Summary
Background and objectives
Information about hospital admissions for skin diseases is restricted to studies describing admissions to single centers, to specific wards, or only for a few ...diagnoses, and there is no information about the outcomes between different wards. The aim of this research is to describe hospital admissions due to dermatological diseases.
Patients and methods
Cross‐sectional study of hospital discharges at Spanish hospitals. Discharges were assumed to be the same as admissions.
Results
519,440 discharges (1.1 % of total discharges) were identified. Most admissions (60.1 %) were done from emergency departments. Only 7 % of cases were admitted to dermatology wards. The most prevalent group was cellulitis and acute lymphangitis. Median age was 57 years, and men were more common. The median length of hospital stay was four days; 40,823 (7.9 %) cases required readmission. There were 13,558 (2.6 %) hospital deaths. After adjusted analysis (by age, sex and group of diagnosis), the OR of readmission was 1.49 (95 % CI: 1.42–1.57) times higher and length of stay was 0.22 (95 % CI: 0.15–0.29) days longer in non‐dermatology wards (P < 0.0001). From 2006–2016, admissions to dermatology wards decreased 38 %, while in non‐dermatology wards they increased 8 %.
Conclusions
A non‐negligible number of patients require dermatological inpatient management. This is mainly provided by non‐dermatologists. Some of our findings may indicate an improved overall care by dermatologists.
Objective
To evaluate the causes of new cases of active tuberculosis (ATB) in patients treated with tumor necrosis factor (TNF) antagonists included in the national registry BIOBADASER (Base de Datos ...de Productos Biológicos de la Sociedad Española de Reumatología) after the dissemination of recommendations to prevent reactivation of latent tuberculosis infection (LTBI).
Methods
Incidence rate of ATB per 100,000 patient‐years and 95% confidence intervals (95% CIs) were calculated in patients entering BIOBADASER after March 2002 and were stratified by compliance with recommendations (complete or incomplete). ATB rates in BIOBADASER were compared with the background rate and the rate in the rheumatoid arthritis cohort EMECAR (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide) not treated with TNF antagonists. In addition, rates of ATB among patients treated with adalimumab, etanercept, and infliximab were estimated and compared only for treatments started after September 2003, when all 3 drugs became fully available.
Results
Following March 2002, a total of 5,198 patients treated with a TNF antagonist were registered in BIOBADASER. Fifteen ATB cases were noted (rate 172 per 100,000 patient‐years, 95% CI 103–285). Recommendations were fully followed in 2,655 treatments. The probability of developing ATB was 7 times higher when recommendations were not followed (incidence rate ratio 7.09, 95% CI 1.60–64.69). Two‐step tuberculosis skin test for LTBI was the major failure in complying with recommendations.
Conclusion
New cases of ATB still occur in patients treated with all available TNF antagonists due to lack of compliance with recommendations to prevent reactivation of LTBI. Continuous evaluation of recommendations is required to improve clinical practice.
Human–wildlife conflicts (HWC) are increasing and are potentially harmful to both people and wildlife. Understanding the current and potential distribution of wildlife species involved in HWC, such ...as carnivores, is essential for implementing management and conservation measures for such species. In this study, we assessed both the current distribution and potential distribution (forecast) of the Egyptian mongoose (Herpestes ichneumon) in the central part of the Iberian Peninsula. We acquired data concerning mongoose occurrences through an online questionnaire sent to environmental rangers. We used the municipality level as the sampling unit because all municipalities within the study area were covered at least by one ranger. Using the information provided by rangers (i.e. occurrences in their municipalities), we constructed environmental favourability distribution models to assess current and potential mongoose distribution through current distribution models (CDM) and ecological models (EM), respectively. >300 rangers participated in the survey and mongooses were reported in a total of 181 of 921 municipalities studied. The CDM model showed a current distribution mainly concentrated on the western part of the study area, where intermediate–high favourability values predominated. The EM model revealed a wider potential distribution, including the south–east part of the study area, which was also characterised by intermediate–high favourability values. Our predictions were verified using independent data, including confirmation of mongoose reproduction by rangers, reports by other experts, and field sampling in some areas. Our innovative approach based on an online survey to rangers coupled with environmental favourability models is shown to be a useful methodology for assessing the current distribution of cryptic but expanding wildlife species, while also enabling estimations of future steps in their expansion. The approach proposed may help policy decision-makers seeking to ensure the conservation of expanding wildlife species, for example, by designing awareness campaigns in areas where the target species is expected to arrive.
Display omitted
•Rangers may be relevant informants of expanding wildlife species, as the mongoose.•Rangers' records and biogeographical models allowed identifying mongoose distribution.•This approach is useful to forecast future distribution of expanding wildlife species.•Egyptian mongoose is expected to expand further in the near future.•Generating knowledge of wildlife distribution is key for management and conservation.
Zusammenfassung
Hintergrund und Ziele
Informationen über Krankenhausaufnahmen wegen Hautkrankheiten beschränken sich auf Studien, die Aufnahmen in einzelnen Zentren, auf bestimmten Stationen oder nur ...für einige wenige Diagnosen erfassen. Aussagen zu Behandlungsergebnissen in unterschiedlichen Abteilungen fehlen. Ziel dieser Untersuchung ist es, Krankenhausaufnahmen wegen dermatologischer Krankheiten zu beschreiben.
Patienten und Methodik
Querschnittsstudie über Krankenhausentlassungen in spanischen Krankenhäusern. Es wurde angenommen, dass die Entlassungsdiagnosen mit den Aufnahmediagnosen identisch sind.
Ergebnisse
519 440 Entlassungen (1,1 % der gesamten Entlassungen) wurden identifiziert. Die meisten Aufnahmen (60,1 %) erfolgten aus Notaufnahmen. Lediglich 7 % der Fälle wurden auf dermatologischen Stationen aufgenommen. Die häufigste Fallgruppe war Phlegmone und akute Lymphangitis. Das mediane Alter lag bei 57 Jahren und Männer waren häufiger betroffen. Die mediane Dauer des Krankenhausaufenthalts betrug vier Tage; 40 823 (7,9 %) Fälle erforderten eine Wiederaufnahme und 13 558 Patienten (2,6 %) verstarben im Krankenhaus. Nach Adjustierung (nach Alter, Geschlecht und Diagnosegruppe) war die
Odds Ratio
(OR) auf nichtdermatologischen Stationen für die Wiederaufnahme 1,49‐mal höher (95 %‐Konfidenzintervall KI: 1,42–1,57) und die Krankenhausverweildauer 0,22 Tage länger (95 %‐KI: 0,15–0,29), (p < 0,0001). Zwischen 2006 und 2016 gingen die Aufnahmen in den dermatologischen Abteilungen um 38 % zurück, während sie in den nichtdermatologischen Abteilungen um 8 % anstiegen.
Schlussfolgerungen
Eine nicht zu vernachlässigende Anzahl von Patienten benötigt eine stationäre dermatologische Versorgung. Diese wird hauptsächlich von Nicht‐Dermatologen erbracht. Einige unserer Resultate deuten auf eine insgesamt bessere Versorgung durch Dermatologen hin.
Background: The management of HIV-positive patients with psoriasis is controversial and limited to individual cases or short series of patients.
Objectives: To evaluate the safety and effectiveness ...of conventional and biologic immunosuppressive drugs in the treatment of patients with psoriasis and concomitant HIV infection.
Methods: A retrospective multicenter study was conducted. The study included data from 2008 to 2016. Inclusion criteria were: HIV adult patients with moderate-to-severe psoriasis, HIV viral load determinations at baseline and at least after 6 months of treatment, and systemic immunosuppressive treatment for at least 6 months. A descriptive analysis was performed.
Results: Twenty-three patients with plaque-type psoriasis and HIV infection (five with AIDS) were included. Median follow-up time was 3.2 years. The main drugs used were etanercept, methotrexate, and ustekinumab. In most cases, viral load and CD4 cell count not only remained stable but also improved throughout the follow-up. Six patients presented severe adverse events during the follow-up, four of them in the AIDS stage. At the end of the follow-up period, 76.5% of the patients had achieved a PASI 75.
Conclusion: Biologic drugs, both anti-TNF alpha agents and ustekinumab, seem to have an acceptable safety profile and high effectiveness in HIV-positive patients.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Current frequency and features for positivity to textile dye mix (TDM) in Spain are unknown.
To study the frequency, clinical features and simultaneous positivity between TDM, para-phenylenediamine ...(PPD) and specific disperse dyes.
We analysed all consecutive patients patch-tested with TDM from the Spanish Contact Dermatitis Registry (REIDAC), from 1 January 2019 to 31 December 2022. Within this group, we studied all selected patients patch-tested with a textile dye series.
Out of 6128 patients analysed, 3.3% were positive to the TDM and in 34% of them, the sensitization was considered currently relevant. TDM positivity was associated with working as a hairdresser/beautician and scalp, neck/trunk and arm/forearm dermatitis. From TDM-positive patients, 57% were positive to PPD. One hundred and sixty-four patients were patch-tested with the textile dye series. Disperse Orange 3 was the most frequent positive dye (16%). One of every six cases positive to any dye from the textile dye series would have been missed if patch-tested with the TDM alone.
Positivity to TDM is common in Spain and often associated with PPD sensitization. TDM is a valuable marker of disperse dyes allergy that should be part of the Spanish and European standard series.
Background: Mortality is increased in rheumatoid arthritis (RA), mainly because of cardiovascular (CV) events, cancer and infections. Recent data suggest that treatment with tumour necrosis factor ...(TNF) antagonists may affect this trend. Objective: To assess whether treatment with TNF antagonists is associated with reduction in CV events, cancer and infection rates, and in mortality in patients with RA treated and not treated with TNF antagonists. Methods: BIOBADASER is a registry for active long-term follow-up of safety of biological treatments in patients with RA. It includes 4459 patients with RA treated with TNF antagonists. EMECAR is an external RA cohort (n = 789) established to define the characteristics of the disease in Spain and to assess comorbidity. The incidence density (ischaemic heart disease) of CV events, cancer and infections was estimated and compared. The standardised mortality ratio was compared with the rate in the general population. A propensity score was used to match cohorts by the probability of being treated. Results: Rates of CV and cancer events are significantly higher in EMECAR than in BIOBADASER (RR 5–7 for different CV events, and RR 2.9 for cancer), whereas the rate of serious infections is significantly higher in BIOBADASER (RR 1.6). Mortality ratio of BIOBADASER by EMECAR is 0.32 (0.20–0.53) for all causes of death, 0.58 (0.24–1.41) for CV events, 0.52 (0.21–1.29) for infection and 0.36 (0.10–1.30) for cancer-related deaths. Conclusion: Morbidity, other than infection, and mortality are not higher than expected in patients with RA treated with TNF antagonists.
Objectives. To assess the retention rate of TNF antagonists in elderly patients suffering from chronic arthropathies and to identify predictive variables of discontinuation by inefficacy or by ...adverse events (AEs).
Methods. All patients treated with TNF antagonists in BIOBADASER 2.0, with a diagnosis of either RA or spondyloarthritis (SpA: AS and PsA) were included and classified as <65 (younger) or 65 years of age (older) at start of the treatment. Cumulative incidence function for discontinuation (inefficacy or AE) was estimated as being the alternative reason for a competing risk. Competing-risks regression models were used to measure the association between study groups, covariates and reason for discontinuation.
Results. A total of 4851 patients were studied; 2957 RA (2291 in the younger group and 666 in the older group) and 1894 SpA (1795 in the younger group and 99 in the older group). Retention curves were statistically differently stratified by age groups, with the SpA younger group having the largest retention rate. Competing-risks regression models showed that in the older group, AEs were the most common reason for discontinuation regardless of the diagnosis of the patient and TNF antagonist molecule, whereas in the younger group, the most common cause of discontinuation was inefficacy.
Conclusion. In conclusion, factors predicting discontinuation of TNF antagonists due to AEs are older age and diagnosis of RA. On the other hand, younger age predicts discontinuation due to lack of efficacy.
To investigate in rheumatoid arthritis (RA) the rate and reason of discontinuation of tumour necrosis factor (TNF) antagonists over the past decade.
RA patients in BIOBADASER 2.0 were stratified ...according to the start date of their first TNF antagonist into 2000-3, 2004-6 and 2007-9 interval years. Cumulative incidence function of discontinuation for inefficacy or toxicity was estimated with the alternative reason as competing risk. Competing risks regression models were used to measure the association of study groups with covariates and reasons for discontinuation. Association is expressed as subhazard ratios (SHR).
2907 RA patients were included in the study. Competing risk regression for inefficacy shows larger SHR for patients starting treatment in 2004-6 (SHR 2.57; 95% CI 1.55 to 4.25) and 2007-9 (SHR 3.4; 95% CI 2.08 to 5.55) than for those starting in 2000-3, after adjusting for TNF antagonists, clinical activity and concomitant treatment. Competing risk regression analysis for adverse events revealed no differences across the three time intervals.
In RA, the discontinuation rate of TNF antagonists in the first year of treatment is higher more recently than a decade ago, inefficacy being the main reason for the increased rate. The rate of discontinuation for adverse events has remained stable.
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