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BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had typical scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of the cases of scabies studied, the patient had already received treatment. In those cases, we observed several remediable shortcomings that could explain why some of these treatments had failed. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

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BACKGROUND: Several studies support the hypothesis that scabies is on the rise in Spain. There are also concerns about the possible development of resistance to treatment and an increase in atypical presentations. The aims of this study were to describe the demographic and clinical characteristics of patients with scabies seen by dermatologists in Spain, to identify the possible emergence of atypical forms of scabies, and to explore the frequency of treatment failures and associated risk factors. METHODS: We conducted an observational, cross-sectional, multicenter study of data collected prospectively in April and May 2023 using the CLINI-AEDVp platform created by the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: Participating dermatologists from 31 hospitals in 15 of Spain's autonomous communities recorded 186 cases of active scabies (51% in women) during the study period. A diagnostic certainty level of A, B or C as per the International Alliance for the Control of Scabies Consensus Criteria was required for diagnosis. Overall, 92% of patients had clinical features of classic scabies and 66% had already been treated with a scabicide for the current episode. Of the treated patients, only 36% had received and completed adequate treatment (including the simultaneous treatment of all household members) and 50% had not received clear written recommendations. CONCLUSIONS: In a high proportion of scabies cases, the patient has already received treatment. In those cases, we observe several remediable shortcomings that could explain why some of these treatments fail. Remedying these deficiencies should lead to better control of scabies and an improved assessment of the actual effectiveness of currently available scabicides.

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El presente trabajo incluye el análisis de los datos obtenidos mediante una encuesta realizada en enero de 2023 a 235 dermatólogos que ejercen actividad asistencial privada en España. Se añade un fotograma posterior al estudio con metodología similar realizado en 2018, al mismo tiempo que se analizan los cambios y adaptaciones que tiene la práctica con los nuevos tiempos y retos emergentes. Comparado con 2018, en 2023 destacan: incrementos en la dedicación a la actividad privada, las teleconsultas, el cobro anticipado de técnicas, la aceptación de pagos con tarjeta bancaria y banca electrónica; cambios en la periodicidad de ajuste de precios; el hecho de que un 60% de los encuestados declare que ha ajustado al alza los precios en el año; un incremento de los precios que se ajusta aproximadamente al del IPC y la observación de que los dermatólogos varones declaran con más frecuencia precios extremos más altos (AU)

The present work includes the analysis of the data obtained through a survey conducted in January 2023 to 235 dermatologists practicing private healthcare activity in Spain. A subsequent frame is added to the study with similar methodology carried out in 2018, while analyzing the changes and adaptations that the practice has with the new times and emerging challenges. Compared to 2018, in 2023 the following findings stand out: increases in dedication to private activity, teleconsultations, advance payment for techniques, acceptance of payments by bank card and electronic banking; changes in the periodicity of price adjustment; the fact that 60% of respondents state that they have adjusted prices upwards in the year; a rise in prices that is approximately in line with that of the CPI, and the observation that male dermatologists more frequently state higher extreme prices (AU)

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This report analyzes findings from a January 2023 survey of 235 dermatologists in private practice in Spain. The data for 2023 are compared to findings from a similar survey of conditions in 2018, to provide a snapshot of each year and identify changes in clinical practice and adaptations to emerging situations and challenges. Noteworthy changes in 2023 vs. 2018 included increased dedication to private practice and teleconsultations, more use of prepayment for procedures, more acceptance of payment by credit card or other electronic means, and variation in the timing of price changes. Sixty percent of the respondents reported planning to raise prices in 2023. The planned pricing adjustments will approximate the rise in the consumer price index. We also found that male dermatologists more often reported fees at the highest end of the range (AU)

El presente trabajo incluye el análisis de los datos obtenidos mediante una encuesta realizada en enero de 2023 a 235 dermatólogos que ejercen actividad asistencial privada en España. Se añade un fotograma posterior al estudio con metodología similar realizado en 2018, al mismo tiempo que se analizan los cambios y adaptaciones que tiene la práctica con los nuevos tiempos y retos emergentes. Comparado con 2018, en 2023 destacan: incrementos en la dedicación a la actividad privada, las teleconsultas, el cobro anticipado de técnicas, la aceptación de pagos con tarjeta bancaria y banca electrónica; cambios en la periodicidad de ajuste de precios; el hecho de que un 60% de los encuestados declare que ha ajustado al alza los precios en el año; un alza de los precios que se ajusta aproximadamente a la del IPC, y la observación de que los dermatólogos varones declaran con más frecuencia precios extremos más altos (AU)

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The present work includes the analysis of the data obtained through a survey conducted in January 2023 to 235 dermatologists practicing private healthcare activity in Spain. A subsequent frame is added to the study with similar methodology carried out in 2018, while analyzing the changes and adaptations that the practice has with the new times and emerging challenges. Compared to 2018, in 2023 the following findings stand out: increases in dedication to private activity, teleconsultations, advance payment for techniques, acceptance of payments by bank card and electronic banking; changes in the periodicity of price adjustment; the fact that 60% of respondents state that they have adjusted prices upwards in the year; a rise in prices that is approximately in line with that of the CPI, and the observation that male dermatologists more frequently state higher extreme prices.

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Rice is a staple food in Senegal, which however imports more than 70% of the rice consumed annually to meet its domestic demand. Despite governmental efforts to increase rice self-sufficiency, both rice supply and yields remain low. Senegalese farmers face challenges related to irrigation infrastructure and fertiliser access, besides those derived from climate change. This study applies Life Cycle Assessment (LCA) combined with financial Life Cycle Costing (LCC) to evaluate alternative scenarios for rice management in the Senegal River Valley and identify sustainability hotspots and potential improvements. Specifically, rice cultivation in Ross Béthio (Saint Louis, Senegal) is assessed based on the observed agricultural practices during the dry seasons of 2016 and 2017. Two scenarios capturing conventional (CONV) and intensive (INT) practices are compared to two reference scenarios (SAED scenarios) according to the recommendations of the official agricultural advisory service. The INT scenario generates the lowest impacts per kg of paddy rice in seven out of thirteen impact categories, including climate change, freshwater and marine eutrophication, ozone depletion and water scarcity. This is due to the higher yields (7.4 t ha-1) relative to CONV (4.8 t ha-1) and the two reference SAED scenarios (6.0 t ha-1). The two latter scenarios show the lowest values in the remaining categories, although they also generate slightly lower profits than INT (138 € t-1 vs. 149 € t-1) due to increased labour costs for additional fertilisation treatments. The results from both LCA and LCC underline the importance of increasing yields to decrease environmental impacts and production costs of rice when estimated per kg of product. Well-designed fertiliser application doses and timing and increased mechanisation can deliver further environmental benefits. Additional improvements (e.g. in irrigation, crop rotations, straw management) could be considered to promote the long-term sustainability and profitability of rice production in Senegal. LCA in combination with financial LCC is identified as a decision-support tool for evaluating the sustainability of alternative crop management practices. Life Cycle Thinking can still benefit from experiential learning based on information exchange between farmers, researchers and extension agents to contribute to a sustainable agriculture and ultimately to food security in Africa.

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BACKGROUND: Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. OBJECTIVE: To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. METHODS: A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. RESULTS: From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site ('COVID arm', 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. CONCLUSIONS: Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.

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The relation between atypical fibroxanthoma and pleomorphic dermal sarcoma has led to confusion and debate in the literature. Both tumors present on sun-exposed skin, typically on the head and neck, in patients of advanced age. Both are comprised of a variable mix of histiocytoid, spindle, epithelioid, and/or giant multinucleated cells with pleomorphic nuclei. No immunohistochemical diagnostic techniques have emerged to distinguish these tumors. Diagnosis is by exclusion. Histologically, atypical fibroxanthoma is seen as a well-circumscribed dermal nodule but there will be no evidence of extensive subcutaneous invasion, tumor necrosis, or lymphovascular or perineural invasion. Therefore, if any of the aforementioned features is present, the diagnosis would be pleomorphic dermal sarcoma. This narrative review of the literature aims to identify the distinguishing and overlapping histopathologic features of these 2 tumors as they have been described in case series.

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INTRODUCCIÓN: Nuestro sistema sanitario le da a la Atención Primaria una importancia crucial al situarla como primer escalón en la asistencia sanitaria. El médico de familia se convierte en el filtro de la patología que atiende y dirige a los pacientes a los diferentes servicios según las necesidades de los mismos. Por tanto, se otorga un papel muy importante que choca con la limitación en el acceso a las pruebas diagnósticas. Sin embargo, en la realidad nos encontramos con limitaciones de los profesionales de Atención Primaria para el acceso a pruebas complementarias. MATERIAL Y MÉTODO: A raíz de la publicación de un catálogo de pruebas de laboratorio accesibles para atención primaria se evaluó el consumo de estas pruebas sin ningún tipo de limitación salvo las de una adecuación de las pruebas al diagnóstico, al igual que ocurre en el hospital durante 6meses, midiendo en número de determinaciones y las unidades relativas de valor consumidas. Se comparó con un período previo y con la actividad desarrollada. RESULTADOS: Tras 6 meses de seguimiento y con una actividad asistencial igual, el consumo de pruebas diagnósticas de laboratorio disminuyó un 24% y las unidades relativas de valor bajaron un 10%. CONCLUSIONES: El acceso a la cartera de servicios de laboratorio por parte de atención primaria no se traduce en un incremento del gasto, a la vez que manda un mensaje positivo sobre el papel que la atención primaria debe desempeñar en nuestro sistema de salud

INTRODUCTION: Our health care system gives crucial importance to Primary Care, since it is the first step in medical care. The family doctor becomes the filter of the diseases that they attend to and direct the patients to the different services according to their needs. Therefore, a very important role is granted that conflicts with the limitation in access to diagnostic tests. However, in reality it appears that the Primary Care professionals have limitations in order to access complementary tests. MATERIAL AND METHOD: After the publication of a list of accessible laboratory tests for Primary Care, the use of these tests was evaluated without any type of limitation, except for the adequacy of the tests to the diagnosis, as happens in the hospital during 6 months, measuring the number of determinations and the relative units of value used. A comparison was made with a previous period and with the activity developed. RESULTS: After 6months of follow-up and with equal care activity, the use of laboratory diagnostic tests decreased by 24%, and the relative value units decreased by 10%. CONCLUSIONS: Access to the portfolio of laboratory services for Primary Care does not translate into an increase in spending, while sending a positive message about the role that primary health care should play in our health system

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INTRODUCTION: Our health care system gives crucial importance to Primary Care, since it is the first step in medical care. The family doctor becomes the filter of the diseases that they attend to and direct the patients to the different services according to their needs. Therefore, a very important role is granted that conflicts with the limitation in access to diagnostic tests. However, in reality it appears that the Primary Care professionals have limitations in order to access complementary tests. MATERIAL AND METHOD: After the publication of a list of accessible laboratory tests for Primary Care, the use of these tests was evaluated without any type of limitation, except for the adequacy of the tests to the diagnosis, as happens in the hospital during 6months, measuring the number of determinations and the relative units of value used. A comparison was made with a previous period and with the activity developed. RESULTS: After 6months of follow-up and with equal care activity, the use of laboratory diagnostic tests decreased by 24%, and the relative value units decreased by 10%. CONCLUSIONS: Access to the portfolio of laboratory services for Primary Care does not translate into an increase in spending, while sending a positive message about the role that primary health care should play in our health system.

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El melanoma cutáneo (MC) es el tumor cutáneo que más muertes provoca, con un aumento importante de la incidencia y la mortalidad en las últimas décadas, especialmente en el paciente anciano. Existen evidencias del diferente comportamiento biológico, así como de las diferencias en el manejo del MC en este subgrupo de pacientes con respecto al resto de otras franjas de edad, evidentemente condicionadas por unas limitadas expectativas de supervivencia y calidad de vida ajenas al melanoma y una elevada incidencia de comorbilidades. El presente artículo revisa los datos actuales más relevantes de la epidemiología, etiopatogenia e inmunología, clínica, prevención y manejo del MC en el anciano

Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly

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Cutaneous melanoma (CM) causes more deaths than any other skin tumor, and incidence and mortality rates have risen in recent years, especially in patients of advanced age. There are differences in the biological behavior of CM tumors in the elderly as well as differential management of the disease, evidently influenced by such factors as limited life expectancy, the high incidence of concomitant conditions in older patients, and issues of quality of life unrelated to CM itself. We review relevant current literature on the epidemiology, etiology, pathogenesis, and immunology of CM as well as research on the clinical features, prevention, and management of these tumors in the elderly.

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Introducción. La distrofia muscular de Duchenne es una enfermedad relacionada con la ausencia de distrofina y caracterizada por debilidad progresiva y pérdida de la deambulación. Se han utilizado los esteroides para retrasar su evolución natural. El objetivo fue observar la respuesta fisiológica y los parámetros alcanzados durante el test de marcha de los 6 minutos y correlacionarlos en pacientes con Duchenne tratados y no tratados con esteroides para compararlos con un grupo control, y demostrar las diferencias entre ellos. Material y métodos. Estudio transversal en pacientes con diagnóstico molecular de distrofia muscular de Duchenne en rehabilitación en México. Incluyó a 11 pacientes entre 4 y 10 años con y sin tratamiento esteroideo pareados con 10 niños sanos, seleccionados de agosto a octubre de 2015. Resultados. Los niños sanos tuvieron un mejor desempeño en los parámetros de distancia (456,35±65,7m) y velocidad (76±19,95m/min). De los niños con Duchenne, los tratados con esteroides contra los no tratados, los primeros lograron mayor distancia (323,35±39,55 vs. 227,75±60,84m) y velocidad (53,87±6,55 vs. 37,9±10,13m/min) con p<0,001. Se encontró correlación negativa velocidad-talla (p=0,05) solo en los tratados con esteroides. Conclusiones. Los esteroides mejoran la marcha debido, en parte, al cierre de las epífisis y al deficiente crecimiento lineal óseo de los pacientes (AU)

Introduction. Duchenne muscular dystrophy is a disease related to the absence of dystrophin and is characterised by progressive weakness and loss of ambulation. Steroids have been used to delay its natural progression. The aim of this study was to observe physiological responses and ambulation parameters during the 6-minute walk test and their correlation in Duchenne patients with and without steroid treatment. These patients were compared with a control group of healthy children and differences were determined between groups. Material and methods. This cross-sectional study in patients with a molecular diagnosis of Duchenne muscular dystrophy in rehabilitation in Mexico included 11 patients aged between 4 and 10 years with and without steroid treatment matched with 10 healthy children from August to October 2015. Results. Healthy children had better results in distance (456.35±65.7m) and speed (76±19.95m/min). Compared with non-steroid-treated Duchenne patients, steroid-treated patients achieved greater distance (323.35±39.55 vs. 227.75±60.84m) and speed (53.87±6.55 vs. 37.9±10.13m/min), P<001. A negative correlation between speed and height (P=.05) was found only in steroid-treated patients. Conclusions. Steroids improve gait, partly due to the closure of the epiphysis and deficient linear bone growth (AU)

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The present study evaluated the measurement of head movements as a valid method for postural emotional studies using the comparison of simultaneous recording of center of pressure (COP) sway as criterion. Thirty female students viewed a set of 12 pleasant, 12 unpleasant and 12 neutral pictures from the International Affective Picture System, repeated twice, using a block presentation procedure while standing on a force platform (AMTI AccuSway). Head movements were recorded using a webcam (©KPC139E) located in the ceiling in line with the force platform and a light-emitting diode (LED) placed on the top of the head. Open source software (CvMob 3.1) was used to process the data. High indices of correlation and coherence between head and COP sway were observed. In addition, pleasant pictures, compared with unpleasant pictures, elicited greater body sway in the anterior-posterior axis, suggesting an approach response to appetitive stimuli. Thus, the measurement of head movement can be an alternative or complementary method to recording COP for studying human postural changes.

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Objetivo. Comprobar si una intervención basada en una observación directa, acompañada de información al personal de enfermería encargado de la extracción de sangre, contribuye a disminuir la hemólisis. Material y métodos. Muestreo aleatorio ponderado en centros de atención primaria del área de gestión sanitaria de la serranía de Málaga y diseño de estudio longitudinal transversal pre y postintervención. Período de estudio: desde agosto de 2012 a enero de 2015. Se determinó el nivel de hemoglobina libre en las muestras extraídas por espectrofotometría directa, y si la intervención realizada influía en el nivel de hemólisis y si esta se mantenía en el tiempo. Resultados. Partiendo de un porcentaje de muestras hemolizadas del 17% preintervención, tras la misma se obtuvo una reducción hasta de 6,1%. Un año más tarde, y en las mismas condiciones, se volvió a medir el porcentaje de hemólisis en las muestras analizadas y el porcentaje se situó en el 9%. Este resultado es superior al obtenido tras la intervención, pero inferior al obtenido antes de la misma. Las condiciones del transporte y del análisis fueron las mismas. Conclusiones. Una intervención basada en la observación directa e informativa en el proceso de extracción de muestras sanguíneas contribuye de manera significativa a reducir el nivel de hemólisis. Este efecto se mantiene en el tiempo, aunque es necesario repetirlo para mantener la efectividad del mismo. Las auditorías y los programas de formación continuada son útiles para asegurar la calidad de los procedimientos y mantener el nivel de atención necesario para un buena calidad asistencial (AU)

Objective. To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. Material and methods. Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. Results. The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. Conclusions. An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care (AU)

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OBJECTIVE: To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. MATERIAL AND METHODS: Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. RESULTS: The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. CONCLUSIONS: An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care.

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