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Abril-Pérez C, Mansilla-Polo M, Escutia-Muñoz B, Sanmartín O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Serra-Guillén C, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Flórez-Menéndez Á, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Botella-Estrada R. Mohs micrographic surgery in immunosuppressed vs immunocompetent patients: Results of a prospective nationwide cohort study (REGESMOHS, Spanish registry of Mohs surgery). J Eur Acad Dermatol Venereol 2024. [PMID: 38733285 DOI: 10.1111/jdv.20103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest. OBJECTIVES This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates. METHODS The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed. RESULTS IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients. CONCLUSIONS This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group.
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Affiliation(s)
- Carlos Abril-Pérez
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Miguel Mansilla-Polo
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | - Begoña Escutia-Muñoz
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Beatriz González-Sixto
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | - Ángeles Flórez-Menéndez
- Complexo Hospitalario Universitario de Pontevedra, Grupo de Investigación DIPO, IIS Galicia Sur-SERGAS-UVIGO, Pontevedra, Spain
| | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | | | - Rafael Botella-Estrada
- Hospital Universitario La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (ISS La Fe), Valencia, Spain
- Universidad de Valencia, Valencia, Spain
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Montero-Vilchez T, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, González-Sixto B, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa E, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Feal-Cortizas JC, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Sanmartin-Jiménez O. Development and validation of a model to predict complex Mohs Micrographic Surgery in clinical practice: REGESMOSH scale. J Eur Acad Dermatol Venereol 2023. [PMID: 36950898 DOI: 10.1111/jdv.19056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION There is still a need to develop a simple algorithm to identify patients likely to need complex Mohs Micrographic Surgery (MMS) and optimize MMS schedule. The main objectives of this study are to identify factors associated with a complex MMS and develop a predictor model of the number of stages needed in surgery and the need for a complex closure. MATERIAL AND METHODS A nationwide prospective cohort study (REGESMOHS, the Spanish Mohs surgery registry) was conducted including all patients with a histological diagnosis of basal cell carcinoma (BCC). Factors related to 3 or more stages and a complex closure (that needing a flap and/or a graft) were explored and predictive models were constructed and validated to construct the REGESMOSH scale. RESULTS 5226 patients that underwent MMS were included in the REGESMOHS registry, with 4402 (84%) having a histological diagnosis of BCC. 3689 (88.9%) surgeries only needed one or two stages and 460 (11.1%) required 3 or more stages. A model to predict the need for 3 or more stages included tumour dimension, immunosuppression, recurrence, location in risk areas, histological aggressiveness, and previous surgery. Regarding the closure type, 1616 (38.8%) surgeries were closed using a non-complex closure technique and 2552 (61.2%) needed a complex closure. A model to predict the need for a complex closure included histological aggressiveness, evolution time, patient age, maximum tumour dimension and location. CONCLUSION We present a model to predict MMS needing ≥ 3 stages and a complex closure based on epidemiological and clinical data validated in a large population (with real practice variability) including different centres that could be easily implemented in clinical practice. This model could be used to optimize surgery schedule and properly inform patients about the surgery duration.
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Affiliation(s)
| | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - Ignacio Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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Tomás-Velázquez A, Sanmartin-Jiménez O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, De Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza JL, Alfaro-Rubio A, Gil P, Delgado-Jiménez Y, Sanchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, De la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa-Rull E, Sanchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Gonzalez-Sixto B, Martorell-Calatayud A, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, García-Doval I, Redondo P. Risk Factors and Rate of Recurrence after Mohs Surgery in Basal Cell and Squamous Cell Carcinomas: A Nationwide Prospective Cohort (REGESMOHS, Spanish Registry of Mohs Surgery). Acta Derm Venereol 2021; 101:adv00602. [PMID: 34694418 PMCID: PMC9455311 DOI: 10.2340/actadv.v101.544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patientyears for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1– 1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.
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Affiliation(s)
- Alejandra Tomás-Velázquez
- Department of Dermatology, University Clinic of Navarra / Fundación Piel Sana, ES-28008 Madrid, Spain.
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4
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Ruiz-Salas V, Sanmartin-Jiménez O, Garcés JR, Vilarrasa E, Miñano-Medrano R, Escutia-Muñoz B, Flórez-Menéndez Á, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt J, Allende-Markixana I, García Bracamonte B, de la Cueva-Dobao P, Ciudad C, Carnero-González L, Vázquez-Veiga H, Sánchez-Sambucety P, Estebaranz JL, Botella-Estrada R, González-Sixto B, Martorell A, Morales-Gordillo V, Toll-Abelló A, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I. Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS. Dermatology 2021; 238:320-328. [PMID: 34380138 DOI: 10.1159/000517010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. OBJECTIVES To describe the risk of MMS complications and the risk factors for them. METHODS A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. RESULTS 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. CONCLUSIONS MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events.
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Affiliation(s)
- Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - Joan R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | - Cristina Ciudad
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Ignacio Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain.,Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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5
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Oro-Ayude M, González-Sixto B, Sanmartin-Jiménez O, Garcés JR, Rodríguez-Prieto MA, Ruiz-Salas V, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Feal Cortizas C, Artola-Igarza JL, Alfaro-Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva-Dobao P, Navarro-Tejedor R, Ciudad-Blanco C, Carnero-González L, Vázquez-Veiga H, Cano-Martínez N, Vilarrasa-Rull E, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Martorell-Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Suárez-Fernández R, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I, Flórez Á. Mohs surgery: a long-term, nationwide prospective cohort to describe recurrence rate and risk factors (REGESMOHS, Spanish Registry of Mohs Surgery). J Eur Acad Dermatol Venereol 2021; 36:e35-e37. [PMID: 34374137 DOI: 10.1111/jdv.17597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M Oro-Ayude
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
| | - B González-Sixto
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
| | | | - J R Garcés
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - V Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | - C Feal Cortizas
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
| | | | | | - P Redondo
- Clínica Universidad de Navarra, Pamplona, Spain
| | - Y Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | - C Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - H Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - N Cano-Martínez
- Hospital Infanta Leonor, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | - E Vilarrasa-Rull
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | - P Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | - L Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - M A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - I Garcia-Doval
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - Á Flórez
- Complexo Universitario Hospitalario Pontevedra, Pontevedra, Spain
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6
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Sánchez-Velázquez A, Bauer-Alonso A, Estrach T, Vega-Díez D, Garcia-Muret P, Haya L, Peñate Y, Acebo E, Fernández de Misa R, Blanes M, Suh-Oh HJ, Izu R, Silva-Díaz E, Sarriugarte J, Román-Curto C, Botella-Estrada R, Mateu-Puchades A, Prieto-Torres L, Morillas V, Morillo M, Sánchez-Caminero P, Calzado L, Pérez-Ferriols A, Pérez A, Domínguez JD, Navedo M, Muniesa C, Combalia A, Arroyo-Andrés J, Descalzo MA, García-Doval I, Ortiz-Romero PL. Patients with primary cutaneous lymphoma are at risk for severe COVID-19. Data from the Spanish Primary Cutaneous Lymphoma Registry. J Eur Acad Dermatol Venereol 2021; 35:e624-e626. [PMID: 34062018 PMCID: PMC8242655 DOI: 10.1111/jdv.17430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Sánchez-Velázquez
- Department of Dermatology, Institute i+12, CIBERONC, Medical School, Hospital Universitario 12 de Octubre, University Complutense, Madrid, Spain
| | - A Bauer-Alonso
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - T Estrach
- Department of Dermatology, IDIBAPS, Hospital Clinico, University of Barcelona, Barcelona, Spain
| | - D Vega-Díez
- Department of Dermatology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - P Garcia-Muret
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, UAB, Barcelona, Spain
| | - L Haya
- Department of Dermatology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Y Peñate
- Department of Dermatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas, Spain
| | - E Acebo
- Department of Dermatology, Hospital Universitario de Cruces, Bizkaia, Spain
| | - R Fernández de Misa
- Department of Dermatology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - M Blanes
- Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain
| | - H J Suh-Oh
- SERGAS-UVIGO, DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Pontevedra, Spain
| | - R Izu
- Department of Dermatology, Hospital Universitario Basurto, Bizkaia, Spain
| | - E Silva-Díaz
- Department of Dermatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - J Sarriugarte
- Department of Dermatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - C Román-Curto
- Department of Dermatology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - R Botella-Estrada
- Department of Dermatology, Hospital Universitario la Fé, Valencia, Spain
| | - A Mateu-Puchades
- Department of Dermatology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - L Prieto-Torres
- Department of Dermatology, Hospital Universitario Lozano Blesa, Valencia, Spain
| | - V Morillas
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Zaragoza, Spain
| | - M Morillo
- Department of Dermatology, Hospital Universitario Virgen de Rocío, Barcelona, Spain
| | - P Sánchez-Caminero
- Department of Dermatology, Hospital General Universitario de Ciudad Real, Sevilla, Spain
| | - L Calzado
- Department of Dermatology, Hospital Universitario de Torrejón, Ciudad Real, Spain
| | - A Pérez-Ferriols
- Department of Dermatology, Hospital General Universitario de Valencia, Madrid, Spain
| | - A Pérez
- Department of Dermatology, Hospital Universitario Nuestra Señora De Valme, Valencia, Spain
| | - J D Domínguez
- Department of Dermatology, Hospital Universitario del Henares, Sevilla, Spain
| | - M Navedo
- Department of Dermatology, Complejo Asistencial Universitario de León, Madrid, Spain
| | - C Muniesa
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - A Combalia
- Department of Dermatology, IDIBAPS, Hospital Clinico, University of Barcelona, Barcelona, Spain
| | - J Arroyo-Andrés
- Department of Dermatology, Institute i+12, CIBERONC, Medical School, Hospital Universitario 12 de Octubre, University Complutense, Madrid, Spain
| | - M A Descalzo
- Unidad de Investigación, Fundación Piel Sana AEDV, León, Spain
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, León, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Madrid, Spain
| | - P L Ortiz-Romero
- Department of Dermatology, Institute i+12, CIBERONC, Medical School, Hospital Universitario 12 de Octubre, University Complutense, Madrid, Spain
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7
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Munera-Campos M, Vilar-Alejo J, Rivera R, Carrascosa JM, Daudén E, Herrera-Acosta E, Sahuquillo-Torralba A, Gómez-García FJ, Baniandrés-Rodríguez O, de la Cueva P, López-Estebaranz JL, Belinchón I, Ferran M, Riera-Monroig J, Rodriguez L, Carretero G, García-Donoso C, Ballescá F, Llamas-Velasco M, Herrera-Ceballos E, Pujol-Marco C, Nieto-Benito LM, Ruiz-Genao DP, Alsina M, Descalzo MA, García-Doval I. The risk of hepatic adverse events of systemic medications for psoriasis: a prospective cohort study using the BIOBADADERM registry. J DERMATOL TREAT 2021; 33:2110-2117. [PMID: 33913796 DOI: 10.1080/09546634.2021.1922572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited information is available regarding the risk of incident liver disease in patients with psoriasis receiving systemic therapies. OBJECTIVES To describe the liver safety findings of conventional and modern systemic therapies for moderate-to-severe psoriasis, and to compare the relative incidence rates of hepatic adverse events (AEs) for each drug. METHODS All the patients on the BIOBADADERM registry were included. Crude and adjusted incidence rate ratios (cIRR and aIRR, respectively) of hepatic AEs, using anti-TNF drugs as reference, were determined. Outcomes of interest were hypertransaminasemia, nonalcoholic fatty liver disease (NADFLD) and a group of other, less represented, hepatic AEs. RESULTS Our study included 3,171 patients exposed to systemic drugs (6279 treatment cycles). Incident hypertransaminasemia was the most frequent hepatic AE (incidence rate of 21 per 1000 patients-years [CI 95% CI 18-23]), followed by NAFLD (8 cases per 1000 patients-years [95% CI 6-10]). Methotrexate (aIRR 3.06 [2.31-4.4]; p = 0.000) and cyclosporine (aIRR 2.37 [1.05-5.35]; p = 0.0378) were associated with an increased risk for hypertransaminasemia when compared to anti-TNF-α agents. No differences were observed between different groups of biologics. Conventional therapies were not associated with new incident NAFLD. CONCLUSIONS Comparative information of the incidence of hepatic AEs could facilitate drug selection in moderate-to-severe psoriasis.
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Affiliation(s)
- M Munera-Campos
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Vilar-Alejo
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - R Rivera
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J M Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - E Daudén
- Department of Dermatology. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - E Herrera-Acosta
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - A Sahuquillo-Torralba
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - F J Gómez-García
- Department of Dermatology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - O Baniandrés-Rodríguez
- Department of Dermatology, CEIMI Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P de la Cueva
- Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J L López-Estebaranz
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - I Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
| | - M Ferran
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - J Riera-Monroig
- Department of Dermatology, Hospital Clínic de Barcelona, UB, Barcelona, Spain
| | - L Rodriguez
- Department of Dermatology, Hospital Virgen del Rocío, Sevilla, Spain
| | - G Carretero
- Department of Dermatology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - C García-Donoso
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ballescá
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - M Llamas-Velasco
- Department of Dermatology. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid, Spain
| | - E Herrera-Ceballos
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Pujol-Marco
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - L M Nieto-Benito
- Department of Dermatology, CEIMI Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D P Ruiz-Genao
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - M Alsina
- Department of Dermatology, Hospital Clínic de Barcelona, UB, Barcelona, Spain
| | - M A Descalzo
- Research Unit. Fundación Piel Sana AEDV, Madrid, Spain
| | - I García-Doval
- Research Unit. Fundación Piel Sana AEDV, Madrid, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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8
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Nieto-Benito LM, Ciudad-Blanco C, Sanmartin-Jimenez O, Garces JR, Rodríguez-Prieto MA, Vilarrasa E, de Eusebio-Murillo E, Miñano-Medrano R, Escutia-Muñoz B, Gonzalez-Sixto B, Artola-Igarza JL, Alfaro Rubio A, Redondo P, Delgado-Jiménez Y, Sánchez-Schmidt JM, Allende-Markixana I, Alonso-Pacheco ML, García-Bracamonte B, de la Cueva Dobao P, Navarro-Tejedor R, Suarez-Fernández R, Carnero-González L, Vázquez-Veiga H, Barchino-Ortiz L, Ruiz-Salas V, Sánchez-Sambucety P, López-Estebaranz JL, Botella-Estrada R, Feal-Cortizas C, Martorell Calatayud A, Gil P, Morales-Gordillo V, Toll-Abelló A, Ocerin-Guerra I, Mayor-Arenal M, Garcia-Donoso C, Cano-Martinez N, Sainz-Gaspar L, Descalzo MA, Garcia-Doval I. Mohs micrographic surgery in dermatofibrosarcoma protuberans: Rate and risk factors for recurrence in a prospective cohort study from the Spanish Registry of Mohs Surgery (REGESMOHS) and review of the literature. Exp Dermatol 2021; 30:717-722. [PMID: 33523531 DOI: 10.1111/exd.14291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/07/2021] [Accepted: 01/17/2021] [Indexed: 12/14/2022]
Abstract
Characterization of patients, surgery procedures and the risk factors for dermatofibrosarcoma protuberans (DFSP) recurrences is poorly defined. In this study, we aimed to describe the demographics, tumor characteristics and interventions of DFSP treated with Mohs micrographic surgery (MSS) to determine the rate and risk factors for recurrence. Data were collected from REGESMOHS, a nationwide prospective cohort study of patients treated with MMS in Spain. From July 2013 to February 2020, 163 patients with DFSP who underwent MMS were included. DFSP was mostly located on trunk and extremities. Recurrent tumors had deeper tumor invasion and required higher number of MMS stages. Paraffin MMS was the most frequently used technique. Overall recurrence rate was 0.97 cases/100 person-years (95% IC = 0.36-2.57). No differences were found in epidemiological, tumor, surgery characteristics or surgical technique (frozen or paraffin MMS [p = 0.6641]) in terms of recurrence. Median follow-up time was 28.6 months with 414 patient-years of follow-up. In conclusion, we found an overall low recurrence rate of DFSP treated with MMS. None of the studied risk factors, including MMS techniques, was associated with higher risk for recurrence.
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Affiliation(s)
| | - Cristina Ciudad-Blanco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Hospital La Zarzuela, Madrid, Spain
| | | | - Joan R Garces
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | | | - Yolanda Delgado-Jiménez
- Hospital Universitario Quirón Salud, Madrid, Spain.,Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | | | | | | | | | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | | | - Laura Sainz-Gaspar
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
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9
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Descalzo MA, Garcia-Doval I. Association of skin diseases, biological treatment and COVID-19 during the first wave of the pandemic. Br J Dermatol 2020; 184:194. [PMID: 33274755 PMCID: PMC7753286 DOI: 10.1111/bjd.19683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
Linked Article: Cho et al. Br J Dermatol 2021; 184:296–303.
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Affiliation(s)
- M A Descalzo
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología (AEDV), Madrid, Ferraz 100, 1° izda, Madrid, 28008, Spain
| | - I Garcia-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología (AEDV), Madrid, Ferraz 100, 1° izda, Madrid, 28008, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Meixoeiro sn, Vigo, 36313, Spain
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10
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Poveda-Montoyo I, García-Doval I, Descalzo MA, Betlloch-Mas I, Miquel-Miquel FJ, Serrano-Manzano M, Martín-Delgado MI, Sanz-Sánchez T, Knöpfel N, Córdoba S, Luca de Tena A, Martín-Santiago A, Silvestre JF. Quality Indicators in Care of Patients With Atopic Dermatitis: Consensus Document of the Spanish Academy of Dermatology and Venereology. Actas Dermosifiliogr (Engl Ed) 2020; 111:567-573. [PMID: 32401727 DOI: 10.1016/j.ad.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/08/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.
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Affiliation(s)
- I Poveda-Montoyo
- Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación ISABIAL, Alicante, España.
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - M A Descalzo
- Unidad de Investigación, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, España
| | - I Betlloch-Mas
- Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación ISABIAL, Alicante, España
| | - F J Miquel-Miquel
- Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, España
| | - M Serrano-Manzano
- Área de Atención Primaria, Equipo de Atención Primaria Martorell Rural, Masquefa, Barcelona, España
| | - M I Martín-Delgado
- Área de Pediatría de Atención Primaria, Centro de Salud Santa Ponsa, Santa Ponsa, Islas Baleares, España
| | - T Sanz-Sánchez
- Servicio de Dermatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - N Knöpfel
- Servicio de Dermatología, Hospital Niño Jesús, Madrid, España; Servicio de Dermatología Pediátrica, Hospital Infantil Universitario de Zúrich, Zúrich, Suiza
| | - S Córdoba
- Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - A Luca de Tena
- Representante de la Asociación de Afectados por la Dermatitis Atópica
| | - A Martín-Santiago
- Servicio de Dermatología, Hospital Universitario Son Espases, Palma, Islas Baleares, España
| | - J F Silvestre
- Servicio de Dermatología, Hospital General Universitario de Alicante, Instituto de Investigación ISABIAL, Alicante, España
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11
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Fernandez-Ferro J, Schwamm LH, Descalzo MA, MacIsaac R, Lyden PD, Lees KR. Missing outcome data management in acute stroke trials testing iv thrombolytics. Is there risk of bias? Eur Stroke J 2020; 5:148-154. [PMID: 32637648 PMCID: PMC7313360 DOI: 10.1177/2396987320905457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Missing outcome data may undermine interpretation of randomised clinical trials by weakening power and limiting apparent effect size. We assessed bias and inefficiency of two imputation methods commonly used in stroke trials evaluating the efficacy of iv thrombolysis. PATIENTS AND METHODS We searched the virtual international stroke trials archive (VISTA)-acute for ischaemic stroke patients with 90-day modified Rankin scale as an outcome, and known thrombolysis status. We excluded any with missing 30-day modified Rankin scale. We planned two analyses; first, we calculated odds ratios for outcome in thrombolysed versus not thrombolysed from imputed-only data, (a) among patients with missing modified Rankin scale 90 and (b) among matched patients with intact data (using propensity score methods and relevant covariates). Imputation approaches were last observation carried forward (LOCF) or multiple imputation. Outcome comparisons used dichotomisation and shift analysis. Thereafter, we calculated whole-population odds ratios using LOCF and multiple imputation (also through dichotomisation and shift analysis); first with the original 1.5% missing outcome data, and then artificially increasing the burden (5%; 10%; 20%; 30%). RESULTS We considered 9657 patients from eight of the studies included in VISTA, 3034 (31%) thrombolysed. Missing data replacement by LOCF with analysis by dichotomisation gave the highest estimate of thrombolysis influence. Imputing while increasing the burden of missing data progressively raised the odds ratios estimates, though thresholds for overestimation were 10% for LOCF; 20% for multiple imputation.Discussion: Replacing missing outcome data tended to overestimate differences of thrombolysed versus non-thrombolysed patients, but had minimal impact below a 10% burden of missing data.Conclusion: In the specific context of acute stroke trials testing iv thrombolytics, replacing missing data by carrying forward the last observation tended to overestimate treatment odds ratios more than multiple imputation.
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Affiliation(s)
- Jose Fernandez-Ferro
- Department of Neurology, Hospital Universitario Rey Juan Carlos, Instituto de Investigacion Sanitaria – Hospital Universitario Fundación Jiménez Díaz, Universidad Autonóma de Madrid, Madrid, Spain
| | - Lee H Schwamm
- Department of Neurology, Comprehensive Stroke Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Miguel A Descalzo
- Fundación Piel Sana, Academia Española de Dermatología y Venereología, Madrid, Spain
| | - Rachael MacIsaac
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Patrick D Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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12
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Cecconi M, Ranza R, Titton DC, Moraes JCB, Bertolo M, Bianchi W, Brenol C, Carvalho HM, de Castro GRW, Costa IP, Cunha MFL, Duarte Â, Fernandes V, Freire M, Louzada-Junior P, Macieira JC, Miranda JRS, Pereira IA, Pinheiro GRC, Stadler B, Toledo RA, Valim V, Descalzo MA, Pinto RMC, Laurindo I. Incidence of Infectious Adverse Events in Patients With Rheumatoid Arthritis and Spondyloarthritis on Biologic Drugs-Data From the Brazilian Registry for Biologics Monitoring. J Clin Rheumatol 2020; 26:73-78. [PMID: 32073519 PMCID: PMC7034387 DOI: 10.1097/rhu.0000000000000935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The safety profile of biologic drugs might present substantial regional differences. Since 2009, the Brazilian Society of Rheumatology has maintained BIOBADABRASIL (Brazilian Registry for Biologic Drugs), a registry for monitoring of biologic therapies in rheumatic diseases. OBJECTIVES The aim of this study was to verify the incidence rate (IR) of serious infections in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients on biologic drugs. METHODS BIOBADABRASIL prospectively included patients with rheumatic diseases who started the first biologic drug or a synthetic disease-modifying antirheumatic drug as a parallel control group. This study focuses on serious infectious adverse events (SIAEs) in RA and SpA patients on biologic drugs compared with controls, from January 2009 to June 2015. Time of exposure was set from initiation of the drug to the date of last administration or censorship. Serious infectious adverse events IR was calculated per 1000 patient/years with 95% confidence interval (CI). RESULTS A total of 1698 patients (RA, 1121; SpA, 577) were included, 7119 patient/years. Serious infectious adverse events were more common among patients on tumor necrosis factor inhibitors (TNFi's) than controls (adjusted IR ratio, 2.96 [95% CI, 2.01-4.36]; p < 0.001). Subsequent TNFi was associated with a higher SIAEs incidence when compared with first TNFI (adjusted IR ratio, 1.55 [95% CI, 1.15-2.08]; p = 0.004). Serious infectious adverse events were associated with age and corticosteroids intake. Serious infectious adverse events were more frequent in the respiratory tract in all subgroups. CONCLUSIONS In BIOBADABRASIL, biologic drugs, especially the subsequent TNFi, were associated with a higher risk of serious infections compared with synthetic DMARDs. Corticosteroid intake and age represented risk factors for SIAEs. Constant monitoring is required to follow the safety profile of drugs in the clinical setting of rheumatic conditions in Brazil.
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Affiliation(s)
| | - Roberto Ranza
- From the Universidade Federal de Uberlândia, Uberlândia
| | | | | | | | | | - Claiton Brenol
- Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre, Porto Alegre
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto A. Toledo
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto
| | | | | | | | - Ieda Laurindo
- Faculdade de Medicina da Universidade Nove de Julho, São Paulo, Brazil
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13
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Rodríguez-Jiménez P, Jimenez YD, Reolid A, Sanmartın-Jimenez O, Garces JR, Rodríguez-Prieto MA, Medrano RM, Vilarrasa E, de Eusebio-Murillo E, Redondo P, Ciudad-Blanco C, Morales-Gordillo V, Toll-Abelló A, Artola-Igarza JL, Pacheco MLA, Markixana IA, Fernández RS, Rubio AA, Vázquez-Veiga H, Flórez-Menéndez A, de la Cueva Dobao P, Botella-Estrada R, Garcia-Bracamonte B, Carnero-González L, Ruiz-Salas V, Sánchez-Sambucety P, López-Estebaranz JL, Gil P, Barchino L, Arenal MM, Ocerin-Guerra I, Hueso L, Seoane-Pose MJ, Gonzalez-Sixto B, Cano-Martinez N, Escutia-Muñoz B, Ortiz-Romero PL, Garcia-Doval I, Descalzo MA. State of the art of Mohs surgery for rare cutaneous tumors in the Spanish Registry of Mohs Surgery (REGESMOHS). Int J Dermatol 2019; 59:321-325. [PMID: 31777957 DOI: 10.1111/ijd.14732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of Mohs micrographic surgery (MMS) for rare cutaneous tumors is poorly defined. We aim to describe the demographics, tumor presentation and topography, surgery characteristics and complications of MMS for rare cutaneous tumors in a national registry. METHODS Prospective cohort study of patients treated with MMS in Spain between July 2013 and June 2018. The inclusion criteria were patients with cutaneous tumors with final diagnosis different from basal cell carcinoma, squamous cell carcinoma, dermatofibrosarcoma protuberans, or any kind of melanoma. RESULTS Five thousand and ninety patients were recorded in the registry, from which only 73 tumors (1.4%) fulfilled the inclusion criteria: atypical fibroxanthoma (18), microcystic adnexal carcinoma (10), extramammary Paget's disease (7), Merkel cell carcinoma (5), dermatofibroma (4), trichilemmal carcinoma (4), desmoplastic trichoepithelioma (4), sebaceous carcinoma (3), leiomyosarcoma (2), porocarcinoma (2), angiosarcoma (2), trichoblastoma (1), superficial acral fibromyxoma (1), and others (10). No intra-surgery morbidity was registered. Postsurgery complications appeared in six patients (9%) and were considered mild. Median follow-up time was 0.9 years during which three Merkel cell carcinomas, one angiosarcoma, one microcystic adnexal carcinoma, and four others recurred (12.3%). CONCLUSION This national registry shows that rare cutaneous tumors represent a negligible part of the total MMS performed in our country with a low complication rate.
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Affiliation(s)
| | - Yolanda D Jimenez
- Hospital Universitario de la Princesa, Madrid, Spain.,Hospital Universitario Quirón Salud, Madrid, Spain
| | | | | | - Joan R Garces
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Centro Médico Teknon, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | - Hugo Vázquez-Veiga
- Complexo Hospitalario Universitario de Santiago, Santiago Compostela, Spain
| | | | | | | | | | | | | | | | | | - Pilar Gil
- Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | | | | | | | | | | | | | | | - Ignacio Garcia-Doval
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain.,Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
| | - Miguel A Descalzo
- Fundación Piel Sana Academia Española de Dermatología, Madrid, Spain
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14
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Rodríguez-Jiménez P, Descalzo MA, Giménez Arnau AM, Silvestre JF, García Gavín J, Fernández Redondo V, Ruiz González I, Mercader García P, Armario-Hita JC, Sánchez-Pérez J. Trend of relevant contact allergens of the feet in Spain over a period of 10 years. Contact Dermatitis 2019; 82:211-217. [PMID: 31625171 DOI: 10.1111/cod.13419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Allergic contact dermatitis (ACD) of the feet accounts for approximately 10% of all patch tested patients. OBJECTIVE To study the clinical profile of patients with feet dermatitis and relevant contact allergens in Spain over a 10-year period. METHODS Retrospective observational study of patients with suspected ACD from the GEIDAC (Spanish Research Group on Contact Dermatitis and Cutaneous Allergy) baseline series from eight hospitals in Spain between 2004 and 2014. The clinical data collected from each patient were age, sex, occupation, history of atopic dermatitis, and eczema location. RESULTS A total of 450 cases clinically presented dermatitis affecting the feet; of these, 41% of were males and 5.6% were suspected to be of occupational origin. As much as 47% were diagnosed with ACD, 20% with atopic dermatitis/dyshidrotic eczema, and 5% with psoriasis. The "feet group" included statistically significantly more females in the age range of 21 to 60 years. The most frequent relevant contact allergens were potassium dichromate, cobalt(II) chloride, p-tert-butylphenol formaldehyde resin, mercapto mix, and mercaptobenzothiazole. CONCLUSIONS ACD is the most frequent clinical diagnosis of feet dermatitis in our series. The most frequent allergens are similar to those published in other series of foot ACD in Europe and the trend has not changed in the studied decade.
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Affiliation(s)
| | - Miguel A Descalzo
- Dermatology department, Unidad de Investigación Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Madrid, Spain
| | | | - Juan F Silvestre
- Dermatology department, Hospital Universitario General de Alicante, Alicante, Spain
| | | | | | | | - Pedro Mercader García
- Dermatology department, Hospital General Universitario Morales Meseguer, Murcia, Spain
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15
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Gutiérrez-González E, Descalzo MA, Molina-Leyva A, Kueder-Pajares T, Buendía-Eisman A, García-Doval I. Matching burden of skin diseases, demand for dermatological consultations and clinical research activity: results from three national studies. Br J Dermatol 2019; 182:225-227. [PMID: 31301228 DOI: 10.1111/bjd.18337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Gutiérrez-González
- Public Health & Preventive Medicine Teaching Unit, National School of Public Health, Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of Health, Madrid, Spain
| | - M A Descalzo
- Research Unit, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Spain
| | - A Molina-Leyva
- Department of Dermatology, Hospital Virgen de las Nieves, Granada, Spain
| | - T Kueder-Pajares
- Department of Dermatology, Hospital de Fuenlabrada, Madrid, Spain
| | | | - I García-Doval
- Research Unit, Fundación Piel Sana de la Academia Española de Dermatología y Venereología, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
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16
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Descalzo MA. Estimating the Prevalence of Psoriasis Using Electronic Health Records. Actas Dermosifiliogr (Engl Ed) 2019; 110:339-340. [PMID: 30635126 DOI: 10.1016/j.ad.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- M A Descalzo
- Unidad de Investigación, Fundación Piel Sana, AEDV, Madrid, España.
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17
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Delgado Jiménez Y, Camarero-Mulas C, Sanmartín-Jiménez O, Garcés JR, Rodríguez-Prieto MÃ, Alonso-Alonso T, Miñano Medrano R, López-Estebaranz JL, de Eusebio Murillo E, Redondo P, Ciudad-Blanco C, Toll A, Artola Igarza JL, Allende Markixana I, Suarez Fernández R, Alfaro Rubio A, Alonso Pacheco ML, Vázquez-Veiga H, de la Cueva Dobao P, Ruiz-Salas V, Vilarrasa E, Barchino L, Morales-Gordillo V, Ocerin-Guerra I, Navarro Tejedor R, Hueso L, Mayor Arenal M, Seoane-Pose MJ, Cano-Martinez N, Garcia-Doval I, Descalzo MA. Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma. Int J Dermatol 2018; 57:1375-1381. [DOI: 10.1111/ijd.14223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/13/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Joan R. Garcés
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Verónica Ruiz-Salas
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona; Barcelona Spain
- Centro Médico Teknon Barcelona; Barcelona Spain
| | | | | | | | | | | | | | | | | | - Ignacio Garcia-Doval
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
| | - Miguel A. Descalzo
- Unidad de investigación; Fundación Piel Sana Academia Española de Dermatología; Madrid Spain
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18
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Garcia-Doval I, Descalzo MA, Mason KJ, Cohen AD, Ormerod AD, Gómez-García FJ, Cazzaniga S, Feldhamer I, Ali H, Herrera-Acosta E, Griffiths CEM, Stern RS, Naldi L. Cumulative exposure to biological therapy and risk of cancer in patients with psoriasis: a meta-analysis of Psonet studies from Israel, Italy, Spain, the U.K. and Republic of Ireland. Br J Dermatol 2018; 179:863-871. [PMID: 29723914 DOI: 10.1111/bjd.16715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cancer risk following long-term exposure to systemic immunomodulatory therapies in patients with psoriasis is possible. OBJECTIVES To assess a dose-response relationship between cumulative length of exposure to biological therapy and risk of cancer. METHODS Four national studies (a healthcare database from Israel, and prospective cohorts form Italy, Spain and the U.K. and Republic of Ireland) collaborating through Psonet (European Registry of Psoriasis) participated in these nested case-control studies, including nearly 60 000 person-years of observation. 'Cases' were patients who developed an incident cancer. Patients with previous cancers and benign or in situ tumours were excluded. Four cancer-free controls were matched to each case on year of birth, sex, geographic area and registration year. Follow-up for controls was censored at the date of cancer diagnosis for the matched case. Conditional logistic regression was performed by each registry. Results were pooled using random-effects meta-analysis. RESULTS A total of 728 cases and 2671 controls were identified. After matching, differences between cases and controls were present for the Charlson Comorbidity Index in all three registries, and in the prevalence of previous exposure to psoralen-ultraviolet A and smoking (the British Association of Dermatologists Biologic Interventions Register only). The risk of first cancers was not significantly associated with cumulative exposure to biologics (adjusted odds ratio per year of exposure 1·02, 95% confidence interval 0·92-1·13). Results were similar if squamous and basal cell carcinomas were included in the outcome. CONCLUSIONS Cumulative length of exposure to biological therapies in patients with psoriasis in real-world clinical practice does not appear to be linked to a higher risk of cancer after several years of use.
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Affiliation(s)
- I Garcia-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - M A Descalzo
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - K J Mason
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - A D Cohen
- Department of Quality Measures and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A D Ormerod
- Division of Applied Medicine, Aberdeen University, Aberdeen, U.K
| | - F J Gómez-García
- Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - S Cazzaniga
- Centro Studi GISED, Fondazione per la Ricerca, Ospedale Maggiore, Bergamo, Italy
| | - I Feldhamer
- Department of Quality Measures and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - H Ali
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - E Herrera-Acosta
- Department of Dermatology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C E M Griffiths
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Dermatology Centre, Salford Royal NHS Foundation Trust, Salford, U.K
| | - R S Stern
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, U.S.A
| | - L Naldi
- Centro Studi GISED, Fondazione per la Ricerca, Ospedale Maggiore, Bergamo, Italy.,Department of Dermatology, AULSS8, Ospedale San Bortolo, Vicenza, Italy
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19
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Molina-Leyva A, Descalzo MA, García-Doval I. Clinical research in Dermatology: resources and activities associated with a higher scientific productivity. GIORN ITAL DERMAT V 2018. [PMID: 29512979 DOI: 10.23736/s0392-0488.18.05864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clinical research papers and their derived metrics can be useful to assess the scientific production of medical and research centers. Diverse factors are probably associated to differences in scientific production. But there are scarce studies analyzing them. Resources are limited and have to be distributed efficiently. The objective of this study was to explore what resources and activities are potentially associated with a higher scientific productivity. METHODS A bibliometric study was performed to obtain information about scientific productivity. Papers included had to meet criteria to be considered clinical research in dermatology, additionally had to be published between the years 2005-2014, had to be included in Pubmed or Embase and had to include a Spanish center of dermatology as the correspondence address. Information about research resources and activities of the year 2015 was gathered by means of an online survey sent to the authors identified in the bibliometric study. RESULTS The search strategy returned 8617 papers and only 1104 of them (12.81%) met the inclusion criteria. 63 out of 113 centers responded to the survey (55.75%). Factors associated with a higher scientific productivity were: the size of the resident program, the amount of time specifically dedicated to research, a lower clinical workload, and the number of clinical trials performed in the last year. CONCLUSIONS We have demonstrated that some factors are associated with a higher scientific productivity. Residency program, more research staff, clinical workload redistribution and research motivation/initiatives are key strategies that could improve scientific productivity of a center.
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Affiliation(s)
- Alejandro Molina-Leyva
- Piel Sana Foundation AEDV, Research Unit of the Spanish Academy of Dermatology and Venerelology, Madrid, Spain -
| | - Miguel A Descalzo
- Piel Sana Foundation AEDV, Research Unit of the Spanish Academy of Dermatology and Venerelology, Madrid, Spain
| | - Ignacio García-Doval
- Piel Sana Foundation AEDV, Research Unit of the Spanish Academy of Dermatology and Venerelology, Madrid, Spain
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20
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Descalzo MA. Clinical Research at the Heart of the Spanish Academy of Dermatology and Venereology. Actas Dermosifiliogr (Engl Ed) 2017; 109:99. [PMID: 29249262 DOI: 10.1016/j.ad.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- M A Descalzo
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Madrid, España.
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21
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Gálvez R, Musella V, Descalzo MA, Montoya A, Checa R, Marino V, Martín O, Cringoli G, Rinaldi L, Miró G. Modelling the current distribution and predicted spread of the flea species Ctenocephalides felis infesting outdoor dogs in Spain. Parasit Vectors 2017; 10:428. [PMID: 28927433 PMCID: PMC6389158 DOI: 10.1186/s13071-017-2357-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background The cat flea, Ctenocephalides felis, is the most prevalent flea species detected on dogs and cats in Europe and other world regions. The status of flea infestation today is an evident public health concern because of their cosmopolitan distribution and the flea-borne diseases transmission. This study determines the spatial distribution of the cat flea C. felis infesting dogs in Spain. Using geospatial tools, models were constructed based on entomological data collected from dogs during the period 2013–2015. Bioclimatic zones, covering broad climate and vegetation ranges, were surveyed in relation to their size. Results The models builded were obtained by negative binomial regression of several environmental variables to show impacts on C. felis infestation prevalence: land cover, bioclimatic zone, mean summer and autumn temperature, mean summer rainfall, distance to urban settlement and normalized difference vegetation index. In the face of climate change, we also simulated the future distributions of C. felis for the global climate model (GCM) “GFDL-CM3” and for the representative concentration pathway RCP45, which predicts their spread in the country. Conclusions Predictive models for current climate conditions indicated the widespread distribution of C. felis throughout Spain, mainly across the central northernmost zone of the mainland. Under predicted conditions of climate change, the risk of spread was slightly greater, especially in the north and central peninsula, than for the current situation. The data provided will be useful for local veterinarians to design effective strategies against flea infestation and the pathogens transmitted by these arthropods.
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Affiliation(s)
- Rosa Gálvez
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, Madrid, Spain
| | - Vicenzo Musella
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Miguel A Descalzo
- Unidad de Investigación, Academia Española de Dermatología y Venereología, Calle Ferraz, 100, Madrid, Spain
| | - Ana Montoya
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, Madrid, Spain
| | - Rocío Checa
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, Madrid, Spain
| | - Valentina Marino
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, Madrid, Spain
| | - Oihane Martín
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, Madrid, Spain
| | - Giuseppe Cringoli
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Regional Centre for Monitoring of Parasitic Diseases, Campania Region, Naples, Italy
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Regional Centre for Monitoring of Parasitic Diseases, Campania Region, Naples, Italy
| | - Guadalupe Miró
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, Madrid, Spain.
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22
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Ascott A, Langan SM, García-Doval I, Descalzo MA, Schmidt SAJ, Nijsten T, Hollestein LM. Report from the first European Dermato-Epidemiology Network forum. Br J Dermatol 2017; 177:e168-e171. [PMID: 28921488 DOI: 10.1111/bjd.15874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
Abstract
The first European Dermato-Epidemiology Network (EDEN) forum was held on 30-31 March 2017 in Madrid, Spain. Dermatoepidemiology describes the study of causes, prevention, health services research and evaluation of interventions of skin diseases. EDEN aims to promote high-quality research, share expertise and facilitate collaboration. These aims were achieved during the EDEN forum by including a preconference course on skin cancer epidemiology; having excellent world-leading guest speakers on causality, quality of care, pharmacoepidemiology and missing data analysis; and including delegates who presented and discussed innovative research findings. The meeting brought together delegates from 11 different countries. We welcome everyone with an interest in clinical research and epidemiology related to skin disease to attend next year's meeting in March 2018 in Berlin.
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Affiliation(s)
- A Ascott
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, U.K
| | - S M Langan
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, U.K
| | - I García-Doval
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain.,Department of Dermatology, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - M A Descalzo
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - S A J Schmidt
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, U.K.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - T Nijsten
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - L M Hollestein
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, U.K.,Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Center (IKNL), Utrecht, the Netherlands
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23
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Dávila-Seijo P, Descalzo MA. Registries as real-world cohort studies that are useful and necessary in the pyramid of evidence. Br J Dermatol 2017; 178:300-301. [PMID: 28889457 DOI: 10.1111/bjd.15968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Dávila-Seijo
- Dermatology and Venereology Department, Umeå University Hospital, Umeå, Sweden.,Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
| | - M A Descalzo
- Research Unit, Fundación Piel Sana Academia Española de Dermatología y Venereología, Madrid, Spain
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24
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Molina-Leyva A, Descalzo MA, García-Doval I. A Map of Clinical Dermatology Research Centers in Spain: Results of the MaIND Study. Actas Dermosifiliogr 2017; 108:830-835. [PMID: 28669411 DOI: 10.1016/j.ad.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/07/2017] [Accepted: 05/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Bibliometric indicators and analyses of clinical research articles can help to quantify the scientific production of hospitals and institutions and identify their main areas of research. The aim of this study was to draw up a bibliometric map of clinical research in dermatology by Spanish hospitals and institutions through an analysis of quantitative, qualitative, and topic-based variables. MATERIAL AND METHOD Bibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in PubMed or Embase in which the corresponding author's affiliation was a Spanish dermatology department or institution. RESULTS Barcelona and Madrid were the provinces with the highest number of articles and citations. The centers with the most articles and citations were Hospital Clínic and Instituto Valenciano de Oncología. Those 2 hospitals also produced the highest number of articles on the most common research topic identified: melanoma. Because the articles were selected on the basis of the affiliation of the corresponding author to a Spanish dermatology center, this analysis does not include collaborative studies or clinical research studies led by nondermatology centers. CONCLUSIONS We have created a bibliometric map of clinical dermatology research in Spain that shows the distribution of scientific production and the main areas of research by province and hospital/institution. This map could be useful for education and research purposes.
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Affiliation(s)
- A Molina-Leyva
- Fundación Piel Sana AEDV, Unidad de investigación de la Academia Española de Dermatología y Venereología, Madrid, España.
| | - M A Descalzo
- Fundación Piel Sana AEDV, Unidad de investigación de la Academia Española de Dermatología y Venereología, Madrid, España
| | - I García-Doval
- Fundación Piel Sana AEDV, Unidad de investigación de la Academia Española de Dermatología y Venereología, Madrid, España
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25
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Dávila-Seijo P, Dauden E, Descalzo MA, Carretero G, Carrascosa JM, Vanaclocha F, Gómez-García FJ, De la Cueva-Dobao P, Herrera-Ceballos E, Belinchón I, López-Estebaranz JL, Alsina M, Sánchez-Carazo JL, Ferrán M, Torrado R, Ferrandiz C, Rivera R, Llamas M, Jiménez-Puya R, García-Doval I. Infections in Moderate to Severe Psoriasis Patients Treated with Biological Drugs Compared to Classic Systemic Drugs: Findings from the BIOBADADERM Registry. J Invest Dermatol 2016; 137:313-321. [PMID: 27677836 DOI: 10.1016/j.jid.2016.08.034] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/29/2016] [Accepted: 08/31/2016] [Indexed: 12/12/2022]
Abstract
Information regarding the safety of biological drugs prescribed to psoriasis patients on daily and long-term bases is insufficient. We used data from the BIOBADADERM registry (Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases) to generate crude rates of infection during therapy with systemic drugs, including biological drugs (infliximab, etanercept, adalimumab, and ustekinumab) and nonbiological drugs (acitretin, cyclosporine, and methotrexate). We also calculated unadjusted and adjusted risk ratios (RRs) (with propensity score adjustment) of infection, serious infections, and recurrent infections of systemic therapies compared with methotrexate, using Poisson regression. Our study included records of 2,153 patients (7,867.5 person-years). The adjusted RR of overall infection was significantly increased in the groups treated with adalimumab with methotrexate (adjusted RR = 2.13, 95% confidence interval [CI] = 1.2-3.7), infliximab (adjusted RR = 1.71, 95% CI = 1.1-2.65), cyclosporine (adjusted RR = 1.58, 95% CI = 1.17-2.15), ustekinumab with methotrexate (adjusted RR = 1.56, 95% CI = 1.08-2.25), and etanercept (adjusted RR = 1.34, 95% CI: 1.02-1.76) compared with methotrexate alone. Cyclosporine had a significant risk of serious infection (adjusted RR = 3.12, 95% CI = 1.1-8.8), followed by adalimumab combined with methotrexate (adjusted RR = 3.28, 95% CI = 0.8-13.5). Adalimumab in combination with methotrexate had the highest risk of infection recurrence (adjusted RR = 4.33, 95% CI = 2.27-8.24).
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Affiliation(s)
- Paula Dávila-Seijo
- Research Unit, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain; Dermatology and Venereology Department, Umeå University Hospital, Umeå, Sweden.
| | - Esteban Dauden
- Dermatology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - M A Descalzo
- Research Unit, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain
| | - Gregorio Carretero
- Dermatology Department, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | - Isabel Belinchón
- Dermatology Department, Hospital General Universitario de Alicante, Departamento de Medicina Clínica, Universidad Miguel Hernández, ISABIAL-FISABIO, Alicante, Spain
| | | | - Merce Alsina
- Dermatology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Marta Ferrán
- Dermatology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Rosa Torrado
- Dermatology Department, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Carlos Ferrandiz
- Dermatology Department, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
| | - Raquel Rivera
- Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mar Llamas
- Dermatology Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Ignacio García-Doval
- Research Unit, Fundación Academia Española de Dermatología y Venereología, Madrid, Spain; Dermatology Derpartment, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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26
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Galiano Mejías S, Carretero G, Ferrandiz C, Vanaclocha F, Daudén E, Gómez-García FJ, Herrera-Ceballos E, Belinchón-Romero I, Sánchez-Carazo JL, López-Estebaranz JL, Alsina M, Ferrán M, Torrado R, Carrascosa JM, Rivera R, Llamas-Velasco M, Jiménez-Puya R, Mendiola MV, Ruiz-Genao D, Descalzo MA, de la Cueva Dobao P. Management of Biologic Therapy in Moderate to Severe Psoriasis in Surgical Patients: Data From the Spanish Biobadaderm Registry. Actas Dermosifiliogr 2016; 108:52-58. [PMID: 27658689 DOI: 10.1016/j.ad.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/02/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE We now have considerable experience in the use of biologic agents to treat psoriasis, but doubts about management arise in certain clinical settings. Surgery is one of them. Although treatment guidelines advise that biologics be suspended before major surgery, data about actual clinical practices and associated complications are lacking. We aimed to analyze current practice in the clinical management of these cases. METHODS Retrospective study of cases in the Biobadaderm database. We analyzed the management of biologic therapy in patients with psoriasis who underwent surgical procedures. RESULTS Forty-eight of the 2113 patients registered in Biobadaderm underwent surgery. The largest percentage of procedures (31%) involved skin lesions. Biologic treatment was interrupted in 42% of the cases. No postsurgical complications were significantly related to treatment interruption. Likewise we detected no associations between treatment interruption and other variables, such as sex, age, or duration or severity of psoriasis. CONCLUSION Continuity of biologic treatment and the risk of postsurgical complications were not associated in this study, although conclusions are limited by the small sample size.
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Affiliation(s)
- S Galiano Mejías
- Servicio de Dermatología, Hospital Infanta Leonor, Madrid, España.
| | - G Carretero
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - C Ferrandiz
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Universitat Autónoma de Barcelona, Barcelona, España
| | - F Vanaclocha
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Daudén
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, España
| | - F J Gómez-García
- Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - E Herrera-Ceballos
- Servicio de Dermatología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - I Belinchón-Romero
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
| | - J L Sánchez-Carazo
- Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - J L López-Estebaranz
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - M Alsina
- Servicio de Dermatología, Hospital Universitario Clinic de Barcelona, Barcelona, España
| | - M Ferrán
- Servicio de Dermatología, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | - R Torrado
- Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - J M Carrascosa
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Universitat Autónoma de Barcelona, Barcelona, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, España
| | - R Jiménez-Puya
- Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Mª V Mendiola
- Servicio de Dermatología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - D Ruiz-Genao
- Servicio de Dermatología, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - M A Descalzo
- Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, España
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Descalzo MA, Clara W, Guzmán G, Mena R, Armero J, Lara B, Saenz C, Aragón A, Chacón R, El-Omeiri N, Méndez-Rico J, Cerpa M, Palekar R, Jara J, Azziz-Baumgartner E. Estimating the burden of influenza-associated hospitalizations and deaths in Central America. Influenza Other Respir Viruses 2016; 10:340-5. [PMID: 26946216 PMCID: PMC4910178 DOI: 10.1111/irv.12385] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives Our objective was to estimate the incidence of influenza‐associated hospitalizations and in‐hospital deaths in Central American Region. Design and setting We used hospital discharge records, influenza surveillance virology data, and population projections collected from Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua to estimate influenza‐associated hospitalizations and in‐hospital deaths. We performed a meta‐analysis of influenza‐associated hospitalizations and in‐hospital deaths. Main outcome measures The highest annual incidence was observed among children aged <5 years (136 influenza‐associated hospitalizations per 100 000 persons). Results Annually, 7 625–11 289 influenza‐associated hospitalizations and 352–594 deaths occurred in the subregion. Conclusions Our results suggest that a substantive number of persons are annually hospitalized because of influenza. Health officials should estimate how many illnesses could be averted through increased influenza vaccination.
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Affiliation(s)
- Miguel A Descalzo
- Universidad del Valle de Guatemala (UVG), Guatemala Ciudad, Guatemala
| | - Wilfrido Clara
- U.S. CDC Regional Office for Central America Region (CDC-CAR), Guatemala Ciudad, Guatemala
| | - Guiselle Guzmán
- Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Ricardo Mena
- Ministerio de Salud Pública y Asistencia Social de Guatemala (MSPAS), Guatemala Ciudad, Guatemala
| | - Julio Armero
- Ministerio de Salud de El Salvador (MINSAL), San Salvador, El Salvador
| | - Bredy Lara
- Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Carlos Saenz
- Ministerio de Salud de Nicaragua (MINSA), Managua, Nicaragua
| | - Anabela Aragón
- Universidad del Valle de Guatemala (UVG), Guatemala Ciudad, Guatemala
| | - Rafael Chacón
- Universidad del Valle de Guatemala (UVG), Guatemala Ciudad, Guatemala
| | | | | | | | - Rakhee Palekar
- Pan American Health Organization, Washington, DC, USA.,U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Jorge Jara
- Universidad del Valle de Guatemala (UVG), Guatemala Ciudad, Guatemala
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Hernández MV, Sanmartí R, Cañete JD, Descalzo MA, Alsina M, Carmona L, Gomez-Reino JJ. Cutaneous adverse events during treatment of chronic inflammatory rheumatic conditions with tumor necrosis factor antagonists: study using the Spanish registry of adverse events of biological therapies in rheumatic diseases. Arthritis Care Res (Hoboken) 2014; 65:2024-31. [PMID: 23926075 DOI: 10.1002/acr.22096] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/30/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To analyze the incidence rate (IR) and risk factors of cutaneous adverse events (CAE) in patients with chronic inflammatory rheumatic diseases treated with tumor necrosis factor (TNF) antagonists. METHODS We analyzed all patients from the BIOBADASER (Base de Datos de Productos Biológicos de la Sociedad Española de Reumatología) registry treated with a TNF antagonist (infliximab, etanercept, or adalimumab). Data collected included age, sex, diagnosis and duration of rheumatic disease, type of TNF antagonist, and concomitant treatment. Type of CAE was classified as local or systemic cutaneous manifestation related to treatment administration (infusion reaction), infection, malignancy, or autoimmune skin disease. Time of onset of CAE and outcome were also recorded. The IRs of CAE per 1,000 patient-years of exposure with 95% confidence intervals (95% CIs) were estimated. Multivariable analysis was performed to identify potential risk factors for CAE. RESULTS A total of 5,437 patients were included, representing 17,330 patient-years of exposure. A total of 920 CAE were reported; the IRs per 1,000 patient-years were 53 (95% CI 50-57) for CAE, 28 (95% CI 25-30) for infection, 15 (95% CI 13-17) for infusion reactions, 5 (95% CI 4-6) for autoimmune skin diseases, and 3 (95% CI 2-4) for skin malignancy. The mean time between starting TNF antagonist treatment and CAE was 1.78 years. In 32% of patients, CAE required TNF antagonist withdrawal. The main risk factors for CAE were female sex and treatment with infliximab, leflunomide, and glucocorticoids. CONCLUSION The IR of CAE in patients treated with TNF antagonists is significant and should be addressed carefully, and withdrawal of therapy is required in some cases.
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Fernández-Espartero C, de Miguel E, Loza E, Tomero E, Gobbo M, Descalzo MA, Collantes-Estévez E, Mulero J, Muñoz-Fernández S, Zarco P, Carmona L. Validity of the ankylosing spondylitis disease activity score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme. Ann Rheum Dis 2013; 73:1350-5. [PMID: 23709245 DOI: 10.1136/annrheumdis-2012-202976] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in early spondyloarthritis (SpA) in comparison with conventional clinical measures of disease activity. METHODS Six hundred and seventy-six incident cases of early SpA from the Esperanza programme were included. Patients were categorised into high and low disease activity states based on patient and physician global assessment scores and on the physician's decision to start treatment with a disease-modifying antirheumatic drug or tumour necrosis factor blocker. The discriminant ability of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) was tested using standardised mean differences between patients with high and low disease activity. Convergent validity was tested by Pearson correlation between ASDAS versions and other measures of disease activity. RESULTS ASDAS-ESR and ASDAS-CRP showed good correlation with BASDAI (r=0.79 and 0.74, respectively). Both indices correlated well with the patient global assessment (r=0.70 in both indices) and moderately with the physician global score (r=0.46 and 0.47, respectively). CRP and ESR showed poor correlation with patient- and physician-derived measures. ASDAS performed similarly across the global SpA sample, ankylosing spondylitis (AS), non-radiographic axial SpA and peripheral SpA. CONCLUSIONS ASDAS performed as a valid activity score even being slightly better than the Bath Ankylosing Spondylitis Disease Activity Index in its ability to discriminate between high and low disease activity in early SpA. ASDAS performed similarly in AS, early forms of SpA, non-radiographic axial SpA and peripheral SpA.
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Affiliation(s)
| | - E de Miguel
- Rheumatology Department, Hospital Universitario de la Paz, Madrid, Spain
| | - E Loza
- Institute for Musculoskeletal Health, Madrid, Spain
| | - E Tomero
- Rheumatology Department, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain
| | - M Gobbo
- Research Unit, Fundación Española de Reumatología, Madrid, Spain
| | - M A Descalzo
- Research Unit, Fundación Española de Reumatología, Madrid, Spain
| | - E Collantes-Estévez
- Rheumatology Department, Hospital Universitario Reina Sofía, Instituto Mainónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - J Mulero
- Rheumatology Department, Hospital Universitario de Puerta de Hierro-Majadahonda, Madrid, Spain
| | - S Muñoz-Fernández
- Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - P Zarco
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - L Carmona
- Institute for Musculoskeletal Health, Madrid, Spain Universidad Camilo José Cela, Madrid, Spain
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Gálvez R, Miró G, Descalzo MA, Molina R. Questionnaire-based survey on the clinical management of canine leishmaniosis in the Madrid region (central Spain). Prev Vet Med 2011; 102:59-65. [PMID: 21821298 DOI: 10.1016/j.prevetmed.2011.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/14/2011] [Accepted: 07/12/2011] [Indexed: 10/17/2022]
Abstract
This paper describes a questionnaire designed to gain information on how veterinarians clinically manage canine leishmaniosis (CanL) in the Madrid region (central Spain). The present survey is one of the several similar questionnaire-based surveys conducted within the framework of the project EDEN (Emerging Diseases in a changing European eNvironment). The questionnaire sought to obtain data regarding the main clinical manifestations observed, the diagnostic methods used and the preventive measures recommended. Its Spanish version was sent by post to veterinary practitioners within the study area in two lots, one sent out in December 2006 and the other in March 2007. Only 174 of the 760 questionnaires sent were completed and returned (reply rate of 23%). Among the completed questionnaires, clinics differed widely in terms of features such as the habitats of the dogs (urban, peri-urban or rural) and patient volumes. Clinics attending dogs from peri-urban/rural habitats reported more suspected (p<0.001), confirmed (p=0.001) and newly diagnosed (p=0.001) cases/year than clinics providing service to a city clientele alone. According to the veterinary practitioners, skin lesions, lymphadenomegaly and weight loss were commonly observed, although these signs are not specific to CanL. Signs described to be of high diagnostic value were epistaxis and kidney disease. All the veterinarians polled reported that a suspicion of Leishmania infantum infection was confirmed by at least a serological method; the immunofluorescence antibody test (IFAT) being the technique most used. To prevent the disease, most vets recommended topical synthetic pyrethroids applied as impregnated collars or spot-ons. It is observed that despite considerable progress is being made in clinical management and controlling the disease, in Madrid Region its incidence continues to increase.
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Affiliation(s)
- R Gálvez
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain
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Gálvez R, Descalzo MA, Guerrero I, Miró G, Molina R. Mapping the current distribution and predicted spread of the leishmaniosis sand fly vector in the madrid region (Spain) based on environmental variables and expected climate change. Vector Borne Zoonotic Dis 2011; 11:799-806. [PMID: 21417927 DOI: 10.1089/vbz.2010.0109] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Leishmaniosis caused by Leishmania infantum is a widespread zoonotic disease that is endemic in the Mediterranean basin. Based on prior point abundance data for the two sand fly vectors of leishmaniosis in the Madrid region (Phlebotomus perniciosus and Phlebotomus ariasi), models were constructed to predict the spatial distribution patterns of these vectors. The models were obtained by negative binomial regression of several environmental variables and then used to map vector distributions. To validate the maps, we used serological prevalence data of Leishmania infection in dogs and incidence data were obtained through questionnaires completed by veterinarians in the region. Seropositive dogs and veterinary clinics registering a higher incidence of canine leishmaniosis appeared closer to our modeled vector foci. In the face of climate change, we simulated the future distributions of the sand flies for each third of the 21st century and predicted their spread in the region.
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Affiliation(s)
- Rosa Gálvez
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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Carmona L, Abasolo L, Descalzo MA, Pérez-Zafrilla B, Sellas A, de Abajo F, Gomez-Reino JJ. Cancer in patients with rheumatic diseases exposed to TNF antagonists. Semin Arthritis Rheum 2010; 41:71-80. [PMID: 21093020 DOI: 10.1016/j.semarthrit.2010.08.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To describe the risk of cancer in patients exposed to tumor necrosis factor (TNF) antagonists. METHODS The following 2 clinical cohorts were studied: (1) BIOBADASER 2.0: a registry of patients suffering from rheumatic diseases exposed to TNF antagonists (2531 rheumatoid arthritis (RA), 1488 spondyloarthropathies, and 675 other rheumatic conditions); and (2) EMECAR: a cohort of 789 RA patients not exposed to TNF antagonists. Cancer incidence rates (IR) per 1000 patient-years and incidence rate ratios (IRR) were calculated for BIOBADASER 2.0 and EMECAR patients. The IR over time in BIOBADASER 2.0 patients was analyzed by joinpoint regression. The IRR was estimated to compare cancer rates in exposed versus nonexposed RA patients. Standardized incidence and mortality ratios (SIR, SMR) were also estimated. Risk factors for cancer in patients exposed to TNF antagonists were investigated by generalized linear models. RESULTS The SMR for cancer in BIODASER 2.0 was 0.67 (95% CI: 0.51-0.86), and the SIR was 0.1 (95% CI 0.03-0.23). The IR in RA patients exposed to TNF antagonists was 5.8 (95% CI: 4.4-7.6), and the adjusted IRR was 0.48 (95% CI: 0.09-2.45). The IR in patients with previous cancer was 26.4 (95% CI: 4.1-171.5). Age, chronic obstructive pulmonary disease, and steroids were associated with a higher risk of developing cancer. The IR decreased after the first 4 months of exposure, without statistical significance. CONCLUSION Overall cancer and mortality rates in patients with rheumatic diseases exposed to TNF antagonists are no higher than in the background Spanish population. However special attention should be paid to elderly patients, those with previous cancers, and patients treated with steroids.
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Affiliation(s)
- Loreto Carmona
- Research Unit, Sociedad Española de Reumatología, Madrid, Spain.
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33
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Carmona L, Descalzo MA, Ruiz-Montesinos D, Manero-Ruiz FJ, Perez-Pampin E, Gomez-Reino JJ. Safety and retention rate of off-label uses of TNF antagonists in rheumatic conditions: data from the Spanish registry BIOBADASER 2.0. Rheumatology (Oxford) 2010; 50:85-92. [PMID: 20601654 DOI: 10.1093/rheumatology/keq207] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare the safety and retention rate of TNF antagonists used in approved indications (AIs) and non-AIs. METHODS Analysis of the Spanish registry BIOBADASER 2.0 (February 2000 to October 2009). Patients were classified into AIs and off-label uses (OUs), according to the European Medicines Agency approval. Retention rates, incidence rates (IRs) and IR ratios (IRRs) of adverse events (AEs) with 95% CI were compared between uses, by log-rank test, cause-specific Cox regression models and generalized linear models with Poisson's distribution. RESULTS First treatment with TNF antagonist was available in 5150 patients, of whom 4594 (89%) were AIs (2854 RA, 882 AS and 858 PsA) and 556 (11%) were OUs [437 chronic arthropathies in the spectrum of SpAs (CA) and 119 chronic immune-mediated diseases (CIDs)]. The IR of AE was largest in CID (649 events per 1000 patient-years) and lowest in PsA (250 events per 1000 patient-years). The occurrence of AEs was significantly associated with OU [IRR of CA vs RA 1.33 (95% CI 1.19, 1.49); IRR of CID vs RA 1.94 (95% CI 1.62, 2.31). The largest hazard ratio for discontinuation was for CID vs RA (1.33; 95% CI 1.02, 1.71) and especially vs AS (2.18; 95% CI 1.63, 2.90). CONCLUSIONS OUs of TNF antagonists need a very close ascertainment of risk/benefit. The safety and retention pattern for CID is similar to that for RA and the pattern for CA resembles that of AS. This study shows an additional value of a national registry.
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Affiliation(s)
- Loreto Carmona
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
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34
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Gálvez R, Descalzo MA, Miró G, Jiménez MI, Martín O, Dos Santos-Brandao F, Guerrero I, Cubero E, Molina R. Seasonal trends and spatial relations between environmental/meteorological factors and leishmaniosis sand fly vector abundances in Central Spain. Acta Trop 2010; 115:95-102. [PMID: 20171154 DOI: 10.1016/j.actatropica.2010.02.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/21/2010] [Accepted: 02/11/2010] [Indexed: 12/01/2022]
Abstract
This paper reports on an entomological survey performed over the period 2006-2008 in Central Spain (mainly in the Madrid province) where canine leishmaniosis (CanL) is endemic. The study area was selected on the grounds of its wide altitude range, which determines both broad climate and vegetation ranges that could affect sand fly distributions. This area was surveyed from NE to SW across its mountain range (Sistema Central) and plateau area using sticky traps mainly on embankments. In 2006 and 2007, 123 sites were sampled (9557 sand flies captured) to establish possible relations between environmental or meteorological factors and vector densities (Phlebotomus perniciosus and Phlebotomus ariasi). The factors correlated with higher vector densities were: a sample site between villages or at the edge of a village, the lack of a paved road, a rural habitat, an east or south-facing wall or wall sheltered from the wind, the presence of livestock or birds, a holm-oak wood vegetation, a lower summer mean temperature and lower annual mean precipitation. This study was followed by a seasonal survey conducted at 16 selected sites (14,353 sand flies) sampled them monthly from May to November 2008. P. perniciosus showed a diphasic seasonal trend with two abundance peaks in July and September whereas P. ariasi showed a monophasic trend with one peak in August. Comparing with data from studies performed in 1991 in the same area, vector densities are significantly higher. A possible explanation for this is that the vectors (mainly P. ariasi) are moving towards higher altitudes perhaps because of global change. This increasing trend could have an impact on CanL and its geographical distribution.
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Affiliation(s)
- R Gálvez
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo s/n, 28220, Majadahonda, Madrid, Spain
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Muñoz-Fernández S, de Miguel E, Cobo-Ibáñez T, Carmona L, Steiner M, Descalzo MA, Ferreira A, Balsa A, Martín-Mola E. Early spondyloarthritis: results from the pilot registry ESPIDEP. Clin Exp Rheumatol 2010; 28:498-503. [PMID: 20659413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 02/16/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Studies on the incidence of spondyloarthritis (SpA) are scarce. Early SpA clinics should facilitate the detection of new cases as well as to decrease the diagnosis and treatment delay. However, the workload of such clinics has not been estimated. METHODS ESPIDEP is a pilot registry of patients with early SpA performed in Madrid, Spain. General practitioners (GPs) agreed and were trained to refer all patients under 45 with either inflammatory back pain or asymmetric arthritis of lower limbs with 3 to 24 month duration of symptoms to a specialised unit during 6 consecutive months. Case definition of SpA was based on the ESSG criteria. The success of the program was measured by: the satisfaction of the GPs regarding the referral process, the percentage of patients correctly derived according to the rheumatologist, the expected incidence of AS. RESULTS From a population of 111,941, the unit attended 52 patients, of whom 43 (83%) had been derived correctly and 35 were diagnosed with SpA (49% women; mean age 33+/-8; mean duration of symptoms 11+/-6 months; 46% HLA-B27 positive). The annual estimated incidence of SpA was 62.5 cases per 100,000 (95% CI: 45-87). Only 20/35 (57%) had radiological sacroiliitis and 4 (11.8%) fulfilled the modified New York criteria for ankylosing spondylitis (annual estimated incidence 7.2 per 100,000 (IC95%: 3.1-14.1)). CONCLUSIONS Around 60 cases of early SpA are expected annually in an area of 100,000. A referral based upon clinical parameters seems efficient. The planning of early SpA clinics may be based upon these figures.
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Carbonell J, Cobo T, Balsa A, Descalzo MA, Carmona L. The incidence of rheumatoid arthritis in Spain: results from a nationwide primary care registry. Rheumatology (Oxford) 2008; 47:1088-92. [PMID: 18511475 DOI: 10.1093/rheumatology/ken205] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Carbonell
- Rheumatology Department, Hospital del Mar, Institut Municipal Atencio Sanitaria, Barcelona
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Naranjo A, Sokka T, Descalzo MA, Calvo-Alén J, Hørslev-Petersen K, Luukkainen RK, Combe B, Burmester GR, Devlin J, Ferraccioli G, Morelli A, Hoekstra M, Majdan M, Sadkiewicz S, Belmonte M, Holmqvist AC, Choy E, Tunc R, Dimic A, Bergman M, Toloza S, Pincus T. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res Ther 2008; 10:R30. [PMID: 18325087 PMCID: PMC2453774 DOI: 10.1186/ar2383] [Citation(s) in RCA: 308] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Accepted: 03/06/2008] [Indexed: 11/17/2022] Open
Abstract
Introduction We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care. Methods The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models. Results Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries. Conclusion In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.
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Affiliation(s)
- Antonio Naranjo
- Hospital de Gran Canaria Dr, Negrin, University of Las Palmas de Gran Canaria, Barranco de la Ballena s/n 35011, Spain.
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Molina R, Miró G, Gálvez R, Nieto J, Descalzo MA. Evaluation of a spray of permethrin and pyriproxyfen for the protection of dogs against Phlebotomus perniciosus. Vet Rec 2006; 159:206-9. [PMID: 16905734 DOI: 10.1136/vr.159.7.206] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Dogs are the main domestic reservoir of Leishmania infantum in the Old World (Leishmania chagasi in the New World) a parasite responsible for many cases of human visceral leishmaniasis in both endemic and non-endemic regions. One strategy for the control of leishmaniasis would be to prevent dogs from being bitten by sandflies, the vector of leishmaniasis. This study was designed to assess the efficacy of spraying a combination of permethrin and pyriproxyfen on to dogs artificially exposed to sandflies. Two groups of four male dogs, one of them treated and the other left untreated as controls, were exposed for one hour to 100 female sandflies seven days before the treatment, on the day of treatment and seven, 14, 21, and 28 days later. After each exposure, sandflies were collected, counted and scored. The prevention of sandfly bite was calculated by measuring the number of fed sandflies (dead and alive) after treatment. In this experimental assay, the repellent effect of the treatment against sandfly bites after 21 days was 71.4 per cent, but the insecticidal effect was only 7.2 per cent.
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Affiliation(s)
- R Molina
- Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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