[Introduction to clinical research in dermatology: the link between clinical practice and research]

Clinical research involves studying patients with a view to improving their care. It enhances the health system, benefits both patients and physicians, and represents the "natural" form of investigation for physicians. It can be conducted at both large and small sites. On initiating a line of research, a specific question should be formulated in terms of PICO (patient, intervention, comparison, and outcome). Each of these components should be precisely defined.The question will subsequently be assessed using the FINER mnemonic (that is, whether it is feasible, interesting, novel, ethical, and relevant). If shortcomings are detected, the research question can be refined or rejected directly. When we have an appropriate question,the next step will be to write our protocol with the assistance of someone trained in clinical research methodology.

[Immunization against viral hepatitis: an obligatory recommendation in consults for sexually transmitted diseases]

Numerous international institutions recommend vaccination against hepatitis B for all non-immune patients that consult for a sexually transmitted disease. It is a simple and safe procedure, frequently forgotten in dermatological clinics. Hepatitis B vaccine is administered via intramuscular route in the deltoid in 3 doses (at months 0, 1 and 6). The vaccine against hepatitis A is indicated for non-immune homosexual men that have a sexually transmitted disease. There exists a combined vaccine A + B that facilitates the administration in these cases.

Bullous pemphigoid triggered by influenza vaccination? Ecological study in Galicia, Spain

BACKGROUND

Influenza vaccination has been suggested to be a trigger for bullous pemphigoid (BP). In our area most new patients with BP are admitted to hospital.

OBJECTIVES

To detect a difference in the rate of admissions to hospital for BP during population influenza vaccination programmes, which are mainly targeted at individuals aged 65 years or older, start in the last week of September and last for 2 months.

METHODS

An ecological study in Galicia, north-west Spain (1997-2005), restricted to people aged 65 years or older. Using Poisson regression, results were controlled for mean age of admission and percentage of the population vaccinated each year.

RESULTS

There were 29 admissions registered during 'vaccination periods' (i.e. approximately 10 weeks per year, including the period of vaccination and two further weeks), and 158 during nonvaccination periods (the rest of the year). The incidence rate ratio of admissions for BP in vaccination vs. nonvaccination periods was 0.85 (95% confidence interval 0.57-1.27, P = 0.43).

CONCLUSIONS

Our data do not support the hypothesis of influenza vaccination being an important trigger for severe BP on a population level.

Inpatient dermatology: characteristics of patients and admissions in a Spanish hospital

BACKGROUND

Inpatient dermatology has not been properly described in many countries. National differences might be important in the evaluation of its usefulness and the applicability of politics of health expenditure restrictions.

OBJECTIVE

To describe inpatient activity and readmission rates in a dermatology department in Spain.

STUDY DESIGN

Cross-sectional prospective study in a single hospital.

SETTING

Secondary care hospital of the National Health Service in Pontevedra (Spain).

METHODS

From May 1997 to December 2000, all discharge sheets (1048) were included in the study, codified and described.

RESULTS

Surgery was the reason for admission in 37% of the inpatients. The most frequent diagnosis were: neoplasm (36%), infection (15%), psoriasis (10%), other (10%), dermatitis (6%) and drug reaction (5%). Readmission rates were 1.8% within 30 days, and 12.5% within 1 year.

CONCLUSIONS

Inpatient dermatology is different in different countries. Compared with what has been described in the USA or UK, our data suggest an important surgical content of inpatient dermatology in Spain, not reported in those countries. Medical diagnoses also differ, consisting of more infections, and less psoriasis and dermatitis in our setting. Readmission rates are low when compared with previously published ones, a finding that supports a long-term benefit of hospitalization.

Abdominal nodules as a presentation of obstruction of the inferior vena cava and factor V Leiden mutation

Abdominal nodular lesions are not usually considered a sign of deep venous thrombosis. However, we have seen a patient with abdominal nodular lesions due to venous thrombosis, that led to the diagnosis of factor V Leiden mutation, a recently described cause of hypercoagulability.

Acquired cutaneous lymphangiectasia in a patient with cirrhotic ascites

BACKGROUND

Lymphangiectasia results from acquired dilation of lymphatic vessels. Areas of skin affected by obstruction or destruction of lymphatic drainage are said to be prone to the development of lymphangiectasia. Cirrhosis is a cause of alterations of lymph flow.

METHODS

Case report.

RESULTS

We report a case of acquired, late-onset, lymphangiectasia associated with alcoholic hepatic cirrhosis. Lesions were scattered over the right, lower, anterior abdominal wall, a region that is drained by a common group of lymphatic vessels that were probably disordered.

CONCLUSION

We think that this is the first reported case of lymphangiectasia associated with altered lymph flow in cirrhosis and ascites.