Novelties in Dermatology
Multiplatform Application to Determine Presence of Metabolic Syndrome and Cardiovascular Risk in Patients With Psoriasis
Calculadora multiplataforma para síndrome metabólico y riesgo cardiovascular en pacientes con psoriasis
R. Taberner
Hospital Son Llàtzer, Servicio de Dermatología, Palma de Mallorca (Illes Balears), Spain
Leído
6874
Vecesse ha leído el artículo
2187
Total PDF
4687
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219012000807" "issn" => "15782190" "doi" => "10.1016/j.adengl.2011.11.020" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "525" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2012;103:111-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2681 "formatos" => array:3 [ "EPUB" => 55 "HTML" => 2024 "PDF" => 602 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731011005187" "issn" => "00017310" "doi" => "10.1016/j.ad.2011.11.003" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "525" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2012;103:111-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7782 "formatos" => array:3 [ "EPUB" => 3 "HTML" => 5265 "PDF" => 2514 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Novedades en dermatología</span>" "titulo" => "Calculadora multiplataforma para síndrome metabólico y riesgo cardiovascular en pacientes con psoriasis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "111" "paginaFinal" => "119" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Multiplatform Application to Determine Presence of Metabolic Syndrome and Cardiovascular Risk in Patients With Psoriasis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3330 "Ancho" => 2500 "Tamanyo" => 284301 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Captura de pantalla correspondiente a la aplicación para iPad (iOS).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Taberner" "autores" => array:1 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Taberner" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219012000807" "doi" => "10.1016/j.adengl.2011.11.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000807?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011005187?idApp=UINPBA000044" "url" => "/00017310/0000010300000002/v1_201304241353/S0001731011005187/v1_201304241353/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219012000637" "issn" => "15782190" "doi" => "10.1016/j.adengl.2011.04.008" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "419" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2012;103:120-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5089 "formatos" => array:3 [ "EPUB" => 44 "HTML" => 4181 "PDF" => 864 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Pyoderma Gangrenosum: A Report of 15 Cases and Review of the Literature" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "120" "paginaFinal" => "126" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pioderma gangrenoso: Presentación de 15 casos y revisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 870 "Ancho" => 2337 "Tamanyo" => 234639 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Appearance before (A) and after (B) treatment with oral prednisone.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.A. Suárez-Pérez, E. Herrera-Acosta, N. López-Navarro, F. Vilchez-Márquez, J.D. Prieto, R.J. Bosch" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.A." "apellidos" => "Suárez-Pérez" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Herrera-Acosta" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "López-Navarro" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Vilchez-Márquez" ] 4 => array:2 [ "nombre" => "J.D." "apellidos" => "Prieto" ] 5 => array:2 [ "nombre" => "R.J." "apellidos" => "Bosch" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Herrera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011002717" "doi" => "10.1016/j.ad.2011.04.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011002717?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000637?idApp=UINPBA000044" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000637/v1_201304241253/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219012000662" "issn" => "15782190" "doi" => "10.1016/j.adengl.2011.05.008" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "425" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2012;103:100-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7751 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 6647 "PDF" => 1056 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermatology</span>" "titulo" => "Basic Concepts in Skin Biopsy. Part II" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "100" "paginaFinal" => "110" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La biopsia cutánea: bases fundamentales. Parte II" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 963 "Ancho" => 1585 "Tamanyo" => 433577 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ballooning (a freeze artifact) of melanocytes in a compound melanocytic nevus. Hematoxylin–eosin, original magnification ×40.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Llamas-Velasco, B.E. Paredes" "autores" => array:2 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 1 => array:2 [ "nombre" => "B.E." "apellidos" => "Paredes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011002778" "doi" => "10.1016/j.ad.2011.05.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011002778?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000662?idApp=UINPBA000044" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000662/v1_201304241253/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Novelties in Dermatology</span>" "titulo" => "Multiplatform Application to Determine Presence of Metabolic Syndrome and Cardiovascular Risk in Patients With Psoriasis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "111" "paginaFinal" => "119" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "R. Taberner" "autores" => array:1 [ 0 => array:3 [ "nombre" => "R." "apellidos" => "Taberner" "email" => array:1 [ 0 => "rtaberner@hsll.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Hospital Son Llàtzer, Servicio de Dermatología, Palma de Mallorca (Illes Balears), Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calculadora multiplataforma para síndrome metabólico y riesgo cardiovascular en pacientes con psoriasis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3340 "Ancho" => 2502 "Tamanyo" => 469669 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular risk calculator (according to REGICOR tables). See text for a description of the functions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis affects between 1.5% and 3% of the world population. When there is no joint involvement, it has traditionally been considered as a chronic inflammatory disease of the skin that affects otherwise healthy individuals, with a negative impact on their quality of life.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, recent studies have suggested that psoriasis is not an isolated phenomenon but occurs in association with other conditions, such as cardiovascular diseases, and that mortality is higher in patients with severe forms of psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The link between psoriasis and arteriosclerosis seems to arise as a result of both the increased prevalence of various cardiovascular risk factors and chronic inflammatory phenomena in these patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is not uncommon for dermatologists to be the only health care professional to see an apparently healthy individual with psoriasis. Dermatologists can therefore play an important role in identifying patients who, in addition to psoriasis, may have an elevated risk of cardiovascular disease and early death. Thus, we can detect potential modifiable and avoidable risk factors, recommend lifestyle changes, and refer individuals at risk to their family physician in the event that pharmacological treatment or a closer follow-up is needed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the progress in our understanding of psoriasis and our realization that it is a chronic inflammatory disease not limited to the skin, large barriers remain when incorporating this knowledge into clinical practice. As physicians, dermatologists should provide the patients with advice and counseling about their disease. If we manage to get the patients to better understand the relationship between psoriasis and other diseases, we can encourage greater determination on their part to change their lifestyle, give up deleterious habits, and adhere to therapy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Psoriasis and Metabolic Syndrome</span><p id="par0025" class="elsevierStylePara elsevierViewall">Obesity, especially abdominal obesity (also known as central obesity), is associated with resistance to the effects of insulin on peripheral glucose and fatty acid utilization. This can lead to type 2 diabetes. Insulin resistance, with the resulting hyperinsulinemia and hyperglycemia, as well as adipokines (cytokines secreted by adipocytes), can lead to endothelial vascular dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which favor the development of arteriosclerotic cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">metabolic syndrome</span> was proposed to indicate a situation where certain metabolic risk factors for the development of type 2 diabetes and cardiovascular disease (abdominal obesity, hyperglycemia, dyslipidemia, and hypertension) are present at the same time.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Definitions of metabolic syndrome vary, although the most widely used are those proposed by the National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP III) and the International Diabetes Federation (IDF).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The 2001 definition of metabolic syndrome by the NCEP/ATP III (updated in 2005) established diagnosis of metabolic syndrome when 3 or more of the 5 criteria listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> are present.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The IDF proposed its criteria for metabolic syndrome in 2004. In this case, central obesity is an essential criterion (with variation according to race/ethnic origin of the patient—in the case of Europeans, a waist circumference >94<span class="elsevierStyleHsp" style=""></span>cm for men and >80<span class="elsevierStyleHsp" style=""></span>cm for women).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Two of the other 4 criteria, which coincide with those of the ATP-III, also need to be met.</p><p id="par8045" class="elsevierStylePara elsevierViewall">According to different meta-analyses, meeting the definition of metabolic syndrome is associated with a relative risk of type 2 diabetes of 5.12 (95% CI, 3.26–8.05), although the difference seems minimal when only fasting glucose levels are considered.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Other studies estimate the relative risk of cardiovascular death to be 1.74 (95% CI, 1.29–2.35).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–14</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Although metabolic syndrome has been proposed as a simple clinical tool for predicting type 2 diabetes and cardiovascular disease, many authors have questioned the concept of this syndrome in recent years. Criticisms include the lack of agreement in the diagnostic criteria, the lack of a unique pathophysiological mechanism, the omission of important known risk factors (age, tobacco use, sex, low-density lipoprotein [LDL] cholesterol, etc.), the inclusion of patients already diagnosed with diabetes and cardiovascular disease, and the fact that treatment is no different to when the components are taken separately. Thus, some authors propose that metabolic syndrome be considered a premorbid condition rather than a clinical diagnosis, although the concept is clearly useful for health education.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–18</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Several studies have found an association between psoriasis and metabolic syndrome. According to Gisondi et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> in a case–control study, 30.1% of patients aged over 40 years with psoriasis met the criteria for metabolic syndrome, with an odds ratio (OR) of 1.65 (95% CI, 1.16–2.35), regardless of tobacco use. The association was stronger in patients with longer-standing disease.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Other studies have found a higher prevalence, up to 44%, for metabolic syndrome in psoriasis patients over 40 years.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Psoriasis and Obesity</span><p id="par0060" class="elsevierStylePara elsevierViewall">Obesity has reached epidemic proportions in Europe, where the prevalence has tripled in the past 20 years. It is estimated that 150 million adults (20% of the population) and 15 million children and adolescents (10%) are obese. According to data from the Spanish Health Survey (2003), 13.3% of the Spanish population is obese. The predominance of obesity is slightly higher in women (13.5%) than men (13%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Diagnosis of obesity is established according to body mass index (BMI) which is calculated by dividing weight in kilograms by the square of height in meters. According to the value, patients can be classified as normal weight (18.5–24.9<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>), overweight (25–29.9<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>), or obese (>30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">For years, psoriasis has been known to be associated with obesity,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> although it has been debated whether obesity causes or is a consequence of psoriasis.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In an Italian case–control study of 560 patients, for a BMI of 26–29<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> and >30<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, the OR of having psoriasis was 1.6 and 1.9, respectively, compared to absence of obesity.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> A British study of 127<span class="elsevierStyleHsp" style=""></span>706 patients with mild psoriasis and 3854 patients with severe psoriasis showed that for severe psoriasis and mild psoriasis, the OR for obesity was 1.8 and 1.3, respectively, compared to absence of psoriasis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Several hypotheses have been put forward to explain the association between psoriasis and obesity, such as social isolation, poor dietary habits, depression, alcohol consumption, and sedentary lifestyle (in particular in patients with psoriatic arthritis). In fact, only 43% of obese patients with psoriasis in the study of Herron et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> exercised for 30<span class="elsevierStyleHsp" style=""></span>minutes or more 2 or 3 times a week, compared to 59% of nonobese patients with psoriasis.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Given that obesity is now considered as a proinflammatory state and that fatty tissue is thought of as an organ with immune and endocrine functions, it is easier to understand why obese patients might be predisposed to the development of psoriasis. Tumor necrosis factor (TNF) α expression is increased in adipocytes of obese rats, and this finding has also been demonstrated in humans. Some authors maintain that the proadipogenic effects of TNF-α are caused by direct autocrine or paracrine effects in the adipose tissue. Furthermore, TNF-α is thought to contribute to insulin resistance.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally, we should remember that body weight can have an effect on the efficacy of psoriasis drugs. It has even been suggested that systemic treatment of psoriasis in obese patients could protect against cardiovascular disease, as shown in a study with methotrexate.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Finally, it is necessary to consider the increase in the risk of adverse reactions when these patients are treated with certain drugs (acitretin, methotrexate, ciclosporin, etc.).<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,27,28</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Psoriasis and Cardiovascular Risk</span><p id="par0095" class="elsevierStylePara elsevierViewall">Arteriosclerosis is responsible for most cases of coronary artery disease. A wide range of factors, often acting in combination, are associated with an increased risk of developing atheromatous plaques in the coronary arteries and other arteries.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The importance of detecting these risk factors lies in the fact that, for the most part, they can be modified by applying specific preventive measures. In the INTERHEART study, which included patients from 52 countries, 90% of the population risk of a first myocardial infarction was accounted for by 9 factors: tobacco use, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, daily fruit and vegetable consumption, regular consumption of small amounts of alcohol, and regular physical activity (the last 3 being protective factors).<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">During the last few years, different multivariate models have been developed to estimate 10-year cardiovascular risk in asymptomatic and apparently healthy individuals. A common feature of all these models is that most of the risk factors are not dichotomic, but rather provide a graduated risk according to their value. This is not the case with metabolic syndrome.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The Framingham<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and REGICOR (<span class="elsevierStyleItalic">Registre Gironí del Cor</span>)<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,32</span></a> tables estimate the 10-year risk of developing coronary artery disease (regardless of whether the outcome is death), whereas the SCORE (Systematic Coronary Risk Evaluation) tables estimate the 10-year risk of death from any cardiovascular cause (including cerebrovascular accident).<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> The SCORE tables are recommended by the Spanish Interdisciplinary Committee for Cardiovascular Prevention (CEIPC). Different tables are available for low- and high-risk populations. In contrast, the REGICOR tables have been chosen as the reference tables by the health services of several Spanish autonomous communities, as they have been validated in the Spanish population.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In most of the studies performed (of a case–control design), psoriasis patients had a statistically significant increase in total cholesterol, LDL cholesterol, and triglycerides compared to controls without psoriasis. In addition, a decrease in serum high-density lipoprotein (HDL) cholesterol has been observed in patients with psoriasis. HDL is a fundamental factor in inverse cholesterol transport, and exerts an anti-inflammatory, antithrombotic, antioxidant, and fibrinolytic effect.<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34,35</span></a> There is therefore an inverse relationship between HDL levels and the development of arteriosclerosis.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition, it should be remembered that certain drugs (such as ciclosporin and acitretin) used in the treatment of psoriasis could be partly responsible for changes in the lipid profile. TNF-α inhibitors can induce triglyceride elevations, but they would have beneficial effects on HDL levels.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Different studies have shown that tobacco use is an independent risk factor for developing psoriasis, and that there is an association with more severe forms of psoriasis and poorer response to treatment.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> The association is particularly strong in the case of pustular psoriasis.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In contrast, the association between psoriasis and hypertension is debatable, as the studies have offered contradictory results albeit with a majority pointing to such an association,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,38,39</span></a> and even an association with more severe hypertension.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Application for Calculating the BMI, Metabolic Syndrome, and Cardiovascular Risk</span><p id="par0135" class="elsevierStylePara elsevierViewall">In view of the results presented above, the role of dermatologists in screening for metabolic syndrome and cardiovascular risk in patients with psoriasis is decisive.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> But in practice, few dermatologists spend any time during a visit on determining these indicators of cardiovascular health. Calculation of the BMI is a tedious process, the cutoff levels for metabolic syndrome depend on the sex of the individual, and the REGICOR tables are somewhat complicated for someone not accustomed to using them regularly.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Therefore, at the dermatology department at the Hospital Son Llàtzer, Spain, we have automated the diagnosis of metabolic syndrome by integrating its assessment into the electronic medical records and obtaining the data through smart forms. These can retrieve the clinical and laboratory data of the patients so that we only have to enter waist circumference and blood pressure. The results can subsequently be exported to a spreadsheet.</p><p id="par0145" class="elsevierStylePara elsevierViewall">However, this tool only represents a local solution. In order to help other dermatologists to detect patients with greater cardiovascular risk, we developed a multiplatform application that allows all these calculations to be done simply and intuitively. The project had the backing of the Psoriasis Group of the Spanish Academy for Dermatology and Venereology (AEDV) and funding from Laboratorios Janssen. Our development partner was the company EC-Europe. Versions were produced for the iOS operating system (for iPhone, iPd Touch and iPAD terminals) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and Android, and an integrated web tool was made available on the webpage of the Psoriasis Group of the AEDV. The applications for all these platforms can be downloaded for free. <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the web addresses for accessing the different versions of the tool, which is divided into 3 parts:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0150" class="elsevierStylePara elsevierViewall">BMI calculator (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). On entering the patient's weight and height, BMI is calculated in kg/m<span class="elsevierStyleSup">2</span> and classified into normal weight, overweight (grades I and II), or obese (grades I-IV).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0155" class="elsevierStylePara elsevierViewall">Metabolic syndrome calculator (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). According to the definition of the ATP-III. Sex, waist circumference, HDL cholesterol, blood pressure, and fasting glucose are entered. The screen displays abnormal parameters in red, and metabolic syndrome is diagnosed when 3 or more positive criteria are present.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0160" class="elsevierStylePara elsevierViewall">Cardiovascular risk calculator (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The application uses the REGICOR tables (validated in the Spanish population), which calculate the 10-year risk of experiencing a coronary event (whether or not the outcome is death). The parameters of sex, blood pressure, and HDL cholesterol are preloaded from previous entries for calculating metabolic syndrome. We therefore only have to enter age, diabetes, tobacco use, total cholesterol, LDL cholesterol, and family history of premature cardiovascular death. In addition to the corresponding risks, we can access a list of therapeutic goals for each case.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></li></ul></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">The results can be sent by e-mail, either to the patients themselves or to ourselves for printing or incorporation into the electronic medical records if available.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The aim of this tool is not to label patients as ill when they are not, but rather to identify those with a high cardiovascular risk who would not otherwise visit their physician. It can also act as a stimulus for fundamental lifestyle changes related to changes in smoking habit, improving diet, and doing more physical exercise.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">The project was developed in partnership with EC-Europe, with funding from Laboratorios Janssen. The author did not receive any fees for the design of the application.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">The author declares no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres95725" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82885" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95724" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82886" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Psoriasis and Metabolic Syndrome" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Psoriasis and Obesity" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Psoriasis and Cardiovascular Risk" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Application for Calculating the BMI, Metabolic Syndrome, and Cardiovascular Risk" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-14" "fechaAceptado" => "2011-11-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82885" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Metabolic syndrome" 2 => "Cardiovascular risk" 3 => "Obesity" 4 => "Mobile phone" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82886" "palabras" => array:5 [ 0 => "Psoriasis" 1 => "Síndrome metabólico" 2 => "Riesgo cardiovascular" 3 => "Obesidad" 4 => "Teléfono móvil" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Traditionally, psoriasis was considered to be a purely cutaneous disease affecting otherwise healthy patients (except for joint involvement). Recent studies have, however, shown a relationship between psoriasis and cardiovascular disease, with increased mortality in patients who have severe forms of psoriasis.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermatologists are thus in a position to play an important role in identifying patients at greater risk of cardiovascular disease and detecting potential risk factors that are, for the most part, manageable and avoidable.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">To this end, we designed a multiplatform application that provides a simple and intuitive tool to determine body mass index, whether or not metabolic syndrome is present, and cardiovascular risk. The application runs on iOS, Android, and the webpage of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AEDV).</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La psoriasis se ha considerado tradicionalmente (en ausencia de artropatía) como una enfermedad puramente cutánea que afecta por lo general a individuos sanos. Pero estudios recientes han demostrado una relación entre psoriasis y enfermedad cardiovascular, con un incremento de la mortalidad de aquellos pacientes con psoriasis graves.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En este sentido, los dermatólogos podemos desempeñar un importante papel en la identificación de aquellos pacientes con un mayor riesgo de enfermedad cardiovascular detectando potenciales factores de riesgo en su mayoría tratables y evitables.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Por este motivo hemos diseñado una aplicación multiplataforma que permite calcular de una manera sencilla e intuitiva el índice de masa corporal, la presencia o no de síndrome metabólico y el riesgo cardiovascular de nuestros pacientes, disponible para dispositivos móviles iOS, Android y en la página web del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (AEDV).</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Taberner R. Calculadora multiplataforma para síndrome metabólico y riesgo cardiovascular en pacientes con psoriasis. Actas Dermosifiliogr. 2012;103:111–9.</p>" ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2875 "Ancho" => 2158 "Tamanyo" => 251553 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Screenshot of the application for iPad (iOS). See text for a description of the functions.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3340 "Ancho" => 2502 "Tamanyo" => 286920 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Body mass index calculator. See text for a description of the functions.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3335 "Ancho" => 2502 "Tamanyo" => 475490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Metabolic syndrome calculator. Pathologic items are highlighted in red. See text for a description of the functions.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3340 "Ancho" => 2502 "Tamanyo" => 469669 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular risk calculator (according to REGICOR tables). See text for a description of the functions.</p>" ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: HDL, high-density lipoprotein.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Men \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Women \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Waist circumference \t\t\t\t\t\t\n \t\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">>102<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\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">>88<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum triglycerides \t\t\t\t\t\t\n \t\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">≥150<span class="elsevierStyleHsp" style=""></span>mg/dL or lipid-lowering treatment \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serum HDL cholesterol \t\t\t\t\t\t\n \t\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"><40<span class="elsevierStyleHsp" style=""></span>mg/dL or lipid-lowering treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><50<span class="elsevierStyleHsp" style=""></span>mg/dL or lipid-lowering treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Blood pressure \t\t\t\t\t\t\n \t\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">≥130/85<span class="elsevierStyleHsp" style=""></span>mm Hg or antihypertensive treatment \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fasting glucose \t\t\t\t\t\t\n \t\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<span class="elsevierStyleHsp" style=""></span>mg/dL or treatment for hyperglycemia \t\t\t\t\t\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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182036.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara">Metabolic syndrome is diagnosed with ≥3 positive criteria.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Definition of Metabolic Syndrome<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> According to the National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP-III) 2005.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">BMI, kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Definition \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.5–24.9 \t\t\t\t\t\t\n \t\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">Normal weight \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.0–26.9 \t\t\t\t\t\t\n \t\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">Grade I overweight \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.0–29.9 \t\t\t\t\t\t\n \t\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">Grade II overweight (preobesity) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.0–34.9 \t\t\t\t\t\t\n \t\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">Grade I obesity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.0–39.9 \t\t\t\t\t\t\n \t\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">Grade II obesity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.0–49.9 \t\t\t\t\t\t\n \t\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">Grade III obesity (morbid obesity) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥50 \t\t\t\t\t\t\n \t\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">Grade IV obesity (super-obesity) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182038.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Definition of Obesity According to Body Mass Index (BMI).</p>" ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">System \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Version \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Internet Address \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span> \t\t\t\t\t\t\n \t\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">iPhone, iPod Touch \t\t\t\t\t\t\n \t\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"><span class="elsevierStyleInterRef" href="http://itunes.apple.com/es/app/calculadora-para-sindrome/id445852426%3Fmt=8">http://itunes.apple.com/es/app/calculadora-para-sindrome/id445852426?mt=8</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span> \t\t\t\t\t\t\n \t\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">iPad \t\t\t\t\t\t\n \t\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"><span class="elsevierStyleInterRef" href="http://itunes.apple.com/es/app/calculadora-para-sindrome/id445872017%3Fmt=8">http://itunes.apple.com/es/app/calculadora-para-sindrome/id445872017?mt=8</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx2"></elsevierMultimedia></span> \t\t\t\t\t\t\n \t\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">Android \t\t\t\t\t\t\n \t\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"><span class="elsevierStyleInterRef" href="https://market.android.com/details%3Fid=com.ec_europe.calculadoramedica%26feature=search_result">https://market.android.com/details?id=com.ec_europe.calculadoramedica&feature=search_result</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx3"></elsevierMultimedia></span> \t\t\t\t\t\t\n \t\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">AEDV Psoriasis Group Website \t\t\t\t\t\t\n \t\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"><span class="elsevierStyleInterRef" href="http://www.aedv.es/grupo_psoriasis/">http://www.aedv.es/grupo_psoriasis/</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182037.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Links to the Different Versions of the Application.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis causes as much disability as other major medical diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.R. Rapp" 1 => "S.R. Feldman" 2 => "M.L. Exum" 3 => "A.B Fleischer Jr." 4 => "D.M. Reboussin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "41" "paginaInicial" => "401" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10459113" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of myocardial infarction in patients with psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.M. Gelfand" 1 => "A.L. Neimann" 2 => "D.B. Shin" 3 => "X. Wang" 4 => "D.J. Margolis" 5 => "A.B. Troxel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2006" "volumen" => "11" "paginaInicial" => "1735" "paginaFinal" => "1741" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The risk of mortality in patients with psoriasis: results from a population-based study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Gelfand" 1 => "A.B. Troxel" 2 => "J.D. Lewis" 3 => "S.K. Kurd" 4 => "D.B. Shin" 5 => "X. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.143.12.1493" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "1493" "paginaFinal" => "1499" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18086997" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular risk factors in patients with plaque psoriasis: a systematic review of epidemiological studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Prey" 1 => "C. Paul" 2 => "V. Bronsard" 3 => "E. Puzenat" 4 => "P-A. Gourraud" 5 => "S. Aractingi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2009.03564.x" "Revista" => array:7 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2010" "volumen" => "24" "numero" => "Suppl 2" "paginaInicial" => "23" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20443997" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lack of appropriate screening for the metabolic syndrome in patients with psoriasis risks underrecognition and undertreatment of important comorbidities: comment on “Prevalence of the metabolic syndrome in psoriasis”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.L. Shelling" 1 => "R.S. Kirsner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2011.55" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2011" "volumen" => "147" "paginaInicial" => "424" "paginaFinal" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21482893" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. DeFronzo" 1 => "E. Ferrannini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "1991" "volumen" => "14" "paginaInicial" => "173" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2044434" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The metabolic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.H. Eckel" 1 => "S.M. Grundy" 2 => "P.Z. Zimmet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)66378-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "365" "paginaInicial" => "1415" "paginaFinal" => "1428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15836891" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2001" "volumen" => "285" "paginaInicial" => "2486" "paginaFinal" => "2497" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11368702" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Grundy" 1 => "J.I. Cleeman" 2 => "S.R. Daniels" 3 => "K.A. Donato" 4 => "R.H. Eckel" 5 => "B.A. Franklin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.105.169404" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "112" "paginaInicial" => "2735" "paginaFinal" => "2752" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16157765" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The metabolic syndrome—a new worldwide definition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.G.M.M. Alberti" 1 => "P. Zimmet" 2 => "J. Shaw" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)67402-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "366" "paginaInicial" => "1059" "paginaFinal" => "1062" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16182882" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome and incident diabetes: current state of the evidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.S. Ford" 1 => "C. Li" 2 => "N. Sattar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc08-0423" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2008" "volumen" => "31" "paginaInicial" => "1898" "paginaFinal" => "1904" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18591398" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome and risk of cardiovascular disease: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Galassi" 1 => "K. Reynolds" 2 => "J. He" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjmed.2006.02.031" "Revista" => array:6 [ "tituloSerie" => "Am J Med" "fecha" => "2006" "volumen" => "119" "paginaInicial" => "812" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17000207" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.S. Gami" 1 => "B.J. Witt" 2 => "D.E. Howard" 3 => "P.J. Erwin" 4 => "L.A. Gami" 5 => "V.K. Somers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2006.09.032" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2007" "volumen" => "49" "paginaInicial" => "403" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17258085" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.G. Wannamethee" 1 => "A.G. Shaper" 2 => "L. Lennon" 3 => "R.W. Morris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archinte.165.22.2644" "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "2005" "volumen" => "165" "paginaInicial" => "2644" "paginaFinal" => "2650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16344423" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The metabolic syndrome: useful concept or clinical tool. Report of a WHO Expert Consultation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.K. Simmons" 1 => "K.G.M.M. Alberti" 2 => "E.A.M. Gale" 3 => "S. Colagiuri" 4 => "J. Tuomilehto" 5 => "Q. Qiao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00125-009-1620-4" "Revista" => array:6 [ "tituloSerie" => "Diabetologia" "fecha" => "2010" "volumen" => "53" "paginaInicial" => "600" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20012011" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The myth of the metabolic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.A.M. Gale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00125-005-1873-5" "Revista" => array:6 [ "tituloSerie" => "Diabetologia" "fecha" => "2005" "volumen" => "48" "paginaInicial" => "1679" "paginaFinal" => "1683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16025251" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Kahn" 1 => "J. Buse" 2 => "E. Ferrannini" 3 => "M. Stern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "2289" "paginaFinal" => "2304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16123508" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Should we dump the metabolic syndrome? Yes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.A.M. Gale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.39477.500197.AD" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2008" "volumen" => "336" "paginaInicial" => "640" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18356231" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case–control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Gisondi" 1 => "G. Tessari" 2 => "A. Conti" 3 => "S. Piaserico" 4 => "S. Schianchi" 5 => "A. Peserico" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2007.07986.x" "Revista" => array:7 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "157" "paginaInicial" => "68" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17553036" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0015028206005164" "estado" => "S300" "issn" => "00150282" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of severity of the cutaneous manifestations and age on the prevalence of several cardiovascular risk factors in patients with psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Rosa" 1 => "R. Machado" 2 => "F. Matias" 3 => "S. Cedrim" 4 => "F. Noronha" 5 => "D. Gaburri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2011" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Lindegård" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatologica" "fecha" => "1986" "volumen" => "172" "paginaInicial" => "298" "paginaFinal" => "304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3089849" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis and body mass index" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Hercogová" 1 => "F. Ricceri" 2 => "L. Tripo" 3 => "T. Lotti" 4 => "F. Prignano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1529-8019.2010.01309.x" "Revista" => array:6 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2010" "volumen" => "23" "paginaInicial" => "152" "paginaFinal" => "154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20415822" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case–control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Naldi" 1 => "L. Chatenoud" 2 => "D. Linder" 3 => "A. Belloni Fortina" 4 => "A. Peserico" 5 => "A.R. Virgili" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0022-202X.2005.23681.x" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol" "fecha" => "2005" "volumen" => "125" "paginaInicial" => "61" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15982303" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of cardiovascular risk factors in patients with psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.L. Neimann" 1 => "D.B. Shin" 2 => "X. Wang" 3 => "D.J. Margolis" 4 => "A.B. Troxel" 5 => "J.M. Gelfand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2006.08.040" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2006" "volumen" => "55" "paginaInicial" => "829" "paginaFinal" => "835" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17052489" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of obesity and smoking on psoriasis presentation and management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Herron" 1 => "M. Hinckley" 2 => "M.S. Hoffman" 3 => "J. Papenfuss" 4 => "C.B. Hansen" 5 => "K.P. Callis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.141.12.1527" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2005" "volumen" => "141" "paginaInicial" => "1527" "paginaFinal" => "1534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16365253" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and psoriasis: from the Medical Board of the National Psoriasis Foundation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Bremmer" 1 => "A.S. Van Voorhees" 2 => "S. Hsu" 3 => "N.J. Korman" 4 => "M.G. Lebwohl" 5 => "M. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2009.09.053" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2010" "volumen" => "63" "paginaInicial" => "1058" "paginaFinal" => "1069" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20692722" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Prodanovich" 1 => "S. Prodanowich" 2 => "F. Ma" 3 => "J.R. Taylor" 4 => "C. Pezon" 5 => "T. Fasihi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2004.06.017" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2005" "volumen" => "52" "paginaInicial" => "262" "paginaFinal" => "267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15692471" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Evidence from the Psocare project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Naldi" 1 => "A. Addis" 2 => "S. Chimenti" 3 => "A. Giannetti" 4 => "M. Picardo" 5 => "C. Tomino" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatology (Basel)" "fecha" => "2008" "volumen" => "217" "paginaInicial" => "365" "paginaFinal" => "373" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Yusuf" 1 => "S. Hawken" 2 => "S. Ounpuu" 3 => "T. Dans" 4 => "A. Avezum" 5 => "F. Lanas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(04)17018-9" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2004" "volumen" => "364" "paginaInicial" => "937" "paginaFinal" => "952" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15364185" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of coronary heart disease using risk factor categories" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.W. Wilson" 1 => "R.B. D’Agostino" 2 => "D. Levy" 3 => "A.M. Belanger" 4 => "H. Silbershatz" 5 => "W.B. Kannel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "1998" "volumen" => "97" "paginaInicial" => "1837" "paginaFinal" => "1847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9603539" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Marrugat" 1 => "P. Solanas" 2 => "R. D’Agostino" 3 => "L. Sullivan" 4 => "J. Ordovas" 5 => "F. Cordón" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2003" "volumen" => "56" "paginaInicial" => "253" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12622955" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Marrugat" 1 => "R. D’Agostino" 2 => "L. Sullivan" 3 => "R. Elosua" 4 => "P. Wilson" 5 => "J. Ordovas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Epidemiol Community Health" "fecha" => "2003" "volumen" => "57" "paginaInicial" => "634" "paginaFinal" => "638" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12883073" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Conroy" 1 => "K. Pyörälä" 2 => "A.P. Fitzgerald" 3 => "S. Sans" 4 => "A. Menotti" 5 => "G. De Backer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "987" "paginaFinal" => "1003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12788299" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipid disturbances in psoriasis: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Pietrzak" 1 => "A. Michalak-Stoma" 2 => "G. Chodorowska" 3 => "J.C. Szepietowski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/S096293519500041X" "Revista" => array:3 [ "tituloSerie" => "Mediators Inflamm" "fecha" => "2010" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18475648" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The lipid profile in psoriasis: a controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Akhyani" 1 => "A.H. Ehsani" 2 => "R.M. Robati" 3 => "A.M. Robati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2007.02260.x" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2007" "volumen" => "21" "paginaInicial" => "1330" "paginaFinal" => "1332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17958837" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous anti TNF-alpha antibody therapy leads to elevated triglyceride and reduced HDL-cholesterol levels in patients with rheumatoid and psoriatic arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Cauza" 1 => "K. Cauza" 2 => "U. Hanusch-Enserer" 3 => "M. Etemad" 4 => "A. Dunky" 5 => "K. Kostner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Wien Klin Wochenschr" "fecha" => "2002" "volumen" => "114" "paginaInicial" => "1004" "paginaFinal" => "1007" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12635469" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between smoking and the clinical severity of psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Fortes" 1 => "S. Mastroeni" 2 => "K. Leffondré" 3 => "F. Sampogna" 4 => "F. Melchi" 5 => "E. Mazzotti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.141.12.1580" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2005" "volumen" => "141" "paginaInicial" => "1580" "paginaFinal" => "1584" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16365261" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis and cardiovascular risk factors: a case–control study on inpatients comparing psoriasis to dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Shapiro" 1 => "A.D. Cohen" 2 => "D. Weitzman" 3 => "R. Tal" 4 => "M. David" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2011" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis and hypertension: a case–control study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.D. Cohen" 1 => "D. Weitzman" 2 => "J. Dreiher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2340/00015555-0741" "Revista" => array:6 [ "tituloSerie" => "Acta Derm Venereol" "fecha" => "2010" "volumen" => "90" "paginaInicial" => "23" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20107721" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis and hypertension severity: results from a case–control study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.W. Armstrong" 1 => "S.W. Lin" 2 => "C.J. Chambers" 3 => "M.E. Sockolov" 4 => "D.L. Chin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0018227" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "e18227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21479272" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiometabolic comorbidities and the approach to patients with psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Gisondi" 1 => "G. Girolomoni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2009" "volumen" => "100" "paginaInicial" => "14" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20096157" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000807/v1_201304241253/en/main.assets" "Apartado" => array:4 [ "identificador" => "6170" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Novelties in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000002/v1_201304241253/S1578219012000807/v1_201304241253/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000807?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 2 | 5 | 7 |
| 2024 Octubre | 67 | 45 | 112 |
| 2024 Septiembre | 76 | 27 | 103 |
| 2024 Agosto | 88 | 54 | 142 |
| 2024 Julio | 82 | 26 | 108 |
| 2024 Junio | 97 | 31 | 128 |
| 2024 Mayo | 66 | 32 | 98 |
| 2024 Abril | 81 | 29 | 110 |
| 2024 Marzo | 69 | 28 | 97 |
| 2024 Febrero | 67 | 32 | 99 |
| 2024 Enero | 60 | 36 | 96 |
| 2023 Diciembre | 58 | 14 | 72 |
| 2023 Noviembre | 77 | 24 | 101 |
| 2023 Octubre | 56 | 26 | 82 |
| 2023 Septiembre | 70 | 25 | 95 |
| 2023 Agosto | 43 | 12 | 55 |
| 2023 Julio | 44 | 42 | 86 |
| 2023 Junio | 42 | 21 | 63 |
| 2023 Mayo | 54 | 26 | 80 |
| 2023 Abril | 40 | 14 | 54 |
| 2023 Marzo | 57 | 17 | 74 |
| 2023 Febrero | 46 | 25 | 71 |
| 2023 Enero | 30 | 36 | 66 |
| 2022 Diciembre | 73 | 44 | 117 |
| 2022 Noviembre | 34 | 31 | 65 |
| 2022 Octubre | 29 | 26 | 55 |
| 2022 Septiembre | 30 | 27 | 57 |
| 2022 Agosto | 23 | 32 | 55 |
| 2022 Julio | 27 | 26 | 53 |
| 2022 Junio | 44 | 21 | 65 |
| 2022 Mayo | 34 | 30 | 64 |
| 2022 Abril | 47 | 37 | 84 |
| 2022 Marzo | 54 | 62 | 116 |
| 2022 Febrero | 42 | 25 | 67 |
| 2022 Enero | 54 | 33 | 87 |
| 2021 Diciembre | 59 | 40 | 99 |
| 2021 Noviembre | 39 | 35 | 74 |
| 2021 Octubre | 47 | 49 | 96 |
| 2021 Septiembre | 25 | 32 | 57 |
| 2021 Agosto | 44 | 40 | 84 |
| 2021 Julio | 37 | 22 | 59 |
| 2021 Junio | 23 | 28 | 51 |
| 2021 Mayo | 30 | 43 | 73 |
| 2021 Abril | 46 | 33 | 79 |
| 2021 Marzo | 59 | 38 | 97 |
| 2021 Febrero | 34 | 22 | 56 |
| 2021 Enero | 26 | 14 | 40 |
| 2020 Diciembre | 20 | 16 | 36 |
| 2020 Noviembre | 31 | 23 | 54 |
| 2020 Octubre | 31 | 12 | 43 |
| 2020 Septiembre | 26 | 11 | 37 |
| 2020 Agosto | 22 | 14 | 36 |
| 2020 Julio | 32 | 18 | 50 |
| 2020 Junio | 52 | 28 | 80 |
| 2020 Mayo | 29 | 15 | 44 |
| 2020 Abril | 45 | 16 | 61 |
| 2020 Marzo | 37 | 15 | 52 |
| 2020 Febrero | 7 | 0 | 7 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Julio | 0 | 1 | 1 |
| 2019 Junio | 2 | 4 | 6 |
| 2019 Mayo | 1 | 20 | 21 |
| 2019 Abril | 0 | 1 | 1 |
| 2019 Marzo | 2 | 6 | 8 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Febrero | 13 | 4 | 17 |
| 2018 Enero | 42 | 6 | 48 |
| 2017 Diciembre | 40 | 9 | 49 |
| 2017 Noviembre | 41 | 6 | 47 |
| 2017 Octubre | 37 | 4 | 41 |
| 2017 Septiembre | 24 | 6 | 30 |
| 2017 Agosto | 36 | 8 | 44 |
| 2017 Julio | 32 | 12 | 44 |
| 2017 Junio | 39 | 12 | 51 |
| 2017 Mayo | 34 | 8 | 42 |
| 2017 Abril | 40 | 11 | 51 |
| 2017 Marzo | 17 | 0 | 17 |
| 2017 Febrero | 27 | 8 | 35 |
| 2017 Enero | 22 | 11 | 33 |
| 2016 Diciembre | 39 | 4 | 43 |
| 2016 Noviembre | 51 | 7 | 58 |
| 2016 Octubre | 44 | 6 | 50 |
| 2016 Septiembre | 35 | 2 | 37 |
| 2016 Agosto | 31 | 10 | 41 |
| 2016 Julio | 28 | 4 | 32 |
| 2016 Junio | 7 | 4 | 11 |
| 2016 Mayo | 6 | 7 | 13 |
| 2016 Abril | 5 | 6 | 11 |
| 2016 Marzo | 6 | 7 | 13 |
| 2016 Febrero | 8 | 10 | 18 |
| 2016 Enero | 16 | 8 | 24 |
| 2015 Diciembre | 11 | 8 | 19 |
| 2015 Noviembre | 22 | 9 | 31 |
| 2015 Octubre | 11 | 9 | 20 |
| 2015 Septiembre | 12 | 2 | 14 |
| 2015 Agosto | 12 | 1 | 13 |
| 2015 Julio | 45 | 5 | 50 |
| 2015 Junio | 58 | 8 | 66 |
| 2015 Mayo | 93 | 12 | 105 |
| 2015 Abril | 53 | 7 | 60 |
| 2015 Marzo | 47 | 10 | 57 |
| 2015 Febrero | 48 | 15 | 63 |
| 2015 Enero | 38 | 7 | 45 |
| 2014 Diciembre | 47 | 9 | 56 |
| 2014 Noviembre | 31 | 7 | 38 |
| 2014 Octubre | 39 | 26 | 65 |
| 2014 Septiembre | 55 | 9 | 64 |
| 2014 Agosto | 51 | 15 | 66 |
| 2014 Julio | 57 | 24 | 81 |
| 2014 Junio | 70 | 8 | 78 |
| 2014 Mayo | 77 | 20 | 97 |
| 2014 Abril | 63 | 8 | 71 |
| 2014 Marzo | 67 | 16 | 83 |
| 2014 Febrero | 18 | 11 | 29 |
| 2014 Enero | 25 | 6 | 31 |
| 2013 Diciembre | 30 | 15 | 45 |
| 2013 Noviembre | 20 | 8 | 28 |
| 2013 Octubre | 17 | 3 | 20 |
| 2013 Septiembre | 13 | 2 | 15 |
| 2013 Agosto | 10 | 8 | 18 |
| 2013 Julio | 7 | 13 | 20 |
| 2013 Junio | 15 | 20 | 35 |
| 2013 Mayo | 13 | 9 | 22 |
| 2013 Abril | 11 | 18 | 29 |
| 2013 Marzo | 13 | 12 | 25 |
| 2013 Febrero | 31 | 5 | 36 |
| 2013 Enero | 29 | 7 | 36 |
| 2012 Diciembre | 16 | 5 | 21 |
| 2012 Noviembre | 1 | 4 | 5 |
| 2012 Octubre | 3 | 4 | 7 |
| 2012 Agosto | 0 | 1 | 1 |
Mostrar todo
