Pius Hospital de Valls

We read with considerable interest the research conducted by Reinders et al.1 This study aimed to address the underutilization of teledermatology in Germany for managing psoriasis, a chronic condition that requires ongoing follow-up care. The relevance of this work is highlighted by the necessity for continuous patient monitoring, the occurrence of acute flares that require prompt—though not necessarily urgent—specialist intervention and the longstanding relationships typically established between patients and their treating physicians. These factors are especially significant in a context where waiting times are increasingly extended. Regrettably, this issue is relevant to many countries, where a lack of specialists significantly limits access to standard care, making the implementation of teledermatology more of a necessity than an option. We fully agree with the authors on the importance of aligning digital health services with the needs explicitly expressed by patients themselves. It emphasizes the importance of understanding the specific requirements associated with each medical condition and the individual needs of patients. In fact—and although it may appear contradictory to some critics—telemedicine is a tool that serves the individualization of medical care. It makes it possible to offer the type and intensity of care that each patient needs, at the right time and in the most convenient setting, which in many cases may be the patient's own home. However, it is important to recognize that acquiring telemedicine technology alone does not guarantee its successful implementation. Telemedicine is a transversal innovation that has repercussions on multiple dimensions of the healthcare organization: from the structure of agendas, allocation of human resources, training, clinical protocols, and face-to-face access circuits, as well as interoperability with other information systems (diagnostic imaging, prescription and dispensing of drugs, etc.). Therefore, the integration of teledermatology into services and consultations, particularly within specialized units such as a psoriasis clinic, necessitates a thorough redesign of both functional and structural aspects to effectively address patient needs. Most of the current perceptions of teledermatology among patients—clearly highlighted in this study—are largely attributable to the technology adoption process that occurred without the corresponding redesign of dermatology services and units implementing it. In addition, the study indicates a low perceived privacy risk among patients, which could reassure authorities considering regulations that balance privacy with accessibility. Efforts might be better directed toward ensuring reimbursement for teledermatology services, aligning them with traditional face-to-face consultations. Regarding technology acceptance and competency, factors such as age and gender play a significant role. Specifically, the findings suggest that full-time employees in Germany—who are predominantly male—and patients with lower incomes suffering from psoriasis may highlight underlying disparities in healthcare access. The preference for a known physician over an unfamiliar dermatologist with access to patient data underscores the importance of viewing medicine as more than an individual transaction between a doctor and a patient. Instead, it is a complex, interconnected relationship where technology can and should be leveraged to benefit both parties. Studies such as that of Reinders and colleagues provide, on the one hand, robust evidence supporting the need for a system-wide, integrated implementation of teledermatology and, on the other, an excellent roadmap for delivering a model of care that is agile, accessible, and individualized—in ways that conventional care has not yet been able to achieve. As the authors rightly point out, customizing teledermatology services to align with patient preferences can enhance its acceptance and effectiveness. PP: Board member of Dermosight. LF: Founder and consultant of DermaQ Salud Digital and Dermapeople. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Patients with isolated distal deep vein thrombosis (DVT) have lower rates of adverse outcomes (death, venous thromboembolism [VTE] recurrence or major bleeding) than those with proximal DVT. It is uncertain if such findings are also observed in patients with cancer. Using data from the international Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, we compared the risks of adverse outcomes at 90 days (adjusted odds ratio [aOR]; 95% CI) and 1 year (adjusted hazard ratio [aHR; 95% CI]) in 886 patients with cancer-associated distal DVT versus 5,196 patients with cancer-associated proximal DVT and 5,974 patients with non-cancer-associated distal DVT. More than 90% of patients in each group were treated with anticoagulants for at least 90 days. At 90 days, the adjusted risks of death, VTE recurrence, or major bleeding were lower in patients with non-cancer-associated distal DVT than in patients with cancer-associated distal DVT (reference): aOR = 0.16 (0.11-0.22), aOR = 0.34 (0.22-0.54), and aOR = 0.47 (0.27-0.80), respectively. The results were similar at 1-year follow-up: aHR = 0.12 (0.09-0.15), aHR = 0.39 (0.28-0.55), and aHR = 0.51 (0.32-0.82), respectively. Risks of death, VTE recurrence, and major bleeding were not statistically different between patients with cancer-associated proximal versus distal DVT, both at 90 days: aOR = 1.11 (0.91-1.36), aOR = 1.10 (0.76-1.62), and aOR = 1.18 (0.76-1.83), respectively, and 1 year: aHR = 1.01 (0.89-1.15), aHR = 1.02 (0.76-1.35), and aHR = 1.10 (0.76-1.61), respectively. However, more patients with cancer-associated proximal DVT, compared with cancer-associated distal DVT, developed fatal pulmonary embolism (PE) during follow-up: The risk difference was 0.40% (95% CI, 0.23 to 0.58). Cancer-associated distal DVT has serious and relatively comparable outcomes compared with cancer-associated proximal DVT. The lower risk of fatal PE from cancer-associated distal DVT needs further investigation.

Background: Recognition of specific allergens triggering immune response is key for the appropriate prescription of allergen-specific immunotherapy (SIT). This study aimed at evaluating the impact of using the commercially available microarray ImmunoCAP ISAC 112 (Thermo Fisher Scientific) on the etiological diagnosis and SIT prescription compared to the conventional diagnostic methods in patients with allergic rhinitis/rhinoconjunctivitis and/or asthma. Methods: 300 patients with respiratory allergic disease, sensitized to three or more pollen aeroallergens from different species, as assessed by skin prick-test (SPT) and specific IgE assays (sIgE), were included in this multicentric, prospective observational study. SPT and a blood test were performed to all patients. Total serum IgE, sIgE (ImmunoCAP ) for allergens found positive in the SPT and sIgE allergen components (ImmunoCAP ISAC 112) were measured. Results: According to SPT results, the most prevalent pollen sensitizers in our population were Olea europaea followed by grass, Platanus acerifolia and Parietaria judaica. The molecular diagnosis (MD) revealed Ole e 1 as the most prevalent pollen sensitizer, followed by Cup a 1, Phl p 1, Cyn d 1, Par j 2, Pla a 1, 2, and 3 and Phl p 5. Immunotherapy prescription changed, due to MD testing, in 51% of the cases, with an increase of prescription of SIT from 39% to 65%. Conclusion: The identification of the allergen eliciting the respiratory disease is essential for a correct immunotherapy prescription. The advances in allergen characterization using methods such as the commercial microarray ImmunoCAP ISAC 112 can help clinicians to improve SIT prescription.

BackgroundUrinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children.MethodsMulticenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed.ResultsNinety-one participants completed the follow-up and were finally included (dexamethasone n = 49 and placebo n = 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups, p = 0.907). Renal damage severity in the early DMSA (β = 0.648, p = 0.023) and procalcitonin values (β = 0.065 p = 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545, p = 0.054), but dexamethasone treatment showed no effect.ConclusionDexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation.Trial registrationClinicaltrials.gov, NCT02034851. Registered in January 14, 2014.Graphical abstract“A higher resolution version of the Graphical abstract is available as Supplementary information.”

BackgroundAge, sex, race and comorbidities are insufficient to explain why some individuals remain asymptomatic after SARS-CoV-2 infection, while others die. In this sense, the increased risk caused by the long-term exposure to air pollution is being investigated to understand the high heterogeneity of the COVID-19 infection course. ObjectivesWe aimed to assess the underlying effect of long-term exposure to NO2 and PM10 on the severity and mortality of COVID-19. MethodsA retrospective observational study was conducted with 2112 patients suffering COVID-19 infection. We built two sets of multivariate predictive models to assess the relationship between the long-term exposure to NO2 and PM10 and COVID-19 outcome. First, the probability of either death or severe COVID-19 outcome was predicted as a function of all the clinical variables together with the pollutants exposure by means of two regularized logistic regressions. Subsequently, two regularized linear regressions were constructed to predict the percentage of dead or severe patients. Finally, odds ratios and effects estimates were calculated. ResultsWe found that the long-term exposure to PM10 is a more important variable than some already stated comorbidities (i.e.: COPD/Asthma, diabetes, obesity) in the prediction of COVID-19 severity and mortality. PM10 showed the highest effects estimates (1.65, 95% CI 1.32–2.06) on COVID-19 severity. For mortality, the highest effect estimates corresponded to age (3.59, 95% CI 2.94–4.40), followed by PM10 (2.37, 95% CI 1.71–3.32). Finally, an increase of 1 µg/m3 in PM10 concentration causes an increase of 3.06% (95% CI 1.11%-4.25%) of patients suffering COVID-19 as a severe disease and an increase of 2.68% (95% CI 0.53%-5.58%) of deaths. DiscussionThese results demonstrate that long-term PM10 burdens above WHO guidelines exacerbate COVID-19 health outcomes. Hence, WHO guidelines, the air quality standard established by the Directive 2008/50/EU, and that of the US-EPA should be updated accordingly to protect human health.