Postnatal growth restriction has high prevalence in very low birth weight (VLBW) preterm neonates, and this could affect their long-term prognosis. Nowadays, there is no consensus on how to monitor growth in these neonates.Objective: This study aimed to compare prevalence of intra- and extrauterine growth restriction (IUGR and EUGR) in a sample of VLBW infants according to the Fenton 2013 charts and INTERGROWTH-21st (IW-21) standards and to analyze concordance between both in the different EUGR definitions criteria (cross-sectional, dynamic, and true).Patients and Methods: An observational retrospective study of 635 VLBW preterm was performed. The study was carried out in Central University Hospital of Asturias. Body measurements (weight, length, and head circumference) were collected at birth and at hospital discharge and expressed in z-scores for the two references (Fenton 2010 and IW-21). Kappa concordance was calculated.Results: Kappa concordance between Fenton and IW-21 was 0.887 for IUGR and 0.580 for static EUGR. Prevalence was higher according to Fenton in IUGR (36.5 vs. 35.1%), in static EUGR (73.8 vs. 59.3%), and in dynamic EUGR (44.3 vs. 29.3%). Despite observing low prevalence of EUGR when IW-21 was used to define EUGR, a statistical association between neonatal morbidity and diagnosis of EUGR was observed.Conclusion: The Fenton and IW-21 concordance for IUGR is good. IW-21 is more restrictive than Fenton in EUGR. Patients diagnosed by IW-21 as EUGR are more likely to have neonatal morbidity, especially if we use EUGR dynamic definition. In our study, we cannot conclude that one graph is better than the other.

Background: Controversy between short-term neonatal growth of very low birth-weight preterm (VLBW) and neurodevelopment may be affected by criteria changes of extrauterine growth restriction (EUGR). Objective: to determine if new EUGR criteria imply modifications in the relationship between old criteria and results of neuropsychological tests in preterm children. Patients and methods: 87 VLBW at 5–7 years of age were studied. Neuropsychological assessment included RIST test (Reynolds Intellectual Sctreening Test) and NEPSY-II (NE neuro, PSY psycolgy assessment) tests. The relationships between these tests and the different growth parameters were analyzed. Results: RIST index was correlated with z-score Fenton’s weight (p = 0.004) and length (p = 0.003) and with z-score IGW-21’s (INTERGRWTH-21 Project) weight (p = 0.004) and length (p = 0.003) at neonatal discharge, but not with z-score difference between birth and neonatal discharge in weight, length, and HC for both. We did not find a statistically significant correlation between Fenton or IGW-21 z-scores and scalar data of NEPSY-II subtasks. Conclusion: In our series, neonatal growth influence on neuropsychological tests at the beginning of primary school does not seem robust, except for RIST test. New EUGR criteria do not improve the predictive ability of the old ones.

Background and objectives: The efficacy and safety of ustekinumab have been proved in clinical trials. In daily clinical practice, knowing the factors that determine survival differences of biological drugs allows psoriasis treatment to be optimized as a function of patient characteristics. The main objectives of this work are to understand ustekinumab drug survival in patients diagnosed with plaque psoriasis in the Hospital Universitario Central de Asturias (HUCA Dermatology Department, and to identify the predictors of drug discontinuation. Materials and Methods: A retrospective hospital-based study, including data from 148 patients who were receiving ustekinumab (Stelara®) between 1 February 2009 and 30 November 2019, were collected. Survival curves were approximated through the Kaplan–Meier estimator and compared using the log-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. Results: The average duration of the treatment before discontinuation was 47.57 months (SD 32.63 months; median 41 months). The retention rates were 82% (2 years), 66% (5 years), and 58% (8 years). Median survival was 80 months (95% confidence interval. CI 36.9 to 123.01 months). The survival study revealed statistically significant differences between patients with arthritis (log-rank test, p < 0.001) and those who had previously received biological treatment (log-rank test, p = 0.026). The five-year prevalence in patients still under treatment was 80% (those without arthritis) and 54% (arthritis patients). In the multivariate analysis, only the patients with arthritis had a lower rate of drug survival. No statistically significant differences were observed for any of the other comorbidities studied. The first and second most frequent causes of discontinuation were secondary failure and arthritis inefficacy, respectively. Conclusion: Ustekinumab is a biological drug conferring high survival in plaque psoriasis patients. Ustekinumab survival is lower in patients with arthritis.

A 12-year-old male with status asthmaticus developed subcutaneous emphysema and pneumomediastinum. He was transferred to our unit, where he received noninvasive ventilation (NIV). This respiratory support technique is not an absolute contraindication in these cases. After 2 h on NIV, he worsened sharply and the subcutaneous emphysema got bigger suddenly. He needed invasive ventilation for 5 days. Final outcome was satisfactory. This case illustrates that it is mandatory to keep a high level of vigilance when using NIV in patients with air leaks.

No abstract

Dear Editor, Chondrodermatitis nodularis helicis (CNH) is an exceptionally investigated disease. 1 Male sex and old age characterize its demographic profile, 1-3 but this has not been recently investigated. With this aim, we performed this descriptive, retrospective, observational investigation including 215 patients histopathologically diagnosed of CNH at Central University Hospital of Asturias, northern Spain, (years 2000-2017). It was approved by the Hospital's ethics committee. Univariate analyses were conducted by chi-squared test and Fisher's test. A two-sided P value of 0.05 was considered statistically significant (R program, The R Foundation, Indianapolis, IN, USA; R Development Core Team, version 3.6.0).The mean age of patients was 68.1 years (women, 71.7; men, 66.2 years; range 24-95 years). Most patients (72%) had more than 60 years at diagnosis and most (65%) were men. This male excess significantly decreased with age (P < 0.01; Table 1). Women became 51.3% after 80 years at diagnosis (male/female Ratio: 0.9).A 56% increase in the CNH diagnosis number was observed during the periods (2000-2008 vs. 2009-2017 years; Table 2). This was greater in women (216.7%) than in men (12%); and evidenced only in the late-onset subgroup (+98%). The most remarkable increase in number was in women over 60 years at diagnosis (277%).As previous but much smaller studies, 1,2 the mean age at diagnosis was 68 years old (published range varies from 40 to 70 years). 2 71% of patients had CNH diagnosis after 60 years. CNH was diagnosed later in women. Children or adolescent were absent supporting the rarity of CNH at this age 4 . We found a 65% male predominance. Nielsen et al. 1 found 60% of males in a PubMed review of 27 studies (including 628 males and 452 females). Wettle et al. 2 reported published variations of the male/female ratio ranging from 1 to 7.6; and early studies reported males outnumbered females by 10 to 1. 5 Female predominance was rarely described. 6,7 We remark that we described for the first time that male excess was age-dependent, (P < 0.01) and reversed after 80 years at diagnosis. Age differences in Ratio Male/Female 3.6 1.3 Decrease

The Folk Psychiatry (FP) model proposes a process through which people understand mental illness, comprising four dimensions: pathologizing, moralizing, psychologizing, and medicalizing. Cultural group differences have been observed in previous research using part of this model, with one prior study suggesting that adherence to cultural values may partly explain these differences. The current study, therefore, evaluated whether horizontal–vertical and individualism–collectivism values contribute to explaining Chinese-Canadian (CC) versus Euro-Canadian (EC) cultural group differences among the FP dimensions. Undergraduate CC ( n = 252) and EC ( n = 296) students participated in an online survey, in which they read vignettes about a person exhibiting symptomatic behaviors of major depression. They were then asked about their impressions of the person’s behavior, based on FP scales. Our results show that CCs were more likely to pathologize and moralize the behaviors described in our study vignette, whereas ECs were more likely to employ psychologizing explanations. When compared with ECs, CCs were significantly more likely to endorse vertical individualism and vertical collectivism and less likely to endorse horizontal collectivism. There was an indirect effect of cultural group on moralizing through the endorsement of vertical (i.e., hierarchical) values. Our findings suggest that valuing social order and adherence to social norms may partly explain why some people view mental health problems as a personal fault.

Objetivo: la pandemia por SARS-CoV-2 ha supuesto un cambio global en el modelo asistencial, potenciando la asistencia telemática, especialmente a nivel de Atención Primaria (AP). El objetivo de nuestro estudio es describir el impacto que han tenido los dos estados de alarma decretados en España en la asistencia de la población infantil a nivel de AP. Material y métodos: estudio observacional retrospectivo. Se analizaron las consultas de AP correspondientes a pacientes pediátricos (<14 años) de un área sanitaria del norte de España y de un Centro de Salud perteneciente a ese área, durante el primer y segundo estados de alarma, y se compararon con sus períodos homólogos del 2019. Resultados: durante el primer estado de alarma en que estableció confinamiento domiciliario y cierre de los colegios, se objetivó un gran descenso de las consultas pediátricas en los centros de salud (758 vs 1381 en 2019), a expensas principalmente de revisiones de salud y enfermedades infecciosas. Dicho descenso no se observó en el segundo estado de alarma (1375 vs 1233 en 2019). En ambos estados de alarma aumentó de forma significativa el porcentaje de consultas telefónicas. Conclusiones: La implantación de los estados de alarma ha supuesto un descenso de la demanda asistencial sobre todo durante la primera ola que podría deberse al temor de las familias a acudir al centro de salud y la disminución de la transmisibilidad de los virus debido al confinamiento domiciliario, así mismo ha supuesto un aumento de la asistencia telemática secundaria a la necesidad de reorganización de la asistencia sanitaria.