Antonio Vélez García-Nieto

Classic Kaposi's sarcoma treated with topical 0.5% timolol gel.

To the editor, Kaposi’s sarcoma (KS) is an angioproliferative disorder closely associated with human herpesvirus type 8. Classic KS is found mainly in elderly males, with lesions beginning slowly and insidiously on the distal lower extremities and occasionally on the hands. Although the disease is very rarely responsible for the death of the patient, there might be complications such as ulceration, bleeding and pain in nodules on pressure areas requiring treatment (1). To date, a uniformly effective and low-risk treatment for KS has not been found, so therapeutic recommendations must be individualized. Topical treatment would be ideal for patients with limited disease confined to the skin, since it may satisfactorily slow progression of classic KS for several years with lower risks of systemic side effects. In this way, some topical agents have been used with various results, including 5% imiquimod cream (2), 0.5% rapamycin ointment (3), 0.1% alitretinoin gel (4) and very recently, 0.5% timolol maleate solution (5). We report here two cases of classic KS successfully treated with topical timolol. We used 0.5% timolol gel, applied twice daily. To our knowledge, this is the second report of classic KS treated with topical timolol.

Angiosarcoma sobre linfedema crónico

Resumen El angiosarcoma que se desarrolla sobre una extremidad con linfedema cronico se denomina sindrome de Stewart-Treves. Este aparece tipicamente como una complicacion de un linfedema de larga evolucion localizado en el brazo, tras mastectomia y/o radioterapia por un cancer de mama. Existen casos de sindrome de Stewart-Treves sobre linfedema cronico en la extremidad superior contralateral al cancer de mama tratado y sobre linfedema cronico de pierna. Presentamos dos casos de este sindrome. El primero corresponde a un tipico sindrome de Stewart-Treves en una mujer de 83 anos, que fue diagnosticada de angiosarcoma en el territorio de un linfedema cronico secundario a mastectomia y radioterapia por un cancer de mama. El segundo caso es mucho mas raro, ya que se trata de un caso de angiosarcoma difuso de pierna, en un hombre de 42 anos e historia de linfedema. La naturaleza agresiva de este sindrome precisa de su conocimiento e investigacion de tratamientos para prevenirlo.

Author-paper affiliation network architecture influences the methodological quality of systematic reviews and meta-analyses of psoriasis

Moderate-to-severe psoriasis is associated with significant comorbidity, an impaired quality of life, and increased medical costs, including those associated with treatments. Systematic reviews (SRs) and meta-analyses (MAs) of randomized clinical trials are considered two of the best approaches to the summarization of high-quality evidence. However, methodological bias can reduce the validity of conclusions from these types of studies and subsequently impair the quality of decision making. As co-authorship is among the most well-documented forms of research collaboration, the present study aimed to explore whether authors’ collaboration methods might influence the methodological quality of SRs and MAs of psoriasis. Methodological quality was assessed by two raters who extracted information from full articles. After calculating total and per-item Assessment of Multiple Systematic Reviews (AMSTAR) scores, reviews were classified as low (0-4), medium (5-8), or high (9-11) quality. Article metadata and journal-related bibliometric indices were also obtained. A total of 741 authors from 520 different institutions and 32 countries published 220 reviews that were classified as high (17.2%), moderate (55%), or low (27.7%) methodological quality. The high methodological quality subnetwork was larger but had a lower connection density than the low and moderate methodological quality subnetworks; specifically, the former contained relatively fewer nodes (authors and reviews), reviews by authors, and collaborators per author. Furthermore, the high methodological quality subnetwork was highly compartmentalized, with several modules representing few poorly interconnected communities. In conclusion, structural differences in author-paper affiliation network may influence the methodological quality of SRs and MAs on psoriasis. As the author-paper affiliation network structure affects study quality in this research field, authors who maintain an appropriate balance between scientific quality and productivity are more likely to develop higher quality reviews.

The differential impact of scientific quality, bibliometric factors, and social media activity on the influence of systematic reviews and meta-analyses about psoriasis

Researchers are increasingly using on line social networks to promote their work. Some authors have suggested that measuring social media activity can predict the impact of a primary study (i.e., whether or not an article will be highly cited). However, the influence of variables such as scientific quality, research disclosures, and journal characteristics on systematic reviews and meta-analyses has not yet been assessed. The present study aims to describe the effect of complex interactions between bibliometric factors and social media activity on the impact of systematic reviews and meta-analyses about psoriasis (PROSPERO 2016: CRD42016053181). Methodological quality was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. Altmetrics, which consider Twitter, Facebook, and Google+ mention counts as well as Mendeley and SCOPUS readers, and corresponding article citation counts from Google Scholar were obtained for each article. Metadata and journal-related bibliometric indices were also obtained. One-hundred and sixty-four reviews with available altmetrics information were included in the final multifactorial analysis, which showed that social media and impact factor have less effect than Mendeley and SCOPUS readers on the number of cites that appear in Google Scholar. Although a journal’s impact factor predicted the number of tweets (OR, 1.202; 95% CI, 1.087–1.049), the years of publication and the number of Mendeley readers predicted the number of citations in Google Scholar (OR, 1.033; 95% CI, 1.018–1.329). Finally, methodological quality was related neither with bibliometric influence nor social media activity for systematic reviews. In conclusion, there seems to be a lack of connectivity between scientific quality, social media activity, and article usage, thus predicting scientific success based on these variables may be inappropriate in the particular case of systematic reviews.

Mycoplasma pneumoniae-associated mucositis

A 35-year-old man was admitted with fever (38°C), mucous sputum, bilateral conjunctivitis, painful oral ulcerations and mild discomfort while urinating. He had previously received a three-day course of azithromycin for suspected respiratory infection, without improvement. Physical examination

Imatinib treatment of therapy resistant generalized deep morphea

Morphea, or localized scleroderma, is a distinctive inflammatory disease that leads to sclerosis of the skin and subcutaneous tissue (1). It is distinguished from systemic sclerosis by the absence of sclerodactyly, Raynaud’s phenomenon, nail fold capillary changes, and organ involvement (2). The term deep morphea describes the microscopic changes affecting mainly the superficial muscle, fascia, subcutis and deep dermis. One of the more severe forms of localized scleroderma is generalized morphea, which is characterized by extensive cutaneous involvement, a persistent behavior, and poor response to therapy (2,3). We describe a case report of a patient with therapy resistant generalized deep morphea who responded to imatinib with improvement not only in her skin manifestations but her mobility and quality of life as well.

Evaluating characteristics of PROSPERO records as predictors of eventual publication of non-Cochrane systematic reviews: a meta-epidemiological study protocol

BackgroundEpidemiology and the reporting characteristics of systematic reviews (SRs) and meta-analyses (MAs) are well known. However, no study has analyzed the influence of protocol features on the probability that a study’s results will be finally reported, thereby indirectly assessing the reporting bias of International Prospective Register of Systematic Reviews (PROSPERO) registration records.ObjectiveThe objective of this study is to explore which factors are associated with a higher probability that results derived from a non-Cochrane PROSPERO registration record for a systematic review will be finally reported as an original article in a scientific journal.Methods/designThe PROSPERO repository will be web scraped to automatically and iteratively obtain all completed non-Cochrane registration records stored from February 2011 to December 2017. Downloaded records will be screened, and those with less than 90% fulfilled or are duplicated (i.e., those sharing titles and reviewers) will be excluded. Manual and human-supervised automatic methods will be used for data extraction, depending on the data source (fields of PROSPERO registration records, bibliometric databases, etc.). Records will be classified into published, discontinued, and abandoned review subgroups. All articles derived from published reviews will be obtained through multiple parallel searches using the full protocol “title” and/or “list reviewers” in MEDLINE/PubMed databases and Google Scholar. Reviewer, author, article, and journal metadata will be obtained using different sources. R and Python programming and analysis languages will be used to describe the datasets; perform text mining, machine learning, and deep learning analyses; and visualize the data. We will report the study according to the recommendations for meta-epidemiological studies adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for SRs and MAs.DiscussionThis meta-epidemiological study will explore, for the first time, characteristics of PROSPERO records that may be associated with the publication of a completed systematic review. The evidence may help to improve review workflow performance in terms of research topic selection, decision-making regarding team selection, planning relationships with funding sources, implementing literature search strategies, and efficient data extraction and analysis. We expect to make our results, datasets, and R and Python code scripts publicly available during the third quarter of 2018.

Abstract analysis method facilitates filtering low-methodological quality and high-bias risk systematic reviews on psoriasis interventions

BackgroundArticle summaries’ information and structure may influence researchers/clinicians’ decisions to conduct deeper full-text analyses. Specifically, abstracts of systematic reviews (SRs) and meta-analyses (MA) should provide structured summaries for quick assessment. This study explored a method for determining the methodological quality and bias risk of full-text reviews using abstract information alone.MethodsSystematic literature searches for SRs and/or MA about psoriasis were undertaken on MEDLINE, EMBASE, and Cochrane database. For each review, quality, abstract-reporting completeness, full-text methodological quality, and bias risk were evaluated using Preferred Reporting Items for Systematic Reviews and Meta-analyses for abstracts (PRISMA-A), Assessing the Methodological Quality of Systematic Reviews (AMSTAR), and ROBIS tools, respectively. Article-, author-, and journal-derived metadata were systematically extracted from eligible studies using a piloted template, and explanatory variables concerning abstract-reporting quality were assessed using univariate and multivariate-regression models. Two classification models concerning SRs’ methodological quality and bias risk were developed based on per-item and total PRISMA-A scores and decision-tree algorithms. This work was supported, in part, by project ICI1400136 (JR). No funding was received from any pharmaceutical company.ResultsThis study analysed 139 SRs on psoriasis interventions. On average, they featured 56.7% of PRISMA-A items. The mean total PRISMA-A score was significantly higher for high-methodological-quality SRs than for moderate- and low-methodological-quality reviews. SRs with low-bias risk showed higher total PRISMA-A values than reviews with high-bias risk. In the final model, only ’authors per review > 6’ (OR: 1.098; 95%CI: 1.012-1.194), ’academic source of funding’ (OR: 3.630; 95%CI: 1.788-7.542), and ’PRISMA-endorsed journal’ (OR: 4.370; 95%CI: 1.785-10.98) predicted PRISMA-A variability. Reviews with a total PRISMA-A score < 6, lacking identification as SR or MA in the title, and lacking explanation concerning bias risk assessment methods were classified as low-methodological quality. Abstracts with a total PRISMA-A score ≥ 9, including main outcomes results and explanation bias risk assessment method were classified as having low-bias risk.ConclusionsThe methodological quality and bias risk of SRs may be determined by abstract’s quality and completeness analyses. Our proposal aimed to facilitate synthesis of evidence evaluation by clinical professionals lacking methodological skills. External validation is necessary.

Eslicarbazepine-induced toxic epidermal necrolysis.

To the Editor: Eslicarbazepine acetate (ESL), member of the dibenzazepine family—which also includes carbamazepine (CBZ) and oxcarbazepine (OXC)—is a new antiepileptic drug approved in 2009 by the European Medicines Agency and in 2013 by the U.S. Food and Drug Administration as adjunctive therapy in adults with partial-onset seizures with or without secondary generalization. The incidence of rash, which is the most common idiosyncratic reaction with all antiepileptic drugs, seems to be lower in patients treated with ESL relative to CBZ and OXC. In fact, since ESL was approved, reports on severe cutaneous adverse drug reactions (cADRs) with this antiepileptic have not been accumulating, with only one case of eslicarbazepineinduced erythema multiforme major reported to date. To our knowledge, we report the first case of toxic epidermal necrolysis (TEN) following treatment with ESL. An 85year-old man with a longstanding history of hypertension treated with captopril, was admitted with fever (38.8°C), stinging eyes, pain upon swallowing, and painful cutaneous lesions on day 19 after taking ESL at doses of 800 mg/day for partial-onset seizures. On physical examination, we observed coalescing dusky red macules over >30% of the body surface, with blisters and detachment of large sheets of necrolytic epidermis all over his chest (Fig. 1A), back (Fig. 1B), and face. The conjunctiva and oral (Fig. 2) and genital mucosa were also involved, and tense blisters were seen in the palmoplantar surfaces. The diagnosis of TEN was confirmed by histopathologic examination of lesional skin. Laboratory examination showed markedly elevated C-reactive protein levels, with renal and hepatic enzymes within normal limits. ESL was withdrawn. The patient was treated with intravenous immunoglobulin at a dose of 2 g/kg/day for 3 days, intravenous corticosteroids (tapered methylprednisolone starting with 125 mg daily), and cyclosporine at a dose of 4 mg/kg for 10 days, and then tapered over another 10 days; He showed a slow but progressive improvement both in symptoms and cutaneous manifestations. Reepithelization of the skin was achieved in 4 weeks. Stevens-Johnson syndrome (SJS) and TEN are rare, acute, and life-threatening mucocutaneous diseases that are nearly always drug-related. Compelling evidence suggests that SJS/TEN is associated with an impaired capacity to A

A Scoping Review Protocol to Explore the Use of Interleukin-1-Targeting Drugs for the Treatment of Dermatological Diseases: Indications, Mechanism of Action, Efficacy, and Safety

IntroductionThe interleukin (IL)-1 pathway has been identified as being involved in inflammatory and neoplastic skin diseases such as psoriasis, atopic dermatitis, neutrophilic dermatosis, melanoma, and squamous cell carcinoma. Drugs developed to target the IL-1 pathway are currently used to treat these pathologies, and although they are becoming more selective, they are not exempt from adverse events and high costs. Integrating the best research evidence with clinical experience and patient needs has been shown to improve care, health, and cost outcomes. This is because evidence-based guidelines rank interventions according to cost-effectiveness. However, evidence on this topic is scarce for several reasons. First, although randomized clinical trials currently provide the best evidence, they are not always available. Second, there are no secondary scientific studies that summarize the use of IL-1-targeting agents in dermatology. We therefore sought to develop an a priori protocol for broadly reviewing the available evidence on the use of IL-1-targeting drugs in the treatment of dermatological diseases.MethodsWe used the latest methodology to perform a scoping review as described in the Joanna Briggs Institute manual.Results/DiscussionDeveloping and applying a methodology for evidence synthesis promotes reproducibility and increases the validity of secondary scientific investigations, making it the optimal strategy for scientifically synthesizing a broad field such as the indications for and the mechanisms of action, efficacies, safety, and costs of IL-1-targeting drugs in the treatment of dermatological diseases. Quantitative synthesis facilitates the detection of knowledge gaps and the identification of new questions that can be addressed through systematic reviews. We present an a priori protocol for exploring the available evidence on this topic.