Sociodemographic, clinical, laboratory, treatment and prognostic characteristics of 156 generalized pustular psoriasis patients in Turkey: a multicentre case series.

BACKGROUND: Generalized pustular psoriasis (GPP) is a rare and severe inflammatory disease characterized by widespread and superficial sterile pustules on an erythematous background. OBJECTIVES: This multicentre study aimed to determine the clinical profile and course in a large cohort of patients with GPP. METHODS: One hundred and fifty-six GPP patients (mean age, 44.2 ± 18.7 years) who met the diagnostic criteria of the European Consensus Report of GPP were included in the study. Sociodemographic characteristics, quality of life, triggering factors of the disease, clinical, laboratory, treatment and prognostic features were evaluated. RESULTS: 61.5% of the patients were female. The rate of working at or below the minimum wage (≤$332.5/month) was 44.9%. Drugs (36.5%) were the most common trigger. While hypocalcaemia (35.7%) was the most important cause of GPP during pregnancy, systemic steroid withdrawal (20%) was the most frequently reported trigger for infantile/juvenile and mixed-type GPP (15%) (P < 0.05). Acute GPP (53.8%) was the most common clinic. Nails were affected in 43.6% of patients, and subungual yellow spots (28.2%) were the most common change. In annular GPP, fever (P < 0.001) and relapse frequency (P = 0.006) were lower than other subtypes, and the number of hospitalizations (P = 0.002) was lower than acute GPP. GPP appeared at a later age in those with a history of psoriasis (P = 0.045). DLQI score (P = 0.049) and joint involvement (P = 0.016) were also higher in this group. Infantile/juvenile GPP was observed in 16.02% of all patients, and arthritis was lower in this group (24.4 vs. 16%). GPP of pregnancy had the worst prognosis due to abortion observed in three patients. CONCLUSIONS: Recent advances in treatment have improved mortality associated with GPP, but abortion remains a significant complication. Although TNF-α inhibitors have proven efficacy in GPP, they can also trigger the disease. Mixed-type GPP is more similar to acute GPP than annular GPP with systemic manifestations and course.

The impact of TFPI on coronary atherosclerotic burden.

OBJECTIVES: We aimed to associate a coronary artery disease (CAD) presence and severity with endothelial dysfunction (ED), carotid intima media thickness (CIMT) and Tissue Factor Pathway Inhibitor (TFPI). BACKGROUND: ED has a central role in atherosclerosis. CIMT and TFPI activity are also related with atherosclerosis and CAD. METHODS: In our prospective observational study, 50 patients had CAD and 30 had normal coronary arteries. Endothelial function was evaluated by endothelium-dependent flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) measurements. CIMT and Serum TFPI levels were also measured. RESULTS: TFPI was a statistically significant determinant between the two groups with an increased level in CAD (+) group (84.9 ± 19.3 vs 70.2 ± 14.7, p = 0.001). There was a positive correlation between CIMT and Gensini (r = 0.34, p = 0.014). There was a strong negative correlation between Gensini and FMD-NMD, statistically significant (FMD: r = -0.715, p < 0.001; NMD: r = -0.718, p < 0.001). CONCLUSION: We observed that ED, increased CIMT and TFPI levels were associated with CAD. Additionally, increased CIMT measurements and decreased FMD and NMD values had a positive correlation with GSS (Tab. 4, Fig. 6, Ref. 50).

Nailfold capillaroscopy in Behçet disease, performed using videodermoscopy.

BACKGROUND: Nailfold capillaroscopy is used for the identification of microvascular involvement in many rheumatic and extrarheumatic diseases. AIM: To determine the nailfold capillary changes in patients with Behçet disease (BD) by videodermoscopy, i.e. nailfold videocapillaroscopy (NVC). METHODS: We used a videodermatoscope (Molemax II, × 30 magnification) to perform nailfold capillaroscopy on 40 patients with BD and 40 healthy controls (HC). All nailfold images were evaluated for capillary density, distribution and morphology, assessing features such as enlargement or tortuosity of the capillaries, microhaemorrhages and avascular areas. RESULTS: Enlarged capillaries were detected in 14 patients, microhaemorrhages in 6 patients, and avascular area in 3 patients. There was a statistically significant difference between patients with BD and healthy controls for capillary dilatation and microhaemorrhages (P < 0.05). Capillaroscopic changes were not associated with sex or clinical characteristics. CONCLUSIONS: Using NVC, nailfold capillary changes were apparent in patients with BD, but not in HC. NVC could be a useful technique for evaluating microvascular damage in BD.

Clinical implications of velocity vector imaging-based two dimensional strain imaging for the evaluation of left ventricular systolic functions.

Two-dimensional (2D) echocardiography is the most common imaging modality used to assess left ventricular (LV) myocardial function. Although the studies revealed useful conclusions, there are some limitations with the conventional measurement of ejection fraction. Two dimensional (2D) strain imaging is newer echocardiographic technique which is utilized for the evaluation of quantitative regional ventricular functions. Velocity vector imaging based- 2D strain imaging is the most recent technology with a few advantages sourced by its software. This review introduces a novel 2D strain imaging technology, explains its fundamental concepts and discusses clinical applications with all the major advantages and limitations.

Comparison of Demodex folliculorum density in haemodialysis patients with a control group.

BACKGROUND: Demodex folliculorum (DF) is resident in human pilosebaceous follicles. Mite density is low in healthy skin. Many cases of demodicosis in association with immunosuppression have been reported. Patients undergoing haemodialysis are also immunosuppressed. OBJECTIVE: We aimed to compare the Demodex folliculorum density in haemodialysis patients and healthy subjects. METHODS: Mite density of 87 patients undergoing haemodialysis was compared with that of age- and sex-matched controls. Two samples of standardized skin surface biopsies were taken from each subject from the forehead, cheek and nose. The number of mites counted on the surface area of 1 cm2 was accepted as the density of DF. The length and width of mites were measured by oculometer. RESULTS: DF density was found in 17 (19.54%) of the 87 dialysis patients and in 9 (10.34%) of 87 controls. A mean mite density of 5.11+/-5.65 was found in dialysis patients and of 2.55+/-1.6 in controls. Differences between the two groups in mite density were not statistically significant (P=0.13). There was also no significant difference in mite length between the two groups (P=0.06). There was, however, a significant difference in mite width (P=0.018). CONCLUSION: Despite the presence of sebaceous gland atrophy in haemodialysis patients, the higher density of DF in these patients than controls supports the supposition that this mite can increase immunosuppression.

Clinico-epidemiologic study of cutaneous leishmaniasis in Diyarbakir Turkey.

Cutaneous leishmaniasis (CL) is a zoonotic disease, endemic and notifiable in southeastern Turkey. We investigated clinical features, individual characteristics, and environmental factors of affected patients, and identified additional patients with CL in Diyarbakir. In 2002 we studied the epidemiology of CL in Dedeköy and Durabeyli towns in Diyarbakir Province. We evaluated patients with any skin lesions. A questionnaire including demographic details was completed by each patient. Clinical details of lesions and other dermatological findings were recorded. We walked around the town and surveyed it for environmental factors. CL was diagnosed in 78 individuals aged 1-85 years (mean age of 20). Although all age groups were affected, the majority of patients were under age 20. The lesions ranged from approximately 0.5 to 20 cm. They were located on the face (46.7 %), upper extremity (23.2 %), lower extremity (5.1 %), and other sites. Different types of lesions were observed such as nodule with crust, nodule with osseous crust, violaceous infiltrative plaque with vegetative nodule, erysipelas-like plaque verrucous annular plaque, and eczema-like plaques. The incidence of CL is increasing in Dicle and Durabeyli towns and the clinical appearance may vary greatly.

Bilateral basal cell carcinoma symmetrically appearing on lower eyelids: a case report.

Basal cell carcinoma is the most common skin malignancy and is found in skin exposed to the sun. It is rarely seen bilaterally in ears, ankles or breasts. There has been no literature about bilateral basal cell carcinoma of lower eyelids symmetrically. A 68-year-old male patient had been suffering from two lesions on his lower eyelids for two years. The first lesion appeared on the right lower eyelid two years ago and got larger. Then the second lesion occurred on the left lower eyelid a year and a half ago. The patient had worked as a farmer for fifteen years. Physical examination revealed ulcerated lesions, with surrounding hyperemia, 12 x 6 mm in size, on both lower eyelids. Both lesions were excised and repaired with lateral malar flap+mucosal graft. One year later, there no evidence of recurrence, and postoperative scars were functionally and cosmetically acceptable. We present a case of bilateral basal cell carcinoma involving both lower eyelids symmetrically, reviewing the literature.

The role of posterior pericardiotomy on the incidence of atrial fibrillation after coronary revascularization.

AIM: Pericardial effusion and atrial fibrillation (AF) are two common complications in coronary revascularization surgery. The aim of this study was to evaluate the efficiency of posterior pericardiotomy in pericardial effusion and AF. METHODS: This randomized prospective study includes 113 patients who underwent isolated CABG procedure between May 2000 and December 2000 in our hospital. Posterior pericardiotomy incision was done in Group I (n=54). Group II constituted the control group (n=59). Postoperative pericardial effusion was assessed by echocardiography and rhythm follow-up was done by the same cardiologist. RESULTS: There was no significant difference between study group and the control group considering the chest drainage (940.18+/-367.96 vs 894.92+/-360.65; p=0.507). The number of patients with remarkable intrapericardial effusion (>50 ml) was significantly lower in the posterior pericardiotomy group (25.93% vs 47.45%, p=0.020). The incidence of postoperative AF was no different between the posterior pericardiotomy group and the control group (12.96% vs 20.34%; p=0.32). In both groups, the incidence of AF was significantly higher in patients with mild or moderate pericardial effusion (29%), compared to patients with no or minimal pericardial effusion (10%), (p=0.017). CONCLUSION: Posterior pericardiotomy significantly reduces the pericardial effusion in coronary bypass procedure postoperatively. Patients with pericardial effusion were subjected to AF more frequently.