to the underlying mechanisms remain. Interferon, possibly aided by cold exposure, may cause perniosis-like lesions. Other cutaneous manifestations were similar to those caused by other viruses, suggesting that SARS-CoV-2 may reactivate or facilitate other viral infections

The Influence of the Exposome in the Cutaneous Squamous Cell Carcinoma, a Multicenter Case–Control Study

Exposome; Squamous cell carcinomaExposoma; Carcinoma cutáneo de células escamosasExposoma; Carcinoma cutani de cèl·lules escamosesIntroduction: The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism’s biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. Objectives: To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. Materials and Method: A multicenter case–control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. Results: A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). Conclusions: The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer

Background: While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. Objective: To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. Methods: Multicentre case–control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. Results: Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p  50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. Conclusions: We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat