dermatologia

#Psoriasis: New findings support efforts to increase access to #NB-UVB treatment

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A new study has also suggested NB-UVB may be valuable for treating non-psoriasis associated pruritus.

While the effectiveness of narrowband UVB phototherapy (NB-UVB) has been demonstrated in clinical trials, opinions on the value of offering this treatment in routine practice vary due to the need for treatment attendance and required infrastructure.

In order to assist in management decisions, scientists examined large-scale and long-term data on the efficacy of NB-UVB for psoriasis under real-world conditions in a new study published in PLoS One.

They found NB-UVB treatment leads to both a major sustained improvement as well as significant reduction in topical treatments in approximately 75 per cent of patients treated for psoriasis, with almost one-third of patients no longer requiring psoriasis-specific topicals and one-quarter of patients no longer needing steroid creams. Results were highly similar between four geographically separate locations.
A statistically significant reduction in anti-histamine prescriptions was also seen and the authors said the reduction in the use of anti-histamines indicates that NB-UVB ameliorates this symptom. “In a wider sense, these data therefore support the use of NB-UVB in non-psoriasis associated pruritus, which is often employed in clinical contexts not favourable to drug treatment,” the authors said.

#New Antibiotic for ‘Superbug’ Gonorrhea

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New Antibiotic for ‘Superbug’ Gonorrhea
Theresa Bebbington August 07, 2017

Resultado de imagem para gonorrhea

 
Some types of the sexually transmitted infection known as gonorrhea have become resistant to several antibiotics – but laboratory research on a new drug is showing promise against this ‘superbug’.Without treatment, gonorrhea infection can lead to pelvic inflammatory disease and infertility in adults, and vision damage in babies when passed from the mother during childbirth.The organism that causes gonorrhea, Neisseria gonorrheae, can adapt and build up resistance to treatment. The first antibiotic it managed to beat was penicillin, which had been curing gonorrhea infections for the first 70 years from when the medicine was first introduced.Cases of gonorrhea resistant to the antibiotic azithromycin have occurred in England, with Public Health England (PHE) reporting 34 cases between November 2014 and April 2016. The cases have been confirmed in both heterosexual men and women, as well as in men who have sex with men. Although the strain of gonorrhea in that outbreak was treatable by a second antibiotic, ceftriaxone, resistance could build up to that drug, too.The World Health Organisation (WHO) currently recommends a combination of both ceftriaxone, which is given by injection, and azithromycin, which is taken by mouth.Antimicrobial resistance occurs when a strain of bacteria evolves to resist each consecutive treatment until no treatments are left, leaving these so-called ‘superbugs’ incurable. Some strains of N. gonorrheae are now currently untreatable due to the lack of alternative treatments. The first case of antibiotic-resistant gonorrhea was reported in Japan in 2011, and similar cases have since been found worldwide.Potential of a New AntibioticClosthioamide, a new class of natural antibiotics discovered in 2010, might eventually offer an alternative for current drugs that are becoming less effective against gonorrhea. For the first time, researchers from Imperial College London and the London School of Hygiene and Tropical Medicine have tested closthioamide on gonorrhea samples in the laboratory.
The researchers used 149 samples of N. gonorrheae taken from hospital patients with infections in the throat, urethra, cervix and rectum. They found that very low amounts (equal to or less than 0.125mg/L) of closthioamide was effective against 146 of the 149 samples – and against all of the samples provided to them by WHO that were known to be resistant to other antibiotics. The results of the study are published in the journal Antimicrobial Agents and Chemotherapy.This laboratory-based study is in an early stage of research. The drug has not yet been tested on animals and humans, but the researchers say the antibiotic shows tremendous promise and could be an exciting new step in the fight against gonorrhea. However, further research is necessary to assess the drug’s safety and effectiveness, and it will be a number of years before closthioamide can be used in real-life human cases.In reaction to the study, Dr Michael Brady, medical director at Terrence Higgins Trust, says: “We still have much to do to address the nation’s poor sexual health and the rates of STIs [sexually transmitted infections] in those most at risk. This research is an important contribution to our efforts, as it raises the hope that this new antibiotic, closthioamide, may be a novel and effective treatment for gonorrhea.

“It is early days and further research is needed to demonstrate the same effect in people that is seen in the laboratory, but this signals an important new step in fighting the infection.”
Prevention Is Key
Meanwhile, it remains important to try to prevent the spread of gonorrhea. According to statistics from the sexual health charity FPA ( Family Planning Association), there were 41,193 new cases of gonorrhea diagnosed in 2015, with men who have sex with men accounting for more than 55% of all gonorrhea diagnoses in 2015.
In his reaction, Dr Brady points out that between 2008 and 2015 gonorrhea rates in the UK rose by 175%. He says: “It is vital that we continue to educate people on how to protect themselves from STIs, including drug resistant gonorrhea, and encourage people to test regularly.”

PHE recommends that people help protect themselves by using condoms. They should use them correctly and consistently with new or casual partners until all partners have a sexual health screen. People should avoid overlapping relationships and get screened regularly if they belong in a higher risk group, such as men who have sex with men.
Although symptoms in men usually develop within two weeks, some men and women don’t have any symptoms.
In men, symptoms of gonorrhea noticeable in the penis include:
A yellowish, white or green discharge
A burning feeling, especially when urinating
Swelling of the foreskin
In women, gonorrhea in the vagina can cause:
A change in discharge
A burning feeling when urinating
Bleeding between periods

SOURCES:
“In vitro susceptibility to closthioamide among clinical and reference strains of Neisseria gonorrheae”, published in Antimicrobial Agents and Chemotherapy
Imperial College London news release
Terrence Higgins Trust emailed statement
FPA (Family Planning Association)
PHE
WHO

WebMD Health News © 2017

#Skin-to-skin: can in reduce procedural in neonates

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If you ask any adult, they’d tell you how comforting it is to have the warm embrace of a loved one when they are going through a tough phase in their lives. In neonatal units, the closest thing to a warm embrace for babies is a technique called skin-to-skin care (SSC) or ‘kangaroo care’ (KC), that was initially developed to keep babies warm, but has shown to be an effective means for maintaining physiological stability and promoting better behavioural responses in babies, or in simple terms, keep them comfortable. But can SSC help with the pain of babies undergoing painful procedures? In this blog, we look at the evidence from a recent Cochrane review that tries to answer this question.

Skin-to-skin care has been shown to be an effective means for maintaining physiological stability in babies

Babies and pain

Babies in hospital requiring medical care often have to undergo painful procedures sometimes for diagnostic procedures, like heel prick, at other times to administer treatment e.g. cannulation to administer medicines. Even procedures like suctioning and removal of dressings can cause quite a bit of discomfort to neonates.

There is evidence that in addition to being painful in the short term, exposure to painful procedures can have adverse neurodevelopmental outcomes on the developing brain.

What can be done to ease the pain?

We have come a long way in our understanding of pain in neonates and its management; however gaps in the knowledge still remain. In addition, studies have shown that the use of pain relief still remains underused in neonates for most daily painful procedures.

Sucrose is perhaps the most commonly used pharmacological means of pain relief in neonatal units in the United Kingdom, and is available as a liquid solution in small plastic containers. It has been shown to be effective and safe in neonates. There is limited evidence on the use of parenteral analgesics in neonates and some studies have found them to be unsafe. Local anaesthetics have not been found to be effective in babies.

Apart from medicines, several behavioural means of pain relief have been tested and found to be effective. These include manoeuvres like non-nutritive sucking, rocking, tucking and positioning. SSC is one such method. There is evidence from this Cochrane review that sucrose is more effective in relieving pain when used with other non-pharmacological methods, like non-nutritive sucking and SSC. The challenge for us caregivers is to balance the provision of effective pain relief while avoiding adverse effects in this most fragile population.

How can skin-to-skin care help with pain?

There is growing recognition that when parents are involved in the care of their babies in neonatal intensive care units (NICUs), it has a positive impact on the growth and comfort of the neonate. This positive impact works both ways; when parents are more closely involved in the care of their babies, it has been shown to allay their anxieties about their babies’ care, and makes them feel more reassured in their parental role. Based on this premise, St James’s University hospital in Leeds has taken the initiative of what’s being called “family integrated care system” which puts parents in charge of the majority of care of their preemies, the results of which have been very promising so far both for the parents and the babies.

Given the advantages of SSC shown in various studies, such as improvements in the baby’s physiological stability and temperature and behavioural responses, it is logical to assume that SSC would have a positive impact as an intervention for pain.

Cochrane evidence on skin-to-skin care

This Cochrane review tries to answer the question whether SSC is an effective intervention for pain in neonates as opposed to no intervention for painful procedures, and compares it to other interventions for pain like sucrose and other analgesics. It also aims to find out the right amount of time of SCC, the right way to do it, as well as its safety and effect on infants of different gestational age.

Since it is very difficult to establish the degree of pain in neonates, studies use surrogate markers for pain, that could be behavioural, like duration of cry or facial grimace; physiological, like changes in heart rate, oxygen saturation; hormonal, like serum cortisol levels, or composite pain scores like Premature Infant Pain Profile (PIPP) and Neonatal Infant Pain Score (NIPS), or a combination of the above.

Is skin-to-skin care an effective intervention for pain?

Seventeen studies with 810 babies were combined to compare the effectiveness of SSC to no treatment. SSC was found to be effective when comparing duration of crying, PIPP at 30, 60 and 90 seconds after the procedure, heart rate during the procedure and NIPS both during the procedure and recovery. It showed no benefit over the control intervention when heart rate variability, oxygen saturations, heart rate following the procedure and PIPP at 120 seconds were compared.

Using the GRADE approach, the quality of evidence in studies favouring SSC was graded as moderate for studies comparing PIPP score at 30 and 90 seconds, duration of crying, and NIPS during recovery; low for PIPP score at 60 seconds, and very low for the studies comparing heart rate during the procedure. The latter was attributed largely to one study with a large effect that skewed the pooled analysis in favour of SSC. For studies showing no benefit of SSC over the control intervention, the quality of evidence was high for studies comparing heart rate following the procedure, and low to very low for those comparing heart rate variability and oxygen saturation.

Does it matter who provides skin-to-skin care?

Two studies were used in this analysis. No difference in effectiveness of SSC was noted between SSC provided by either parent. However, it’s important to note that parents may not always be available to provide SSC e.g. for procedures done out of hours. In such cases, perhaps pharmacological interventions like sucrose alone should be used.

How does skin-to-skin compare to other treatments?

Three studies compared SSC with glucose/sucrose, used alone or in combination. Two of these studies favoured SSC over glucose. The third study found SSC to be more effective when used in combination with sucrose than alone.

Studies comparing SSC to breastfeeding, expressed breast milk and enhanced SSC (SSC enhanced by the mother rocking, singing and offering a pacifier) found no advantage over standard SSC.

What’s the ideal duration of skin-to-skin care?

Two studies compared the duration of SSC using different outcomes, both seem to favour 30 minutes to either longer or shorter duration. Other studies used different durations ranging from two minutes to three hours but made no comparisons, so no conclusions could be drawn from them.

Skin-to-skin care is probably an effective intervention for procedural pain

Summary of evidence

This review included 25 well-designed studies, however, not all studies could be included to test different outcomes because of differences in designs or the methods used to measure outcomes.

SSC probably is an effective intervention for pain during procedures for neonates.  When compared to glucose/sucrose it is probably better, and may have a synergistic effect when used together. SSC is an effective intervention no matter who the provider is. Based on current evidence no conclusions can be drawn about the ideal duration of SSC or whether it is differently effective at different gestations. None of the studies showed any adverse effects.

Where does this leave us?

The notion that newborns can feel pain was treated with skepticism by both researchers and clinicians until the late twentieth century, so much so, that major surgeries on neonates were performed without the use of anaesthetics well until the mid 1980s.

It’s important to remember that activism from parents, along with landmark work by some researchers played an important role in changing that perception. We have come a long way. However, the role of parents in caring and providing comfort to newborn babies in the neonatal unit continues to be underutilized, and so does the use of interventions to reduce pain in neonates during procedures routinely undertaken in the nursery.

Skin-to-skin care is a safe and effective intervention that has a two-pronged benefit of reducing procedural pain in neonates as well as allowing for greater parental participation in the care of their babies. There are still, however, gaps in our knowledge of neonatal pain in general as well as some aspects of SSC. As the authors of the Cochrane review pointed out we are still not sure what is the right duration of SSC, how it affects infants of different gestations and whether the effect diminishes with repeated use. As more neonatal units adapt SSC in the care of newborns, more data should become available and we should have answers to some of these questions.

 

Asad Abbas has nothing to disclose. He is on Twitter @occamrazr

 

El #aceite de oliva, los #frutos secos y el #pescado azul pueden contribuir a una mejor tolerancia a la #exposición solar

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Este tipo de alimentos contiene grasas insaturadas saludables que refuerzan las membranas celulares.

Este tipo de alimentos contiene grasas insaturadas saludables que refuerzan las membranas celulares.

Durante el verano, es importante consumir alimentos que aporten a la piel los nutrientes necesarios para que se regenere y proteja desde dentro, como por ejemplo el aceite de oliva, los frutos secos y el pescado azul (como sardinas o anchoas), ya que estos pueden contribuir a una mejor tolerancia a la exposición solar, según especialistas de la Universitat Oberta de Catalunya (UOC).

Esto es así porque este tipo de alimentos contiene grasas insaturadas saludables que refuerzan las membranas celulares, así como vitamina E con efecto antioxidante y, según la directora académica del máster universitario de Nutrición y Salud de la UOC, Alicia Aguilar, “los alimentos antioxidantes ayudan a reparar la piel o a minimizar los procesos de oxidación en las células causados por los rayos ultravioletas”.

En este sentido, existen otros alimentos como el agua, los vegetales y las frutas con pigmentos que ayudan también a mantener la piel en buen estado ante el impacto de los rayos solares. No obstante, los especialistas de la UOC han recalcado que esta dieta no es sustitutiva del uso de cremas solares, sino que es un complemento recomendable para disfrutar del sol y del bronceado de forma saludable.

Así, el agua es “fundamental” a la hora de hidratarse correctamente, sobre todo en jornadas de playa. Además, se puede complementar la ingesta de agua con el consumo de alimentos ricos en este elemento, como el melón y la sandía, verduras o sopas frías como el gazpacho. El método más efectivo y sencillo para detectar si se está hidratado es fijarse en la orina: “tiene que ser muy clara y sin olor, casi como el agua”, ha subrayado el nutricionista y profesor de la UOC, Àlex Vidal.

Igualmente, para minimizar el impacto o reparar los efectos de los rayos ultravioletas hay que dar “protagonismo” a los alimentos ricos en antioxidantes, es decir, los que son ricos en vitamina C y provitamina A (betacarotenos).

“En los dos primeros casos, volvemos a las frutas y verduras y, especialmente, las que tienen coloraciones anaranjadas, moradas o rojizas, del tipo cerezas, melocotones, zanahorias, tomates, etc. Estos alimentos nos ayudan a luchar contra la oxidación y el envejecimiento celular”, ha señalado Vidal.

En cuanto a los batidos y zumos, el profesor ha afirmado que “son una buena opción para ingerir fruta y pasan muy bien, pero no pueden sustituir ni una comida ni la ración diaria recomendada de fruta”, porque cuando se ingiere esta última en formato zumo se puede no estar aprovechando todos los nutrientes.

Los medicamentos, perfumes o #filtros solares son los principales causantes de la #alergia al sol

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No es hereditaria ni más frecuente en individuos con predisposición a sufrir otras afecciones alérgicas.

No es hereditaria ni más frecuente en individuos con predisposición a sufrir otras afecciones alérgicas.

Los medicamentos, perfumes o filtros solares son los principales causantes de la alergia al sol, según ha informado la Sociedad Española de Alergología e Inmunología Clínica (SEAIC), que ha recordado que estas alergias pueden desarrollarse en cualquier persona, porque no son hereditarias ni más frecuentes en individuos con predisposición a sufrir otras afecciones alérgicas.

“Realmente no se trata de una alergia al sol sino de reacciones alérgicas que requieren de la exposición a la luz para su aparición. En este grupo se incluyen las fotodermatitis y la urticaria solar. Ambas constituyen aproximadamente el 10% de todas las enfermedades por fotosensibilidad”, ha comentado el experto del Comité de Alergia Cutánea de la SEAIC, José Luis García Abujeta.

En concreto, según ha señalado, algunos fármacos perfumes y cremas solares son los principales responsables de reacciones de fotosensibilidad ya que por la acción de la luz solar estos productos se pueden convertir en sustancias alérgicas.

Entre los medicamentos, los antiinflamatorios no esteroideos son los que más la causan ya que producen un eccema en la zona de la aplicación en zonas expuestas al sol e incluso reacciones más extensas cuando la administración es sistémica.

“Estas lesiones pueden durar días y semanas produciendo una descamación de la zona afectada. Puede afectar también a personas que administran ese medicamento a otros (padres a hijos, parejas, personal sanitario, etcétera) por eso es muy importante el lavado correcto de las manos tras su aplicación y el uso de guantes. “Otros medicamentos pueden provocar, aunque con menor frecuencia, esta dermatitis y afectan más a personas mayores de 40 años por un mayor consumo de estos fármacos”, ha explicado el experto.

Además, en las cremas solares se relaciona los eccemas con algunos filtros solares empleados en ellas. En concreto, según ha argumentado el especialista, la fitofotodermatitis relaciona la exposición al sol en zonas del cuerpo que han estado en contacto con algunas plantas de forma casual, como hierbas que rozan las piernas descubiertas, de forma ocupacional (trabajo) o por afición a tocar higueras (hojas y tronco), frutos cítricos u otras plantas cultivadas.

En relación con esto, el uso de perfumes, especialmente aquellos con componentes cítricos, puede producir un eccema en los días posteriores en la zona donde se ha aplicado y expuesto al sol. “La mejor prevención de la alergia al sol es disminuir la exposición incontrolada y en lo posible evitar sustancias fotosensibilizantes como medicamentos tópicos, perfumes o cremas solares de baja calidad. Además, antes de cualquier exposición al sol si un paciente está tomando medicamentos es necesario que consulte con su médico los posibles riesgos de la radiación solar en relación con su toma”, ha insistido García Abujeta.

Por otra parte, las reacciones inmediatas más frecuentes de la alergia al sol son la urticaria solar o la erupción polimorfa solar, un trastorno raro que se produce por un mecanismo de hipersensibilidad inmediata frente a un fotoalérgeno desconocido.

“A los pocos minutos de la exposición solar se produce eritema, picor y lesiones habonosas (ronchas) en la zona, que persisten entre unos minutos y un par de horas, desapareciendo sin dejar lesión alguna. Cuando la exposición es muy intensa y/o la superficie afectada es muy grande, puede acompañarse de sintomatología general como dolor de cabeza, náuseas, dificultad respiratoria e hipotensión, pudiéndose incluso producir pérdida de conocimiento. Para su prevención se recomienda evitar en lo posible las exposiciones solares y el uso de antihistamínicos orales para su tratamiento”, ha enfatizado.

Por otro lado, la erupción solar polimorfa es una de las fotodermatosis más frecuentes y llega a afectar hasta a un 15 o un 20% de la población general. Se caracteriza por la aparición de una erupción cutánea de morfología variada que se localiza de manera predominante en la cara, escote, antebrazos y zona anterior de las piernas y que puede durar varios días hasta su desaparición.

“Aparece en las primeras exposiciones solares y mejora tras exposiciones repetidas a medida que la piel se broncea. En general no entraña gravedad y, una adecuada protección solar, exposiciones cortas y progresivas, y, ocasionalmente, el uso de antihistamínicos suele ser suficientes para su control”, ha apostillado el especialista.

Finalmente, García Abujeta se ha referido a la dermatitis atópica, una patología cutánea que se puede empeorar por el cloro de las piscinas. En caso de acudir a estos recintos se aconseja una ducha posterior al baño y el uso de cremas hidratantes para disminuir la posible reacción. Asimismo, los baños en el mar son recomendables, pero se debe tener precaución con la exposición solar excesiva mediante el uso de cremas solares adecuadas para niños, evitando la exposición en niños muy pequeños.

“Si se observa algún tipo de reacción tras una exposición solar es muy importante acudir inmediatamente al médico para empezar un tratamiento cuanto antes, siempre indicando la medicación utilizada previamente o las cremas aplicadas a modo de protección frente al sol”, ha zanjado el especialista.

 

#Alcohol intake may increase risk of #nonmelanoma skin cancers

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The finding follows a new meta-analysis involving more than 95,000 cases of nonmelanoma skin cancer.

Alcohol intake may increase the risk of developing nonmelanoma skin cancers, an analysis of existing evidence suggests.

To date, studies on the association between alcohol and nonmelanoma skin cancer have produced conflicting or inconclusive findings. However, a new analysis of 13 eligible case-control and cohort studies, involving 95,241 cases of nonmelanoma skin cancer, has found that higher alcohol intake is significantly associated with an increased risk for both basal cell carcinoma and cutaneous squamous cell carcinoma, in a dose-dependent manner. For every 10g increase in alcohol intake per day, the risk of basal cell carcinoma increased by 7 per cent and the risk of cutaneous squamous cell carcinoma increased by 11 per cent.

Presenting the findings in the British Journal of Dermatology , the authors say the results should be interpreted with caution due to potential residual confounding. “Nonetheless,” they say, “because alcohol drinking is a prevalent and modifiable behaviour, it could serve as an important public health target to reduce the global health burden of nonmelanoma skin cancers.”

According to World Health Organization figures, between 2 and 3 million cases of nonmelanoma skin cancers are diagnosed worldwide each year, and rates are on the increase.

El consumo diario de # tomate podría reducir en un 50% el riesgo de # cáncer de piel (Sci Rep)

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Los carotenoides que dan a los tomates su color pueden proteger la piel contra los daños de los rayos ultravioletas.

Los carotenoides que dan a los tomates su color pueden proteger la piel contra los daños de los rayos ultravioletas.

El consumo diario de tomate podría reducir en un 50% el riesgo de cáncer de piel, según ha puesto de manifiesto un estudio realizado en ratones por investigadores de la Ohio State University (Estados Unidos), y que ha sido publicado en la revista “Scientific Reports”.

En concreto, los científicos han comprobado que los roedores macho que habían sido alimentados con una dieta rica en tomate durante 35 semanas tenían un 50 menos de riesgo de padecer un tumor de piel, en comparación con aquellos que no habían recibido este alimento.

A juicio de los expertos, estos resultados se pueden explicar por el hecho de que los carotenoides de la dieta, los compuestos de pigmentación que dan a los tomates su color, pueden proteger la piel contra los daños de los rayos ultravioletas.

No obstante, no se encontraron diferencias en el riesgo cuando se analizaron a ratones hembra. “Este estudio nos mostró que tenemos que considerar el sexo cuando se exploran diferentes estrategias preventivas, porque lo que funciona en los hombres no siempre funciona igual de bien en las mujeres y viceversa”, ha asegurado la autora principal del estudio, Tatiana Oberyszyn.

De hecho, investigaciones anteriores realizadas en personas ya han señalado que comer pasta con tomate puede amortiguar las quemaduras solares y proteger contra los rayos solares gracias a que los carotenoides se depositan en la piel después de comer.

En el nuevo estudio, los investigadores del Estado de Ohio han encontrado que sólo los ratones machos alimentados con tomates rojos deshidratados tenían reducciones en el crecimiento del tumor, mientras que aquellos alimentadas con tomates de mandarina, que han demostrado contener más licopeno biodisponible, tuvieron menos tumores que el grupo control, si bien la diferencia no fue estadísticamente significativa.