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        "titulo" => "Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy&#58; Current Situation and Trends"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Variaci&#243;n por a&#241;os de los al&#233;rgenos con sensibilizaci&#243;n global en los a&#241;os de estudio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#37;&#44; tanto en la poblaci&#243;n total como diferenciada por sexos&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El Registro Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea &#40;REIDAC&#41; tiene entre sus objetivos la vigilancia epidemiol&#243;gica de la dermatitis de contacto&#46; Para ello&#44; resulta fundamental conocer si se producen alteraciones de las prevalencias de las positividades a los distintos al&#233;rgenos en el tiempo<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Las pruebas epicut&#225;neas constituyen el m&#233;todo fundamental para detectar la sensibilizaci&#243;n a al&#233;rgenos de contacto&#44; resultando una herramienta esencial para el diagn&#243;stico de una dermatitis al&#233;rgica de contacto &#40;DAC&#41;&#46; El estudio de cualquier paciente con sospecha de DAC debe incluir una bater&#237;a est&#225;ndar nacional o internacional de pruebas epicut&#225;neas y&#44; opcionalmente&#44; una o m&#225;s bater&#237;as espec&#237;ficas&#44; pudi&#233;ndose tambi&#233;n incluir los productos propios del paciente<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La bater&#237;a est&#225;ndar espa&#241;ola es una bater&#237;a din&#225;mica que se actualiza peri&#243;dicamente por los miembros del Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea &#40;GEIDAC&#41;&#46; Para ello se tienen en cuenta diferentes criterios&#44; tales como la frecuencia de sensibilizaci&#243;n &#40;superior al 0&#44;5-1&#37;&#41;&#44; as&#237; como otras caracter&#237;sticas como que se trate de al&#233;rgenos emergentes en literatura dermatol&#243;gica o pa&#237;ses colindantes&#44; o que tengan especial importancia para un grupo de pacientes o &#225;mbito de exposici&#243;n&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de nuestro trabajo es describir las variaciones en las tendencias temporales en positividades a al&#233;rgenos en la serie est&#225;ndar del GEIDAC en el periodo comprendido entre 2018 y el 31 de diciembre de 2022&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">El REIDAC recoge&#44; de forma prospectiva&#44; los resultados de todos los pacientes parcheados de forma consecutiva en los centros participantes&#46; Los datos son anonimizados en origen y el registro cumple con todos los est&#225;ndares &#233;ticos en materia de consentimiento informado y legislaci&#243;n de protecci&#243;n de datos&#46; En el registro se recogen de forma sucesiva&#44; adem&#225;s de las positividades y relevancias presentes&#44; las variables epidemiol&#243;gicas&#44; cl&#237;nicas y al&#233;rgicas de los pacientes a los que se les realizaron pruebas epicut&#225;neas en los centros incluidos durante este periodo&#44; incluyendo los datos necesarios para obtener el &#237;ndice Male&#44; Occupational dermatitis&#44; Atopic dermatitis&#44; Hand dermatitis&#44; Leg dermatitis&#44; Facial dermatitis&#44; Age<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40 years &#40;MOAHLFA&#41;&#46; En este estudio hemos utilizado los datos desde el 2018 hasta el 31 de diciembre de 2022<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Las pruebas epicut&#225;neas se realizaron siguiendo las recomendaciones de la European Society of Contact Dermatitis<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a>&#44; consider&#225;ndose positivas las lecturas &#40;&#43;&#41;&#44; &#40;&#43;&#43;&#41; o &#40;&#43;&#43;&#43;&#41;&#46; Se determin&#243; la relevancia de acuerdo con la historia cl&#237;nica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La &#250;ltima actualizaci&#243;n de la bater&#237;a est&#225;ndar del GEIDAC data de enero de 2022&#59; en ella se incluyeron 4 nuevos al&#233;rgenos &#40;hidroxietil metacrilato&#44; mezcla de colorantes textiles&#44; hidroper&#243;xidos de linalool e hidroper&#243;xidos de limoneno&#41; y se eliminaron 3 &#40;dihidrocloruro de etilendiamina&#44; metildibromoglutaronitrilo e hydroxyisohexyl-3-cyclohexene-carboxaldehyde&#41;&#44; que no han sido incluidos en el estudio actual<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo del &#237;ndice MOAHLFA&#44; as&#237; como de la prevalencia de cada al&#233;rgeno&#44; y se compar&#243; su distribuci&#243;n a lo largo de los a&#241;os&#46; Los resultados se mostraron gr&#225;ficamente&#46; Las comparaciones de homogeneidad se realizaron mediante la prueba de &#967;<span class="elsevierStyleSup">2</span> y la de tendencia lineal mediante pruebas de tendencia lineal para scores&#46; Para el an&#225;lisis de tendencia se obtuvieron valores de p crudos y ajustados por el MOAHLFA&#46; Tambi&#233;n se present&#243; la prevalencia de cada al&#233;rgeno de la bater&#237;a estandarizado por edad y sexo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se realizaron con STATA v&#46;17&#46;0 &#40;Stata Corp&#46; 2021&#46; Stata Statistical Software&#58; Release 17&#41;&#46; Se consider&#243; estad&#237;sticamente significativo un valor de p &#40;ajustado con la correcci&#243;n de Bonferroni para comparaciones m&#250;ltiples&#41; inferior a 0&#44;0016&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">REIDAC fue aprobado por el Comit&#233; de &#201;tica del Complejo Hospitalario Universitario Insular-Materno Infantil &#40;2017&#47;964&#41; y su funcionamiento cumple con la Declaraci&#243;n de Helsinki&#46; Todos los pacientes firmaron el consentimiento informado para participar&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">El n&#250;mero total de pacientes incluidos en el REIDAC durante el periodo de estudio fue de 11&#46;327&#46; La distribuci&#243;n por a&#241;os de dicha poblaci&#243;n&#44; as&#237; como la descripci&#243;n del &#237;ndice MOAHLFA por a&#241;o de esta&#44; se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Aunque hay diferencias estad&#237;sticamente significativas en algunas de las variables&#44; condicionadas por el gran tama&#241;o muestral&#44; estas son cl&#237;nicamente poco relevantes y&#44; al ajustar los valores por esas diferencias&#44; no hay cambios en las tendencias&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se representa el total de positivos a los diferentes al&#233;rgenos en la serie est&#225;ndar del GEIDAC en los pacientes estudiados en el global de a&#241;os de estudio&#44; tanto en el total de la poblaci&#243;n estudiado como diferenciando por sexos&#44; estandarizada por sexo y edad&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Como puede observarse&#44; los al&#233;rgenos que mostraron una frecuencia de sensibilizaci&#243;n global mayor durante el periodo de estudio fueron sulfato de n&#237;quel&#44; metilisotiazolinona&#44; cloruro de cobalto&#44; metilcloroisotiazolinona&#47;metilisotiazolinona &#40;MCI&#47;MI&#41; y mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Encontramos algunas diferencias respecto al sexo&#59; as&#237;&#44; mientras para las mujeres&#44; los al&#233;rgenos m&#225;s frecuentemente positivos son el sulfato de n&#237;quel&#44; la metilisotiazolinona&#44; el cloruro de cobalto&#44; la MCI&#47;MI&#44; la mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span> y la parafenilendiamina &#40;PPD&#41;&#44; en el var&#243;n ser&#237;an el sulfato de n&#237;quel&#44; la MCI&#47;MI y el dicromato pot&#225;sico&#44; encontrando as&#237; menor sensibilizaci&#243;n a PPD en varones que en mujeres &#40;2&#44;31 vs&#46; 3&#44;31&#41;&#44; y una mayor sensibilizaci&#243;n al dicromato pot&#225;sico &#40;4&#44;7 vs&#46; 2&#44;38&#41;&#44; entre otras diferencias&#46; La frecuencia de sensibilizaci&#243;n de los al&#233;rgenos incorporados en enero de 2022 en los pacientes estudiados fue del 4&#44;44&#37; para el hidroxietil metacrilato&#44; del 2&#44;58&#37; para la mezcla de colorantes textiles&#44; del 4&#44;59&#37; en el caso de hidroper&#243;xidos de linalool y del 3&#44;92&#37; para hidroper&#243;xidos de limoneno&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> podemos ver el porcentaje de positividades de los diferentes al&#233;rgenos incluidos en la serie est&#225;ndar del GEIDAC en los diferentes a&#241;os de estudio&#46; Se incluyen al final de dicha tabla los al&#233;rgenos incluidos recientemente en la bater&#237;a est&#225;ndar del GEIDAC&#59; dado que en los primeros a&#241;os no se parchearon de forma sistem&#225;tica y&#44; por tanto&#44; se estudiaron en un n&#250;mero mucho menor de pacientes&#44; no se han incluido en el estudio de las tendencias&#44; no incluyendo en la tabla los datos de estos previos a su inclusi&#243;n en el 2022&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Podemos observar c&#243;mo el porcentaje de positividades de metilisotiazolinona baja con el tiempo&#44; con una tendencia ordenada&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Podemos ver representada en las siguientes figuras la variaci&#243;n por porcentaje de positividades de los diferentes al&#233;rgenos durante los a&#241;os de estudio&#44; de forma global y diferenciada por sexos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> aparecen representados los al&#233;rgenos con una sensibilizaci&#243;n superior al 4&#37; &#40;sulfato de n&#237;quel&#44; metilisotiazolinona&#44; cloruro de cobalto&#44; MCI&#47;MI&#44; mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los al&#233;rgenos que mostraron una frecuencia de sensibilizaci&#243;n global durante el periodo de estudio de entre un 1-4&#37; fueron PPD&#44; mezcla de fragancias <span class="elsevierStyleSmallCaps">ii</span>&#44; b&#225;lsamo de Per&#250;&#44; dicromato pot&#225;sico&#44; formaldeh&#237;do&#44; mezcla de carbas&#44; mezcla de tiuranes&#44; resina de p-tert-butilfenol-formaldeh&#237;do y colofonia&#44; apareciendo representados en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se representa la variaci&#243;n por porcentaje de positividades a lo largo de los a&#241;os del resto de los al&#233;rgenos&#44; los cuales mostraron una frecuencia de sensibilizaci&#243;n cada uno de ellos de forma global<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#37;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">La vigilancia epidemiol&#243;gica en dermatitis de contacto resulta fundamental para conocer las variaciones que se producen a lo largo de los a&#241;os en las sensibilizaciones a los diferentes al&#233;rgenos&#44; permitiendo as&#237; aplicar medidas adecuadas para su evitaci&#243;n tanto a nivel individual como comunitario&#46; En Espa&#241;a&#44; dicha vigilancia est&#225; entre los objetivos del REIDAC&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En 1977 se public&#243; el primer estudio epidemiol&#243;gico de estas caracter&#237;sticas a nivel nacional&#44; incluyendo a 2&#46;806 pacientes estudiados mediante pruebas epicut&#225;neas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a>&#46; Los al&#233;rgenos m&#225;s frecuentemente positivos en aquel momento fueron el n&#237;quel&#44; el dicromato pot&#225;sico&#44; el tetrametiltiuram-disulfuro&#44; el PPD&#44; la mezcla de mercaptos y los alquitranes de la madera&#46; Desde entonces&#44; los diferentes cambios en la exposici&#243;n han dado lugar tanto a cambios en los al&#233;rgenos de estudio &#40;habi&#233;ndose realizado diferentes modificaciones en la serie est&#225;ndar del GEIDAC<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;4</span></a>&#41; como a diferencias en las frecuencias de sensibilizaciones a los mismos&#46; Sin embargo&#44; algunos de los al&#233;rgenos que ya resultaban ser los m&#225;s frecuentes en aquellos a&#241;os persisten si&#233;ndolo actualmente&#46; En 2011&#44; en otra publicaci&#243;n que incluye 1&#46;161 pacientes estudiados en 5 centros a nivel nacional<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a>&#44; se recogen como al&#233;rgenos m&#225;s frecuentemente positivos el sulfato de n&#237;quel &#40;25&#44;88&#37;&#41;&#44; el dicromato pot&#225;sico &#40;5&#44;31&#37;&#41;&#44; el cobalto &#40;5&#44;10&#37;&#41;&#44; la mezcla de fragancias &#40;4&#44;64&#37;&#41; y el b&#225;lsamo de Per&#250; &#40;4&#44;44&#37;&#41;&#46; Encontramos tambi&#233;n una publicaci&#243;n reciente en nuestro &#225;mbito&#44; pero centrada en una determinada poblaci&#243;n de Gran Canaria&#44; que obtiene tambi&#233;n como al&#233;rgenos m&#225;s frecuentes el sulfato de n&#237;quel&#44; la MCI&#47;MI&#44; la metilisotiazolinona&#44; la PPD y el dicromato pot&#225;sico&#44; incluso a frecuencias m&#225;s elevadas que las detectadas a nivel nacional<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En la literatura internacional encontramos otras publicaciones que&#44; de la misma forma&#44; tratan de recoger los cambios experimentados a lo largo de los a&#241;os en el porcentaje de sensibilizaci&#243;n a los diferentes al&#233;rgenos&#46; En la mayor&#237;a de estas serien no se recogen de forma sistem&#225;tica los cambios observados en los distintos a&#241;os&#44; y no siempre est&#225;n recogidos de forma prospectiva&#46; Encontramos algunas series correspondientes a otras poblaciones<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a>&#44; algunas de las cuales&#44; aun englobando un mayor n&#250;mero de a&#241;os&#44; incluyen menor n&#250;mero de pacientes<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a>&#46; Asimismo&#44; encontramos varias publicaciones a nivel europeo<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#8211;15</span></a> que&#44; o bien se centran en datos de a&#241;os anteriores a los nuestros&#44; o bien&#44; adem&#225;s de esto&#44; se centran en un determinado grupo de eczemas al&#233;rgicos de contacto&#44; como aquellos asociados a exposici&#243;n laboral<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a>&#44; o producidos por un grupo de al&#233;rgenos espec&#237;ficos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Con la tecnolog&#237;a actual se puede realizar una aproximaci&#243;n en tiempo real a los al&#233;rgenos m&#225;s frecuentes en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Entre los resultados obtenidos&#44; destaca la persistencia de la alta sensibilizaci&#243;n al <span class="elsevierStyleItalic">sulfato de n&#237;quel&#44;</span> la cual&#44; como coment&#225;bamos&#44; ya se recog&#237;a desde los primeros estudios realizados en Espa&#241;a &#40;25&#44;88&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a>&#44; y tambi&#233;n se recoge en otros estudios europeos &#40;23&#44;98&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a>&#46; Se trata de un metal que forma parte de aleaciones&#44; siendo las sales de n&#237;quel las responsables de la dermatitis&#44; favoreci&#233;ndose su liberaci&#243;n y penetraci&#243;n en la piel sobre todo por la sudoraci&#243;n&#46; En 1994 se estableci&#243; una normativa a nivel europeo que regulaba la liberaci&#243;n de n&#237;quel en joyas&#44; no haci&#233;ndose efectiva hasta 2021&#46; A pesar de que su sensibilizaci&#243;n persiste siendo alta&#44; en muchos de los casos positivos detectados hoy en d&#237;a no se encuentra una relevancia presente&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Tambi&#233;n se observa c&#243;mo la <span class="elsevierStyleItalic">PPD</span> sigue produciendo una alta sensibilizaci&#243;n en nuestro medio&#44; sobre todo en mujeres&#44; como se coment&#243; anteriormente&#46; En una publicaci&#243;n reciente sobre la sensibilizaci&#243;n a PPD en varios centros espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a>&#44; se recog&#237;a que permanec&#237;a bastante estable&#44; en torno a un 4&#37; de los pacientes parcheados&#44; entre los a&#241;os 2004-2014&#44; no habi&#233;ndose producido cambios significativos a pesar de la regulaci&#243;n realizada en 2009 en relaci&#243;n con los tintes capilares &#40;pasando su concentraci&#243;n m&#225;xima del 6 al 2&#37;&#41;&#46; Se han propuesto varias hip&#243;tesis en la persistencia de dicha sensibilizaci&#243;n&#44; como son el mantenimiento del h&#225;bito de realizarse tatuajes temporales con henna&#44; habitualmente adulterada con PPD&#44; cuya concentraci&#243;n no est&#225; regulada<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a>&#44; o cambios en el estilo de vida que condicionan que cada vez m&#225;s pacientes utilicen cosm&#233;ticos que contienen PPD a edades m&#225;s tempranas&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro estudio tambi&#233;n destaca la persistencia de la alta sensibilizaci&#243;n a <span class="elsevierStyleItalic">fragancias I&#44;</span> a pesar de los cambios regulatorios introducidos en el etiquetado obligatorio de determinadas fragancias&#44; persistiendo a niveles parecidos a los publicados en series nacionales previas &#40;4&#44;99&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> y recientes europeas &#40;3&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Destaca tambi&#233;n la alta sensibilizaci&#243;n a <span class="elsevierStyleItalic">isotiazoloninonas</span>&#44; tanto a <span class="elsevierStyleItalic">MCI&#47;MI</span> &#40;la cual persiste alta a lo largo de todos los a&#241;os del estudio&#41; como a <span class="elsevierStyleItalic">metilisotiazolinona</span>&#46; En esta &#250;ltima&#44; aun persistiendo alta&#44; se detecta a lo largo de los a&#241;os de estudio un descenso en la frecuencia de sensibilizaci&#243;n tanto en los valores brutos como ajustados por sexo y edad&#44; siendo el &#250;nico al&#233;rgeno en cuyo cambio se encuentra la significaci&#243;n estad&#237;stica&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La metilisotiazolinona es un derivado de las isotiazolinonas&#44; ampliamente utilizado como conservante en cosm&#233;ticos que se aclaran&#44; detergentes dom&#233;sticos&#44; pinturas al agua y productos industriales&#46; La sensibilizaci&#243;n a la misma tiene lugar tanto en el &#225;mbito dom&#233;stico&#44; debido principalmente a la exposici&#243;n a cosm&#233;ticos y detergentes dom&#233;sticos&#44; como en el &#225;mbito laboral&#44; especialmente en los trabajadores de la limpieza&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Es bien conocida la epidemia que se produjo a dicho al&#233;rgeno al inicio del siglo <span class="elsevierStyleSmallCaps">xxi</span><a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46; Como consecuencia&#44; despu&#233;s de reconocer el problema&#44; la industria cosm&#233;tica europea recomend&#243; no usar metilisotiazolinona en cosm&#233;ticos sin aclarado a finales de 2013&#46; Al mismo tiempo&#44; el Comit&#233; Cient&#237;fico sobre Seguridad del Consumidor reevalu&#243; el riesgo&#44; lo que result&#243; en la recomendaci&#243;n de prohibir el uso de metilisotiazolinona en cosm&#233;ticos sin aclarado y restringir el nivel m&#225;ximo permitido a 15<span class="elsevierStyleHsp" style=""></span>ppm en cosm&#233;ticos con aclarado&#46; Si bien llev&#243; tiempo que esta recomendaci&#243;n se tradujera en una regulaci&#243;n real&#44; y la regulaci&#243;n nuevamente permiti&#243; periodos de transici&#243;n&#44; era de suponer un cambio en las tendencias de sensibilizaci&#243;n&#44; que queda confirmado seg&#250;n nuestro registro con los datos recientes&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En Estados Unidos&#44; seg&#250;n los datos m&#225;s recientes del Grupo de Dermatitis de Contacto de Am&#233;rica del Norte&#44; la prevalencia m&#225;s alta de sensibilizaci&#243;n a isotiazolinonas se produjo a&#241;os m&#225;s tarde que a nivel europeo<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a>&#46; As&#237;&#44; mientras en Europa la sensibilizaci&#243;n a MCI&#47;MI en los a&#241;os 2013-2014 llegaba a niveles de 5&#44;4-7&#44;6&#37;&#44; antes de disminuir en los a&#241;os 2017-2018 a 3&#44;2-4&#44;4&#37;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a>&#44; en Estados Unidos&#44; la positividad a MCI&#47;MI aument&#243; de un 2&#44;5&#37; en 2009-2010 al 10&#44;8&#37; en 2017-2018&#46; Lo mismo ocurri&#243; para la metilisotiazolinona&#44; donde las reacciones disminuyen en Europa al 3&#44;4-5&#44;5&#37; frente al 15&#37; en el Grupo de Dermatitis de Contacto de Am&#233;rica del Norte durante 2017-2018&#46; Esto probablemente se deba a la falta de regulaci&#243;n en cuanto al uso de isotiazolinonas en cosm&#233;ticos en los Estados Unidos&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Seg&#250;n datos publicados recientemente por el REIDAC<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a>&#44; la sensibilizaci&#243;n tanto a MI como a MCI&#47;MI est&#225; asociada a ser trabajador activo&#44; la dermatitis de manos&#44; el uso de detergentes y una edad superior a 40 a&#241;os&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Se pueden apreciar algunos otros cambios en las tendencias de sensibilizaci&#243;n a al&#233;rgenos&#44; sin que ninguno sea significativo&#46; As&#237;&#44; en el caso de la <span class="elsevierStyleItalic">neomicina</span>&#44; se ve una tendencia a la baja desde que se inici&#243; la recogida de datos&#44; no siendo significativa&#44; quiz&#225;s indicando un menor uso de medicamentos t&#243;picos que incluyan combinaciones de antibi&#243;ticos y otros principios &#40;corticoides&#44; antif&#250;ngicos&#44; etc&#46;&#41;&#46; En Espa&#241;a no se financian desde hace varios a&#241;os las prescripciones de productos t&#243;picos que combinan corticoides con antibi&#243;ticos&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Lo mismo podemos apreciar con el <span class="elsevierStyleItalic">dicromato pot&#225;sico&#44;</span> en el que&#44; de la misma forma&#44; se aprecia una tendencia a la baja a la sensibilizaci&#243;n a dicho al&#233;rgeno&#44; no resultando tampoco significativa&#46; Las fuentes m&#225;s frecuentes de exposici&#243;n al dicromato pot&#225;sico son el cemento h&#250;medo y los productos de cuero curtidos con cromo&#46; Desde 2005 se ha restringido el uso de cementos con m&#225;s de 2<span class="elsevierStyleHsp" style=""></span>ppm de cromo hexavalente&#44; habi&#233;ndose detectado un descenso en la sensibilizaci&#243;n al mismo seg&#250;n datos hist&#243;ricos y en determinadas regiones<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;26</span></a>&#46; Probablemente la disminuci&#243;n en la sensibilizaci&#243;n al mismo est&#233; en relaci&#243;n con dicha regulaci&#243;n&#44; as&#237; como con las mejores medidas preventivas de obra practicadas por los trabajadores de la construcci&#243;n&#46; Adem&#225;s&#44; un probable menor uso de calzado de cuero en los &#250;ltimos a&#241;os tambi&#233;n ha podido contribuir a su disminuci&#243;n&#44; si bien no existen suficientes datos a d&#237;a de hoy que confirmen esta hip&#243;tesis&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos incluido los datos de los al&#233;rgenos incorporados de forma m&#225;s reciente en la bater&#237;a est&#225;ndar del GEIDAC&#44; pudiendo apreciarse una sensibilizaci&#243;n alta a nivel global en todos ellos &#40;hidroxietil metacrilato&#44; textile dye mix&#44; hidroper&#243;xidos de linalool e hidroper&#243;xidos de limoneno&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Para una poblaci&#243;n determinada&#44; los cambios en la sensibilizaci&#243;n a diferentes al&#233;rgenos dependen en general de las caracter&#237;sticas qu&#237;micas de estos &#40;los cuales&#44; en general&#44; no var&#237;an&#41; y del grado de exposici&#243;n a los mismos&#46; De manera que&#44; asumiendo que las caracter&#237;sticas de nuestra poblaci&#243;n se mantienen bastante homog&#233;neas a lo largo de los a&#241;os &#40;no se ven grandes diferencias en los datos de MOAHLFA entre los distintos a&#241;os&#44; tal y como podemos ver en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; a excepci&#243;n&#44; quiz&#225;s&#44; de la cara&#44; observ&#225;ndose una disminuci&#243;n en el periodo 2020-2022 respecto a los a&#241;os previos&#44; tal vez influido por el uso de la mascarilla en esos a&#241;os de pandemia COVID&#41;&#44; las diferencias detectadas en la sensibilizaci&#243;n se deber&#237;an a cambios en las diferentes exposiciones&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0185" class="elsevierStylePara elsevierViewall">Seg&#250;n los datos obtenidos en nuestro estudio&#44; destaca la persistencia de la alta sensibilizaci&#243;n a al&#233;rgenos como el n&#237;quel&#44; la MCI&#47;MI y la mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Solo se detecta una tendencia a disminuir de forma significativa en el caso de la metilisotiazolinona&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Queremos destacar la importancia de los registros multic&#233;ntricos&#44; que nos permiten recoger datos a gran escala y&#44; con ello&#44; detectar tendencias&#46; Esto nos permite observar posibles aumentos en la sensibilizaci&#243;n a determinados al&#233;rgenos&#44; que nos hagan pensar en la necesidad de tomar medidas para reducir estaO bien&#44; como ocurre con la metilisotiazolinona&#44; corroborar la eficacia de las medidas llevadas a cabo para reducir su sensibilizaci&#243;n&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0195" 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="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El Registro Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea tiene entre sus objetivos la vigilancia epidemiol&#243;gica de la dermatitis de contacto&#46; Para ello es importante conocer si se producen alteraciones en el tiempo de las prevalencias de las positividades a los distintos al&#233;rgenos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describir las variaciones en las tendencias temporales en positividades a al&#233;rgenos en la serie est&#225;ndar del GEIDAC en el periodo comprendido entre 2018 y el 31 de diciembre de 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional multic&#233;ntrico de pacientes estudiados consecutivamente mediante pruebas epicut&#225;neas dentro del estudio de un posible eczema al&#233;rgico de contacto recogidos de forma prospectiva en el seno del Registro Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea&#46; Se analizaron los datos mediante 2 pruebas estad&#237;sticas&#58; una de homogeneidad &#40;para ver si hay cambios en los diferentes a&#241;os&#41; y otra de tendencia &#40;para ver si los cambios siguen una tendencia lineal&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 11&#46;327 pacientes en el periodo de estudio&#46; Los al&#233;rgenos en los que de forma global se detect&#243; una sensibilizaci&#243;n mayor fueron sulfato de n&#237;quel&#44; metilisotiazolinona&#44; cloruro de cobalto&#44; metilcloroisotiazolinona&#47;metilisotiazolinona y mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Se detect&#243; una disminuci&#243;n estad&#237;sticamente significativa en el porcentaje de positividades de metilisotiazolinona a lo largo de a&#241;os de estudio con una tendencia ordenada&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Si bien se pueden apreciar diferentes cambios en las tendencias a sensibilizaciones a varios de los al&#233;rgenos de la bater&#237;a est&#225;ndar&#44; se observa que persiste una alta sensibilizaci&#243;n al n&#237;quel&#44; a la metilcloroisotiazolinona&#47;metilisotiazolinona y a la mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Solo se aprecia una tendencia a disminuir de forma significativa en el caso de la metilisotiazolinona&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy&#46; Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31&#44; 2022&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This was a multicenter&#44; observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy&#46; The data was analyzed using 2 statistical tests&#58; one homogeneity test &#40;to describe the changes seen over time&#41; and one trend test &#40;to see whether the changes described followed a linear trend&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 11327 patients were included in the study&#46; Overall&#44; the allergens associated with a highest sensitization were nickel sulfate&#44; methylisothiazolinone&#44; cobalt chloride&#44; methylchloroisothiazolinone&#47;methylisothiazolinone&#44; and fragrance mix <span class="elsevierStyleSmallCaps">i</span>&#46; A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Although various changes were seen in the sensitizations trends to several allergens of the standard testing&#44; it became obvious that a high sensitization to nickel&#44; methylchloroisothiazolinone&#47;methylisothiazolinone and fragrances mix <span class="elsevierStyleSmallCaps">i</span> remained&#46; Only a significant downward trend was seen for methylisothiazolinone&#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" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="12" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MOAHLFA por a&#241;o</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">&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="11" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#241;o de consulta</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">&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">2018</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">2019</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">2020</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">2021</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">2022</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">p&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&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-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">Total muestras&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">1&#46;067&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&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">3&#46;436&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&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">1&#46;701&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&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&#46;421&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&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&#46;702&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&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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">Hombre &#40;M&#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">322&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">1&#46;063&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">476&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">750&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">839&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">0&#44;1902&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">Factores ocupacionales &#40;O&#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">106&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">311&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">194&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">195&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">8&nbsp;\t\t\t\t\t\t\n
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                  \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">0&#44;5362&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#46;</p>"
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              "etiqueta" => "&#42;&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#46;</p>"
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        "descripcion" => array:1 [
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        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">IPPD&#58; N-isopropyl-n-phenyl-phenylendiamine&#59; 2-HEMA&#58; hidroxietil metacrilato&#59; &#37; Estd&#46; &#40;IC 95&#37;&#41;&#58; porcentaje estandarizado por edad y sexo &#40;intervalo de confianza del 95&#37;&#41;&#46;</p>"
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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" 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">&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="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Todos</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mujeres</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hombres</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">&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="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</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">&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">&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">Positividad &#40;&#43;&#47;&#43;&#43;&#47;&#43;&#43;&#43;&#41;</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">&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">Positividad &#40;&#43;&#47;&#43;&#43;&#47;&#43;&#43;&#43;&#41;</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">&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">Positividad &#40;&#43;&#47;&#43;&#43;&#47;&#43;&#43;&#43;&#41;</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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&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">&#37; Estd&#46; &#40;IC 95&#37;&#41;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&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">&#37; Estd&#46; &#40;IC 95&#37;&#41;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&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">&#37; Estd&#46; &#40;IC 95&#37;&#41;&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">1&#46; Sulfato de n&#237;quel&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">1&#46;1258&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&#46;604 &#40;23&#44;13&#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">17&#44;01 &#40;16&#44;31-17&#44;71&#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">7&#46;836&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&#46;266 &#40;28&#44;92&#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">22&#44;96 &#40;22&#44;03-23&#44;91&#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">3&#46;420&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">338 &#40;9&#44;88&#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">8&#44;08 &#40;7&#44;17-9&#44;03&#41;&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">2&#46; Alcoholes de la lanolina&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&#46;241&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">66 &#40;0&#44;59&#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">0&#44;46 &#40;0&#44;35-0&#44;61&#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">7&#46;820&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 &#40;0&#44;55&#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">0&#44;46 &#40;0&#44;32-0&#44;64&#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">3&#46;419&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 &#40;0&#44;67&#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">0&#44;46 &#40;0&#44;27-0&#44;76&#41;&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">3&#46; Sulfato de neomicina&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&#46;241&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">99 &#40;0&#44;88&#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">0&#44;95 &#40;0&#44;78-1&#44;14&#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">7&#46;820&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 &#40;0&#44;88&#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">0&#44;84 &#40;0&#44;65-1&#44;06&#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">3&#46;419&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 &#40;0&#44;88&#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">1&#44;11 &#40;0&#44;79-1&#44;53&#41;&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">4&#46; Dicromato pot&#225;sico&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&#46;255&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">347 &#40;3&#44;08&#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">3&#44;09 &#40;2&#44;78-3&#44;42&#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">7&#46;831&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">186 &#40;2&#44;38&#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
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                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3591227.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Positividades a los diferentes al&#233;rgenos incluidos en la serie est&#225;ndar del GEIDAC en el total de los pacientes estudiados&#44; y diferenciados por sexo</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">IPPD&#58; N-isopropyl-n-phenyl-phenylendiamine&#59; 2-HEMA&#58; hidroxietil metacrilato&#59; Pos&#58; positividad&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se resaltan los datos que presentan diferencias estad&#237;sticamente significativas&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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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="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&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">p corregido&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">0&#44;0016&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">&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">&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="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Porcentaje de positividad por a&#241;o de consulta</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">&nbsp;\t\t\t\t\t\t\n
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                  \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">&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">&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">&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">2018&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">2019&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">2020&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">2021&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">2022&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">&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">&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">&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="" 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">p homogeneidad&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">p tendencia&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">p tendencia ajustada&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">1&#46; Sulfato de n&#237;quel&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&#44;93&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&#44;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">23&#44;65&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;87&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;20&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">0&#44;4592&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">0&#44;1031&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">0&#44;2061&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">2&#46; Alcoholes de la lanolina&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">0&#44;75&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">0&#44;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">0&#44;65&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">0&#44;67&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">0&#44;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">0&#44;7052&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">0&#44;7065&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">0&#44;6004&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">3&#46; Sulfato de neomicina&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">1&#44;03&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">1&#44;14&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">0&#44;77&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">0&#44;83&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">0&#44;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">0&#44;2239&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">0&#44;0331&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">0&#44;0445&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">4&#46; Dicromato pot&#225;sico&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">3&#44;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">3&#44;66&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">3&#44;19&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&#44;54&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&#44;76&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">0&#44;1255&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">0&#44;0397&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\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">29&#46; Textile dye mix&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#46; Hidroper&#243;xidos de linalool&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de positividades de los diferentes al&#233;rgenos incluidos en la serie est&#225;ndar del GEIDAC en los diferentes a&#241;os de estudio</p>"
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ORIGINAL
Vigilancia epidemiológica en los últimos 4 años del Registro Español de Investigación en Dermatitis de Contacto y Alergia Cutánea: situación actual y tendencias
Four-year Epidemiological Surveillance of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy: Current Situation and Trends
F. Tous-Romeroa,
Corresponding author
fatimatousro@gmail.com

Autor para correspondencia.
, L. Borrego-Hernandob, I. García-Dovalc, P. Mercader-Garcíad, J.F. Silvester-Salvadore, A. Sánchez-Gilof, T. Sanz-Sánchezg, A.M. Giménez-Arnauh, V. Zaragoza-Nineti, J. Miquel-Miquelj, R. González Pérezk, S. Córdoba-Guijarrol, J.M. Carrascosa-Carrillom, M.E. Gática-Ortegan, I. Ruíz-Gonzálezo, E. Serra-Baldrichp, A. Pastor-Nietoq, M. Rodríguez-Sernar, J. Sánchez-Pérezs, G. Melé i Ninott..., P. Sánchez-Pedreño Guillénu, J. Ortiz-de FrutosaVer más
a Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
b Servicio de Dermatología, Hospital Universitario Insular de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
c Unidad de Investigación, Fundación Piel Sana AEDV, Madrid, España
d Servicio de Dermatología, Hospital General Universitario José M. Morales Meseguer, Murcia, España
e Servicio de Dermatología, Hospital General de Alicante, Alicante, España
f Servicio de Dermatología, Hospital Rey Juan Carlos, Madrid, España
g Servicio de Dermatología, Hospital Universitario Infanta Sofía, Madrid, España
h Servicio de Dermatología, Hospital del Mar, Barcelona, España
i Servicio de Dermatología, Hospital Universitario de Valencia, Valencia, España
j Servicio de Dermatología, Hospital Universitario Arnau de Vilanova, Valencia, España
k Servicio de Dermatología, Hospital Universitario Araba, Vitoria, Álava, España
l Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
m Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
n Servicio de Dermatología, Complejo Hospitalario Universitario de Toledo, Toledo, España
o Servicio de Dermatología, Complejo Asistencial Universitario de León, León, España
p Servicio de Dermatología, Hospital de la Santa Creu i San Pau, Barcelona, España
q Servicio de Dermatología, Hospital Fundación Jiménez Díaz, Madrid, España
r Servicio de Dermatología, Hospital Universitario La Fe, Valencia, España
s Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
t Servicio de Dermatología, Hospital Sagrat Cor, Barcelona, España
u Servicio de Dermatología, Hospital Virgen de la Arrixaca, Murcia, España
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Variaci&#243;n por a&#241;os de los al&#233;rgenos con sensibilizaci&#243;n global en los a&#241;os de estudio<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#37;&#44; tanto en la poblaci&#243;n total como diferenciada por sexos&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El Registro Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea &#40;REIDAC&#41; tiene entre sus objetivos la vigilancia epidemiol&#243;gica de la dermatitis de contacto&#46; Para ello&#44; resulta fundamental conocer si se producen alteraciones de las prevalencias de las positividades a los distintos al&#233;rgenos en el tiempo<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Las pruebas epicut&#225;neas constituyen el m&#233;todo fundamental para detectar la sensibilizaci&#243;n a al&#233;rgenos de contacto&#44; resultando una herramienta esencial para el diagn&#243;stico de una dermatitis al&#233;rgica de contacto &#40;DAC&#41;&#46; El estudio de cualquier paciente con sospecha de DAC debe incluir una bater&#237;a est&#225;ndar nacional o internacional de pruebas epicut&#225;neas y&#44; opcionalmente&#44; una o m&#225;s bater&#237;as espec&#237;ficas&#44; pudi&#233;ndose tambi&#233;n incluir los productos propios del paciente<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La bater&#237;a est&#225;ndar espa&#241;ola es una bater&#237;a din&#225;mica que se actualiza peri&#243;dicamente por los miembros del Grupo Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea &#40;GEIDAC&#41;&#46; Para ello se tienen en cuenta diferentes criterios&#44; tales como la frecuencia de sensibilizaci&#243;n &#40;superior al 0&#44;5-1&#37;&#41;&#44; as&#237; como otras caracter&#237;sticas como que se trate de al&#233;rgenos emergentes en literatura dermatol&#243;gica o pa&#237;ses colindantes&#44; o que tengan especial importancia para un grupo de pacientes o &#225;mbito de exposici&#243;n&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de nuestro trabajo es describir las variaciones en las tendencias temporales en positividades a al&#233;rgenos en la serie est&#225;ndar del GEIDAC en el periodo comprendido entre 2018 y el 31 de diciembre de 2022&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">El REIDAC recoge&#44; de forma prospectiva&#44; los resultados de todos los pacientes parcheados de forma consecutiva en los centros participantes&#46; Los datos son anonimizados en origen y el registro cumple con todos los est&#225;ndares &#233;ticos en materia de consentimiento informado y legislaci&#243;n de protecci&#243;n de datos&#46; En el registro se recogen de forma sucesiva&#44; adem&#225;s de las positividades y relevancias presentes&#44; las variables epidemiol&#243;gicas&#44; cl&#237;nicas y al&#233;rgicas de los pacientes a los que se les realizaron pruebas epicut&#225;neas en los centros incluidos durante este periodo&#44; incluyendo los datos necesarios para obtener el &#237;ndice Male&#44; Occupational dermatitis&#44; Atopic dermatitis&#44; Hand dermatitis&#44; Leg dermatitis&#44; Facial dermatitis&#44; Age<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40 years &#40;MOAHLFA&#41;&#46; En este estudio hemos utilizado los datos desde el 2018 hasta el 31 de diciembre de 2022<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Las pruebas epicut&#225;neas se realizaron siguiendo las recomendaciones de la European Society of Contact Dermatitis<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a>&#44; consider&#225;ndose positivas las lecturas &#40;&#43;&#41;&#44; &#40;&#43;&#43;&#41; o &#40;&#43;&#43;&#43;&#41;&#46; Se determin&#243; la relevancia de acuerdo con la historia cl&#237;nica&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La &#250;ltima actualizaci&#243;n de la bater&#237;a est&#225;ndar del GEIDAC data de enero de 2022&#59; en ella se incluyeron 4 nuevos al&#233;rgenos &#40;hidroxietil metacrilato&#44; mezcla de colorantes textiles&#44; hidroper&#243;xidos de linalool e hidroper&#243;xidos de limoneno&#41; y se eliminaron 3 &#40;dihidrocloruro de etilendiamina&#44; metildibromoglutaronitrilo e hydroxyisohexyl-3-cyclohexene-carboxaldehyde&#41;&#44; que no han sido incluidos en el estudio actual<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis descriptivo del &#237;ndice MOAHLFA&#44; as&#237; como de la prevalencia de cada al&#233;rgeno&#44; y se compar&#243; su distribuci&#243;n a lo largo de los a&#241;os&#46; Los resultados se mostraron gr&#225;ficamente&#46; Las comparaciones de homogeneidad se realizaron mediante la prueba de &#967;<span class="elsevierStyleSup">2</span> y la de tendencia lineal mediante pruebas de tendencia lineal para scores&#46; Para el an&#225;lisis de tendencia se obtuvieron valores de p crudos y ajustados por el MOAHLFA&#46; Tambi&#233;n se present&#243; la prevalencia de cada al&#233;rgeno de la bater&#237;a estandarizado por edad y sexo&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos los an&#225;lisis estad&#237;sticos se realizaron con STATA v&#46;17&#46;0 &#40;Stata Corp&#46; 2021&#46; Stata Statistical Software&#58; Release 17&#41;&#46; Se consider&#243; estad&#237;sticamente significativo un valor de p &#40;ajustado con la correcci&#243;n de Bonferroni para comparaciones m&#250;ltiples&#41; inferior a 0&#44;0016&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">REIDAC fue aprobado por el Comit&#233; de &#201;tica del Complejo Hospitalario Universitario Insular-Materno Infantil &#40;2017&#47;964&#41; y su funcionamiento cumple con la Declaraci&#243;n de Helsinki&#46; Todos los pacientes firmaron el consentimiento informado para participar&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0055" class="elsevierStylePara elsevierViewall">El n&#250;mero total de pacientes incluidos en el REIDAC durante el periodo de estudio fue de 11&#46;327&#46; La distribuci&#243;n por a&#241;os de dicha poblaci&#243;n&#44; as&#237; como la descripci&#243;n del &#237;ndice MOAHLFA por a&#241;o de esta&#44; se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Aunque hay diferencias estad&#237;sticamente significativas en algunas de las variables&#44; condicionadas por el gran tama&#241;o muestral&#44; estas son cl&#237;nicamente poco relevantes y&#44; al ajustar los valores por esas diferencias&#44; no hay cambios en las tendencias&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se representa el total de positivos a los diferentes al&#233;rgenos en la serie est&#225;ndar del GEIDAC en los pacientes estudiados en el global de a&#241;os de estudio&#44; tanto en el total de la poblaci&#243;n estudiado como diferenciando por sexos&#44; estandarizada por sexo y edad&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Como puede observarse&#44; los al&#233;rgenos que mostraron una frecuencia de sensibilizaci&#243;n global mayor durante el periodo de estudio fueron sulfato de n&#237;quel&#44; metilisotiazolinona&#44; cloruro de cobalto&#44; metilcloroisotiazolinona&#47;metilisotiazolinona &#40;MCI&#47;MI&#41; y mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Encontramos algunas diferencias respecto al sexo&#59; as&#237;&#44; mientras para las mujeres&#44; los al&#233;rgenos m&#225;s frecuentemente positivos son el sulfato de n&#237;quel&#44; la metilisotiazolinona&#44; el cloruro de cobalto&#44; la MCI&#47;MI&#44; la mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span> y la parafenilendiamina &#40;PPD&#41;&#44; en el var&#243;n ser&#237;an el sulfato de n&#237;quel&#44; la MCI&#47;MI y el dicromato pot&#225;sico&#44; encontrando as&#237; menor sensibilizaci&#243;n a PPD en varones que en mujeres &#40;2&#44;31 vs&#46; 3&#44;31&#41;&#44; y una mayor sensibilizaci&#243;n al dicromato pot&#225;sico &#40;4&#44;7 vs&#46; 2&#44;38&#41;&#44; entre otras diferencias&#46; La frecuencia de sensibilizaci&#243;n de los al&#233;rgenos incorporados en enero de 2022 en los pacientes estudiados fue del 4&#44;44&#37; para el hidroxietil metacrilato&#44; del 2&#44;58&#37; para la mezcla de colorantes textiles&#44; del 4&#44;59&#37; en el caso de hidroper&#243;xidos de linalool y del 3&#44;92&#37; para hidroper&#243;xidos de limoneno&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> podemos ver el porcentaje de positividades de los diferentes al&#233;rgenos incluidos en la serie est&#225;ndar del GEIDAC en los diferentes a&#241;os de estudio&#46; Se incluyen al final de dicha tabla los al&#233;rgenos incluidos recientemente en la bater&#237;a est&#225;ndar del GEIDAC&#59; dado que en los primeros a&#241;os no se parchearon de forma sistem&#225;tica y&#44; por tanto&#44; se estudiaron en un n&#250;mero mucho menor de pacientes&#44; no se han incluido en el estudio de las tendencias&#44; no incluyendo en la tabla los datos de estos previos a su inclusi&#243;n en el 2022&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Podemos observar c&#243;mo el porcentaje de positividades de metilisotiazolinona baja con el tiempo&#44; con una tendencia ordenada&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Podemos ver representada en las siguientes figuras la variaci&#243;n por porcentaje de positividades de los diferentes al&#233;rgenos durante los a&#241;os de estudio&#44; de forma global y diferenciada por sexos&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> aparecen representados los al&#233;rgenos con una sensibilizaci&#243;n superior al 4&#37; &#40;sulfato de n&#237;quel&#44; metilisotiazolinona&#44; cloruro de cobalto&#44; MCI&#47;MI&#44; mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Los al&#233;rgenos que mostraron una frecuencia de sensibilizaci&#243;n global durante el periodo de estudio de entre un 1-4&#37; fueron PPD&#44; mezcla de fragancias <span class="elsevierStyleSmallCaps">ii</span>&#44; b&#225;lsamo de Per&#250;&#44; dicromato pot&#225;sico&#44; formaldeh&#237;do&#44; mezcla de carbas&#44; mezcla de tiuranes&#44; resina de p-tert-butilfenol-formaldeh&#237;do y colofonia&#44; apareciendo representados en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se representa la variaci&#243;n por porcentaje de positividades a lo largo de los a&#241;os del resto de los al&#233;rgenos&#44; los cuales mostraron una frecuencia de sensibilizaci&#243;n cada uno de ellos de forma global<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1&#37;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">La vigilancia epidemiol&#243;gica en dermatitis de contacto resulta fundamental para conocer las variaciones que se producen a lo largo de los a&#241;os en las sensibilizaciones a los diferentes al&#233;rgenos&#44; permitiendo as&#237; aplicar medidas adecuadas para su evitaci&#243;n tanto a nivel individual como comunitario&#46; En Espa&#241;a&#44; dicha vigilancia est&#225; entre los objetivos del REIDAC&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">En 1977 se public&#243; el primer estudio epidemiol&#243;gico de estas caracter&#237;sticas a nivel nacional&#44; incluyendo a 2&#46;806 pacientes estudiados mediante pruebas epicut&#225;neas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">2</span></a>&#46; Los al&#233;rgenos m&#225;s frecuentemente positivos en aquel momento fueron el n&#237;quel&#44; el dicromato pot&#225;sico&#44; el tetrametiltiuram-disulfuro&#44; el PPD&#44; la mezcla de mercaptos y los alquitranes de la madera&#46; Desde entonces&#44; los diferentes cambios en la exposici&#243;n han dado lugar tanto a cambios en los al&#233;rgenos de estudio &#40;habi&#233;ndose realizado diferentes modificaciones en la serie est&#225;ndar del GEIDAC<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;4</span></a>&#41; como a diferencias en las frecuencias de sensibilizaciones a los mismos&#46; Sin embargo&#44; algunos de los al&#233;rgenos que ya resultaban ser los m&#225;s frecuentes en aquellos a&#241;os persisten si&#233;ndolo actualmente&#46; En 2011&#44; en otra publicaci&#243;n que incluye 1&#46;161 pacientes estudiados en 5 centros a nivel nacional<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a>&#44; se recogen como al&#233;rgenos m&#225;s frecuentemente positivos el sulfato de n&#237;quel &#40;25&#44;88&#37;&#41;&#44; el dicromato pot&#225;sico &#40;5&#44;31&#37;&#41;&#44; el cobalto &#40;5&#44;10&#37;&#41;&#44; la mezcla de fragancias &#40;4&#44;64&#37;&#41; y el b&#225;lsamo de Per&#250; &#40;4&#44;44&#37;&#41;&#46; Encontramos tambi&#233;n una publicaci&#243;n reciente en nuestro &#225;mbito&#44; pero centrada en una determinada poblaci&#243;n de Gran Canaria&#44; que obtiene tambi&#233;n como al&#233;rgenos m&#225;s frecuentes el sulfato de n&#237;quel&#44; la MCI&#47;MI&#44; la metilisotiazolinona&#44; la PPD y el dicromato pot&#225;sico&#44; incluso a frecuencias m&#225;s elevadas que las detectadas a nivel nacional<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En la literatura internacional encontramos otras publicaciones que&#44; de la misma forma&#44; tratan de recoger los cambios experimentados a lo largo de los a&#241;os en el porcentaje de sensibilizaci&#243;n a los diferentes al&#233;rgenos&#46; En la mayor&#237;a de estas serien no se recogen de forma sistem&#225;tica los cambios observados en los distintos a&#241;os&#44; y no siempre est&#225;n recogidos de forma prospectiva&#46; Encontramos algunas series correspondientes a otras poblaciones<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a>&#44; algunas de las cuales&#44; aun englobando un mayor n&#250;mero de a&#241;os&#44; incluyen menor n&#250;mero de pacientes<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a>&#46; Asimismo&#44; encontramos varias publicaciones a nivel europeo<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9&#8211;15</span></a> que&#44; o bien se centran en datos de a&#241;os anteriores a los nuestros&#44; o bien&#44; adem&#225;s de esto&#44; se centran en un determinado grupo de eczemas al&#233;rgicos de contacto&#44; como aquellos asociados a exposici&#243;n laboral<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a>&#44; o producidos por un grupo de al&#233;rgenos espec&#237;ficos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Con la tecnolog&#237;a actual se puede realizar una aproximaci&#243;n en tiempo real a los al&#233;rgenos m&#225;s frecuentes en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Entre los resultados obtenidos&#44; destaca la persistencia de la alta sensibilizaci&#243;n al <span class="elsevierStyleItalic">sulfato de n&#237;quel&#44;</span> la cual&#44; como coment&#225;bamos&#44; ya se recog&#237;a desde los primeros estudios realizados en Espa&#241;a &#40;25&#44;88&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a>&#44; y tambi&#233;n se recoge en otros estudios europeos &#40;23&#44;98&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a>&#46; Se trata de un metal que forma parte de aleaciones&#44; siendo las sales de n&#237;quel las responsables de la dermatitis&#44; favoreci&#233;ndose su liberaci&#243;n y penetraci&#243;n en la piel sobre todo por la sudoraci&#243;n&#46; En 1994 se estableci&#243; una normativa a nivel europeo que regulaba la liberaci&#243;n de n&#237;quel en joyas&#44; no haci&#233;ndose efectiva hasta 2021&#46; A pesar de que su sensibilizaci&#243;n persiste siendo alta&#44; en muchos de los casos positivos detectados hoy en d&#237;a no se encuentra una relevancia presente&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Tambi&#233;n se observa c&#243;mo la <span class="elsevierStyleItalic">PPD</span> sigue produciendo una alta sensibilizaci&#243;n en nuestro medio&#44; sobre todo en mujeres&#44; como se coment&#243; anteriormente&#46; En una publicaci&#243;n reciente sobre la sensibilizaci&#243;n a PPD en varios centros espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a>&#44; se recog&#237;a que permanec&#237;a bastante estable&#44; en torno a un 4&#37; de los pacientes parcheados&#44; entre los a&#241;os 2004-2014&#44; no habi&#233;ndose producido cambios significativos a pesar de la regulaci&#243;n realizada en 2009 en relaci&#243;n con los tintes capilares &#40;pasando su concentraci&#243;n m&#225;xima del 6 al 2&#37;&#41;&#46; Se han propuesto varias hip&#243;tesis en la persistencia de dicha sensibilizaci&#243;n&#44; como son el mantenimiento del h&#225;bito de realizarse tatuajes temporales con henna&#44; habitualmente adulterada con PPD&#44; cuya concentraci&#243;n no est&#225; regulada<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a>&#44; o cambios en el estilo de vida que condicionan que cada vez m&#225;s pacientes utilicen cosm&#233;ticos que contienen PPD a edades m&#225;s tempranas&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro estudio tambi&#233;n destaca la persistencia de la alta sensibilizaci&#243;n a <span class="elsevierStyleItalic">fragancias I&#44;</span> a pesar de los cambios regulatorios introducidos en el etiquetado obligatorio de determinadas fragancias&#44; persistiendo a niveles parecidos a los publicados en series nacionales previas &#40;4&#44;99&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> y recientes europeas &#40;3&#44;4&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Destaca tambi&#233;n la alta sensibilizaci&#243;n a <span class="elsevierStyleItalic">isotiazoloninonas</span>&#44; tanto a <span class="elsevierStyleItalic">MCI&#47;MI</span> &#40;la cual persiste alta a lo largo de todos los a&#241;os del estudio&#41; como a <span class="elsevierStyleItalic">metilisotiazolinona</span>&#46; En esta &#250;ltima&#44; aun persistiendo alta&#44; se detecta a lo largo de los a&#241;os de estudio un descenso en la frecuencia de sensibilizaci&#243;n tanto en los valores brutos como ajustados por sexo y edad&#44; siendo el &#250;nico al&#233;rgeno en cuyo cambio se encuentra la significaci&#243;n estad&#237;stica&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La metilisotiazolinona es un derivado de las isotiazolinonas&#44; ampliamente utilizado como conservante en cosm&#233;ticos que se aclaran&#44; detergentes dom&#233;sticos&#44; pinturas al agua y productos industriales&#46; La sensibilizaci&#243;n a la misma tiene lugar tanto en el &#225;mbito dom&#233;stico&#44; debido principalmente a la exposici&#243;n a cosm&#233;ticos y detergentes dom&#233;sticos&#44; como en el &#225;mbito laboral&#44; especialmente en los trabajadores de la limpieza&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Es bien conocida la epidemia que se produjo a dicho al&#233;rgeno al inicio del siglo <span class="elsevierStyleSmallCaps">xxi</span><a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46; Como consecuencia&#44; despu&#233;s de reconocer el problema&#44; la industria cosm&#233;tica europea recomend&#243; no usar metilisotiazolinona en cosm&#233;ticos sin aclarado a finales de 2013&#46; Al mismo tiempo&#44; el Comit&#233; Cient&#237;fico sobre Seguridad del Consumidor reevalu&#243; el riesgo&#44; lo que result&#243; en la recomendaci&#243;n de prohibir el uso de metilisotiazolinona en cosm&#233;ticos sin aclarado y restringir el nivel m&#225;ximo permitido a 15<span class="elsevierStyleHsp" style=""></span>ppm en cosm&#233;ticos con aclarado&#46; Si bien llev&#243; tiempo que esta recomendaci&#243;n se tradujera en una regulaci&#243;n real&#44; y la regulaci&#243;n nuevamente permiti&#243; periodos de transici&#243;n&#44; era de suponer un cambio en las tendencias de sensibilizaci&#243;n&#44; que queda confirmado seg&#250;n nuestro registro con los datos recientes&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En Estados Unidos&#44; seg&#250;n los datos m&#225;s recientes del Grupo de Dermatitis de Contacto de Am&#233;rica del Norte&#44; la prevalencia m&#225;s alta de sensibilizaci&#243;n a isotiazolinonas se produjo a&#241;os m&#225;s tarde que a nivel europeo<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a>&#46; As&#237;&#44; mientras en Europa la sensibilizaci&#243;n a MCI&#47;MI en los a&#241;os 2013-2014 llegaba a niveles de 5&#44;4-7&#44;6&#37;&#44; antes de disminuir en los a&#241;os 2017-2018 a 3&#44;2-4&#44;4&#37;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">24&#44;25</span></a>&#44; en Estados Unidos&#44; la positividad a MCI&#47;MI aument&#243; de un 2&#44;5&#37; en 2009-2010 al 10&#44;8&#37; en 2017-2018&#46; Lo mismo ocurri&#243; para la metilisotiazolinona&#44; donde las reacciones disminuyen en Europa al 3&#44;4-5&#44;5&#37; frente al 15&#37; en el Grupo de Dermatitis de Contacto de Am&#233;rica del Norte durante 2017-2018&#46; Esto probablemente se deba a la falta de regulaci&#243;n en cuanto al uso de isotiazolinonas en cosm&#233;ticos en los Estados Unidos&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Seg&#250;n datos publicados recientemente por el REIDAC<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a>&#44; la sensibilizaci&#243;n tanto a MI como a MCI&#47;MI est&#225; asociada a ser trabajador activo&#44; la dermatitis de manos&#44; el uso de detergentes y una edad superior a 40 a&#241;os&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Se pueden apreciar algunos otros cambios en las tendencias de sensibilizaci&#243;n a al&#233;rgenos&#44; sin que ninguno sea significativo&#46; As&#237;&#44; en el caso de la <span class="elsevierStyleItalic">neomicina</span>&#44; se ve una tendencia a la baja desde que se inici&#243; la recogida de datos&#44; no siendo significativa&#44; quiz&#225;s indicando un menor uso de medicamentos t&#243;picos que incluyan combinaciones de antibi&#243;ticos y otros principios &#40;corticoides&#44; antif&#250;ngicos&#44; etc&#46;&#41;&#46; En Espa&#241;a no se financian desde hace varios a&#241;os las prescripciones de productos t&#243;picos que combinan corticoides con antibi&#243;ticos&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Lo mismo podemos apreciar con el <span class="elsevierStyleItalic">dicromato pot&#225;sico&#44;</span> en el que&#44; de la misma forma&#44; se aprecia una tendencia a la baja a la sensibilizaci&#243;n a dicho al&#233;rgeno&#44; no resultando tampoco significativa&#46; Las fuentes m&#225;s frecuentes de exposici&#243;n al dicromato pot&#225;sico son el cemento h&#250;medo y los productos de cuero curtidos con cromo&#46; Desde 2005 se ha restringido el uso de cementos con m&#225;s de 2<span class="elsevierStyleHsp" style=""></span>ppm de cromo hexavalente&#44; habi&#233;ndose detectado un descenso en la sensibilizaci&#243;n al mismo seg&#250;n datos hist&#243;ricos y en determinadas regiones<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;26</span></a>&#46; Probablemente la disminuci&#243;n en la sensibilizaci&#243;n al mismo est&#233; en relaci&#243;n con dicha regulaci&#243;n&#44; as&#237; como con las mejores medidas preventivas de obra practicadas por los trabajadores de la construcci&#243;n&#46; Adem&#225;s&#44; un probable menor uso de calzado de cuero en los &#250;ltimos a&#241;os tambi&#233;n ha podido contribuir a su disminuci&#243;n&#44; si bien no existen suficientes datos a d&#237;a de hoy que confirmen esta hip&#243;tesis&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">En nuestro estudio hemos incluido los datos de los al&#233;rgenos incorporados de forma m&#225;s reciente en la bater&#237;a est&#225;ndar del GEIDAC&#44; pudiendo apreciarse una sensibilizaci&#243;n alta a nivel global en todos ellos &#40;hidroxietil metacrilato&#44; textile dye mix&#44; hidroper&#243;xidos de linalool e hidroper&#243;xidos de limoneno&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Para una poblaci&#243;n determinada&#44; los cambios en la sensibilizaci&#243;n a diferentes al&#233;rgenos dependen en general de las caracter&#237;sticas qu&#237;micas de estos &#40;los cuales&#44; en general&#44; no var&#237;an&#41; y del grado de exposici&#243;n a los mismos&#46; De manera que&#44; asumiendo que las caracter&#237;sticas de nuestra poblaci&#243;n se mantienen bastante homog&#233;neas a lo largo de los a&#241;os &#40;no se ven grandes diferencias en los datos de MOAHLFA entre los distintos a&#241;os&#44; tal y como podemos ver en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; a excepci&#243;n&#44; quiz&#225;s&#44; de la cara&#44; observ&#225;ndose una disminuci&#243;n en el periodo 2020-2022 respecto a los a&#241;os previos&#44; tal vez influido por el uso de la mascarilla en esos a&#241;os de pandemia COVID&#41;&#44; las diferencias detectadas en la sensibilizaci&#243;n se deber&#237;an a cambios en las diferentes exposiciones&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusiones</span><p id="par0185" class="elsevierStylePara elsevierViewall">Seg&#250;n los datos obtenidos en nuestro estudio&#44; destaca la persistencia de la alta sensibilizaci&#243;n a al&#233;rgenos como el n&#237;quel&#44; la MCI&#47;MI y la mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Solo se detecta una tendencia a disminuir de forma significativa en el caso de la metilisotiazolinona&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Queremos destacar la importancia de los registros multic&#233;ntricos&#44; que nos permiten recoger datos a gran escala y&#44; con ello&#44; detectar tendencias&#46; Esto nos permite observar posibles aumentos en la sensibilizaci&#243;n a determinados al&#233;rgenos&#44; que nos hagan pensar en la necesidad de tomar medidas para reducir estaO bien&#44; como ocurre con la metilisotiazolinona&#44; corroborar la eficacia de las medidas llevadas a cabo para reducir su sensibilizaci&#243;n&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Financiaci&#243;n</span><p id="par0205" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicto de intereses</span><p id="par0195" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Abstract"
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              "titulo" => "Background"
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          "titulo" => "Keywords"
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          "titulo" => "Introducci&#243;n"
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          "titulo" => "Conflicto de intereses"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2023-06-22"
    "fechaAceptado" => "2023-10-31"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec1846677"
          "palabras" => array:6 [
            0 => "Pruebas epicut&#225;neas"
            1 => "Metilisotiazolinona"
            2 => "GEIDAC"
            3 => "REIDAC"
            4 => "Vigilancia epidemiol&#243;gica"
            5 => "Tendencias"
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            0 => "Patch tests"
            1 => "Methylisothiazolinone"
            2 => "GEIDAC"
            3 => "REIDAC"
            4 => "Epidemiological surveillance"
            5 => "Trends"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El Registro Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea tiene entre sus objetivos la vigilancia epidemiol&#243;gica de la dermatitis de contacto&#46; Para ello es importante conocer si se producen alteraciones en el tiempo de las prevalencias de las positividades a los distintos al&#233;rgenos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describir las variaciones en las tendencias temporales en positividades a al&#233;rgenos en la serie est&#225;ndar del GEIDAC en el periodo comprendido entre 2018 y el 31 de diciembre de 2022&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional multic&#233;ntrico de pacientes estudiados consecutivamente mediante pruebas epicut&#225;neas dentro del estudio de un posible eczema al&#233;rgico de contacto recogidos de forma prospectiva en el seno del Registro Espa&#241;ol de Investigaci&#243;n en Dermatitis de Contacto y Alergia Cut&#225;nea&#46; Se analizaron los datos mediante 2 pruebas estad&#237;sticas&#58; una de homogeneidad &#40;para ver si hay cambios en los diferentes a&#241;os&#41; y otra de tendencia &#40;para ver si los cambios siguen una tendencia lineal&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron un total de 11&#46;327 pacientes en el periodo de estudio&#46; Los al&#233;rgenos en los que de forma global se detect&#243; una sensibilizaci&#243;n mayor fueron sulfato de n&#237;quel&#44; metilisotiazolinona&#44; cloruro de cobalto&#44; metilcloroisotiazolinona&#47;metilisotiazolinona y mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Se detect&#243; una disminuci&#243;n estad&#237;sticamente significativa en el porcentaje de positividades de metilisotiazolinona a lo largo de a&#241;os de estudio con una tendencia ordenada&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Si bien se pueden apreciar diferentes cambios en las tendencias a sensibilizaciones a varios de los al&#233;rgenos de la bater&#237;a est&#225;ndar&#44; se observa que persiste una alta sensibilizaci&#243;n al n&#237;quel&#44; a la metilcloroisotiazolinona&#47;metilisotiazolinona y a la mezcla de fragancias <span class="elsevierStyleSmallCaps">i</span>&#46; Solo se aprecia una tendencia a disminuir de forma significativa en el caso de la metilisotiazolinona&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Antecedentes"
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            "titulo" => "Objetivos"
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            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The epidemiological surveillance of contact dermatitis is one of the objectives of the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy&#46; Knowing whether the prevalence of positive tests to the different allergens changes over time is important for this monitoring process&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe the various temporary trends in allergen positivity in the GEIDAC standard series from 2018 through December 31&#44; 2022&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This was a multicenter&#44; observational trial of consecutive patients analyzed via patch tests as part of the study of possible allergic contact dermatitises collected prospectively within the Spanish Registry of Research in Contact Dermatitis and Cutaneous Allergy&#46; The data was analyzed using 2 statistical tests&#58; one homogeneity test &#40;to describe the changes seen over time&#41; and one trend test &#40;to see whether the changes described followed a linear trend&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A total of 11327 patients were included in the study&#46; Overall&#44; the allergens associated with a highest sensitization were nickel sulfate&#44; methylisothiazolinone&#44; cobalt chloride&#44; methylchloroisothiazolinone&#47;methylisothiazolinone&#44; and fragrance mix <span class="elsevierStyleSmallCaps">i</span>&#46; A statistically significant decrease was found in the percentage of methylisothiazolinone positive tests across the study years with an orderly trend&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Although various changes were seen in the sensitizations trends to several allergens of the standard testing&#44; it became obvious that a high sensitization to nickel&#44; methylchloroisothiazolinone&#47;methylisothiazolinone and fragrances mix <span class="elsevierStyleSmallCaps">i</span> remained&#46; Only a significant downward trend was seen for methylisothiazolinone&#46;</p></span>"
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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" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="12" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">MOAHLFA por a&#241;o</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">&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="11" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A&#241;o de consulta</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">&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">2018</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">2019</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">2020</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">2021</th><th class="td" title="\n
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                  \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">2022</th><th class="td" title="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;436&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">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">1&#46;701&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">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">2&#46;421&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">100&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">2&#46;702&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;573&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;790&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">67&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">Alguno positivo &#40;P&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">490&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
                  \t\t\t\t">46&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">1&#46;595&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">769&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;090&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">45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;196&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;5362&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
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><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">&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="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Todos</th><th class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mujeres</th><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Resultado</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">&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">&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">Positividad &#40;&#43;&#47;&#43;&#43;&#47;&#43;&#43;&#43;&#41;</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">&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">Positividad &#40;&#43;&#47;&#43;&#43;&#47;&#43;&#43;&#43;&#41;</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">&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">Positividad &#40;&#43;&#47;&#43;&#43;&#47;&#43;&#43;&#43;&#41;</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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&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">&#37; Estd&#46; &#40;IC 95&#37;&#41;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&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">&#37; Estd&#46; &#40;IC 95&#37;&#41;&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">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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&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">&#37; Estd&#46; &#40;IC 95&#37;&#41;&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">1&#46; Sulfato de n&#237;quel&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">1&#46;1258&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&#46;604 &#40;23&#44;13&#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">17&#44;01 &#40;16&#44;31-17&#44;71&#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">7&#46;836&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&#46;266 &#40;28&#44;92&#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">22&#44;96 &#40;22&#44;03-23&#44;91&#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">3&#46;420&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">338 &#40;9&#44;88&#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">8&#44;08 &#40;7&#44;17-9&#44;03&#41;&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">2&#46; Alcoholes de la lanolina&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&#46;241&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">66 &#40;0&#44;59&#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">0&#44;46 &#40;0&#44;35-0&#44;61&#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">7&#46;820&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 &#40;0&#44;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;984&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">68 &#40;3&#44;43&#41;&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
                  \t\t\t\t">4&#44;15 &#40;3&#44;31-5&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3591227.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Positividades a los diferentes al&#233;rgenos incluidos en la serie est&#225;ndar del GEIDAC en el total de los pacientes estudiados&#44; y diferenciados por sexo</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">IPPD&#58; N-isopropyl-n-phenyl-phenylendiamine&#59; 2-HEMA&#58; hidroxietil metacrilato&#59; Pos&#58; positividad&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se resaltan los datos que presentan diferencias estad&#237;sticamente significativas&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Todos&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">&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">&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">p corregido&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">0&#44;0016&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">&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">&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="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Porcentaje de positividad por a&#241;o de consulta</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">&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">&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">&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">&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">2018&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">2019&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">2020&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">2021&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">2022&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">&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">&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">&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="" 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">p homogeneidad&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">p tendencia&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">p tendencia ajustada&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">1&#46; Sulfato de n&#237;quel&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&#44;93&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&#44;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">23&#44;65&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;87&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;20&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">0&#44;4592&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">0&#44;1031&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">0&#44;2061&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">2&#46; Alcoholes de la lanolina&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">0&#44;75&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">0&#44;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">0&#44;65&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
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                  \t\t\t\t">5&#44;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
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;0002</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;0000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;0232&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#46; Mezcla de fragancias <span class="elsevierStyleSmallCaps">ii</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29&#46; Textile dye mix&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30&#46; Hidroper&#243;xidos de linalool&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de positividades de los diferentes al&#233;rgenos incluidos en la serie est&#225;ndar del GEIDAC en los diferentes a&#241;os de estudio</p>"
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Article information
ISSN: 00017310
Original language: Spanish
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