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Clinical study of the effectiveness of the “3-sulphates solution” on balanitis and balanoposthitis
Estudio clínico de la eficacia del «agua de 3 sulfatos» en la balanitis y la balanopostitis
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(a) Erythema, (b) edema, (c) stinging, (d) itching, and (e) exudate.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Balanitis and balanoposthitis are frequent reasons for consultation in urology and dermatology.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Acute balanitis/balanoposthitis is the most common. It occurs abruptly or insidiously, and it presents with erythema, edema, exudate, maceration, smelly purulent discharge, itching, and stinging. The most common causes are often irritative, infectious, or traumatic, although in many cases they are unknown.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In irritative and acute non-specific balanitis it is usual, along with proper hygiene and removing of irritants, to use astringent solutions (antiexudative) with antiseptic capacity. The local use of topical sulfates as non-specific treatment of balanitis is collected in multiple treaties of dermatology and urology<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,5,6</span></a>; however, we found no prospective study that it does.</p><p id="par0015" class="elsevierStylePara elsevierViewall">With this study, we aim to evaluate the efficacy of a classic topical astringent formula “3-sulfate water” based on zinc sulfate, copper, and aluminum–potassium in the treatment of patients with acute irritative and non-specific balanitis/balanoposthitis. We have compared it with a control group, treated with saline solution.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study followed a double-blind design, with randomized distribution of the treatments, comparing the effectiveness of a solution of “3-sulfate water” (experimental treatment) and a physiological saline solution (control group).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Three health centers took part: the “Lluis Alcanyís’ hospital in Xàtiva (Servei d’Urología), the “Sagrat Cor” hospital in Barcelona (Servei d’ Urología), and the urological clinic of Dr. Peyri. The inclusion of patients was conducted from June 2012 to December 2013 (19 months). 50 adult patients diagnosed with non-specific or irritative balanitis or balanoposthitis were selected, who were randomized so that 30 patients received the solution of the “3-sulfate water” and another 20 patients saline solution as a control.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We excluded infectious or other-cause balanitis, patients with severe systemic diseases, those treated with other therapies that could interfere, and those who presented with other skin lesions in the genital area (herpes, syphilis, chancroid) or allergic dermatitis. The treatment consisted of the application of the solution 2 times a day (morning and evening) either by immersing the penis for 5–6<span class="elsevierStyleHsp" style=""></span>min in an aliquot of the solution using a small plastic cup or by fomentation with a soaked gauze applied on the penis for 5 or 6<span class="elsevierStyleHsp" style=""></span>min (in this case the operation was repeated 2 times). The composition of the “3-sulfate water” was: 2<span class="elsevierStyleHsp" style=""></span>‰ zinc sulphate, 2<span class="elsevierStyleHsp" style=""></span>‰ aluminum–potassium sulphate, and 1<span class="elsevierStyleHsp" style=""></span>‰ copper sulfate. The duration of the treatment was 10 days.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Each patient underwent 2 controls, a baseline one (day 0) and a final one (day 10). In the baseline control, assessment of the initial symptoms was collected and the treatment was handed, and in the final control we evaluated the final symptoms and an overall assessment of both the physician and patient was issued on the efficacy and tolerability of the treatment. The symptomatology assessed was: exudate, erythema, edema, stinging, and itching according to the following score: 0<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>absence; 1<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>mild; 2<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>moderate, and 3<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>intense.</p><p id="par0040" class="elsevierStylePara elsevierViewall">During treatment the patient had to note any adverse events that might be perceived and the physician assessed their intensity (mild, moderate, or severe) and their causation (probable, possible, unlikely, unrelated) with the treatment in the final control.</p><p id="par0045" class="elsevierStylePara elsevierViewall">For the statistical analysis of results, we used the Chi-square test for qualitative characteristics, and Student–Fisher's <span class="elsevierStyleItalic">T</span> to compare quantitative parameters.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 50 patients who started treatment, 47 finished it; one of the patients did not perform successful treatment and the other two did not return to the final control, so they were excluded from the final analysis. Of those who completed the treatment, 27 received the “3-sulfate water” solution and the remaining 20 the physiological solution. The groups have been homogeneous in terms of age (54 years in the experimental group and 59 in the control), diagnosis (12 balanitis [44%]), and (15 balanoposthitis [56%] in the first group, and 9 [45%] and 11 [55%] in the control group) and in the method of treatment (immersion or fomentation) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">After the treatment, there was a clear overall symptomatic improvement in both groups, as reflected in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>(a–e).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">When comparing the symptoms, we observed a trend to a better evolution of the group treated with the “3-sulfate water” in all clinical parameters, and in one of them the differences were statistically significant: in the evolution of the exudate. This sign improved or disappeared in 25 of the 27 patients treated with the “3-sulfate water” and in the remaining 2 it remained constant, while in the control one 13 of the 20 improved or were cured, 3 remained constant, and 4 worsened. This difference is statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.025) and favorable to “3-sulfate water”. In terms of overall judgments of doctor and patient, favorable differences are observed in the treatment with the “3-sulfate water”, although they did not reach significant differences compared to control.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally, tolerability was excellent in 96% of the ‘3-sulfate water’ group and in 89% of the control group. In the first one, there was a case of moderate tolerability without the patient referring any adverse event, and in the second one, a case of increased secretion (probably related), another of pruritus (probably related), and another of itching (possibly related) were recorded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The study shows that both the “3-sulfate water” and the saline solution are effective in the treatment of balanitis/balanoposthitis, with favorable overall results. This is logical, since poor hygiene favors the emergence of balanitis and balanoposthitis.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,4</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The “3-sulfate water” has proven significantly more effective than the control in the removal of the exudate, confirming the well-known astringent and drying capacity of this classic formula.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5–7</span></a> The antiexudative effectiveness is important to eliminate this possible element, the exudate, which favors bacterial/fungal growth and chronification of the process,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,7</span></a> and this has been evident in our study.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The remaining parameters studied evolved more favorably with the “3-sulfate water” and perhaps they could have achieved significant differences with a larger sample size.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">The “3-sulphate water” has proven significantly more effective than the saline solution in removing the exudate from the acute balanitis and balanoposthitis in our study. The tolerability of the treatments has been excellent.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres437239" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec460420" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres437240" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec460421" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-05-06" "fechaAceptado" => "2014-05-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec460420" "palabras" => array:6 [ 0 => "Balanitis" 1 => "Balanoposthitis" 2 => "“3 sulphates solution”" 3 => "Copper sulphate" 4 => "Zinc sulphate" 5 => "Potassium aluminum sulphate" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec460421" "palabras" => array:6 [ 0 => "Balanitis" 1 => "Balanopostitis" 2 => "«Agua de 3 sulfatos»" 3 => "Sulfato de cobre" 4 => "Sulfato de cinc" 5 => "Sulfato alumínico-potásico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Despite scientific literature mentions the application of“‘3 sulphates solution” (copper sulphate, zinc sulphate and alum) as a treatment for acute balanitis and balanoposthitis, no clinical trials evaluating its efficacy have been found. In our study we evaluate the efficacy of this solution in acute balanitis and balanoposthitis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A double-blind randomized study was designed to compare the efficacy of “3 sulphates solution” (intervention) with saline solution (control) in 50 patients (30 patients and 20 patients, respectively) who suffer from acute balanitis or balanoposthitis. Exudate, erythema, edema, burning, and itching were the clinical parameters assessed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">For all clinical parameters assessed, the outcomes obtained with “3 sulphates solution” are higher than control, although significant differences only have been found for exudate.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In our study, the “3 sulphates solution” is significantly more effective than saline solution for removing exudates in acute balanitis and balanoposthitis. Tolerability was excellent in both treatments.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La utilización del «agua de 3 sulfatos» (sulfato de cinc, cobre y alumínico-potásico) se cita en la literatura como un posible tratamiento para la balanitis y balanopostitis; ahora bien, no existen trabajos prospectivos que documenten su eficacia clínica. Pretendemos estudiar dicha eficacia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos un estudio aleatorizado doble ciego sobre 50 pacientes con balanitis o balanopostitis en el que se comparan los resultados clínicos del «agua de 3 sulfatos» (30 pacientes) frente a una solución salina (20 pacientes). Los parámetros clínicos estudiados han sido: exudado, eritema, edema, escozor y prurito.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Una vez aplicados los test estadísticos, hemos observado que el «agua de 3 sulfatos» ha sido superior al suero salino en todos los parámetros clínicos estudiados, aunque las diferencias solo han sido significativas para el parámetro exudado.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El «agua de los 3 sulfatos» se ha mostrado significativamente más eficaz que el suero fisiológico en la eliminación del exudado de las balanitis y balanopostitis agudas de nuestro estudio. La tolerabilidad de los tratamientos ha sido excelente.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gonzalvo V, Polo A, Serrallach F, Gutiérrez A, Peyri E. Estudio clínico de la eficacia del «agua de 3 sulfatos» en la balanitis y la balanopostitis. Actas Urol Esp. 2015;39:118–121.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3149 "Ancho" => 3210 "Tamanyo" => 462083 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evolution of symptoms after treatment. (a) Erythema, (b) edema, (c) stinging, (d) itching, and (e) exudate.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>NS for all comparisons.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control (Saline solution) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Water 3 (Sulfates) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Age (mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD, years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Diagnosis, n</span> (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Balanitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (44) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Balanoposthitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (56) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Type</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-specific \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Irritative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (30) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other (atrophic, diabetic) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Application method, n</span> (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inmersion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fomentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (25) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab682445.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Comparability of the treatment groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balanitis and balanoposthitis: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. 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Arango" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "1996" "paginaInicial" => "1" "paginaFinal" => "246" "editorial" => "ENE ediciones" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Balanopostitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "X. Bordas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "1989" "volumen" => "4" "paginaInicial" => "325" "paginaFinal" => "332" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dermatosis del aparato genital masculino" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Peyri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Tratado de urología" "paginaInicial" => "1341" "paginaFinal" => "1363" "serieFecha" => "2006" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Formulación magistral en dermatología para el médico de atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Ribera Pibernat" 1 => "J.M. Casanova Seuma" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "FMC Form Med Contin Aten Prim" "fecha" => "1997" "volumen" => "4" "paginaInicial" => "198" "paginaFinal" => "206" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Formulación magistral en atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Rosales Zábal" 1 => "J.C. Muñoz Beltrán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "SEMERGEN-Med Fam" "fecha" => "2001" "volumen" => "2" "paginaInicial" => "53" "paginaFinal" => "58" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Terapéutica dermatológica. Fundamentos de Medicina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Vélez" 1 => "W. Rojas" 2 => "J. Borrero" 3 => "J. Restrepo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:6 [ "edicion" => "6.a ed." "fecha" => "2002" "paginaInicial" => "545" "paginaFinal" => "546" "editorial" => "Fondo Editorial (CIB)" "editorialLocalizacion" => "Colombia" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003900000002/v2_201502240227/S2173578615000050/v2_201502240227/en/main.assets" "Apartado" => array:4 [ "identificador" => "6274" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003900000002/v2_201502240227/S2173578615000050/v2_201502240227/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578615000050?idApp=UINPBA00004N" ]
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