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BACKGROUND: Parental stress experienced in the context of caring for children with autism spectrum disorder (ASD) in preschool is significant and has been poorly studied; studies tend to focus on more advanced ages of children where parental symptomatology has become chronic. The current study sought to provide new empirical evidence on factors associated with parental stress. METHODS: An exhaustive search was conducted in four academic databases: CINAHL Complete, Medline Complete, Web of Science (WoS), and Scopus, limiting the articles to those published between 2017 and 2023. RESULTS: The sample obtained consisted of 24 selected articles, which were produced in 11 countries, and all were in English. In terms of content, the topics addressed were the manifestation of parental stress, factors of the child with ASD and their relationship with parental stress, factors of parents of children with ASD, family factors of parents of children with ASD, social factors of parents of children with ASD, parental stress and access to formal care services, and parental stress and specialized interventions. CONCLUSIONS: It is possible to affirm that research reports indicate that the general level of stress among parents of children with ASD is compared to their reference groups, both in relation to child-related stress and other stressors. The variables that affect parental stress exhibit a reciprocal influence among them, so interventions aimed at early childhood should incorporate both the children and their parental figures. This is in consideration of the impact that stress has on the mental health of parents, establishing that parents with better health have early access to support services during the early years of parenting, as well as in later years.
INTRODUCCIÓN: El estrés parental vivenciado en el contexto de cuidado de los niños con trastorno del espectro autistas en etapa preescolar es significativo y ha sido muy poco estudiado, las investigaciones tienden a focalizarse en edades de los niños más avanzada donde la sintomatología de los padres se ha cronificado. El objetivo de la presente investigación fue actualizar el corpus de evidencia empírica referida a los factores relacionados con el Estrés parental. MÉTODOS: Se realizó una búsqueda exhaustiva en cuatro bases de datos académicas: CINAHL Complete, Medline Complete, Web of Science (WoS) y Scopus, limitando los artículos publicados entre los años 2017 y 2023. RESULTADOS: La muestra obtenida fue de 24 artículos seleccionados, los cuales fueron producidos por 11 países todos de habla inglesa. En cuanto al contenido, los temas abordados son: La manifestación del estrés parental, factores del niño con TEA y su relación con el estrés parental, factores de los padres de los niños con TEA, factores familiares de los padres de los niños con TEA, factores sociales de los padres de los niños con TEA, estrés parental y acceso a los servicios formales de atención, y estrés parental e intervenciones especializadas. CONCLUSIONES: Es posible afirmar que las investigaciones reportan que el nivel general de estrés de los padres de niños con TEA es superior al de sus grupos de referencia, tanto en relación al estrés relacionado con el niño, como el que no. Las variables que afectan el estrés parental presentan una influencia recíproca entre éstas, por lo que las intervenciones dirigidas a la primera infancia deberían incorporar a los niños y a sus figuras parentales. Esto, en atención al impacto que el estrés presenta en la salud mental de los padres, estableciendo que los padres con mejor salud mental presentan mayor acceso temprano a los servicios de apoyo durante los primeros años de crianza, y en los años posteriores.
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Trastorno del Espectro Autista , Padres , Estrés Psicológico , Humanos , Padres/psicología , Preescolar , Accesibilidad a los Servicios de SaludRESUMEN
BACKGROUND: Racial and ethnic differences in health care may result in significant morbidity. The objective of this study was to determine whether there was an association between a patient's race or ethnicity and the receipt of an antiemetic agent preoperatively, during surgery, and in the recovery room. METHODS: A single-institution retrospective study of adult patients (>18 years) who had undergone cancer-related operating room procedures under anesthesia between March 2016 and August 2021 was conducted. A multivariable logistic regression model was fitted to estimate the effects of covariates on antiemetic administration. RESULTS: Of the 60,595 patients included in the study, 3053 (5.0%) self-identified as Asian, 5376 (8.9%) as Black, 8431 (13.9%) as Hispanic or Latino, 42,533 (70.2%) as White, and 1202 (2.0%) as belonging to another racial or ethnic group. Multivariable analyses showed significant associations between a patient's race or ethnicity and the receipt of antiemetics in the preoperative holding area, operating room, and recovery room (all P < .001). In the preoperative holding area, White patients (8962 of 42,533 [21.1%]; odds ratio [OR], 1.188; 95% confidence interval [CI], 1.100-1.283; P < .001) had higher odds of receiving an antiemetic than Black patients (1006 of 5376 [18.7%]). Intraoperatively, the odds were significantly greater for Hispanic or Latino (7323 of 8431 [86.9%]; OR, 1.175; 95% CI, 1.065-1.297; P = .001) and patients who identified as belonging to another race (1078 of 1202 [89.7%]; OR, 1.582; 95% CI, 1.290-1.941; P < .001) than for Black patients (4468 of 5376 [83.1%]). In the recovery room, Asian (499 of 3053 [16.3%]; OR, 1.328; 95% CI: 1.127-1.561; P < .001), Hispanic or Latino (1335 of 8431 [15.8%]; OR, 1.208; 95% CI, 1.060-1.377; P < .005), and White patients (6533 of 42,533 [15.4%]; OR, 1.276; 95% CI, 1.140-1.427; P < .001) had significantly higher odds of receiving antiemetics than Black patients (646 of 5376 [12%]). CONCLUSIONS: This retrospective study suggests significant differences between the administrations of antiemetics to patients of different races or ethnicities, with Black patients often being less likely to receive an antiemetic than patients belonging to all other races or ethnicities.
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Contrast enhanced pulmonary vein magnetic resonance angiography (PV CE-MRA) has value in atrial ablation pre-procedural planning. We aimed to provide high fidelity, ECG gated PV CE-MRA accelerated by variable density Cartesian sampling (VD-CASPR) with image navigator (iNAV) respiratory motion correction acquired in under 4 min. We describe its use in part during the global iodinated contrast shortage. VD-CASPR/iNAV framework was applied to ECG-gated inversion and saturation recovery gradient recalled echo PV CE-MRA in 65 patients (66 exams) using .15 mmol/kg Gadobutrol. Image quality was assessed by three physicians, and anatomical segmentation quality by two technologists. Left atrial SNR and left atrial/myocardial CNR were measured. 12 patients had CTA within 6 months of MRA. Two readers assessed PV ostial measurements versus CTA for intermodality/interobserver agreement. Inter-rater/intermodality reliability, reproducibility of ostial measurements, SNR/CNR, image, and anatomical segmentation quality was compared. The mean acquisition time was 3.58 ± 0.60 min. Of 35 PV pre-ablation datasets (34 patients), mean anatomical segmentation quality score was 3.66 ± 0.54 and 3.63 ± 0.55 as rated by technologists 1 and 2, respectively (p = 0.7113). Good/excellent anatomical segmentation quality (grade 3/4) was seen in 97% of exams. Each rated one exam as moderate quality (grade 2). 95% received a majority image quality score of good/excellent by three physicians. Ostial PV measurements correlated moderate to excellently with CTA (ICCs range 0.52-0.86). No difference in SNR was observed between IR and SR. High quality PV CE-MRA is possible in under 4 min using iNAV bolus timing/motion correction and VD-CASPR.
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Medios de Contraste , Interpretación de Imagen Asistida por Computador , Angiografía por Resonancia Magnética , Variaciones Dependientes del Observador , Compuestos Organometálicos , Valor Predictivo de las Pruebas , Venas Pulmonares , Humanos , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/cirugía , Venas Pulmonares/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Medios de Contraste/administración & dosificación , Compuestos Organometálicos/administración & dosificación , Anciano , Técnicas de Imagen Sincronizada Cardíacas , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Ablación por Catéter , ElectrocardiografíaRESUMEN
Anti-soybean agglutinin (SBA) IgY was produced, and its potential to neutralize the haemagglutinating activity of SBA in vitro was tested. Thirty-five-week-old hens [treatment (n = 5) and control (n = 5)] were immunized with SBA or injected with saline 4 times every 15 days. Eggs were collected after the last immunization, and IgY was extracted using the polyethylene glycol (PEG) method. Serum anti-SBA IgY titres in immunized hens increased after the first immunization and reached a plateau between days 45 and 60. In contrast, specific IgY titres in the control group remained at basal levels throughout the evaluation. Average IgY titres were significantly higher in the treatment group on days 15, 30, 45, and 60. Total IgY content in the egg yolk extract was 38.7 ± 1.6 and 37.7 ± 1.5 mg/ml for the treatment and control groups, respectively. The specific anti-SBA IgY titer detected in the egg yolk extract was significantly higher (p < 0.001) for hens in the treatment group compared to the control group, with OD450nm values of 0.98 ± 0.05 and 0.058 ± 0.02, respectively. The specificity of anti-SBA IgY was confirmed by the Western blotting, and the inhibition of SBA-induced haemagglutination in vitro was compared with D-galactose, a known molecule that binds to SBA and blocks its binding to erythrocytes. The inhibition of SBA-induced haemagglutination by the anti-SBA IgY reached 512 units of haemagglutination inhibition (UHI), compared to 8 or 256 UHI, respectively, when IgY from control chickens or D-galactose was used. Thus, anti-SBA IgY antibodies were efficiently produced in large quantities and effectively inhibited SBA-induced haemagglutination in vitro.
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El presente artículo describe el proceso de implementación de tres guías elaboradas por la Registered Nurses' Association of Ontario (RNAO) de Canadá, en el módulo enfermería en el adulto en la Escuela de Enfermería de la Universidad de Talca, proceso que se enmarca en el convenio establecido entre la Universidad de Talca y esta asociación, a través del Departamento de Enfermería de la Universidad de Chile, host leader del Programa de Guías de Buenas Prácticas Clínicas de la RNAO. Esta implementación se llevó a cabo a través de diversas metodologías de enseñanza-aprendizaje que han permitido a los estudiantes integrar y aplicar la Enfermería Basada en Evidencia en la práctica clínica y también, establecer una alianza entre la institución académica y los centros de asistencia sanitaria.
This article describes the implementation process of three guidelines developed by the Registered Nurses' Association of Ontario (RNAO) in the adult nursing module at the School of Nursing of the University of Talca. This process is part of the agreement reached between the University of Talca and this association, through the Department of Nursing of the University of Chile, Host Leader of the RNAO's Best Clinical Practice Guidelines Program. This implementation has been carried out through various teaching-learning methodologies that have allowed students to integrate and apply Evidence-Based Nursing in clinical practice and also to establish an alliance between the academic institution and health care centers.
Este artigo descreve o processo de implementação de três diretrizes desenvolvidas pela Associação de Enfermeiros Registrados de Ontario (RNAO, sigla em inglês) do Canadá no módulo de enfermagem para adultos da Escola de Enfermagem da Universidade de Talca. Esse processo faz parte do acordo estabelecido entre a Universidade de Talca e esta associação, por meio do Departamento de Enfermagem da Universidade do Chile, host leader do Programa de Boas Práticas Clínicas da RNAO. Essa implementação foi realizada por meio de várias metodologias de ensino-apredizagem que permitiram aos estudantes integrarem a Enfermagem Baseada em Evidências à prática clínica, e também estabelecer uma aliança entre a instituição académica e os centros de saúde.
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OBJECTIVES: Improving family-centered outcomes is a priority in oncologic critical care. As part of the Intensive Care Unit (ICU) Patient-Centered Outcomes Research Collaborative, we implemented patient- and family-centered initiatives in a comprehensive cancer center. METHODS: A multidisciplinary team was created to implement the initiatives. We instituted an open visitation policy (OVP) that revamped the use of the two-way communication boards and enhanced the waiting room experience by hosting ICU family-centered events. To assess the initiatives' effects, we carried out pre-intervention (PRE) and post-intervention (POST) family/caregiver and ICU practitioner surveys. RESULTS: A total of 159 (PRE = 79, POST = 80) family members and 147 (PRE = 95, POST = 52) ICU practitioners participated. Regarding the decision-making process, family members felt more included (40.5% vs. 68.8%, p < 0.001) and more supported (29.1% vs. 48.8%, p = 0.011) after the implementation of the initiatives. The caregivers also felt more control over the decision-making process in the POST survey (34.2% vs. 56.3%, p = 0.005). Although 33% of the ICU staff considered OVP was beneficial for the ICU, 41% disagreed and 26% were neutral. Only half of them responded that OVP was beneficial for patients and 63% agreed that OVP was beneficial for families. Half of the practitioners agreed that OVP resulted in additional work for staff. SIGNIFICANCE OF RESULTS: Our project effectively promoted patient- and family-centered care. The families expressed satisfaction with the communication of information and the decision-making process. However, the ICU staff felt that the initiatives increased their work load. Further research is needed to understand whether making this project universal or introducing additional novel practices would significantly benefit patients admitted to the ICU and their family.
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Instituciones Oncológicas , Atención Integral de Salud , Unidades de Cuidados Intensivos , Neoplasias , Atención Dirigida al Paciente , Relaciones Profesional-Familia , Humanos , Cuidados Críticos/organización & administración , Familia/psicología , Unidades de Cuidados Intensivos/organización & administración , Neoplasias/terapia , Instituciones Oncológicas/organización & administración , Atención Dirigida al Paciente/organización & administración , Mejoramiento de la Calidad , Masculino , Femenino , Adulto , Persona de Mediana EdadRESUMEN
Abstract Background: A timely search for professional help regarding mental health issues in adolescents is critical in preventing severe disorders. However, adolescents generally tend not to seek help. This investigation aimed to study Chilean adolescents willingness to seek help in mental health issues by identifying their preferred help-seeking sources. Methods: We conducted a cross-sectional-correlational study with 493 high school students between 14 and 19 years of age (mean ± standard deviation = 16.28 ± 1.29). The instruments we used were the general help-seeking questionnaire (vignette version), adapted and validated in Chile, and a sociodemographic questionnaire. Results: Data showed that adolescents are more willing to seek help from informal rather than from formal sources. We identified no sex differences in terms of willingness to seek help from formal sources. However, males were more willing to seek help from informal sources. Conclusions: Similar to other cultures, Chilean adolescents are more willing to seek help from informal sources regarding mental health problems.
Resumen Introducción: La búsqueda de ayuda profesional oportuna para temas de salud mental en adolescentes es fundamental para evitar el desarrollo de trastornos más graves. No obstante, en general los adolescentes tienden a no solicitar ayuda. El objetivo de la presente investigación fue identificar las fuentes de ayuda para problemas de salud mental a las que los adolescentes chilenos están más dispuestos a dirigirse. Métodos: Estudio transversal-correlacional en el que participaron 493 estudiantes de secundaria de entre 14 y 19 años (media ± desviación estándar = 16.28 ± 1.29). Los instrumentos aplicados fueron el Cuestionario General de Búsqueda de Ayuda (versión viñeta), adaptado y validado en Chile, y un cuestionario de datos sociodemográficos. Resultados: Los resultados obtenidos muestran que los adolescentes prefieren buscar ayuda en fuentes informales. No se identificaron diferencias por sexo en la disposición a buscar ayuda en fuentes formales, pero sí en la disposición a buscar ayuda en fuentes informales, pues los varones mostraron mayor disposición a hacerlo. Conclusiones: En concordancia con la evidencia en otras culturas, los adolescentes chilenos presentan una mayor disposición a buscar ayuda para problemas de salud mental en fuentes informales.
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BACKGROUND: A timely search for professional help regarding mental health issues in adolescents is critical in preventing severe disorders. However, adolescents generally tend not to seek help. This investigation aimed to study Chilean adolescents' willingness to seek help in mental health issues by identifying their preferred help-seeking sources. METHODS: We conducted a cross-sectional-correlational study with 493 high school students between 14 and 19 years of age (mean ± standard deviation = 16.28 ± 1.29). The instruments we used were the general help-seeking questionnaire (vignette version), adapted and validated in Chile, and a sociodemographic questionnaire. RESULTS: Data showed that adolescents are more willing to seek help from informal rather than from formal sources. We identified no sex differences in terms of willingness to seek help from formal sources. However, males were more willing to seek help from informal sources. CONCLUSIONS: Similar to other cultures, Chilean adolescents are more willing to seek help from informal sources regarding mental health problems.
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The Sweet's syndrome, is an inflammatory skin disorder characterized by extensive infiltration of neutrophils in the dermis with extension to the subcutis, known as acute febrile neutrophilic dermatosis. It may occur as a paraneoplastic syndrome. To our knowledge, there are currently few reports about transformation of a myelodysplastic syndrome to acute myeloid leukemia and concurrent necrotizing Sweet syndrome in the literature. Herein we describe an unusual case in a young patient with these characteristics that evolved to a fatal outcome.
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Objetivo: Determinar la validez y confiabilidad de la versión colombiana de la Escala de cuidado individualizado (ICS-paciente) diseñada por la Doctora Riitta Suhonen y colaboradores, en pacientes hospitalizados en una institución hospitalaria de la ciudad de Bogotá. Diseño del estudio: Este es un estudio de tipo metodológico, planteado en cuatro etapas que corresponden a la validez facial, validez de contenido, estimación de fiabilidad y validez de constructo. La muestra de pacientes (n=170) para la estimación de confiabilidad y validez de constructo fue recolectada en los servicios de hospitalización de un hospital universitario privado sin ánimo de lucro en la ciudad de Bogotá. Resultados: Esta escala presentó un índice de validez facial y de contenido superior a 0,80 en cada una de las variables evaluadas. En cuanto a la validez de constructo, el instrumento en general evalúa el concepto de cuidado individualizado planteado por la autora; sin embargo, la estructura factorial obtenida difiere de la resultante en la validación de la escala original, y de las obtenidas en otras investigaciones. La confiabilidad, en términos de consistencia interna, fue estimada mediante el coeficiente de alfa de Cronbach, que reportó un valor de 0,935 para la parte A y de 0,919 para la parte B. Conclusión: La versión colombiana de la Escala de cuidado individualizado ICS-paciente resulta válida y confiable para la medición de la percepción del cuidado individualizado de enfermería recibido por el paciente adulto, enmarcado en el modelo de atención centrado en el paciente. Se exponen las recomendaciones para el uso de este instrumento en futuros estudios.
Objective: Determine the validity and reliability of the Colombian version of the Individualized Care Scale (ICS-patient) designed by Dr. Riitta Suhonen and collaborators, in patients hospitalized in a hospital institution of the city of Bogotá. Study design: This is a methodological study, raised in four stages that correspond to facial validity, content validity, reliability estimation and construct validity. The sample of patients (n = 170) for estimating reliability and construct validity was collected in the hospitalization services of a private non-profit university hospital in the city of Bogotá. Results: This scale presented an index of face and content validity greater than 0.80 in each of the variables evaluated. Regarding construct validity, the instrument generally assesses the concept of individualized care proposed by the author; However, the factorial structure obtained differs from the one resulting from the validation of the original scale, and from those obtained in other investigations. Reliability, in terms of internal consistency, was estimated using Cronbach's alpha coefficient, which reported a value of 0.935 for part A and 0.919 for part B. Conclusion: The Colombian version of the ICS-Patient Individualized Care Scale resulting valid and reliable for measuring the perception of individualized nursing care received by adult patients, framed in the patient-centered care model. Recommendations for the use of this instrument in future studies are presented.
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Humanos , Masculino , Femenino , Reproducibilidad de los Resultados , Atención Dirigida al Paciente , Atención de EnfermeríaRESUMEN
BACKGROUND: Cardiac injury is common in COVID-19 patients and is associated with increased mortality. However, it remains unclear if reduced cardiac function is associated with cardiac injury, and additionally if mortality risk is increased among those with reduced cardiac function in COVID-19 patients. HYPOTHESIS: The aim of this study was to assess cardiac function among COVID-19 patients with and without biomarkers of cardiac injury and to determine the mortality risk associated with reduced cardiac function. METHODS/RESULTS: This retrospective cohort study analyzed 143 consecutive COVID-19 patients who had an echocardiogram during hospitalization between March 1, 2020 and May 5, 2020. The mean age was 67 ± 16 years. Cardiac troponin-I was available in 131 patients and an increased value (>0.03 ng/dL) was found in 59 patients (45%). Reduced cardiac function, which included reduced left or right ventricular systolic function, was found in 40 patients (28%). Reduced cardiac function was found in 18% of patients without troponin-I elevation, 42% with mild troponin increase (0.04-5.00 ng/dL) and 67% with significant troponin increase (>5 ng/dL). Reduced cardiac function was also present in more than half of the patients on mechanical ventilation or those deceased. The in-hospital mortality of this cohort was 28% (N = 40). Using logistic regression analysis, we found that reduced cardiac function was associated with increased mortality with adjusted odds ratio (95% confidence interval) of 2.65 (1.18 to 5.96). CONCLUSIONS: Reduced cardiac function is highly prevalent among hospitalized COVID-19 patients with biomarkers of myocardial injury and is independently associated with mortality.
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COVID-19/mortalidad , Lesiones Cardíacas/mortalidad , Troponina I/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , COVID-19/sangre , Causas de Muerte , Ecocardiografía Doppler de Pulso , Femenino , Lesiones Cardíacas/sangre , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios RetrospectivosRESUMEN
Circumscribed storiform collagenoma is a rare benign tumor. It appears as an isolated skin lesion or as part of the clinical spectrum of Cowden syndrome. The pathogenesis is still controversial. Although its clinical expression is heterogeneous, it has a characteristic histological pattern. We describe a case of a solitary circumscribed storiform collagenoma not associated with Cowden syndrome.
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Fibroma/patología , Neoplasias Cutáneas/patología , Enfermedades del Colágeno/patología , Femenino , Dedos/patología , Humanos , Persona de Mediana EdadRESUMEN
Introducción: En la especie humana, las diferencias obedecen a variaciones biológicas ligadas a los caracteres sexuales, conducta socio-cultural y epigenética en cada grupo poblacional. Estas variaciones biológicas entre sexos se analizan desde el punto de vista morfológico. Algunos estudios refieren que la morfometría, relacionando el tamaño y forma del esqueleto humano, conduce a resultados más fidedignos y reproducibles. Objetivo: comparar los caracteres morfológicos y morfométricos de los detalles anatómicos propios de la rama mandibular para determinar el sexo en mandíbulas humanas, en dos poblaciones venezolanas. Materiales e métodos: la muestra fue 16 mandíbulas encontradas como hallazgo fortuito en el 2004 (Población A) y 08 mandíbulas humanas procedentes de la Colección de paleodemográfica, constituida por restos óseos de la población del yacimiento del Valle de Quíbor (Edo. Lara) (Población B). Posteriormente, fueron analizadas morfológico y métricamente, empleando los puntos de referencia anatómicos o PAR/Lamarck, y valoradas en el paquete estadístico SSPS (versión 19). Resultados: la rama mandibular es una muestra confiable para la discriminación sexual, después del análisis morfológico y métrico, de los 16 individuos procedentes de la población A, 07 corresponden con los criterios femeninos y 09 a masculinos. En la muestra de 08 individuos procedente de la población B, se identificaron 03 individuos femeninos y 05 masculinos. Conclusiones: el uso de métodos morfológico e morfométrico siguen siendo necesarios como primer paso para el reconocimiento de individuos en las ciencias forenses. No obstante, fue más efectivo la discriminación sexual mediante los parámetros morfométricos en relación al método morfológico.
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Humanos , Masculino , Femenino , Caracteres Sexuales , Antropología Forense , Odontología Forense , MandíbulaRESUMEN
BACKGROUND: Langerhans cell histiocytosis (LCH) is a neoplasm of the monocyte-macrophage lineage, characterized by clonal proliferation and dissemination of cells that express CD1a+ and CD207. It is a disorder that predominates in childhood. Although the skin is the second most frequently affected organ (30-60%), isolated cutaneous involvement is rare; its frequency does not exceed 4 to 12 percent of cases. Single system-LCH usually has a good prognosis. We describe a case of LCH with isolated cutaneous involvement that presented in an adult patient and was refractory to polychemotherapy.
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Vesícula/etiología , Dermatitis Irritante/etiología , Dermatosis de la Mano/etiología , Hiperpigmentación/etiología , Juglans/efectos adversos , Naftoquinonas/efectos adversos , Anciano , Vesícula/patología , Dermatitis Irritante/patología , Dermatosis de la Mano/patología , Humanos , Hiperpigmentación/patología , MasculinoRESUMEN
Morbihan's disease is characterized by the presence of chronic and persistent edema of the periorbital tissue, forehead, glabella, nose, and cheeks. In some cases, it is related to acne and rosacea, but its exact etiology remains unknown. A defined therapeutic approach has yet to be established for the treatment of Morbihan's disease. To date, the systemic and surgical options attempted have not been very successful and/or do not yield sustained results. Isotretinoin is a key systemic treatment used for the treatment of various skin conditions. However, there are few reports of isotretinoin being used to treat Morbihan's disease. Here, we present the details of three patients with Morbihan's disease who were successfully treated long-term with isotretinoin.
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BACKGROUND: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions. OBJECTIVE: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care. METHODS: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings. RESULTS: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively. CONCLUSION: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.
Antecedentes: Los abordajes diagnósticos y las estrategias terapéuticas de la dermatitis atópica generalmente son inconsistentes entre los médicos y entre las instituciones de salud. Objetivo: Consensar las opiniones de expertos para reducir las variaciones en la práctica respecto al diagnóstico y tratamiento de pacientes ≥ 12 años con dermatitis atópica para mejorar su cuidado. Métodos: Búsqueda sistemática de la literatura en PubMed y GREAT. Con apoyo metodológico y utilizando el método Delphi se desarrolló un consenso formal entre 16 expertos en dermatología y alergología, basándose en la evidencia actual y su aplicabilidad en el contexto mexicano. A parte de una comunicación electrónica intensa, se discutieron los puntos en desacuerdo en dos reuniones presenciales. Resultados: Los expertos clínicos alcanzaron consenso en 46 declaraciones relacionadas con la definición, clasificación, estrategias de diagnóstico y tratamiento de la dermatitis atópica. Para el diagnóstico sugerimos se usan los criterios de Williams y el SCORAD (por parte del médico) y POEM (por parte del paciente) para definir la gravedad. Aunado a cuidados generales y educación terapéutica, sugerimos cuatro pasos para tratamiento, según gravedad: 1. Manejo tópico con antiinflamatorio (y sistémico: antihistamínico/antileucotrieno evidencia reducida) 2. Fototerapia, 3. Ciclosporina A y 4. Dupilumab, con la posibilidad de manejarlo antes si se necesita efecto rápido. En la dermatitis atópica extrínseca sugerimos agregar inmunoterapia con alérgenos o una dieta de eliminación si existe una alergia IgE-mediada, inhalatoria o alimentaria, respectivamente. Conclusión: El panel de expertos realizó consenso en aspectos relevantes de la dermatitis atópica con enfoque en la adaptación transcultural de evidencia reciente.