Increased prevalence of hypertension among people living with HIV: where to begin?

Abstract INTRODUCTION: Cardiovascular diseases (CDVs) have become increasingly important for progressively older people living with HIV (PLHIV). Identification of gaps requiring improvement in the care cascade for hypertension, a primary risk factor for CVDs, is of utmost importance. This study analyzed the prevalence of hypertensive status and described the care cascade for hypertension screening, diagnosis, treatment, treatment adherence, and management in PLHIV. METHODS: This cross-sectional study included 298 PLHIV (age >40 years) who visited a referral center in the western Brazilian Amazon. Data were collected through a structured questionnaire interview and medical examinations. Thus, information regarding sociodemographic and clinical aspects, blood pressure, weight, height, body mass index, and laboratory profile was obtained. Descriptive and analytical statistics were performed, and results were considered significant ifp <0.05. RESULTS: In total, 132 (44.3%) participants reported that their blood pressure was never measured. The prevalence of hypertension was found to be 35.9% (107/298). Of these 107 participants, only 36 (33.6%) had prior knowledge of their hypertensive status, and 19 of 36 (52.7%) participants had visited a physician or cardiologist to seek treatment. Adherence to the BP-lowering treatment was noted in 11 (10.2%) participants. CONCLUSIONS: An increased prevalence of hypertension was found, and most of the hypertensive participants were unaware of their hypertensive status. In addition, blood pressure control was poor in the study population. This indicated that public health professionals did not sufficiently consider the full spectrum of healthcare and disease management for PLHIV.

Técnicas quirúrgicas y láser en cicatrices atróficas de acné / Surgical and laser techniques in atrophic acne scars

Las cicatrices de acné, especialmente las de tipo atrófico, constituyen una complicación frecuente del acné vulgar que se asocia a un importante impacto psicológico. Múltiples terapias se han utilizado para mejorar su aspecto, sin embargo, ninguna ha demostrado ser completamente eficaz y segura. El tratamiento quirúrgico en acné cicatricial incluye técnicas como escisión elíptica, escisión o elevación por punch, subcisión y distintos tipos de láser. El objetivo de esta revisión es presentar la evidencia disponible respecto a las técnicas quirúrgicas y dispositivos láser utilizados en cicatrices atróficas de acné.

Acne scars, especially the atrophic type, are a common complication of acne vulgaris, which is associated with a major psychological impact. Multiple therapies have been used to improve its appearance, however, none has proven completely effective and safe. Surgical treatment includes surgical techniques such as elliptical excision, punch excision or elevation, subcision and different types of lasers. The aim of this review is to present the available evidence regarding the surgical techniques and laser devices used in atrophic acne scars.

Uso de N-acetilcisteína tópica en ictiosis: experiencia clínica en una serie de casos / Use of topical N-acetylcysteine ​​in ichthyosis: clinic experience in a series of cases

Las ictiosis son trastornos generalizados de la queratinización, que se caracterizan por presentar hiperqueratosis y/o descamación. El tratamiento es sintomático e incluye terapias tópicas y sistémicas. La N-Acetilcisteína (NAC) tópica ha mostrado utilidad en algunos reportes. Se describirá la experiencia con el uso de NAC 10% y urea 5% en novobase II (NB II) en 6 pacientes con distintos tipos de ictiosis hereditarias. Caso Nº1: Escolar masculino de 7 años con Ictiosis lamelar (IL) en tratamiento con fórmula de NAC hace 4 años con buena respuesta. Caso N°2, 3 y 4: Escolar masculino de 7 años, escolar masculino de 5 años y lactante masculino de 1 año 8 meses con Ictiosis recesiva ligada a X (IRLX), en tratamiento con fórmula de NAC con buena respuesta. Caso N°5: Mujer de 18 años con Eritrodermia ictiosiforme congénita (EIC), inicia tratamiento con fórmula de NAC, pero se suspende por mala tolerancia. Caso N°6: Preescolar femenina de 3 años, con Ictiosis epidermolítica (IE), inicia tratamiento con fórmula de NAC con mala tolerancia por lo que también se suspende. Se evaluaron los efectos de la fórmula de NAC en diferentes tipos de ictiosis, mostrando un buen perfil de seguridad y eficacia en IL e IRLX, sin embargo, en EIC e IE su uso estuvo restringido por efectos adversos. El tratamiento con fórmula de NAC presenta buena respuesta y tolerancia en pacientes con IL e IRLX, por lo que podría considerarse en el tratamiento habitual de estos pacientes.

Ichthyosis are generalized disorders of keratinization, characterized by hyperkeratosis and/or scaling. Treatment is symptomatic and includes topical and systemic therapies. Topical N-acetylcysteine (NAC) has shown utility in some reports. We describe the experience using 10% NAC and 5% urea in novobase II (NB II) in 6 patients with different types of hereditary ichthyosis. Case N°1: 7-year-old boy with lamellar Ichthyosis (IL) in treatment with NAC formula 4 years ago, with good response. Case N°2, 3 and 4: 7-year-old boy, 5-year-old boy and 1-year-8-month-old male infant, with X-recessive recessive Ichthyosis (IRLX) in treatment with NAC formula with good response. Case N°5: An 18-year-old woman with congenital ichthyosiform erythroderma (EIC) begins treatment with NAC formula but is discontinued because of poor tolerance. Case No. 6:3-year-old girl, with epidermolytic Ichthyosis (IE), starts treatment with NAC formula with poor tolerance and is also suspended. The effects of the NAC formula on different types of ichthyosis were evaluated, showing a good safety and efficacy profile in IL and IRLX, however, in EIC and IE, its use was restricted by adverse effects. Treatment with NAC formula has a good response and tolerance in patients with IL and IRLX, so it could be considered in the usual treatment of these patients.

Análisis descriptivo de 561 biopsias con diagnóstico de melanoma entre los años 2006 y 2012 en un laboratorio de dermatopatología de la región metropolitana / Descriptive analysis of 561 biopsies with melanoma diagnosis between 2006 and 2012

Durante las últimas décadas la incidencia de melanoma maligno(MM) ha aumentado en gran parte de los países del mundo. Entre los factores más importantes en el desarrollo de un MM está el fototipo del paciente y la exposición a radiación UV. Nuestro país cuenta con escasa información epidemiológica respecto a MM. En este trabajo se analiza la información disponible en las biopsias de piel con diagnóstico de MM procesadas en un laboratorio de dermatopatología en un periodo de siete años. La muestra contó con 561 biopsias, de los cuales el 60,61 por ciento correspondió a sexo femenino, la edad promedio de la muestra fue 54,14 años. Respecto a la localización de las lesiones, el 34,33 por ciento se encontró en extremidades inferiores, 25,70 por ciento en tronco, 21,68 por ciento en cabeza y cuello y 18,27 por ciento en extremidades superiores. El diagnóstico histológico fue melanoma in situ en el 52,88 por ciento de los pacientes e infiltrante en el 47,12 por ciento. Este último grupo se analizó en base al índice de Breslow, observando que el 32,68 por ciento de los pacientes se encontraba en etapa T1. Este trabajo es un aporte para el desarrollo de mayor información epidemiológica respecto a MM, pero dado que se trata de casos exclusivos del sector privado de salud, no es extrapolable a toda la población. Por esto sería de gran utilidad realizar un estudio similar en pacientes atendidos en hospitales, especialmente para revisar el espesor que tienen los melanomas al momento del diagnóstico.

During the last decades, incidence of malignant melanoma (MM) has raised in most countries of the world. Skin phototype and sun exposure are the most important factors related with the development of MM. In our country the epidemiological information in MM is scarse. In this study we analyze available information of skin biopsies with MM diagnosis processed in a dermatopathology lab in a period of 7 years. We analyzed 561 biopsies, 60,61 percent females, with average age of 54,14 years. The lesions were located on lower extremities in 34,33 percent, 25,70 percent on trunk, 21,68 percent on head and neck and 18,27 percent on upper extremities. The histologic diagnosis was in situ melanoma in the 52,88 percent cases and infiltrative melanoma in 47,12 percent cases. Of this last group 32,68 percent were on T1 stage (Breslow index). This study is contributing to the development of more epidemiological information on MM. Because all the cases belong to private practice, we cannot extrapolate the information to global population. It would be useful to replicate this study on public hospital population, with special attention on MM thickness at the diagnosis.

Alopecia areata incógnita: casos clínicos y revisión de la literatura / Alopecia areata incognita: clinical cases and literature review

La alopecia areata incógnita es un tipo de alopecia no cicatricial, que ha sido considerada por algunos autores como parte del espectro de alopecia areata. Se presenta como caída difusa de cabello, con visualización variable de vellos cortos, puntos amarillos, puntos negros y pelos en signos de exclamación a la dermatoscopía, y hallazgos histológicos que, si bien varían de acuerdo al tiempo de evolución, son similares a lo encontrado en biopsias de pacientes con patrones clásicos de alopecia areata. Desde que Rebora et al. describe por primera vez su hipótesis de alopecia areata incógnita, se han publicado diversos estudios dirigidos a establecer criterios que permitan definir esta entidad. Sin embargo, aún no se ha llegado a consenso. A continuación, se describen los hallazgos clínicos, dermatoscópicos e histopatológicos de pacientes con alopecia difusa de difícil manejo vistos en el Departamento de Dermatología de la Pontificia Universidad Católica de Chile

Alopecia areata incognita, a type of non-scarring alopecia, has been considered by some authors as a subtype of alopecia areata. Clinically it is characterized by diffuse hair fall, with variable display of short hairs, yellow dots, black dots and exclamation mark hairs on dermoscopy. Its histological findings are similar to those found in biopsies of patients with classical pattern of alopecia areata, although substancial changes may be seen according to the evolution of the disease. Since Rebora et al. described his hypothesis of alopecia areata incognita, several studies have been published to establish a criteria in order to define this entity. However, still no consensus has been reached. In this review, we describe the clinical, dermoscopic and histopathologic features of patients seen at the Dermatology Department of the Pontificia Universidad Católica de Chile with the diagnosis of diffuse alopecia with difficult management.