Crescentic Glomerulonephritis and Membranous Nephropathy: A Rare Overlap.

Background: Membranous nephropathy (MN) is a disease that affects the basement membrane of the glomeruli of the kidney resulting in proteinuria. The concurrent incidence of vasculitic glomerulonephritis and MN in the same patient is unusual. Herein, we report a case with this unusual combination. Case: Our patient is a 53-year-old Hispanic male with a medical history of tobacco use, type 2 diabetes mellitus, and hypertension who presented with hematuria and was found to have nephrotic range proteinuria and renal impairment. Blood workup revealed positive ANCA serology, which led to a renal biopsy that showed crescentic vasculitis in addition to membranous nephropathy. The patient was started on intermittent hemodialysis (HD) and treated initially with intravenous (IV) pulse steroids; subsequently, oral prednisolone and IV cyclophosphamide were initiated. The patient remained HD dependent at the time of discharge with the resolution of hematuria. A follow-up with an outpatient nephrology clinic was arranged. Conclusion: Membranous nephropathy complicated by crescentic glomerulonephritis has a more aggressive clinical course and decline in renal function compared to MN alone which can lead to initiating renal replacement therapy. However, immunosuppressive drugs can result in significant improvement of renal function if started early enough.

Superficial cutaneous fungal infections in tropical countries.

Superficial fungal infections represent an important cause of morbidity for people worldwide, particularly in the tropics. Fungal infections affect the skin, hair, or the nails, and tend to thrive in the heat and humidity of tropical countries. Because of environmental and cultural factors unique to the tropics, the causative organisms and presentation of these infections may differ from those in industrialized countries. Treatment options include topical and systemic therapy. However, social and socioeconomic factors in developing tropical countries may necessitate different treatment approaches to achieve success.

Compounding dermatologic preparations in developing countries.

Access to medications and their proper use are essential in developing countries. An interdisciplinary team of dermatologists and pharmacists created a master list of preparations useful for treating the most common dermatologic disorders in tropical and equatorial areas. The first pilot project was done at Cardinal Leger Hospital in Leogane, Haiti. Training was given to local staff at that hospital in 2005. Four years later, the clinic continues to prepare and offer, at a reasonable price, drugs that the population needs.

Prognostic factors for life expectancy in nonagenarians with nonmelanoma skin cancer: implications for selecting surgical candidates.

BACKGROUND: Controversy exists over surgical intervention for nonmelanoma skin cancer in the very elderly. OBJECTIVE: We sought to define variables that are prognostic for survival in the elderly after surgery for skin cancer. METHODS: We reviewed 99 charts of nonagenarians who had Mohs micrographic surgery for nonmelanoma skin cancer and recorded data on comorbid conditions and date of death. Comorbid conditions were quantified by the Charlson index. RESULTS: Patients with Charlson scores of zero (no comorbidities) had a statistically significant longer survival than patients with Charlson scores of >/=3 (multiple comorbidities). Women survived longer than men at both 1 and 5 years. No patient died within 30 days of operation. CONCLUSION: Charlson scores of >/=3 in nonagenarians predict shorter survival. Although this parameter may predict shorter survival when skin cancer surgery is considered in a cohort of elderly patients, it remains difficult to predict accurately the survival of individual patients with scores >/=3.