Evaluation of hemodialysis vascular access. Perspective from Mexico.

Chronic kidney disease (CKD) has become a global health problem. In 2019, it was related to 2.53% of general global mortality (2.35-2.66%); in the same year, in Latin America, mortality related to CKD reached 5.25% (4.92-5.49%), with an annual increase of 3.37%, proving increased mortality of 102% between 1990 and 2017. A nephrology specialty in Mexico recently fulfilled its first 50 years. Despite being relatively young, nephrologists are interested in "new" sub-specialties of nephrology and learning novel techniques and problem-solving skills. Our group is the first in our country to focus solely and exclusively on comprehensive VA care and we want to position ourselves as the first Mexican interdisciplinary group focused on vascular access (GIMEXAV).

Reference values for oxygen saturation from sea level to the highest human habitation in the Andes in acclimatised persons.

Oxygen saturation, measured by pulse oximetry (SpO2), is a vital clinical measure. Our descriptive, cross-sectional study describes SpO2 measurements from 6289 healthy subjects from age 1 to 80 years at 15 locations from sea level up to the highest permanent human habitation. Oxygen saturation measurements are illustrated as percentiles. As altitude increased, SpO2 decreased, especially at altitudes above 2500 m. The increase in altitude had a significant impact on SpO2 measurements for all age groups. Our data provide a reference range for expected SpO2 measurements in people from 1 to 80 years from sea level to the highest city in the world.

Caracterización clínica y comorbilidades de pacientes con psoriasis grave al inicio del tratamiento con terapia biológica / Clinical characterization and comorbidities of patients with severe psoriasis treated with biologic therapy

OBJETIVO. Describir las características clínicas y comorbilidades de pacientes con psoriasis grave al inicio del tratamiento con terapia biológica en el departamento de Dermatología del Hospital Luis N. Sáenz. MATERIAL y MÉTODOS. Estudio transversal de carácter retrospectivo. Se revisó las historias clínicas de los pacientes atendidos entre enero 2009 y diciembre 2013 y que cumplieron con los criterios de psoriasis grave (porcentaje de superficie corporal y/o PAS1 mayor a 20) los cuales fueron tratados con terapia biológica. Se obtuvo variables como la edad, sexo, PAS1, índice de calidad de vida en Dermatología (DLQl) así como la presencia de comorbilidades (diabetes, hipertensión arterial, dislipidemias y artritis psoriática). RESULTADOS. Participaron del estudio 24 pacientes. La edad promedio fue de 56,37 años, la mayor frecuencia fueron varones (87,5 %). Se encontró un PAS1 promedio de 16,7, un DLQ1 promedio de 12,08, tiempo de enfermedad promedio de 15,08 años, superficie corporal afectada de 29,04 % y un índice de masa corporal promedio de 27,59. Las comorbilidades más frecuentes fueron la hipertensión arterial (41,66 %) y la artritis psoriática (30 %). Se determinó el coeficiente de correlación de Pearson entre el PAS/ respecto al tiempo de enfermedad (r = 0,23), y el DLQ1 (r = 0,245) pero con significancia > 0,05. CONCLUSIÓN. Existen altos índices de PAS1, DLQ1 y porcentaje de afectación corporal, así como alto porcentaje de comorbilidades metabólicas y sobrepeso en la presente serie de pacientes con psoriasis grave. En estadios graves no se evidencia correlación significativa del PASI entre el DLQ/ o el tiempo de enfermedad de los pacientes.

OBJECTIVE. To describe the clinical characteristics and comorbidities of patients with severe psoriasis at the start of biologic therapy in the Department of Dermatology, Hospital Luis Saen; N. MATERIAL AND METHODS. A retrospective cross-sectional study. The medical records of patients seen between January 2009 and December 2013 were reviewed and met the criteria for severe psoriasis (percentage of body surface and/or greater PASI 20) which were treated with biologic therapy. Variables such as age, sex, PAS1 index Dermatology Life Quality (DLQ1) and the presence of comorbidities (diabetes, hypertension, dyslipidemia, and psoriatic arthritis) was obtained. RESULTS. The study included 24 patients. The average age was 56,37 years, were more often male (87,5 %). PAS/ 16,7 average a 12,08 average DLQI, mean disease duration of 15,08 years, body surface area of 29,04 % and an average body mass of27,59 was found. The most frequent comorbidities were hypertension (41,66 %) and psoriatic arthritis (30 %). The Pearson correlation coefficient between PASI disease over time (r = 0,23), and the DLQI (r = 0,245) with significance determined but > 0,05. CONCLUSION. There are high rates of PASI, DLQ1 and percentage of body involvement, and high percentage of overweight and metabolic comorbidities in this series of patients with severe psoriasis. In severe stages no significant correlation between the PAS1 evidenced time DLQI or patient condition.

Successful treatment of pityriasis rubra pilaris with adalimumab - case report.

Pityriasis Rubra Pilaris (PRP) is an uncommon skin disorder characterized by follicular keratosis, palmoplantar keratoderma, and erythroderma. The traditional preferred treatment is oral retinoids, but over the last decade, biologic therapy with anti-TNF agents has been used with success. We report the case of a 51 year- old man with a clinical and histopathological diagnosis of PRP. He underwent therapy with adalimumab and showed clearance of skin lesions within the fourth week of treatment.

Desarrollo de penfigoide buloso en paciente con psoriasis vulgar / Development of bullous pemphigoid in patients with psoriasis vulgaris

Las enfermedades ampollares se asocian raramente con psoriasis. A la fecha, alrededor de 60 reportes de coexistencia entre penfigoide buloso y psoriasis vulgar están disponibles en la literatura. Se reporta el caso de un paciente de 84 años de edad con bullas que aparecen sobre una base de placas eritematosas en extremidades, tórax y abdomen. El paciente fue tratado satisfactoriamente con metotrexato más prednisoma.

Blistering diseases are rarely associated with psoriasis. To this point about 60 reports of coexistence between bullous pemphigoid and psoriasis vulgaris are available in the literature. We report the case of an 84 year-old male with blisters and bullae over erythematous plaque lesions on his extremities, chest and abdomen. This patient was successfully treated with oral methotrexate plus prednisone.

Fibrohistiocitoma maligno cutáneo con metástasis satélites / Malígnant fibrous histiocytoma with satellite metastasis

El fibrohistiocitoma maligno es un tumor subcutáneo de larga evolución y localizado principalmente en extremidades. Se presenta el caso de una paciente de 77 años con una tumoracián nodular de superficie ulcerada con múltiples pápulas perilesionales en su pierna derecha. Se realizó la confirmación histopatológica y de inmunohistoquimica compatible con Fibrohistiacitoma maligno asociado a metástasis cutáneas satélites.

Malignant fibrous histiocytoma is a subcutaneous tumor of long evolution, more frequently located in the extremities. We present the case of a 77 year- old female with a nodular ulcerated tumor with multiple perilesional papules on her right lower leg. Histopathology and immunohistochemistry were consistent with cutaneous malignant fibrous histiocytoma associated to satellite metastasis.

Presentación inusual de morfea en placas en un niño / Unusual presentation of morphea in plates in child

La morfea de presentación infantil se caracteriza por manifestarse como lesiones lineares, localizadas con mayor frecuencia en uno de los miembros o en la región facial. La morfea tiene mayor prevalencia en el sexo femenino. Se presenta el caso de un niño de once años sin morbilidad adicional, con lesiones planas, hiperpigmentadas y atróficas, localizadas en la parte medialy lateral del tercio inferior de ambas piernas. Las lesiones fueron confirmadas histopatologicamente como morfea superficial.

Child onset morphea is usually characterized by linear lesions, more frequently located in one limb or in the facial region, more prevalent in white female children. We report the case of a 11year-old male child without additional morbidity, with atrophic and hyperpigmented flat plaque lesions, located in the inner and outer side of the lower third part of both legs. The lesions were pathologically confirmed as superficial morphea.

Melanoma subungueal in situ: reporte de dos casos / Subungual melanoma in situ: report of two cases

El melanoma subungueal es un tipo infrecuente de melanoma lentiginoso acral, con una proporción media de 0.7%a 3,5%, más frecuente en personas con fototipo de piel oscuras. Se presentan dos casos de melanoma subungueal insitu atendidos en el servicio de Dermatología del Hospital Nacional PNP æLuis N. SáenzÆ, Lima, Perú. El primer caso corresponde a una paciente de 60 años, con tiempo de enfermedad de cinco años caracterizado por melanoniquia y signo de Hutchinson en el primer dedo de la mano derecha. El segundo caso es de un paciente de 59 años, con tiempo de enfermedad de cuatro años, caracterizado por cambio progresivo de coloración de la uña del segundo dedo de maño derecha. La histopatología informó en ambos pacientes el diagnóstico de melanoma in situ, y ambos pacientes fueron sometidos a amputación de la falange distal.

Subungual melanoma is an infrequent type of Lentiginous acral melanoma, with a media proportion of 0,7% to 3,5%, more frequent in dark-skinned fototypes. We present two cases of subungual melanoma attended at Dermatology Service of Hospital Nacional PNP æLuis N. SaenzÆ, Lima, Peru. The first is a 60 years-old female,with a lesion for the past 5 years, characterized by melanonychia and HutchinsonÆs sign of the first right finger. The second one is a 59 years-old patient with progressive change in coloration of the nail for the past 4 years, in the second finger of his right hand. The histopathology informed that both patients had the diagnosis of melanoma in situ, and both of them under went surgical removal of the distal phalanx.