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principalmente por su subjetividad y por el sesgo de memoria<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a>&#46; Sin embargo&#44; S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> sugieren que esta escala puede ser fiable en la medida en que se realice una estandarizaci&#243;n de la metodolog&#237;a de evaluaci&#243;n de la misma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En varios pa&#237;ses se ha determinado la DEM teniendo en cuenta el fototipo&#44; y algunos estudios han mostrado que no existe una buena correlaci&#243;n entre estas variables<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;9-12</span></a>&#46; En Colombia solo hay una publicaci&#243;n realizada en poblaci&#243;n escolar que no encontr&#243; correlaci&#243;n entre la DEM para UVB y el fototipo<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para la medici&#243;n m&#225;s objetiva del eritema cut&#225;neo se han utilizado diferentes instrumentos&#44; entre ellos el color&#237;metro triest&#237;mulo &#40;crom&#225;metro&#41; y el espectrofot&#243;metro de reflectancia simple de banda estrecha &#40;Mexameter MX&#174;-18&#41;&#44; que muestran una buena correlaci&#243;n con la evaluaci&#243;n visual<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVB de banda estrecha &#40;UVBBE&#41;&#44; en un grupo de individuos colombianos de diferentes fototipos&#44; y el grado de correlaci&#243;n existente entre la DEM y los fototipos&#44; as&#237; como establecer el nivel de correlaci&#243;n-concordancia entre dos m&#233;todos de medici&#243;n&#58; visual vs&#46; Mexameter MX&#174;-18&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dise&#241;o&#44; poblaci&#243;n y muestra</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de corte transversal para evaluar la sensibilidad de la piel a la RUV en t&#233;rminos de los valores de la DEM en una muestra de poblaci&#243;n colombiana y la correlaci&#243;n-concordancia de dos m&#233;todos de medici&#243;n de la DEM&#58; visual y por Mexameter MX&#174;-18 &#40;Courage Khazaka Electronic&#44; K&#246;ln&#44; Alemania&#41;&#46; El Mexameter MX&#174;-18 es un espectrofot&#243;metro que mide la absorci&#243;n de la luz a dos longitudes de onda&#44; 568<span class="elsevierStyleHsp" style=""></span>nm para la hemoglobina y 660<span class="elsevierStyleHsp" style=""></span>nm para la melanina&#44; que arroja como resultado un &#237;ndice de eritema y un &#237;ndice de melanina&#46; Se efectu&#243; un muestreo secuencial por conveniencia&#44; incluyendo sujetos sanos&#44; mayores de 18<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; quienes asistieron al Hospital Universitario Centro Dermatol&#243;gico Federico Lleras Acosta en Bogot&#225; &#40;Colombia&#41; y otorgaron su consentimiento para participar en el estudio&#46; Se excluyeron los pacientes que refer&#237;an estar en tratamiento con alg&#250;n tipo de medicaci&#243;n sist&#233;mica fotosensibilizante durante los 2<span class="elsevierStyleHsp" style=""></span>meses previos al inicio del estudio&#44; que hab&#237;an usado corticoides t&#243;picos durante los 8<span class="elsevierStyleHsp" style=""></span>d&#237;as previos o tomado antihistam&#237;nicos orales 2<span class="elsevierStyleHsp" style=""></span>d&#237;as antes&#44; los que ten&#237;an una historia personal o familiar de fotosensibilidad&#44; los que hubieran estado expuestos a la radiaci&#243;n solar natural o artificial de la piel de la espalda durante las 6<span class="elsevierStyleHsp" style=""></span>semanas previas al estudio&#44; as&#237; como los extranjeros o hijos de padres extranjeros&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para el c&#225;lculo del tama&#241;o de la muestra se emple&#243; la f&#243;rmula propuesta para la estimaci&#243;n de correlaci&#243;n y concordancia en estudios de corte transversal&#44; que emplea datos ordinales y continuos<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#44; teniendo en cuenta un valor alfa de 0&#44;05&#44; una precisi&#243;n esperada del 10&#37; y un coeficiente de correlaci&#243;n del 0&#44;8 &#40;basado en un estudio piloto desarrollado por los investigadores&#41;&#46; Con base en lo anterior se calcul&#243; un tama&#241;o de muestra de 75 individuos&#44; en quienes se les deb&#237;a determinar la DEM para UVA&#44; UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVBBE&#44; y luego evaluar las dos t&#233;cnicas de medici&#243;n de la DEM&#46; Todos los procedimientos del estudio fueron aprobados por el comit&#233; de &#233;tica en investigaci&#243;n institucional y siguieron todas las recomendaciones establecidas por la declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedimiento de evaluaci&#243;n de la DEM</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cada sujeto fue evaluado con la escala de fototipos de Fitzpatrick<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#46; Posteriormente se irradi&#243; la piel de la espalda con dosis crecientes en 20&#37; de UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-II&#58; 15-43<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> y fototipos<span class="elsevierStyleHsp" style=""></span>III-IV&#58; 30-72<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; UVA &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-II&#58; 20-50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> y fototipos<span class="elsevierStyleHsp" style=""></span>III-IV&#58; 42-100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; y UVBBE &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-II&#58; 50-550<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> y fototipos<span class="elsevierStyleHsp" style=""></span>III-IV&#58; 100-970<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; Para administrar UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVA se utiliz&#243; el simulador solar &#171;Solar Light multiport&#187; modelo 601&#44; de 300<span class="elsevierStyleHsp" style=""></span>mw &#40;Glenside&#44; Pennsylvania&#44; Estados Unidos&#41;&#44; que tiene 6<span class="elsevierStyleHsp" style=""></span>gu&#237;as l&#237;quidas de 9<span class="elsevierStyleHsp" style=""></span>mm&#46; Para la UVBBE se utiliz&#243; la cabina de fototerapia Daavlin 305&#47;350 &#40;Bryan&#44; Ohio&#44; Estados Unidos&#41;&#44; con una potencia de 4&#44;3<span class="elsevierStyleHsp" style=""></span>mw&#47;cm<span class="elsevierStyleSup">2</span> a una distancia de 15<span class="elsevierStyleHsp" style=""></span>cm&#44; colocando un molde de pl&#225;stico blanco de 4<span class="elsevierStyleHsp" style=""></span>capas con 8<span class="elsevierStyleHsp" style=""></span>campos&#44; cada uno de 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; sobre la piel de la espalda y cubriendo el resto de la piel del cuerpo y de la cara con tela gruesa que no permitiera el paso de la RUV&#44; adem&#225;s de gafas de fotoprotecci&#243;n&#46; Las dosis de radiaci&#243;n fueron medidas con el dos&#237;metro PMA-2100 y sus respectivos detectores &#40;SUV PMA2103 y UVA PMA2113&#41; para el simulador solar&#44; calibrados por Solar Light&#44; y con el radi&#243;metro IL-1700 y su detector para UVB de banda estrecha &#40;International Light&#44; Newburyport&#44; MA&#44; Estados Unidos&#41; para la cabina de fototerapia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La lectura de la DEM se realiz&#243; 24<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de la irradiaci&#243;n&#44; teniendo en cuenta la dosis m&#237;nima de radiaci&#243;n con la que se obtuvo un eritema m&#237;nimo perceptible&#46; Dos observadores entrenados realizaron las lecturas&#58; visual y por Mexameter MX&#174;-18&#46; Para la medici&#243;n con el Mexameter MX&#174;-18 se realizaron 3 lecturas apoyando la pieza de mano en la piel no irradiada y 3 lecturas por cada campo irradiado&#44; de las cuales se obtuvo el promedio&#59; si no se obten&#237;a eritema se repet&#237;a el procedimiento con dosis mayores en aumento geom&#233;trico&#46; El valor de la DEM por el Mexameter MX&#174;-18 fue determinada por un f&#237;sico y correspondi&#243; a la dosis con la cual se obtuvo la m&#225;xima pendiente de las curvas dosis-respuesta para cada individuo&#44; seg&#250;n la metodolog&#237;a previamente publicada<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; La dosis m&#225;xima de UVA que se pudo administrar con el simulador solar fue de 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#59; a efectos del an&#225;lisis&#44; a las personas que no presentaron eritema con esa dosis se les asign&#243; de forma arbitraria un valor de DEM de 120<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para cada una de las variables se realizaron an&#225;lisis descriptivos empleando las medidas estad&#237;sticas de resumen m&#225;s apropiadas&#46; En el caso de las variables categ&#243;ricas&#44; se resumi&#243; la informaci&#243;n en tablas de frecuencia con valores absolutos y relativos &#40;sexo y fototipo&#41;&#46; Para la DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE&#44; mediciones visuales y por Mexameter MX&#174;-18&#41;&#44; dado que los datos no presentaron distribuci&#243;n normal&#44; se emple&#243; la mediana y el rango intercuart&#237;lico &#40;RIC&#58; diferencia entre el p75 y el p25&#41;&#46; La correlaci&#243;n entre el fototipo y la medici&#243;n de la DEM&#44; en sus diferentes modalidades&#44; se evalu&#243; mediante el coeficiente de correlaci&#243;n de Spearman&#44; con su respectivo intervalo de confianza del 95&#37; y su valor<span class="elsevierStyleHsp" style=""></span>p&#46; Adicionalmente&#44; para evaluar el nivel de correlaci&#243;n-concordancia entre las diferentes mediciones de la DEM&#44; se emple&#243; el estad&#237;stico de correlaci&#243;n-concordancia de LIN&#44; reportado con su intervalo de confianza del 95&#37; y valor<span class="elsevierStyleHsp" style=""></span>p&#46; Los an&#225;lisis se realizaron en el software estad&#237;stico Stata 14&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se incluyeron en el estudio 113 sujetos&#44; con una edad mediana de 27<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;RIC&#58; 18-56<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#44; de los cuales el 66&#37; eran mujeres&#46; No hubo individuos de fototipos<span class="elsevierStyleHsp" style=""></span>V y<span class="elsevierStyleHsp" style=""></span>VI&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se registra el n&#250;mero total de individuos y su distribuci&#243;n por fototipo&#46; En 111 sujetos se evalu&#243; la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVBBE&#44; y solo en 91 individuos para UVA&#44; debido a dificultades para permanecer el tiempo que demandaba la prueba&#46; En 21 de los 91 no se observ&#243; eritema con la dosis m&#225;xima de UVA administrada&#44; 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> &#40;3 fueron fototipo<span class="elsevierStyleHsp" style=""></span>II&#44; 7 fototipo<span class="elsevierStyleHsp" style=""></span>III y 11 fototipo<span class="elsevierStyleHsp" style=""></span>IV&#41;&#44; y en 14 sujetos el Mexameter MX&#174;-18 no detect&#243; eritema &#40;uno fototipo<span class="elsevierStyleHsp" style=""></span>II&#44; 7 fototipo<span class="elsevierStyleHsp" style=""></span>III y 6 fototipo<span class="elsevierStyleHsp" style=""></span>IV&#41;&#46; El comportamiento de la mediana de la DEM y su respectivo rango intercuart&#237;lico por fototipo y m&#233;todo de medici&#243;n se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>a-c&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Para poder comparar los resultados con las publicaciones sobre el tema se determin&#243; la media de la DEM evaluada visualmente&#44; a pesar de que la muestra no observ&#243; distribuci&#243;n normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Correlaci&#243;n entre los fototipos y la DEM</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se evalu&#243; la correlaci&#243;n entre los fototipos con cada una de las mediciones de la DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA&#44; UVBBE&#41;&#44; tanto en la alternativa visual como con el Mexameter MX&#174;-18&#46; Se encontr&#243; una correlaci&#243;n que oscil&#243; entre 0&#44;5 y 0&#44;69&#46; Las correlaciones m&#225;s bajas fueron las registradas para la UVBBE&#44; tanto visual como con el Mexameter MX&#174;-18 &#40;0&#44;5 y 0&#44;53&#44; respectivamente&#41;&#46; El detalle del coeficiente de correlaci&#243;n obtenido para cada medici&#243;n y su respectivo valor de<span class="elsevierStyleHsp" style=""></span>p se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Correlaci&#243;n-concordancia entre la DEM visual y por Mexameter MX&#174;-18</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se estim&#243; el nivel de correlaci&#243;n-concordancia entre cada una de las mediciones de la DEM&#44; comparando la alternativa visual con el Mexameter MX&#174;-18&#46; En todos los casos el coeficiente de LIN fue superior a 0&#44;8 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>d-f&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">En este estudio se determin&#243; la DEM para UVA&#44; UVBBE y UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB en una muestra de poblaci&#243;n colombiana&#46; En las investigaciones realizadas utilizando un simulador solar el valor promedio de la DEM de UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB para los diferentes fototipos var&#237;a&#59; sin embargo&#44; el valor para los fototipos<span class="elsevierStyleHsp" style=""></span>I al<span class="elsevierStyleHsp" style=""></span>IV de la poblaci&#243;n de este estudio fue similar a los datos publicados por P&#233;rez-Ferriols et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> en Espa&#241;a&#44; probablemente debido a que nuestra poblaci&#243;n comparte genes espa&#241;oles por el mestizaje<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#46; En un estudio realizado en la India&#44; el valor promedio de la DEM para el fototipo<span class="elsevierStyleHsp" style=""></span>IV fue similar a los resultados para este fototipo en Espa&#241;a y en el presente estudio<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#46; Para el fototipo<span class="elsevierStyleHsp" style=""></span>III el promedio de la DEM fue similar en los asi&#225;ticos australianos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#44; espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> y colombianos&#46; En poblaci&#243;n china los valores promedio de la DEM de acuerdo con el fototipo son m&#225;s altos<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#44; y es posible que esto se deba a que el estudio se realiz&#243; en la piel del gl&#250;teo&#44; que tiene una sensibilidad menor a la de la espalda<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9&#44;22</span></a>&#44; y a las diferencias gen&#233;ticas &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El valor promedio de la DEM para los fototipos<span class="elsevierStyleHsp" style=""></span>I-IV en los estudios realizados con otras fuentes de UVB &#40;l&#225;mparas fluorescentes UVB&#41;&#44; en Brasil<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#44; en Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a> y para algunos fototipos en el Reino Unido<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> es similar al de nuestra poblaci&#243;n para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#46; En contraste&#44; los valores promedio de la DEM en Corea<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#44; y especialmente en Singapur<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#44; son mucho m&#225;s altos para los mismos fototipos &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46; Las diferencias podr&#237;an explicarse por la variabilidad gen&#233;tica y debido a que en el estudio de Singapur se irradi&#243; la piel del gl&#250;teo&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Si se comparan los resultados del presente estudio con el de Medell&#237;n &#40;Colombia&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#44; en este &#250;ltimo se observa un mayor valor promedio de la DEM por fototipo&#44; lo que podr&#237;a obedecer a que se utiliz&#243; como definici&#243;n de la DEM la m&#237;nima dosis que produc&#237;a eritema con bordes bien definidos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En la literatura revisada se encontraron pocas publicaciones acerca de los valores de la DEM de UVA&#44; quiz&#225; por la dificultad de disponer de una fuente de RUV que emita dosis altas de UVA en per&#237;odos cortos de tiempo&#46; Al comparar las medianas de la DEM de UVA del presente estudio con los rangos obtenidos por Fitzpatrick<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#44; los valores en J&#47;cm<span class="elsevierStyleSup">2</span> son similares para los fototipos<span class="elsevierStyleHsp" style=""></span>I &#40;22 vs&#46; 20-35&#41; y<span class="elsevierStyleHsp" style=""></span>II &#40;42 vs&#46; 30-35&#41;&#44; pero son m&#225;s altos para los fototipos<span class="elsevierStyleHsp" style=""></span>III &#40;86 vs&#46; 40-55&#41; y<span class="elsevierStyleHsp" style=""></span>IV &#40;100 vs&#46; 50-80&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a la UVBBE&#44; los valores promedio de la DEM en poblaci&#243;n espa&#241;ola<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> &#40;obtenidos a partir de la aplicaci&#243;n de un factor de conversi&#243;n a los resultados de la DEM para UVB&#41; son similares a los del presente estudio para todos los fototipos&#46; En Detroit&#44; Carretero-Mangolis y Lim<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> reportan que la mediana de la DEM para fototipos<span class="elsevierStyleHsp" style=""></span>I-II fue de 600<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> y la de los fototipos<span class="elsevierStyleHsp" style=""></span>III-IV de 700<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#44; valores an&#225;logos a los del presente estudio&#58; 550 y 770<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#44; respectivamente&#46; En 352 pacientes con psoriasis en el Reino Unido los valores de la mediana de la DEM por fototipo fueron menores&#58; 200&#44; 280&#44; 390 y 550<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-IV&#44; respectivamente&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Consistente con lo publicado por otros autores<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;11&#44;12&#44;24</span></a>&#44; evidenciamos que hay una tendencia al aumento de la DEM a medida que aumenta el fototipo&#46; Sin embargo&#44; la escala de fototipos de Fitzpatrick no es suficiente para hacer una buena discriminaci&#243;n&#46; De hecho&#44; los valores de la DEM de UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE se superponen en los diferentes fototipos&#44; de modo que dos personas podr&#237;an tener el mismo valor de la DEM aun perteneciendo a distintos fototipos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;6&#44;25&#44;27&#44;28</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Algunos autores han establecido que no existe correlaci&#243;n entre la DEM y el fototipo<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;9&#44;12&#44;29</span></a> y otros s&#237; la encuentran<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;24&#44;30&#44;31</span></a>&#46; El presente estudio explor&#243; esta relaci&#243;n y encontr&#243; una correlaci&#243;n catalogada como buena para UVA y UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y moderada para UVBBE&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La correlaci&#243;n-concordancia entre las mediciones de la DEM visual y por Mexameter MX&#174;-18 fue muy buena para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE&#44; como se ha evidenciado en algunos estudios<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Teniendo en cuenta los resultados&#44; las dos formas de medici&#243;n son intercambiables&#44; por lo que la determinaci&#243;n visual sigue siendo muy &#250;til en la pr&#225;ctica cl&#237;nica&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Dentro de las limitaciones del presente estudio tenemos que la muestra es peque&#241;a&#44; especialmente para el fototipo<span class="elsevierStyleHsp" style=""></span>I&#44; y no es representativa de toda la poblaci&#243;n colombiana puesto que no fue posible incluir individuos con fototipos<span class="elsevierStyleHsp" style=""></span>V y<span class="elsevierStyleHsp" style=""></span>VI&#44; que se encuentran en otras regiones geogr&#225;ficas del pa&#237;s&#46; Por otra parte&#44; algunos individuos no presentaron un eritema con la dosis m&#225;xima administrada de UVA &#40;100<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; y para el an&#225;lisis de los datos se asumi&#243; un valor de la DEM de 120<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; lo que puede no corresponder a la DEM real de estos sujetos&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">En este estudio&#44; en el que se determin&#243; la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE en un grupo de colombianos con fototipos I-IV&#44; se encontr&#243; una superposici&#243;n de los valores de la DEM en los diferentes fototipos&#44; una correlaci&#243;n moderada a buena de esta con los fototipos&#44; y una muy buena correlaci&#243;n entre las mediciones visuales y por un m&#233;todo objetivo como es el Mexameter MX&#174;-18&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">El Hospital Universitario Centro Dermatol&#243;gico Federico Lleras Acosta &#40;Bogot&#225;&#44; Colombia&#41; fue la instituci&#243;n que aport&#243; los recursos econ&#243;micos para la realizaci&#243;n de este estudio&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes y objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La determinaci&#243;n de la dosis eritematosa m&#237;nima &#40;DEM&#41; es necesaria para el estudio de la fotosensibilidad cut&#225;nea&#44; debe determinarse en cada poblaci&#243;n&#44; dadas las diferencias gen&#233;ticas y las metodolog&#237;as utilizadas&#46; El objetivo de este estudio fue determinar la DEM en poblaci&#243;n colombiana&#44; su correlaci&#243;n con los fototipos y la concordancia de dos alternativas de medici&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Pacientes y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio de corte trasversal que incluy&#243; 113 personas en Bogot&#225; &#40;Colombia&#41;&#46; Se determin&#243; la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVA utilizando un simulador solar y para UVB de banda estrecha &#40;UVBBE&#41; con una cabina de fototerapia&#46; La evaluaci&#243;n se realiz&#243; visualmente y por Mexameter MX&#174;-18&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mediana de la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB fue de 22<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> para fototipos<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II y de 33 y 43<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> para fototipos<span class="elsevierStyleHsp" style=""></span>III y<span class="elsevierStyleHsp" style=""></span>IV&#44; respectivamente&#59; para UVA fue de 22&#44; 42&#44; 86 y 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> y para UVBBE de 390&#44; 550&#44; 770 y 885<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-IV&#44; respectivamente&#41;&#46; La correlaci&#243;n entre los fototipos y la DEM oscil&#243; entre 0&#44;5 y 0&#44;69&#46; El nivel de correlaci&#243;n-concordancia de LIN entre el m&#233;todo visual y el Mexameter fue superior a 0&#44;8 en todos los casos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este estudio permiti&#243; conocer los valores de DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE para los diferentes fototipos en la poblaci&#243;n colombiana&#44; y evidenci&#243; una correlaci&#243;n muy buena entre los m&#233;todos de medici&#243;n evaluados y una correlaci&#243;n moderada a buena entre la DEM y los fototipos&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The minimal erythema dose &#40;MED&#41;&#44; an essential measurement in studies of skin photosensitivity&#44; requires establishing MED values for specific populations&#44; given genetic variation&#46; Different ways to assess erythema are also relevant&#46; We aimed to determine MED values in a sample of Colombian patients and correlations between MED and Fitzpatrick skin type&#46; We also studied concordance correlation between MEDs and two alternative ways to assess erythema&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study of 113 individuals in Bogot&#225;&#44; Colombia&#46; We used a solar simulator to measure UV-A radiation and combined UV-A and UV-B &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#41; radiation&#44; o se podr&#237;a suprimir este t&#233;rmino porque UVA y UVB son t&#233;rminos conocidos for MED calculation&#46; Narrowband UV-B &#40;NBUVB&#41; radiation was measured in a phototherapy cabin&#46; Erythema was assessed visually and with a Mexameter MX 18 device&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The median MEDs of UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB radiation were 22<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> for Fitzpatrick skin types<span class="elsevierStyleHsp" style=""></span>I and<span class="elsevierStyleHsp" style=""></span>II&#44; and 33 and 43<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#44; respectively&#44; for types<span class="elsevierStyleHsp" style=""></span>III and<span class="elsevierStyleHsp" style=""></span>IV&#46; The MEDs of UV-A radiation were 22&#44; 42&#44; 86&#44; and 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> for types<span class="elsevierStyleHsp" style=""></span>I&#44; II&#44; III&#44; and<span class="elsevierStyleHsp" style=""></span>IV&#44; respectively&#46; The MEDs of NBUVB light were 390&#44; 550&#44; 770&#44; and 885<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> for the 4 skin types&#46; The correlation between MEDs and skin types ranged from 0&#46;5 to 0&#46;69&#46; Lin&#39;s concordance correlation coefficients between visual and Mexameter assessments of erythema were greater than 0&#46;8 in all cases&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This study allowed us to understand MED values for UV-A&#44; UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; and NBUVB according to different skin types in the Colombian population&#46; Concordance correlation coefficients between the different methods of erythema assessment were very good&#46; Correlations between MEDs and skin types were moderate to good&#46;</p></span>"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">a-c&#41;<span class="elsevierStyleHsp" style=""></span>Diagramas de caja y bigotes para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB &#40;MEDTOT&#41;&#44; UVA y UVBBE &#40;NBUVB&#41; para las DEM medidas por m&#233;todo visual y Mexameter MX&#174;-18 para los fototipos 1 al 4&#59; se aprecia el aumento progresivo de la mediana&#44; especialmente desde el fototipo 2 al 4&#46; d-f&#41;<span class="elsevierStyleHsp" style=""></span>Diagramas de correlaci&#243;n-concordancia entre los m&#233;todos visual y por Mexameter MX&#174;-18&#58; se observa una buena correlaci&#243;n para las diferentes longitudes de onda&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#47;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#47;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&#47;8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#47;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#47;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#47;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#47;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#47;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVBBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">390&#47;390&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#47;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">550&#47;550&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">380&#47;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">770&#47;590&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">420&#47;220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">885&#47;770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">330&#47;470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2352192.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Fototipos y DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE&#41; visual y por Mexameter</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Tipo de radiaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fototipo I</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fototipo II</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fototipo III</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fototipo IV</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">498&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">225&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">275&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Sitio irradiado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">India<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Asi&#225;ticos australianos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a></td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="3" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " rowspan="4" align="left" valign="\n
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                  \t\t\t\t">Colombia &#40;este estudio&#41;</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2352193.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Valores promedio de la DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#41; en los estudios realizados con simulador solar</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Pa&#237;s&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Fototipo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DEM UVB</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sitio irradiado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">mJ&#47;cm<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Corea<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Singapur<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gl&#250;teo</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reino Unido<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gl&#250;teo</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Dosis eritematosa mínima: correlación con el fototipo y método de medición en una muestra de población colombiana
Minimal Erythema Dose: Correlation with Fitzpatrick Skin Type and Concordance Between Methods of Erythema Assessment in a Patient Sample in Colombia
M.C. Valbuena Mesaa,
Corresponding author
marvalbuen@yahoo.com

Autor para correspondencia.
, J.A. Nova Villanuevaa, G. Sánchez Vanegasb
a Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia
b Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n de la sensibilidad de la piel a la radiaci&#243;n ultravioleta &#40;RUV&#41; es fundamental para el estudio de la fotosensibilidad cut&#225;nea&#44; lo que es crucial para las fotodermatosis&#44; la fotocarcinog&#233;nesis&#44; la fotoprotecci&#243;n y el uso de la fototerapia<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Una de las pruebas que se utiliza con mayor frecuencia para medir dicha sensibilidad es la determinaci&#243;n de la dosis eritematosa m&#237;nima &#40;DEM&#41;&#44; que se define como la m&#237;nima dosis de RUV capaz de inducir un eritema perceptible en la piel&#44; y usualmente se eval&#250;a 24<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de la irradiaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La detecci&#243;n visual de la DEM es subjetiva y su valor puede verse afectado por diferentes factores&#44; como la fuente de luz&#44; los incrementos realizados&#44; el &#225;rea irradiada&#44; la exposici&#243;n previa a la RUV&#44; la definici&#243;n de la DEM&#44; la temperatura de la piel y la variabilidad intraobservador e interobservador<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">2</span></a>&#46; Adem&#225;s&#44; las diferencias &#233;tnicas influyen en la variabilidad de la detecci&#243;n de la DEM&#44; por lo que se requiere la validaci&#243;n de la medici&#243;n de esta en cada poblaci&#243;n&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Existen m&#233;todos indirectos que valoran la posible sensibilidad de un individuo frente a la RUV sin necesidad de la determinaci&#243;n de la DEM&#44; y entre ellos el m&#225;s utilizado es la escala de fototipos de Fitzpatrick<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#46; La fiabilidad y la validez de este sistema se han cuestionado&#44; principalmente por su subjetividad y por el sesgo de memoria<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;6&#44;7</span></a>&#46; Sin embargo&#44; S&#225;nchez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">8</span></a> sugieren que esta escala puede ser fiable en la medida en que se realice una estandarizaci&#243;n de la metodolog&#237;a de evaluaci&#243;n de la misma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En varios pa&#237;ses se ha determinado la DEM teniendo en cuenta el fototipo&#44; y algunos estudios han mostrado que no existe una buena correlaci&#243;n entre estas variables<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;9-12</span></a>&#46; En Colombia solo hay una publicaci&#243;n realizada en poblaci&#243;n escolar que no encontr&#243; correlaci&#243;n entre la DEM para UVB y el fototipo<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Para la medici&#243;n m&#225;s objetiva del eritema cut&#225;neo se han utilizado diferentes instrumentos&#44; entre ellos el color&#237;metro triest&#237;mulo &#40;crom&#225;metro&#41; y el espectrofot&#243;metro de reflectancia simple de banda estrecha &#40;Mexameter MX&#174;-18&#41;&#44; que muestran una buena correlaci&#243;n con la evaluaci&#243;n visual<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue determinar la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVB de banda estrecha &#40;UVBBE&#41;&#44; en un grupo de individuos colombianos de diferentes fototipos&#44; y el grado de correlaci&#243;n existente entre la DEM y los fototipos&#44; as&#237; como establecer el nivel de correlaci&#243;n-concordancia entre dos m&#233;todos de medici&#243;n&#58; visual vs&#46; Mexameter MX&#174;-18&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dise&#241;o&#44; poblaci&#243;n y muestra</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de corte transversal para evaluar la sensibilidad de la piel a la RUV en t&#233;rminos de los valores de la DEM en una muestra de poblaci&#243;n colombiana y la correlaci&#243;n-concordancia de dos m&#233;todos de medici&#243;n de la DEM&#58; visual y por Mexameter MX&#174;-18 &#40;Courage Khazaka Electronic&#44; K&#246;ln&#44; Alemania&#41;&#46; El Mexameter MX&#174;-18 es un espectrofot&#243;metro que mide la absorci&#243;n de la luz a dos longitudes de onda&#44; 568<span class="elsevierStyleHsp" style=""></span>nm para la hemoglobina y 660<span class="elsevierStyleHsp" style=""></span>nm para la melanina&#44; que arroja como resultado un &#237;ndice de eritema y un &#237;ndice de melanina&#46; Se efectu&#243; un muestreo secuencial por conveniencia&#44; incluyendo sujetos sanos&#44; mayores de 18<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; quienes asistieron al Hospital Universitario Centro Dermatol&#243;gico Federico Lleras Acosta en Bogot&#225; &#40;Colombia&#41; y otorgaron su consentimiento para participar en el estudio&#46; Se excluyeron los pacientes que refer&#237;an estar en tratamiento con alg&#250;n tipo de medicaci&#243;n sist&#233;mica fotosensibilizante durante los 2<span class="elsevierStyleHsp" style=""></span>meses previos al inicio del estudio&#44; que hab&#237;an usado corticoides t&#243;picos durante los 8<span class="elsevierStyleHsp" style=""></span>d&#237;as previos o tomado antihistam&#237;nicos orales 2<span class="elsevierStyleHsp" style=""></span>d&#237;as antes&#44; los que ten&#237;an una historia personal o familiar de fotosensibilidad&#44; los que hubieran estado expuestos a la radiaci&#243;n solar natural o artificial de la piel de la espalda durante las 6<span class="elsevierStyleHsp" style=""></span>semanas previas al estudio&#44; as&#237; como los extranjeros o hijos de padres extranjeros&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para el c&#225;lculo del tama&#241;o de la muestra se emple&#243; la f&#243;rmula propuesta para la estimaci&#243;n de correlaci&#243;n y concordancia en estudios de corte transversal&#44; que emplea datos ordinales y continuos<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a>&#44; teniendo en cuenta un valor alfa de 0&#44;05&#44; una precisi&#243;n esperada del 10&#37; y un coeficiente de correlaci&#243;n del 0&#44;8 &#40;basado en un estudio piloto desarrollado por los investigadores&#41;&#46; Con base en lo anterior se calcul&#243; un tama&#241;o de muestra de 75 individuos&#44; en quienes se les deb&#237;a determinar la DEM para UVA&#44; UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVBBE&#44; y luego evaluar las dos t&#233;cnicas de medici&#243;n de la DEM&#46; Todos los procedimientos del estudio fueron aprobados por el comit&#233; de &#233;tica en investigaci&#243;n institucional y siguieron todas las recomendaciones establecidas por la declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedimiento de evaluaci&#243;n de la DEM</span><p id="par0045" class="elsevierStylePara elsevierViewall">Cada sujeto fue evaluado con la escala de fototipos de Fitzpatrick<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#46; Posteriormente se irradi&#243; la piel de la espalda con dosis crecientes en 20&#37; de UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-II&#58; 15-43<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> y fototipos<span class="elsevierStyleHsp" style=""></span>III-IV&#58; 30-72<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; UVA &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-II&#58; 20-50<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> y fototipos<span class="elsevierStyleHsp" style=""></span>III-IV&#58; 42-100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#41; y UVBBE &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-II&#58; 50-550<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> y fototipos<span class="elsevierStyleHsp" style=""></span>III-IV&#58; 100-970<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#46; Para administrar UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVA se utiliz&#243; el simulador solar &#171;Solar Light multiport&#187; modelo 601&#44; de 300<span class="elsevierStyleHsp" style=""></span>mw &#40;Glenside&#44; Pennsylvania&#44; Estados Unidos&#41;&#44; que tiene 6<span class="elsevierStyleHsp" style=""></span>gu&#237;as l&#237;quidas de 9<span class="elsevierStyleHsp" style=""></span>mm&#46; Para la UVBBE se utiliz&#243; la cabina de fototerapia Daavlin 305&#47;350 &#40;Bryan&#44; Ohio&#44; Estados Unidos&#41;&#44; con una potencia de 4&#44;3<span class="elsevierStyleHsp" style=""></span>mw&#47;cm<span class="elsevierStyleSup">2</span> a una distancia de 15<span class="elsevierStyleHsp" style=""></span>cm&#44; colocando un molde de pl&#225;stico blanco de 4<span class="elsevierStyleHsp" style=""></span>capas con 8<span class="elsevierStyleHsp" style=""></span>campos&#44; cada uno de 1<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">2</span>&#44; sobre la piel de la espalda y cubriendo el resto de la piel del cuerpo y de la cara con tela gruesa que no permitiera el paso de la RUV&#44; adem&#225;s de gafas de fotoprotecci&#243;n&#46; Las dosis de radiaci&#243;n fueron medidas con el dos&#237;metro PMA-2100 y sus respectivos detectores &#40;SUV PMA2103 y UVA PMA2113&#41; para el simulador solar&#44; calibrados por Solar Light&#44; y con el radi&#243;metro IL-1700 y su detector para UVB de banda estrecha &#40;International Light&#44; Newburyport&#44; MA&#44; Estados Unidos&#41; para la cabina de fototerapia&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">La lectura de la DEM se realiz&#243; 24<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de la irradiaci&#243;n&#44; teniendo en cuenta la dosis m&#237;nima de radiaci&#243;n con la que se obtuvo un eritema m&#237;nimo perceptible&#46; Dos observadores entrenados realizaron las lecturas&#58; visual y por Mexameter MX&#174;-18&#46; Para la medici&#243;n con el Mexameter MX&#174;-18 se realizaron 3 lecturas apoyando la pieza de mano en la piel no irradiada y 3 lecturas por cada campo irradiado&#44; de las cuales se obtuvo el promedio&#59; si no se obten&#237;a eritema se repet&#237;a el procedimiento con dosis mayores en aumento geom&#233;trico&#46; El valor de la DEM por el Mexameter MX&#174;-18 fue determinada por un f&#237;sico y correspondi&#243; a la dosis con la cual se obtuvo la m&#225;xima pendiente de las curvas dosis-respuesta para cada individuo&#44; seg&#250;n la metodolog&#237;a previamente publicada<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a>&#46; La dosis m&#225;xima de UVA que se pudo administrar con el simulador solar fue de 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#59; a efectos del an&#225;lisis&#44; a las personas que no presentaron eritema con esa dosis se les asign&#243; de forma arbitraria un valor de DEM de 120<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Para cada una de las variables se realizaron an&#225;lisis descriptivos empleando las medidas estad&#237;sticas de resumen m&#225;s apropiadas&#46; En el caso de las variables categ&#243;ricas&#44; se resumi&#243; la informaci&#243;n en tablas de frecuencia con valores absolutos y relativos &#40;sexo y fototipo&#41;&#46; Para la DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE&#44; mediciones visuales y por Mexameter MX&#174;-18&#41;&#44; dado que los datos no presentaron distribuci&#243;n normal&#44; se emple&#243; la mediana y el rango intercuart&#237;lico &#40;RIC&#58; diferencia entre el p75 y el p25&#41;&#46; La correlaci&#243;n entre el fototipo y la medici&#243;n de la DEM&#44; en sus diferentes modalidades&#44; se evalu&#243; mediante el coeficiente de correlaci&#243;n de Spearman&#44; con su respectivo intervalo de confianza del 95&#37; y su valor<span class="elsevierStyleHsp" style=""></span>p&#46; Adicionalmente&#44; para evaluar el nivel de correlaci&#243;n-concordancia entre las diferentes mediciones de la DEM&#44; se emple&#243; el estad&#237;stico de correlaci&#243;n-concordancia de LIN&#44; reportado con su intervalo de confianza del 95&#37; y valor<span class="elsevierStyleHsp" style=""></span>p&#46; Los an&#225;lisis se realizaron en el software estad&#237;stico Stata 14&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se incluyeron en el estudio 113 sujetos&#44; con una edad mediana de 27<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;RIC&#58; 18-56<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#44; de los cuales el 66&#37; eran mujeres&#46; No hubo individuos de fototipos<span class="elsevierStyleHsp" style=""></span>V y<span class="elsevierStyleHsp" style=""></span>VI&#46; En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> se registra el n&#250;mero total de individuos y su distribuci&#243;n por fototipo&#46; En 111 sujetos se evalu&#243; la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVBBE&#44; y solo en 91 individuos para UVA&#44; debido a dificultades para permanecer el tiempo que demandaba la prueba&#46; En 21 de los 91 no se observ&#243; eritema con la dosis m&#225;xima de UVA administrada&#44; 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> &#40;3 fueron fototipo<span class="elsevierStyleHsp" style=""></span>II&#44; 7 fototipo<span class="elsevierStyleHsp" style=""></span>III y 11 fototipo<span class="elsevierStyleHsp" style=""></span>IV&#41;&#44; y en 14 sujetos el Mexameter MX&#174;-18 no detect&#243; eritema &#40;uno fototipo<span class="elsevierStyleHsp" style=""></span>II&#44; 7 fototipo<span class="elsevierStyleHsp" style=""></span>III y 6 fototipo<span class="elsevierStyleHsp" style=""></span>IV&#41;&#46; El comportamiento de la mediana de la DEM y su respectivo rango intercuart&#237;lico por fototipo y m&#233;todo de medici&#243;n se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>a-c&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Para poder comparar los resultados con las publicaciones sobre el tema se determin&#243; la media de la DEM evaluada visualmente&#44; a pesar de que la muestra no observ&#243; distribuci&#243;n normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Correlaci&#243;n entre los fototipos y la DEM</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se evalu&#243; la correlaci&#243;n entre los fototipos con cada una de las mediciones de la DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA&#44; UVBBE&#41;&#44; tanto en la alternativa visual como con el Mexameter MX&#174;-18&#46; Se encontr&#243; una correlaci&#243;n que oscil&#243; entre 0&#44;5 y 0&#44;69&#46; Las correlaciones m&#225;s bajas fueron las registradas para la UVBBE&#44; tanto visual como con el Mexameter MX&#174;-18 &#40;0&#44;5 y 0&#44;53&#44; respectivamente&#41;&#46; El detalle del coeficiente de correlaci&#243;n obtenido para cada medici&#243;n y su respectivo valor de<span class="elsevierStyleHsp" style=""></span>p se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Correlaci&#243;n-concordancia entre la DEM visual y por Mexameter MX&#174;-18</span><p id="par0075" class="elsevierStylePara elsevierViewall">Se estim&#243; el nivel de correlaci&#243;n-concordancia entre cada una de las mediciones de la DEM&#44; comparando la alternativa visual con el Mexameter MX&#174;-18&#46; En todos los casos el coeficiente de LIN fue superior a 0&#44;8 &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>d-f&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">En este estudio se determin&#243; la DEM para UVA&#44; UVBBE y UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB en una muestra de poblaci&#243;n colombiana&#46; En las investigaciones realizadas utilizando un simulador solar el valor promedio de la DEM de UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB para los diferentes fototipos var&#237;a&#59; sin embargo&#44; el valor para los fototipos<span class="elsevierStyleHsp" style=""></span>I al<span class="elsevierStyleHsp" style=""></span>IV de la poblaci&#243;n de este estudio fue similar a los datos publicados por P&#233;rez-Ferriols et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> en Espa&#241;a&#44; probablemente debido a que nuestra poblaci&#243;n comparte genes espa&#241;oles por el mestizaje<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a>&#46; En un estudio realizado en la India&#44; el valor promedio de la DEM para el fototipo<span class="elsevierStyleHsp" style=""></span>IV fue similar a los resultados para este fototipo en Espa&#241;a y en el presente estudio<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a>&#46; Para el fototipo<span class="elsevierStyleHsp" style=""></span>III el promedio de la DEM fue similar en los asi&#225;ticos australianos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&#44; espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> y colombianos&#46; En poblaci&#243;n china los valores promedio de la DEM de acuerdo con el fototipo son m&#225;s altos<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a>&#44; y es posible que esto se deba a que el estudio se realiz&#243; en la piel del gl&#250;teo&#44; que tiene una sensibilidad menor a la de la espalda<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9&#44;22</span></a>&#44; y a las diferencias gen&#233;ticas &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El valor promedio de la DEM para los fototipos<span class="elsevierStyleHsp" style=""></span>I-IV en los estudios realizados con otras fuentes de UVB &#40;l&#225;mparas fluorescentes UVB&#41;&#44; en Brasil<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a>&#44; en Estados Unidos<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">23</span></a> y para algunos fototipos en el Reino Unido<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> es similar al de nuestra poblaci&#243;n para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#46; En contraste&#44; los valores promedio de la DEM en Corea<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a>&#44; y especialmente en Singapur<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a>&#44; son mucho m&#225;s altos para los mismos fototipos &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46; Las diferencias podr&#237;an explicarse por la variabilidad gen&#233;tica y debido a que en el estudio de Singapur se irradi&#243; la piel del gl&#250;teo&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Si se comparan los resultados del presente estudio con el de Medell&#237;n &#40;Colombia&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">12</span></a>&#44; en este &#250;ltimo se observa un mayor valor promedio de la DEM por fototipo&#44; lo que podr&#237;a obedecer a que se utiliz&#243; como definici&#243;n de la DEM la m&#237;nima dosis que produc&#237;a eritema con bordes bien definidos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En la literatura revisada se encontraron pocas publicaciones acerca de los valores de la DEM de UVA&#44; quiz&#225; por la dificultad de disponer de una fuente de RUV que emita dosis altas de UVA en per&#237;odos cortos de tiempo&#46; Al comparar las medianas de la DEM de UVA del presente estudio con los rangos obtenidos por Fitzpatrick<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a>&#44; los valores en J&#47;cm<span class="elsevierStyleSup">2</span> son similares para los fototipos<span class="elsevierStyleHsp" style=""></span>I &#40;22 vs&#46; 20-35&#41; y<span class="elsevierStyleHsp" style=""></span>II &#40;42 vs&#46; 30-35&#41;&#44; pero son m&#225;s altos para los fototipos<span class="elsevierStyleHsp" style=""></span>III &#40;86 vs&#46; 40-55&#41; y<span class="elsevierStyleHsp" style=""></span>IV &#40;100 vs&#46; 50-80&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Con relaci&#243;n a la UVBBE&#44; los valores promedio de la DEM en poblaci&#243;n espa&#241;ola<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> &#40;obtenidos a partir de la aplicaci&#243;n de un factor de conversi&#243;n a los resultados de la DEM para UVB&#41; son similares a los del presente estudio para todos los fototipos&#46; En Detroit&#44; Carretero-Mangolis y Lim<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> reportan que la mediana de la DEM para fototipos<span class="elsevierStyleHsp" style=""></span>I-II fue de 600<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> y la de los fototipos<span class="elsevierStyleHsp" style=""></span>III-IV de 700<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#44; valores an&#225;logos a los del presente estudio&#58; 550 y 770<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#44; respectivamente&#46; En 352 pacientes con psoriasis en el Reino Unido los valores de la mediana de la DEM por fototipo fueron menores&#58; 200&#44; 280&#44; 390 y 550<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-IV&#44; respectivamente&#41;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Consistente con lo publicado por otros autores<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;11&#44;12&#44;24</span></a>&#44; evidenciamos que hay una tendencia al aumento de la DEM a medida que aumenta el fototipo&#46; Sin embargo&#44; la escala de fototipos de Fitzpatrick no es suficiente para hacer una buena discriminaci&#243;n&#46; De hecho&#44; los valores de la DEM de UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE se superponen en los diferentes fototipos&#44; de modo que dos personas podr&#237;an tener el mismo valor de la DEM aun perteneciendo a distintos fototipos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">2&#44;6&#44;25&#44;27&#44;28</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Algunos autores han establecido que no existe correlaci&#243;n entre la DEM y el fototipo<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;9&#44;12&#44;29</span></a> y otros s&#237; la encuentran<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;24&#44;30&#44;31</span></a>&#46; El presente estudio explor&#243; esta relaci&#243;n y encontr&#243; una correlaci&#243;n catalogada como buena para UVA y UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y moderada para UVBBE&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La correlaci&#243;n-concordancia entre las mediciones de la DEM visual y por Mexameter MX&#174;-18 fue muy buena para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE&#44; como se ha evidenciado en algunos estudios<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#44;14</span></a>&#46; Teniendo en cuenta los resultados&#44; las dos formas de medici&#243;n son intercambiables&#44; por lo que la determinaci&#243;n visual sigue siendo muy &#250;til en la pr&#225;ctica cl&#237;nica&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Dentro de las limitaciones del presente estudio tenemos que la muestra es peque&#241;a&#44; especialmente para el fototipo<span class="elsevierStyleHsp" style=""></span>I&#44; y no es representativa de toda la poblaci&#243;n colombiana puesto que no fue posible incluir individuos con fototipos<span class="elsevierStyleHsp" style=""></span>V y<span class="elsevierStyleHsp" style=""></span>VI&#44; que se encuentran en otras regiones geogr&#225;ficas del pa&#237;s&#46; Por otra parte&#44; algunos individuos no presentaron un eritema con la dosis m&#225;xima administrada de UVA &#40;100<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#41;&#44; y para el an&#225;lisis de los datos se asumi&#243; un valor de la DEM de 120<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span>&#44; lo que puede no corresponder a la DEM real de estos sujetos&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusi&#243;n</span><p id="par0125" class="elsevierStylePara elsevierViewall">En este estudio&#44; en el que se determin&#243; la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE en un grupo de colombianos con fototipos I-IV&#44; se encontr&#243; una superposici&#243;n de los valores de la DEM en los diferentes fototipos&#44; una correlaci&#243;n moderada a buena de esta con los fototipos&#44; y una muy buena correlaci&#243;n entre las mediciones visuales y por un m&#233;todo objetivo como es el Mexameter MX&#174;-18&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financiaci&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">El Hospital Universitario Centro Dermatol&#243;gico Federico Lleras Acosta &#40;Bogot&#225;&#44; Colombia&#41; fue la instituci&#243;n que aport&#243; los recursos econ&#243;micos para la realizaci&#243;n de este estudio&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes y objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La determinaci&#243;n de la dosis eritematosa m&#237;nima &#40;DEM&#41; es necesaria para el estudio de la fotosensibilidad cut&#225;nea&#44; debe determinarse en cada poblaci&#243;n&#44; dadas las diferencias gen&#233;ticas y las metodolog&#237;as utilizadas&#46; El objetivo de este estudio fue determinar la DEM en poblaci&#243;n colombiana&#44; su correlaci&#243;n con los fototipos y la concordancia de dos alternativas de medici&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Pacientes y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio de corte trasversal que incluy&#243; 113 personas en Bogot&#225; &#40;Colombia&#41;&#46; Se determin&#243; la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB y UVA utilizando un simulador solar y para UVB de banda estrecha &#40;UVBBE&#41; con una cabina de fototerapia&#46; La evaluaci&#243;n se realiz&#243; visualmente y por Mexameter MX&#174;-18&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mediana de la DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB fue de 22<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> para fototipos<span class="elsevierStyleHsp" style=""></span>I y<span class="elsevierStyleHsp" style=""></span>II y de 33 y 43<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> para fototipos<span class="elsevierStyleHsp" style=""></span>III y<span class="elsevierStyleHsp" style=""></span>IV&#44; respectivamente&#59; para UVA fue de 22&#44; 42&#44; 86 y 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> y para UVBBE de 390&#44; 550&#44; 770 y 885<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> &#40;fototipos<span class="elsevierStyleHsp" style=""></span>I-IV&#44; respectivamente&#41;&#46; La correlaci&#243;n entre los fototipos y la DEM oscil&#243; entre 0&#44;5 y 0&#44;69&#46; El nivel de correlaci&#243;n-concordancia de LIN entre el m&#233;todo visual y el Mexameter fue superior a 0&#44;8 en todos los casos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este estudio permiti&#243; conocer los valores de DEM para UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; UVA y UVBBE para los diferentes fototipos en la poblaci&#243;n colombiana&#44; y evidenci&#243; una correlaci&#243;n muy buena entre los m&#233;todos de medici&#243;n evaluados y una correlaci&#243;n moderada a buena entre la DEM y los fototipos&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The minimal erythema dose &#40;MED&#41;&#44; an essential measurement in studies of skin photosensitivity&#44; requires establishing MED values for specific populations&#44; given genetic variation&#46; Different ways to assess erythema are also relevant&#46; We aimed to determine MED values in a sample of Colombian patients and correlations between MED and Fitzpatrick skin type&#46; We also studied concordance correlation between MEDs and two alternative ways to assess erythema&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study of 113 individuals in Bogot&#225;&#44; Colombia&#46; We used a solar simulator to measure UV-A radiation and combined UV-A and UV-B &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#41; radiation&#44; o se podr&#237;a suprimir este t&#233;rmino porque UVA y UVB son t&#233;rminos conocidos for MED calculation&#46; Narrowband UV-B &#40;NBUVB&#41; radiation was measured in a phototherapy cabin&#46; Erythema was assessed visually and with a Mexameter MX 18 device&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The median MEDs of UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB radiation were 22<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> for Fitzpatrick skin types<span class="elsevierStyleHsp" style=""></span>I and<span class="elsevierStyleHsp" style=""></span>II&#44; and 33 and 43<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span>&#44; respectively&#44; for types<span class="elsevierStyleHsp" style=""></span>III and<span class="elsevierStyleHsp" style=""></span>IV&#46; The MEDs of UV-A radiation were 22&#44; 42&#44; 86&#44; and 100<span class="elsevierStyleHsp" style=""></span>J&#47;cm<span class="elsevierStyleSup">2</span> for types<span class="elsevierStyleHsp" style=""></span>I&#44; II&#44; III&#44; and<span class="elsevierStyleHsp" style=""></span>IV&#44; respectively&#46; The MEDs of NBUVB light were 390&#44; 550&#44; 770&#44; and 885<span class="elsevierStyleHsp" style=""></span>mJ&#47;cm<span class="elsevierStyleSup">2</span> for the 4 skin types&#46; The correlation between MEDs and skin types ranged from 0&#46;5 to 0&#46;69&#46; Lin&#39;s concordance correlation coefficients between visual and Mexameter assessments of erythema were greater than 0&#46;8 in all cases&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This study allowed us to understand MED values for UV-A&#44; UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#44; and NBUVB according to different skin types in the Colombian population&#46; Concordance correlation coefficients between the different methods of erythema assessment were very good&#46; Correlations between MEDs and skin types were moderate to good&#46;</p></span>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
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                  \t\t\t\t" scope="col">Tipo de radiaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MedianaVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQVIS&#47;MEX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#47;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#47;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">UVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22&#47;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;5&#47;8&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#47;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#47;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#47;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#47;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#47;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UVBBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">390&#47;390&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">160&#47;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">770&#47;590&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">420&#47;220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">885&#47;770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">330&#47;470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Media&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">India<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gl&#250;teo</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asi&#225;ticos australianos<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda o gl&#250;teo</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Colombia &#40;este estudio&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2352193.png"
              ]
            ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Valores promedio de la DEM &#40;UVA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>UVB&#41; en los estudios realizados con simulador solar</p>"
        ]
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      7 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabla 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
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        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">72&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Singapur<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gl&#250;teo</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " rowspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reino Unido<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a></td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Espalda</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">III&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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ISSN: 00017310
Original language: Spanish
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