Fibroxantoma atípico: caso clínico / Scalp atypical fibroxanthoma: report of one case

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

Toxicidad severa asociada a metotrexato: caso clínico / Severe toxicity associated with methotrexate: clinical case

El metotrexato (MTX) es un agente anti folato con actividad antineoplásica e inmunosupresora que ha alcanzado gran aceptación y uso debido a su eficacia en distintos desórdenes reumatológicos. Sin embargo, tiene el potencial para causar complicaciones serias y, a veces, mortales, principalmente hematológicas, hepáticas o pulmonares. Los factores de riesgo para el desarrollo de pancitopenia incluyen edad avanzada, alteración de la función renal, niveles bajos de ácido fólico y uso concomitante de otros fármacos que modifiquen el metabolismo del folato. Presentamos un caso de pancitopenia severa y estomatitis, secundaria a una dosis estándar de MTX, en una paciente de 53 años de edad, con Artritis Reumatoídea (AR) de 10 años de evolución y enfermedad renal crónica en hemodiálisis trisemanal. Es muy importante prestar atención a los factores de riesgo asociados a la aparición de efectos adversos antes de iniciar terapia con MTX en pacientes reumatológicos. Además, los pacientes con MTX deben ser monitorizados durante su tratamiento para identificar efectos adversos hematológicos severos, como la pancitopenia.

Methotrexate (MTX) is an agent for anti-folate with antineoplastic activity and immunosuppressive that has achieved wide acceptance and use due to its efficacy in various rheumatologic disorders. However, it has the potential to cause complications serious and sometimes deadly, primarily hematologic, hepatic or pulmonary. The factors of risk for the development of pancytopenia include advanced age, renal function, low levels of folic acid and concomitant use of other drugs that alter the metabolism of folate. We present a case of severe pancytopenia and stomatitis, secondary to a standard dose of MTX in patient of 53 years, with rheumatoid arthritis (RA) of 10 years of evolution and chronic kidney disease on hemodialysis immediately. It is very important to pay attention to the risk factors associated with the occurrence of adverse effects, before initiating therapy with MTX in rheumatologic patients. In addition MTX patients should be monitored during treatment to identify severe haematological adverse effects such as pancytopenia.

Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad / Evaluation of a program for management of metabolic syndrome in adults with overweight and obesity

Background: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). Aim: To evaluate the impact of PASAF on nutritional status and metabolic parameters. Patients and Methods: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. Result: We evaluated 526 subjects aged ≥ 18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was < 50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥ 5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥ 5% of their initial weight. Conclusions: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.