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Background and objective: primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. Patients and methods: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. Results: information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). Conclusion: the characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Objectives(1) What is the hacker community made up of and what are the main vulnerable industries? (2) What are the main types of digital threats and how are they characterized? (3) What are the vulnerabilities and damage caused by cyber-attacks? (4) What are the ways to detect digital threats? (5) What measures can be taken to prevent and avoid these attacks? (6) What does the cyber security management process consist of? (7) What cybersecurity evidence and trends can be selected?Methodsdocument analysis; data selection and assambly; synthesis; conceptualization; interpretation.ResultsThe research results are: a presentation of the hacker community and the main vulnerable industries; a brief definition of the types of digital threats; presentation of various vulnerabilities and damages caused by cyber-attacks; a selection of the ways to detect digital threats; a selection of the main measures to prevent and avoid these attacks; cybersecurity management process and a selection of evidence and trends regarding cyber security. Also, two conceptualizations are proposed: the approach to cyber risk management and 10 basic actions to prevent and avoid cyber risks.ConclusionsThe current and future situation is not encouraging for the management of organizations in terms of the risks caused by cyber-attacks, which are increasing significantly. The solution to prevent and avoid these threats is for civil and military organizations to implement Cybersecurity risk management.

Tradicionalmente se habló de la continuidad de la política exterior brasileña. Los cambios de gobierno —e incluso de régimen político—, los distintos modelos económicos o planes o programas gubernamentales solo la ajustaron a sus cosmovisiones sin mover demasiado el amperímetro. Efectivamente, puede sostenerse que existen dos visiones de cómo lograr los mismos objetivos que fungen como un interés nacional más estructural que permea posiciones ideológicas y miradas del mundo. Liberales y nacionalistas, conservadores y progresistas, institucionalistas pragmáticos y autonomistas son casi en tándem posiciones distintas que, no obstante, han defendido los mismos intereses. En parte, esta coherencia, pudo mantenerse por laexistencia de Itamaraty, el ministerio de Relaciones Exteriores, en donde existe (o existía) un componente estructural por sobre el componente político, el cual, independientemente de los cambios contextuales, mantiene determinadas directrices, principios, valores y objetivos. Así, la política exterior se ha desarrollado a través del tiempo de tal forma que las metas orgánicas fueron más importantes que las gubernamentales

A lo largo del trabajo se buscó evidenciar la relación entre populismo y política exterior analizando un caso en particular, las relaciones exteriores de las dos administraciones de Cristina Fernández de Kirchner (2007-2015). Para ello, se trabajó con unas variables precisas identificadas por Destradi y Plagemann (2019) que permiten caracterizar una política exterior como populista. Según los autores, los gobiernos populistas tienden a plantear relaciones bilaterales más conflictivas, intentan debilitar la gobernanza global y sus instituciones, y a centralizar y personalizar la elaboración de sus políticas exteriores. Además, se identificó otra característica como propia de los populismos: y es la predisposición a establecer nuevas asociaciones internacionales en detrimento a las tradicionales. En este sentido, cada una de ellas, en menor o mayor medida, sirvieron para explicar la política exterior de CFK, permitiendo entender su comportamiento internacional, como así también, la validez de las variables planteadas por autores.

OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.

Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Of the 3946 patients in the registry, 24 were aged 21 years or younger. The mean age of this group when they started treatment upon registration on Biobadaderm was 16.1 years and the mean Psoriasis Area and Severity Index was 9.4. In 67% the first treatment recorded was with a conventional systemic drug. Treatment was discontinued in 14 patients (58%) due to adverse events or a loss or lack of effectiveness. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs.

Background: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. Objective: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. Methods: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. Results: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P

El estudio DIADERM fue promovido por la Fundacion Piel Sana de la AEDV, que recibio ayuda economica de Novartis. La compania farmaceutica no participo en la recogida de datos, ni en el analisis de los datos, ni en la interpretacion de los resultados., Introducción: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales forman parte de la formación específica de los médicos especialistas en Dermatología y Venereología en España. El presente estudio pretende analizar la carga que suponen dichas patologías en la actividad dermatológica pública y privada del sistema de salud español. Material y método: Estudio observacional de corte transversal de dos períodos de tiempo describiendo los diagnósticos realizados en consultas externas dermatológicas, obtenidos a través de la encuesta anónima DIADERM, realizada a una muestra aleatoria y representativa de dermatólogos. A partir de la codificación de diagnósticos CIE-10, se seleccionó toda la patología relacionada (36 diagnósticos codificados en los dos períodos), que se clasificó en 12 grupos. Resultados: Tan solo el 3,16% de los diagnósticos globales fueron de infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales. Los 3 grupos diagnósticos más frecuentes fueron las lesiones por virus del papiloma humano anogenital, seguido de los molluscum contagiosum y las dermatosis anogenitales inflamatorias. Con significación estadística, y comparando con el global de diagnósticos, los seleccionados constituyeron más habitualmente el motivo de consulta primario y, en el ámbito privado, fue más frecuente que viniesen derivados de otros especialistas. Conclusión: Las infecciones e infestaciones de transmisión predominantemente sexual y otras dermatosis anogenitales tienen un peso muy limitado en la asistencia dermatológica en España, a pesar de que la inclusión del diagnóstico de molluscum contagiosum sobreestima estos diagnósticos. La ausencia de inclusión de centros y consultas monográficas de ITS en la muestra aleatoria contribuye a la infrarrepresentación de estas parcelas de la especialidad. Es importante hacer un esfuerzo decidido por potenciarlas con consultas y centros monográficos., Background and objective: Predominantly sexually transmitted infections (STIs) and infestations and other anogenital dermatoses are covered in the training of specialists in dermatology and venereology in Spain. This study aimed to analyze the proportion of the dermatology caseload these diseases account for within the public and private dermatological activity of the Spanish health system. Material and methods: Observational cross-sectional study of time periods describing the diagnoses made in outpatient dermatology clinics, obtained through the anonymous DIADERM survey of a representative random sample of dermatologists. Based on diagnostic codes of the International Classification of Diseases, Tenth Revision, 36 related diagnoses were selected, and classified into 12 groups. Results: Only 3.16% of diagnoses corresponded to STIs and other anogenital dermatoses. The most common diagnostic group was anogenital human papillomavirus infection, followed by molluscum contagiosum, and inflammatory anogenital dermatoses. Lesions with these diagnoses were usually the main reasons for first visits in the National Health Service. In private practice, the diagnoses usually came after referrals from other physicians. Conclusions: STIs and other anogenital dermatoses account for a very small proportion of the dermatology caseload in Spain, although the inclusion of molluscum contagiosum diagnoses overestimates these conditions. The fact that no STI centers or monographic STI consultations were included in the random sample of dermatology partly explains the under-representation of these areas of the specialty. A determined effort to support and promote monographic STI centres and clinics should be made., Fundacion Piel Sana de la AEDV

Palbociclib was approved in the United States in 2015 to treat estrogen receptor-positive/human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). This study evaluated outcomes and safety in patients treated with palbociclib in Australia and India with hormone receptor-positive (HR+)/HER2- ABC before palbociclib became commercially available.Postmenopausal women (≥18 years) with HR+/HER2- ABC who were appropriate candidates for letrozole therapy received palbociclib 125 mg once daily for 21 days followed by 7 days off, and letrozole 2.5 mg once daily (continuous). Safety, tumor response, and patient-reported outcomes (Australian cohort) were evaluated.In total, 252 patients received palbociclib plus letrozole (Australia, n = 152; India, n = 100). More patients in the Australian versus Indian cohort had received prior chemotherapy (advanced/metastatic setting: 45.9% vs. 32.0%), endocrine therapy (advanced/metastatic setting: 63.2% vs. 54.3%), and advanced/metastatic therapies (61.8% vs. 31.0%). The most frequently reported all-grade palbociclib-related treatment-emergent adverse events were neutropenia (66.7%), fatigue (35.3%), and stomatitis (26.6%); grade 3/4 neutropenia was reported as palbociclib-related in 62.7% of patients. Febrile neutropenia was reported in six patients (2.4%). Eight patients (3.2%) discontinued because of an adverse event. The objective response rate was 19.4% (95% CI, 14.7%-24.9%) overall and 2.3% in Australian patients with ≥2 lines of prior therapy for metastatic disease. Patient-reported quality of life scores were maintained throughout the study.In an expanded access setting in Australia and India, palbociclib plus letrozole was well tolerated in patients with HR+/HER2- ABC, with a safety profile consistent with previous reports.

Background MGMT promoter methylation status can change in response to several factors, including treatment with alkylating agents. Some authors have attempted to quantify these alterations with inconsistent results. This study aims to determine changes in MGMT promoter methylation status by pyrosequencing, which quantitatively yields results, providing percentages of methylation of a given CpG dinucleotide in a cohort of patients reoperated for recurrent glioblastoma and having previously completed the Stupp protocol. Methods A total of 25 pairs of glioblastoma preselected tumor samples were retrospectively analyzed using conventional DNA extraction techniques, bisulfite conversion, and PCR amplification of the MGMT promoter gene. Methylation status was obtained using pyrosequencing of 4 CpG dinucleotides within the enhancer region of the MGMT promoter gene and depicted as percentages or categories (hypermethylated, intermediate methylation, unmethylated). Matched samples were compared using Wilcoxon signed-rank test, and the log-rank test was employed to establish a correlation between survival data and methylation status. Results Median value of MGMT promoter methylation status declined after adjuvant treatment from 22.25–16.15%. (p = 0.872). A correlation without statistical significance between methylation in primary samples and OS was found (p = 0.102). Lower degrees of association were obtained when studying primary methylation and PFS (p = 0.187). Intermediate methylation status at recurrence was more linked to PPS (p = 0.03) Conclusions Switching in both directions was observed when analyzing methylation status as a continuous variable. These data suggest that the dynamics of epigenetics may be very complex and not entirely explained by clonal selection or tumor heterogeneity.

Background: Data regarding pathologic response of Trastuzumab based chemotherapy in locally advanced HER2 positive breast cancer in neoadjuvant setting is scarce. Methods: A retrospective analysis was conducted from January 2014 to January 2019 at a tertiary cancer care centre in North India and 81 breast cancer patients who underwent neoadjuvant chemotherapy were included. The clinical and pathologic characteristics, response, toxicity and survival data was collected, collated and analyzed. Results: The most commonly observed tumor characteristics at baseline were clinical stage T4 (72.8%), nodal stage N2 (40.7%), invasive ductal carcinoma on histology (98.8%), grade 3 (66.7%) and hormone receptor negativity (54.3%). In terms of post treatment characteristics, a higher incidence of partial response (55.6%), post treatment tumor stage ypT0 (45.7%), nodal status ypN0 (54.3%), absence of extracapsular invasion (77.8%) and absence of pathologic complete response (pCR, 63%) were observed. pCR was attained in 30 patients and was most commonly associated with clinical tumor stage T4 (26/30), nodal stage N2-N3 (19/30), grade 3 (21/30) and hormone receptor negativity (20/30). Altogether, 19.75% had grade 3/4 adverse events. At 6 years, 86% v/s 61% patients were disease free (p=0.037) and 93% v/s 79% patients (p=0.181) were alive in the pCR and no pCR groups, respectively. Conclusion: Even in locally advanced breast cancer (LABC), Trastuzumab had good response in terms of pCR and survival outcomes. Thus, one can be encouraged to use this single HER2 blockade if dual blockade is not feasible in HER2 positive LABC in the neoadjuvant setting.

Background: There are severaltherapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity. Methods: Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n = 601). Results: The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported. Conclusions: As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed. Yes Introducción: Existen diversas opciones terapéuticas para los hemangiomas infantiles (HI). El propranolol se utiliza con base en un ensayo pivotal. Nuestro objetivo fue describir las aracterísticas del HI en la práctica clínica, incluyendo las terapias utilizadas, así como com parar las características de los pacientes tratados con propranolol y las de los pacientes del ensayo, para valorar su validez externa. Métodos: Se incluyó consecutivamente a los pacientes que acudieron a doce hospitales espanoles ˜ desde junio de 2016 a octubre de 2019 (n = 601). Resultados: La edad media fue de 3,9 (DE:1,9) meses, con una ratio mujer-varón de 2:1. La mayoría de los HI fueron de tipo localizado (82%, 495), superficial (64%, 383) y ubicados en cara (25%, 157) y tronco (31%, 188). El tamano˜ mediano fue de 17 (RI: 10-30) x 12 (RI: 7-20) mm. Se encontraron complicaciones en 16 (3%) pacientes. Se inició tratamiento en el 52% (311) de los casos. La mayoría de los pacientes recibió timolol (76%, 237), reservándose propranolol para las complicaciones o los HI de alto riesgo. El compromiso estético fue el principal motivo de iniciar la terapia (64%, 199). Las diversas características de los pacientes y de los HI tratados con propranolol fueron similares a las del ensayo clínico pivotal, aunque 1/3 de los HI no alcanzó el diámetro mínimo para cumplir los criterios de inclusión, y no se comunicó información pronóstica importante. Conclusiones: Dado que muchos pacientes reciben tratamiento debido al compromiso estético, existe una necesidad de conocer mejor los resultados estéticos de las terapias e incrementar la evidencia sobre el uso de timolol, que actualmente es la terapia más común. El propranolol está siendo utilizado en una población generalmente similar a la del ensayo; sin embargo, esta afirmación no puede confirmarse de manera definitiva.

The clinical presentation of acute coronary syndromes (ACS) as ST-elevation ACS (STEACS) or non-ST-elevation ACS (NSTEACS) differs between women and men. The aim of this study was to describe the difference in the clinical presentation of ACS between sexes. A total of 10,019 patients included in the Epi-Cardio Registry were analyzed. A higher proportion of women than men presented with NSTEACS (60.3% vs 46.7%; P0.001). The difference between sexes was driven by a higher prevalence of ACS with non-obstructive coronary arteries (20.9% vs 6.6%) mainly in young women, since ACS without coronary lesions were mostly NSTEACS (77.7% vs 22.3%). In patients with obstructive coronary heart disease, there were no differences in the clinical presentation between sexes. In conclusion, younger women are more likely than men to present ACS with non-obstructive coronary arteries, whereas no significant difference exists between sexes regarding the prevalence of ACS with obstructive coronary artery disease.

Resumen Antecedentes y objetivo El carcinoma de celulas de Merkel es un tipo de cancer de piel infrecuente y agresivo. Hay una gran variacion en su manejo y las diferentes guias extranjeras que existen cubren parcialmente los problemas identificados como principales. El objetivo de la presente guia es servir de referencia a los dermatologos espanoles para mejorar aspectos controvertidos del diagnostico, estadificacion y tratamiento del carcinoma de celulas de Merkel. Materiales y metodos Se empleo el metodo ADAPTE: se escogio a miembros del Grupo Espanol de Dermato-Oncologia y Cirugia (GEDOC) con experiencia en el tratamiento de estos tumores y con interes en participar en la elaboracion de la guia. Tras resumir el proceso de atencion y elaborar las preguntas clinicas relevantes, se hizo una busqueda de guias, que se seleccionaron segun su puntuacion mediante el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II). Tras la busqueda de las respuestas en dichas guias, se elaboraron posteriormente las recomendaciones. Por ultimo, se sometio la guia a revision externa. Resultados Las guias con mejor puntuacion fueron las de National Comprehensive Cancer Network, la European consensus-based interdisciplinary guideline, Alberta Healthservices Clinical practice guideline, American Cancer Society y Cutaneous Oncology Group of the French Society of Dermatology. Se obtuvieron en total 9 preguntas clinicas, contestadas a partir de estas guias. Conclusiones Esta guia responde a preguntas habituales en la practica clinica diaria y sirve a los dermatologos como referencia en la toma de decisiones, siempre teniendo presentes los recursos y preferencias del paciente.

Resumen Antecedentes y objetivos El conocimiento de las rutas de origen y derivacion de los pacientes atendidos en consulta dermatologica presencial y de teledermatologia en Espana tiene interes desde el punto de vista de la gestion sanitaria. El objetivo de este estudio es describir las rutas de derivacion y la frecuencia y caracteristicas de la teledermatologia en Espana. Material y metodos Estudio transversal descriptivo sobre la muestra del estudio DIADERM, que recogio la actividad de 80 dermatologos espanoles, seleccionados mediante muestreo aleatorio estratificado, durante 6 dias. Se estudiaron el origen y destino de los pacientes en funcion de la financiacion, el tipo de consulta y la edad de los pacientes. Se describio la frecuencia de las consultas por teledermatologia, su origen y destino, el tipo de financiacion, la edad de los pacientes y los diagnosticos mas frecuentes, comparandolos con la consulta presencial. Resultados El origen mas frecuente en la consulta privada es el directo, mientras que en la publica es la atencion primaria y el propio dermatologo. Un 66% de los pacientes se derivan a dermatologia y un 27% son dados de alta. No existen diferencias en estos porcentajes entre consulta publica y privada. El indice sucesivas/primeras fue de 0,8 para la consulta publica y de 0,2 para la privada. La teledermatologia representa un 1% de las consultas. El 80% procede de atencion primaria y el 17% tiene origen directo. Se deriva a atencion primaria el 33%, en mayor proporcion que en consulta presencial. Galicia, Andalucia y Cataluna son las regiones donde representa un mayor porcentaje de consultas. Conclusiones Los resultados sugieren una alta capacidad resolutiva de las consultas de dermatologia en Espana. La teledermatologia representa un porcentaje pequeno de las consultas, y el acceso a ella se da en un porcentaje relevante de pacientes por via directa.

Resumen: El diagnóstico y tratamiento del melanoma en atención especializada es un campo en el que se han producido numerosos cambios. El objetivo de esta guía es ofrecer a los dermatólogos españoles una referencia para resolver las dudas clínicas más frecuentes basándose en la evidencia actual. Para la realización de esta guía se escogió a miembros del Grupo Español de Dermato-Oncología y Cirugía con experiencia en el tratamiento de estos tumores y con interés en participar en la elaboración de la guía. Se hizo una adaptación de las guías de práctica clínica existentes mediante el método ADAPTE: inicialmente se resumió el proceso de atención y se elaboraron las preguntas clínicas relevantes. Se seleccionaron las guías mejor puntuadas mediante el instrumento AGREE II, realizando la búsqueda de las respuestas en dichas guías y elaborando las recomendaciones. Finalmente se sometió la guía a revisión externa. La guía se estructuró a partir de 21 preguntas clínicas que fueron seleccionadas por su relevancia, dado que se centran en aspectos que pueden plantear decisiones difíciles en el manejo del melanoma, y se han respondido empleando la evidencia obtenida de las mejores guías existentes. Entre las limitaciones de esta guía merece reseñarse que la evidencia es escasa para responder a algunas preguntas. En algunos aspectos el cambio es rápido y exige una actualización frecuente de la guía. Esta guía responde a preguntas habituales sobre el manejo del melanoma en la práctica clínica diaria, sirviendo a los dermatólogos como referencia en la toma de decisiones, siempre teniendo presente los recursos y preferencias del paciente. Abstract: Specialist approaches to the diagnosis and treatment of melanoma have undergone many changes. This guideline aims to provide Spanish dermatologists with evidence-based information for resolving the most common doubts that arise in clinical practice. Members of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating melanoma were invited to participate in drafting the guideline. The group developed a new guideline on the basis of existing ones, using the ADAPTE collaboration process, first summarizing the care process and posing relevant clinical questions, then selecting guidelines with the best scores according to the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. Finally, the group searched the selected guidelines for answers to the clinical questions, drafted recommendations, and sent them for external review. The guideline is structured around 21 clinical questions chosen for their relevance to issues that make clinical decisions about the management of melanoma difficult. Evidence from existing guidelines was used to answer the questions. A limitation of this guide derives from the scarce evidence available for answering some questions. Moreover, some areas are changing rapidly, so recommendations must be updated often. The present guideline offers answers to clinical questions about the routine management of melanoma in clinical practice and provides dermatologists with a reference to guide decisions, taking into consideration the resources available and patient preferences.

[EN]: Introduction: The COVID-19 pandemic outbreak introduced dramatic changes in all our lives, daily practice, and medical conferences. In search of a tool to spread dermatologic knowledge during confinement, an online medical meeting was held on April 25th to 26th, 2020. In this study, we aimed to assess the characteristics, opinion and satisfaction of the attendees to a free-of-charge online congress. Secondarily, we intended to explain how this meeting was prepared. Material and Methods: Online survey administered to the attendees to an online congress organised via the Telegram® Messenger App. Its organisation and planning, which needed no financial support and was done by volunteer organisers, moderators and speakers, is described step by step. Results: The satisfaction of both speakers and attendees was very high. All participants considered that this format had a great present and future, and most of them rated it as superior to regular face-to-face meetings. Female gender and predominantly private practice favoured this opinion. Discussion: The COVID-19 pandemic has forced the cancellation of most scientific gatherings. This has been seen by some authors as an excellent opportunity, encouraging medical societies and organisations to lead the change to virtual meetings. Although confinement did not allow real contact, our online meeting showed it was possible to ensure interaction and participation between attendees, moderators and speakers. Dermatologists enjoyed some dermatologic science, even despite the extraordinary circumstances disrupting their daily clinical practice. Most of them felt they were participating in something new and compelling that many felt superior to traditional meetings., [ES]: Introducción: La pandemia de COVID-19 introdujo cambios drásticos en nuestras vidas. Tratando de encontrar una herramienta adecuada para la formación y el debate dermatológico durante el confinamiento, se celebró un congreso médico on-line durante los días 25 y 26 de abril del 2020. El objetivo del presente estudio fue evaluar las características, la opinión y el grado de satisfacción de los asistentes a dicho congreso. En segundo lugar, se buscó explicar cómo se organizó este formato de reunión. Material y métodos: Se entregó un cuestionario a los asistentes a un congreso on-line realizado a través de la aplicación Telegram® Messenger App. Se describió paso a paso su organización y planificación. No se necesitó apoyo financiero, ya que fue realizado de manera voluntaria. Resultados: El grado de satisfacción tanto de los ponentes como de los asistentes fue muy elevado. Todos los participantes consideraron que este formato tenía un gran presente y futuro. La mayoría lo calificó como superior a las reuniones presenciales tradicionales. Ser del sexo femenino y tener una práctica clínica predominantemente privada favorecieron esta opinión. Discusión: La pandemia obligó a cancelar la mayoría de las reuniones científicas presenciales. Esto fue visto por algunos autores como una excelente oportunidad para mejorar y liderar el cambio a las reuniones virtuales. Aunque el confinamiento no permitió un contacto real, nuestra reunión demostró que era posible asegurar la interacción entre los participantes. Los dermatólogos pudieron participar en una actividad formativa a pesar de que debido a las circunstancias se interrumpiera su actividad práctica diaria. La mayoría de los asistentes tuvieron la sensación de que esta era una actividad nueva y atractiva, que superaba incluso a las reuniones presenciales tradicionales.

Background: Heavy menstrual bleeding (HMB) affects up to 35% of women at some point in their lives, and has an important impact on their quality of life (QoL). Current techniques to assess and quantify menstrual blood loss are inconvenient and the correlation between actual and perceived blood loss is poor. This study aimed to develop and validate a screening questionnaire in Spanish to identify HMB in women of reproductive age. Methods: The study consisted of two phases: the conceptual development of a set of items to discriminate between women with and without HMB and the assessment of the sensitivity and specificity of these items. Correlation of the screening tool with women's perception of the intensity of bleeding and the interference in their daily life activities was also assessed. Results: An initial set of 46 items were identified, from which 21 items were selected following the cognitive interviews. For the psychometric validation phase, 389 patients were enrolled, of whom 364 were assessable: 211 cases with Pictorial Blood loss Assessment Chart-confirmed excessive menstrual loss (EML) and 153 controls. Six items met entry criteria in the model and together yielded a sensitivity of 86.7% and specificity of 89.5% to identify cases and controls. These items were weighted according to their contribution to the final model to yield a tool that can be scored from 0 to 10 being 3 the cutoff point to diagnose EML that interferes in QoL. Conclusions: The 6-item SAMANTA questionnaire represents a valid screening tool to easily identify women with EML that interfere with QoL.

Resumen El grado de conocimiento y aplicacion de las guias de practica clinica sobre el manejo de la dermatitis atopica son desconocidos en nuestro entorno. El objetivo de este estudio es elaborar indicadores de calidad basados en las guias de practica clinica existentes, para mejorar la atencion de los pacientes. Tras una busqueda bibliografica de guias de practica clinica, un grupo de 11 panelistas selecciono las de mayor calidad mediante el instrumento AGREE II. Posteriormente se extrajeron recomendaciones con alto nivel de evidencia y propusieron un indicador de calidad asistencial asociado a un estandar para medir el grado de cumplimiento de cada recomendacion. De los 150 indicadores propuestos, se obtuvo consenso en 21 de ellos tras la realizacion del metodo Delphi modificado. La implementacion de los indicadores consensuados en este estudio pretende estandarizar las actuaciones de los profesionales sanitarios para mejorar la calidad asistencial de los pacientes con dermatitis atopica.

En este artículo nos interesa analizar los sentidos puestos en juego por los y las docentes de Formación ética y ciudadana del tercer ciclo de educación general básica de escuelas de la ciudad de Paraná en relación con las prácticas realizadas por la Asociación civil Conciencia desde el grupo de trabajo de la localidad de Paraná, jurisdicción educativa de Entre Ríos, durante la década de 1990.1 Se indagan las intervenciones formativas que esta Asociación desarrolló como partícipe activa del debate público y en respuesta a las demandas gestadas por los nuevos contenidos curriculares en el marco de la transformación educativa en curso en el período estudiado. Nos interrogamos sobre los modos de apropiación que produjeron los y las docentes de esas intervenciones llevadas a cabo desde el grupo de trabajo local en articulación con el Ministerio de Cultura y Educación de la Nación, el Consejo General de Educación de la provincia de Entre Ríos y organismos multilaterales. El corpus empírico comprende textos-manuales elaborados por la Asociación Conciencia, entrevistas a docentes e integrantes del grupo de trabajo Conciencia a nivel local, documentaria oficial y otras discursividades sociales. El análisis realizado nos ha posibilitado trazar el horizonte discursivo (Angenot, 2010) en el cual se tramaban nuevas formas de articulación entre las organizaciones de la sociedad civil, las políticas educativas, los relatos de ciudadanía y las culturas escolares.

Resumen Antecedentes y objetivo El carcinoma basocelular supone el cancer de piel mas frecuente en la poblacion. Hay una gran variabilidad en su manejo y las diferentes guias extranjeras que existen son dificilmente aplicables en nuestro medio. El objetivo de la presente guia es servir de referencia a los dermatologos espanoles para mejorar el manejo de este tumor basandose en la evidencia actual. Materiales y metodos Se escogio a miembros del Grupo Espanol de Dermato-Oncologia y Cirugia (GEDOC) con experiencia en el tratamiento de estos tumores y con interes en participar en la elaboracion de la guia. Se hizo una adaptacion de las guias de practica clinica existentes mediante el metodo ADAPTE, se resumio el proceso de atencion, y se elaboraron las preguntas clinicas relevantes. Se seleccionaron las guias mejor puntuadas mediante el instrumento AGREE II, realizando la busqueda de las respuestas en dichas guias y elaborando posteriormente las recomendaciones. Finalmente se sometio la guia a revision externa. Resultados Las guias con mejor puntuacion fueron las de la British Association of Dermatologits (BAD), del National Comprehensive Cancer Network (NCCN), del European Dermatology Forum (EDF) y de la European Academy of Dermatology and Venereology (EADV). Se obtuvieron en total 11 preguntas clinicas, contestadas a partir de estas guias. Conclusiones Esta guia responde a preguntas habituales sobre el manejo del carcinoma basocelular en la practica clinica diaria y sirve a los dermatologos como referencia en la toma de decisiones, siempre teniendo en cuenta los recursos y las preferencias del paciente.

This paper reviews the state of the art in agricultural and food sustainability with special emphasis on metrics for monitoring progress toward their accomplishment, and with a view to assisting stakeholders in facing the challenges involved. Priorities, bottlenecks, alternatives, conclusions and recommendations are considered. Finding long-lasting solutions in this scenario will inevitably require revising rural development and smallholder agriculture, and bringing about structural changes for the benefit of the poorer stakeholders. Better farming systems, new technologies, quality education and effective business models can be useful toward creating decent jobs, solving resource constraints, expanding market participation, and alleviating physical hardship in the agricultural sector -particularly among women and young people. Agriculture in industrialized countries will additionally require restructuring with new policies aimed at favoring low- and medium-income countries. On the other hand, high-income countries will have to face pressing challenges including unhealthy diets, food waste generation, balancing food and biofuel production, and developing fair agricultural policies. In addition, the richer should lead the way to higher levels of productivity, resource efficiency, food safety and traceability, and environmental friendliness in order to provide useful lessons for technological development and policing in developing countries. This is why, after presenting the actual world status of food sustainability and how its global governance is linked to environmental, economic and social dimensions, some measures and indicators for monitoring progress are reviewed with the final aim of providing solutions and recommendations for the sustainability of the food production and consumption system.

Este relato de experiência apresenta uma discussão sobre a mediação de escrita realizada em caráter de extensão na oficina de escrita, oferecida em plataforma on-line, ‘Eu, professora, e a escrita de mim’, a qual foi promovida durante a pandemia da COVID-19 e voltou-se a professoras da educação básica. A discussão teórica mobilizada na oficina perpassa a teoria da enunciação (BENVENISTE, 2014), as qualidades discursivas –Unidade Temática, Concretude, Questionamento e Objetividade (GUEDES, 2009) e a concepção de subjetividade relacionada à leitura literária (PETIT, 2009). Em via de mão dupla entre teoria e prática, este texto reflete sobre estratégias voltadas ao exercício da escrita de si e, a partir do estudo de um caso de escrita e reescrita realizadas naoficina, aponta para a leitura pública, a discussão com leitores interessados e as qualidades discursivas como recursos importantes para a mobilização da(s) subjetividade(s) nas produções escritas, em especial, em relatos de experiência.

BACKGROUND: Hand eczema is common in patients with atopic dermatitis (AD), but few studies have described the characteristics of these patients in large, representative populations from different geographic regions and occupational settings. OBJECTIVE: To describe the epidemiological, clinical, and allergy profile of patients with hand eczema who underwent patch testing and compare patients with and without AD. METHODS: Analysis of data from the Spanish Contact Dermatitis Registry, a multicenter registry of patients who undergo patch testing in Spain. RESULTS: We included 1466 patients with hand eczema who were patch tested between January 2018 and June 2020. Those with AD were younger and had had symptoms for longer before testing. They were also more likely to have been exposed to occupational triggers (38% vs 53% for patients without AD). The only profession for which significant differences were found was hairdressing. The most common allergens were nickel sulfate, methylchloroisothiazolinone/methylisothiazolinone, cobalt chloride, potassium dichromate, fragrance mixes I and II, and formaldehyde. The most common diagnoses were allergic contact dermatitis (24% vs 31% in patients with and without AD, P=.0224) and irritant contact dermatitis (18% and 35% respectively, P

Background Eosinophils in peripheral blood are one of the emerging biomarkers in chronic obstructive pulmonary disease (COPD) patients. However, when analysing the relationship between peripheral eosinophilia and COPD prognosis, highly variable results are obtained. The aim of our study is to describe the serum eosinophilia levels in COPD patients and to analyse their relationship to prognosis following hospital admission. Methods A prospective observational study was conducted from 1 October 2016 to 1 October 2018 in the following Spanish centres: Salnés County Hospital in Vilagarcía de Arousa, Arquitecto Marcide Hospital in Ferrol and the University Hospital Complex in Santiago de Compostela. The patients were classified using three cut-off points of blood eosinophil count (BEC): 150 cells/µL, 300 cells/µL, and 400 cells/µL; in addition, the peripheral BEC was analysed on admission. Results 615 patients were included in the study, 86.2% male, mean age 73.9 years, and mean FEV1 52.7%. The mean stay was 8.4 days, and 6% of all patients were readmitted early. No significant relationship was observed between the BEC, neither in the stable phase nor in the acute phase, and hospital stay, readmissions, deaths during admission, the need for intensive care, or the condition of frequent exacerbator. Conclusion The results of our study do not seem to support the usefulness of BEC as a COPD biomarker.KEY MESSAGESThere is evidence that BEC participates in pathophysiological mechanisms of the COPD.BEC may be useful as a biomarker in COPD for aspects such as the optimization of treatments.We did not find any relationship between BEC levels and prognosis following hospital admission for AECOPD.

Resumen {0>El debut de la psoriasis en la edad pediatrica, aunque generalmente leve, puede requerir tratamiento sistemico en las formas moderadas o graves de la enfermedad. Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. El objetivo de este trabajo es analizar la frecuencia relativa, las caracteristicas de los pacientes, el tratamiento empleado y los eventos adversos (EA) observados a partir del registro BIOBADADERM en ninos y jovenes con psoriasis moderada-grave. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Del total de 3946 pacientes del registro, se incluyen 24 pacientes menores de 21 anos, con una edad media al inicio del tratamiento en BIOBADADERM de 16,1 anos y un PASI medio de 9,4. Of the 3946 patients in the registry, 24 were aged 21 years or younger.They had mean age of 16.1 years on starting treatment. When the registry was started, they had a Psoriasis Area and Severity Index of 9.4 El 67% de los pacientes estaba en tratamiento sistemico clasico al inicio del registro. and 67% were being treated with a conventional systemic drug. Treatment was discontinued in 14 patients ({0>14 pacientes (58%) suspendieron el tratamiento por perdida o falta de eficacia o por EA. 58%) due to adverse events or a loss or lack of effectiveness. En conclusion, los datos del registro BIOBADADERM muestran que los menores representan un grupo muy pequeno dentro de los pacientes con psoriasis que reciben tratamiento sistemico y son manejados mas frecuentemente con tratamientos clasicos. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs.

Objetivo: los pacientes diagnosticados de cáncer queratinocítico (carcinoma basocelular y carcinoma epidermoide cutáneo) o cáncer cutáneo no melanoma (CCNM) tienen un riesgo aumentado de desarrollar una segunda neoplasia cutánea. Nuestro objetivo es describir la frecuencia, tasa de incidencia y factores de riesgo predisponentes para desarrollar una segunda neoplasia cutánea en una cohorte de pacientes tratados mediante cirugía micrográfica de Mohs (CMM). Material y métodos: estudio prospectivo de una cohorte nacional de pacientes incluidos para realización de CMM para tratar CCNM en 22 centros españoles (julio 2013-febrero 2020) REGESMOHS. Las variables analizadas incluyen las características demográficas, la frecuencia de aparición de segundas neoplasias cutáneas, sus tasas de incidencia y factores de riesgo, y se estimaron utilizando un modelo de regresión logístico multivariante de efectos mixtos. Resultados: fueron intervenidos 4.768 pacientes: 4.397 (92%) carcinomas basocelulares, y 371 (8%) carcinomas epidermoides. El tiempo medio de seguimiento fue de 2,4 años. Se diagnosticó un nuevo tumor durante el seguimiento en 1.201 pacientes (25%); 1.013 (21%) fueron carcinomas basocelulares, 154 (3%) carcinomas epidermoides cutáneos, 20 melanomas (0,4%) La tasa de incidencia fue de 107 (101-113) por 1.000 personas/año para cualquier tumor; 90 (85-96) para el carcinoma basocelular, 14 (12-16) para el carcinoma epidermoide cutáneo y 2 (1-3) para el melanoma. El riesgo de nueva neoplasia fue mayor en varones que en mujeres 738 (61%) vs. 463 (39%). Los factores de riesgo más significativos fueron la historia de múltiples tumores previos al diagnóstico (RR: 4,6; IC 95%: 2,9-7,1); la inmunosupresión (RR: 2,1; IC 95%: 1,4-3,1) y paciente varón (RR: 1,6; IC 95%: 1,4-1,9). Conclusión: los pacientes diagnosticados de cáncer queratinocítico intervenido mediante cirugía de Mohs tienen un riesgo aumentado de aparición de segundas neoplasias, sobre todo en aquellos pacientes con historia de tumores múltiples al diagnóstico, inmunodeprimidos y varones.

A new measurement of the 235U(n,f) fission cross section was carried out at n_TOF. The experiment covered the neutron energy range from 10 MeV up to 500 MeV, and it used the 1H(n,n) cross section as normalization for the neutron fluence measurement. In this contribution, the measurements and the characterization of the detectors covering the incident energy range up to 150 MeV are discussed.

The measurement of the 235U(n,f) reaction cross section in the neutron energy region 10 MeV to 500 MeV was carried out at the CERN n_TOF facility. The experimental campaign, completed in 2018, provided precise and accurate data on the fission reaction relative to neutron-proton elastic scattering. A description and characterization of the used setup for the simultaneous measurement of fission fragments and neutron flux is reported here.

Accurate neutron capture cross section data for minor actinides (MAs) are required to estimate the production and transmutation rates of MAs in light water reactors, critical fast reactors like Gen-IV systems, and other innovative reactor systems such as accelerator driven systems (ADS). In particular, 244Cm, 246Cm and 248Cm play a role in the transport, storage and transmutation of the nuclear waste of the current nuclear reactors, due to the contribution of these isotopes to the radiotoxicity, neutron emission, and decay heat in the spent nuclear fuel. Also, capture reactions in these Cm isotopes open the path for the formation of heavier elements. In this work, the results of the capture cross section measurement on 244Cm, 246Cm and 248Cm performed at the CERN n_TOF facility are presented. It is important to notice that the Cm samples used in the experiment at n_TOF have been used previously in an experiment at J-PARC, this experiment and the previous one done in the 70s with a nuclear explosion were the only previous capture experiments for these isotopes. At n_TOF, the capture cross section measurements of 244Cm, 246Cm and 248Cm were performed at the 20 m vertical flight path (EAR2) with three C6D6 total energy detectors. In addition, the cross section of 244Cm was measured at the 185 m flight path (EAR1) with a Total Absorption Calorimeter (TAC). The combination of measurements in EAR1 and EAR2 has contributed to controlling and reducing the systematic uncertainties in the results. The compatibility of the different measurements performed and the techniques to obtain the results are presented in this paper as well as the procedure to obtain the resonance parameters.

The neutron capture cross section of 241Am is an important quantity for nuclear energy production and fuel cycle scenarios. Several measurements have been performed in recent years with the aim to reduce existing uncertainties in evaluated data. Two previous measurements, performed at the 185 m flight-path station EAR1 of the neutron time-of-flight facility n_TOF at CERN, have permitted to substantially extend the resolved resonance region, but suffered in the near-thermal energy range from the unfavorable signal-to-background ratio resulting from the combination of the high radioactivity of 241Am and the rather low thermal neutron flux. The here presented 241Am(n,γ) measurement, performed with C6D6 liquid scintillator gamma detectors at the 20 m flight-path station EAR2 of the n_TOF facility, took advantage of the much higher neutron flux. The current status of the analysis of the data, focussed on the low-energy region, will be described here.

Incidence of human papillomavirus (HPV)-associated oral cancers is on the rise. However, epidemiological data of this subset of cancers are limited. Dental hospital poses a unique advantage in detection of HPV-positive oral malignancies. We assessed the utility of formalin-fixed paraffin-embedded (FFPE) tissues, which are readily available, for evaluation of high-risk HPV infection in oral cancer. For protocol standardization, we used 20 prospectively collected paired FFPE and fresh tissues of histopathologically confirmed oral cancer cases reported in Oral Medicine department of a dental hospital for comparative study. Only short PCRs (~ 200 bp) of DNA isolated using a modified xylene-free method displayed a concordant HPV result. For HPV analysis, we used additional 30 retrospectively collected FFPE tissues. DNA isolated from these specimens showed an overall 23.4% (11/47) HPV positivity with detection of HPV18. Comparison of HPV positivity from dental hospital FFPE specimens with overall HPV positivity of freshly collected oral cancer specimens (n = 55) from three cancer care hospitals of the same region showed notable difference (12.7%; 7/55). Further, cancer hospital specimens showed HPV16 positivity and displayed a characteristic difference in reported sub-sites and patient spectrum. Overall, using a xylene-free FFPE DNA isolation method clubbed with short amplicon PCR, we showed detection of HPV-positive oral cancer in dental hospitals.

Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1–1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.

Nitrogen oxides (NOx) are among the main atmospheric pollutants; therefore, it is important to monitor and detect their presence in the atmosphere. To this end, low-dimensional carbon structures have been widely used as NOx sensors for their outstanding properties. In particular, carbon nanotubes (CNTs) have been widely used as toxic-gas sensors owing to their high specific surface area and excellent mechanical properties. Although pristine CNTs have shown promising performance for NOx detection, several strategies have been developed such as surface functionalization and defect engineering to improve the NOx sensing of pristine CNT-based sensors. Through these strategies, the sensing properties of modified CNTs toward NOx gases have been substantially improved. Therefore, in this review, we have analyzed the defect engineering and surface functionalization strategies used in the last decade to modify the sensitivity and the selectivity of CNTs to NOx. First, the different types of surface functionalization and defect engineering were reviewed. Thereafter, we analyzed experimental, theoretical, and coupled experimental–theoretical studies on CNTs modified through surface functionalization and defect engineering to improve the sensitivity and selectivity to NOx. Finally, we presented the conclusions and the future directions of modified CNTs as NOx sensors.