The Impact of Subthalamic Deep Brain Stimulation on Apathy in Parkinson's Disease Patients.

AIM: To investigate the impact of subthalamic deep brain stimulation (STN DBS) on apathy and the possible relationship between apathy, depression, and levodopa equivalent dosage (LED) in Parkinson's Disease (PD) patients. MATERIAL AND METHODS: A total of 26 patients have been evaluated via the Unified Parkinson Disease Rating Scale (UPDRS), Beck Depression Inventory (Beck D), and Beck Anxiety Inventory (Beck A), Montreal Cognitive Assessment (MoCA), Parkinson Disease Questionnaire (PDQ-39) just before and 6 months after DBS. RESULTS: Apathy scores (AES) showed a slight decrease from 54.00 ± 10.30 to 52.69 ± 8.88 without any statistical significance (p=0.502) after DBS therapy. No correlation was detected between the post-treatment changes in apathy and UPDRS scores, Beck D, Beck A. Although the direction of the correlation between changes in AES scores and LED values was negative, the results did not reach statistical significance. CONCLUSION: STN DBS therapy does not have a negative effect on apathy in PD Patients. Despite the satisfactory motor improvement, conservative dopaminergic dose reduction after surgery seems to be the main point to prevent apathy increase in PD patients after STN DBS.

Demographic and clinical characteristics of our patients diagnosed with laryngeal dystonia.

PURPOSE: Laryngeal dystonia (LD) is a focal dystonia affecting laryngeal musculature with no known etiology or cure. The present study evaluated the sociodemographic and clinical features of patients diagnosed with LD. MATERIALS AND METHODS: All patients diagnosed with LD at our University Hospital's Ear, Nose, and Throat Department between January 2017 and July 2023 were retrospectively analyzed. The study included 43 patients. RESULTS: Out of the 43 patients, 19 (44%) were male. At the time of diagnosis, the mean age of the patients was 35.1 years (ranging from 17 to 65 years). The mean elapsed time between the first symptom onset and the first diagnosis was 49.2 months (min. 4 months, max. 240 months). Of the participants, 94% had adductor-type LD. None of the patients had a family history of LD. Of the patients, 9 (20%) experienced a life-altering event or trauma just before the onset of symptoms. All patients who consumed alcohol reported symptom relief with alcohol intake. A total of 67.6% of patients stated that their symptoms were triggered by stress. All of our patients received at least one Botulinum toxin injection, with an average of 2.75 dosages per patient. CONCLUSION: The gender distribution was approximately equitable between males and females. There was a tendency for men to receive a diagnosis earlier than women following the manifestation of symptoms. A significant number of patients associate the emergence of their symptoms with a stressful event or traumatic experience. This study represents the initial investigation into the sociodemographic characteristics of patients within the Turkish population.

Epidemiological characteristics of different types of adult acne in Turkey: a prospective, controlled, multicenter study.

INTRODUCTION: Acne occurring in adults over the age of 25 years is known as acne tarda or adult acne. Three types of adult acne are recognized: persistent, late-onset, and recurrent acne. Most studies do not compare the characteristics between the three variants. In addition, little is known about adult acne in males. This study describes the epidemiological factors of adult acne and investigates certain triggering factors by sex and different types of adult acne. METHODS: A multicenter, prospective, descriptive study was conducted. Patients with adult acne and an acne-free control group were compared regarding medical history, family history, smoking and drinking habits, and dietary factors. In addition, triggering and prognostic factors were investigated by sex and three different types of acne: persistent, late-onset, and recurrent acne. RESULTS: The participants included 944 (88.56%) female and 122 (11.44%) male patients with adult acne, and 709 (73.85%) female and 251 (26.15%) male control patients. The consumption of crackers, chocolate, and pasta was significantly more common in the acne group than in the control group (p = 0.017, 0.002, and 0.040, respectively). Male patients with adult acne had a significantly longer disease duration than female patients with adult acne (p = 0.024). The most common type of acne was recurrent acne, followed by persistent and late-onset acne. Among patients with persistent acne, 14.5% had polycystic ovary syndrome (PCOS), whereas 12.2% of patients with recurrent acne and 11.1% of patients with late-onset acne had PCOS. Severe acne was more common in the persistent acne type (28.13%). The cheek (59.90%) was the most common involvement area, and stress (55.23%) was the most common triggering factor regardless of sex. CONCLUSIONS: Although adult female and male patents with adult acne share similar triggering factors, the involvement areas can differ, which may indicate the additional hormonal etiology of female adult acne. Further epidemiological studies on adult acne in both sexes may illuminate the pathogenesis of the disease, thus making possible the development of new treatment strategies.

Internalized Stigma in Hidradenitis Suppurativa: A Multicenter Cross-Sectional Study.

BACKGROUND: Hidradenitis suppurativa (HS) causes significant physical, social, and psychological burdens. Internalized stigma, acceptance of negative attitudes and stereotypes of society regarding a person's illness, has not been studied previously in HS. OBJECTIVES: The objective of this study was to investigate the internalized stigma state of HS patients and identify the factors affecting it. METHODS: This multicenter, prospective, cross-sectional study included 731 patients. Internalized Stigma Scale (ISS), Hurley staging, Physician Global Assessment, Dermatology Life Quality Index (DLQI), Skindex-16, Beck Depression Inventory-II (BDI-II), and Visual Analog Scale (VAS)-pain score were used in the study. RESULTS: The mean ISS value (57.50 ± 16.90) was comparable to the mean ISS values of studies in visible dermatological and various psychiatric diseases. A significant correlation was found between the mean values of ISS and all disease activity scores, quality of life measures, BDI-II, and VAS-pain scores. Obesity, family history, low education and income level, vulva/scrotum involvement and being actively treated are significant and independent predictive factors for high internalized stigma in multivariate analysis. CONCLUSIONS: HS patients internalize society's negative judgements, which may create a profound negative effect on access to health care. Therefore, in addition to suppressing disease activity, addressing internalized stigma is fundamental for improving health care quality.

Skin manifestations following anti-COVID-19 vaccination: A multicentricstudy from Turkey.

PURPOSE: After the emergence of the pandemic caused by the COVID-19 virus, vaccination with various vaccines has started to be implemented across the world. To identify dermatological reactions developing after the COVID-19 vaccines administered in Turkey and determine their clinical features and risk factors that may play a role in their development. MATERIALS AND METHODS: The study included patients aged ≥18 years, who presented to 13 different dermatology clinics in Turkey between July 2021 and September 2021 after developing dermatological reactions following the administration of the COVID-19 vaccine. After providing written consent, the patients were asked to complete a standard survey including questions related to age, gender, occupation, comorbidities, the regular medication used, the onset of cutaneous reactions after vaccination, and localization of reactions. Dermatological reactions were categorized according to whether they developed after the first or second dose of the vaccine or whether they occurred after the inactivated or messenger RNA (mRNA) vaccine. The relationship between dermatological reactions and some variables such as gender and comorbidities was also evaluated. RESULTS: A total of 269 patients [116 women (43.1%), 153 men (56.9%)] were included in the study. It was observed that the dermatological diseases and reactions that most frequently developed after vaccination were urticaria (25.7%), herpes zoster (24.9%), maculopapular eruption (12.3%), and pityriasis rosea (4.5%). The rate of dermatological reactions was 60.6% after the administration of the mRNA vaccine and 39.4% after that of the inactivated vaccine. There was a statistically significantly higher number of reactions among the patients that received the mRNA vaccine (p = 0.001). CONCLUSION: The most common reactions in our sample were urticaria, herpes zoster, and maculopapular eruption. Physicians should know the dermatological side effects of COVID-19 vaccines and their clinical features.

The effect of COVID-19 on development of hair and nail disorders: a Turkish multicenter, controlled study.

BACKGROUND: A broad spectrum of skin diseases, including hair and nails, can be directly or indirectly triggered by COVID-19. It is aimed to examine the type and frequency of hair and nail disorders after COVID-19 infection. METHODS: This is a multicenter study conducted on consecutive 2171 post-COVID-19 patients. Patients who developed hair and nail disorders and did not develop hair and nail disorders were recruited as subject and control groups. The type and frequency of hair and nail disorders were examined. RESULTS: The rate of the previous admission in hospital due to COVID-19 was statistically significantly more common in patients who developed hair loss after getting infected with COVID-19 (P < 0.001). Telogen effluvium (85%) was the most common hair loss type followed by worsening of androgenetic alopecia (7%) after COVID-19 infection. The mean stress scores during and after getting infected with COVID-19 were 6.88 ± 2.77 and 3.64 ± 3.04, respectively, in the hair loss group and were 5.77 ± 3.18 and 2.81 ± 2.84, respectively, in the control group (P < 0.001, P < 0.001). The frequency of recurrent COVID-19 was statistically significantly higher in men with severe androgenetic alopecia (Grades 4-7 HNS) (P = 0.012; Odds ratio: 2.931 [1.222-7.027]). The most common nail disorders were leukonychia, onycholysis, Beau's lines, onychomadesis, and onychoschisis, respectively. The symptoms of COVID-19 were statistically significantly more common in patients having nail disorders after getting infected with COVID-19 when compared to the control group (P < 0.05). CONCLUSION: The development of both nail and hair disorders after COVID-19 seems to be related to a history of severe COVID-19.

Use of Complementary and Alternative Medicine among Patients with Acne Vulgaris and Factors Perceived to Trigger the Disease: A Multicentre Cross-Sectional Study with 1571 Patients.

Background: Acne vulgaris (AV) is among the common skin diseases for which patients refer to complementary and alternative medicine (CAM). Aims and Objectives: To investigate the approaches to CAM methods and factors believed to increase the disease in 1,571 AV patients. Materials and Methods: The sociodemographic characteristics of the patients and disease severity according to the Food and Drug Administration criteria were recorded. The Cardiff Acne Disability Index (CADI) was used to assess the impact of acne on the patient's life and the history of CAM use was noted. The patients also listed the factors that they thought worsened their disease and reported their gluten-free diet experiences. Results: Of all the patients, 74.41% had a history of using CAM methods. CAM use was significantly higher in women, patients with severe AV, those with a higher CADI score and non-smokers. As a CAM method, 66.37% of the patients reported having used lemon juice. The respondents most frequently applied CAM methods before consulting a physician (43.94%), for a duration of 0-2 weeks (38.97%). They learned about CAM methods on the internet (56.24%) and considered CAM methods to be natural (41.86%). The patients thought that food (78.55%) and stress (17.06%) worsened their disease. They considered that the most common type of food that exacerbated their symptoms was junk food (63.84%) and a gluten-free diet did not provide any benefit in relieving AV (50%). Conclusion: Physicians need to ask patients about their CAM use in order to be able to guide them appropriately concerning treatments and applications with a high level of evidence.

Tattoos: Demographics, Motivations, and Regret in Dermatology Patients.

Background: Tattoos are very popular in today's world. Objectives: The aim of this study was to determine the demographics, the characteristics of tattoos, motivations for getting tattoos, tattooing practices and tattoo regret. Materials and Method: This multi-centre, cross-sectional study was conducted among. 302 patients attending to the dermatology outpatient clinics and having at least one tattoo. A questionnaire form including all needed data about patients, tattoo characteristics and possible reasons for obtaining tattoos was designed and applied to all participants. Results: Of 302 patients, 140 (46,4%) were females and 162 (53,6%) were men. The mean age was28,3 ± 8,1 years (min-max, 16-62) for all study group, 53% of participants (n = 160) had at least one tattoo involving letters or number, 80 participants (26%) stated regret for at least one of their tattoos, and 34 of them (42,5%) had their unwanted tattoo removed or camouflaged with a new tattoo. The most common reason for regret was 'not liking the tattoo anymore'. The most common motivations for having tattoos were 'to feel independent', 'to feel better about himself/herself' and 'to look good'. Women had higher scores than men regarding tattoo motivations of 'to be an individual' and 'to have a beauty mark'. Conclusion: Given the rates, tattoo regret is a significant issue and as motivations differ between genders, age groups and other demographic characteristics; tattoos are not just an ink or drawing on the body, but a tool for individuals to express themselves and to construct self-identity. Tattoos have deep symbolic meanings for emotions, and they may be a clue for behavioural patterns of individuals.

Rates of skincare product and cosmetic procedure use in patients with acne vulgaris and the effective factors: A multicenter study with 1,755 patients.

BACKGROUND: Skincare products and cosmetic procedures are used as an adjunct or complementary to conventional drug therapy for acne vulgaris (AV). OBJECTIVE: To evaluate the use of skincare products and the frequency of cosmetic procedures in AV treatment. METHODS: A total of 1,755 patients with AV completed the survey prepared by the researchers and the Cardiff Acne Disability Index (CADI) questionnaire. The clinical findings and the Food and Drug Administration (FDA) severity scores were recorded by the dermatologists. RESULTS: For AV, 66.7% of the patients stated that they used skincare products and 26.7% had undergone cosmetic procedures. The use of skincare products was statistically significantly higher in women (female: 74.5%, male: 57.7%, p < 0.0001); older people (users: 22 ± 7.6years, non-users: 21.2 ± 5.7 years, p < 0.0001); patients with a higher CADI score (users: 7 ± 3.7, non-users: 6.9 ± 4.3, p = 0.010); FDA severity score 2 and 3 (FDA-1: 58.1%; FDA-2: 72.4%, FDA-3: 73%, FDA-4: 67%, p < 0.0001); long-term disease (users: 57 ± 43 months; non-users: 47.7 ± 42.3 months, p < 0.0001); facial involvement (present: 70.2%, absent: 51.4%, p = 0.017); high income levels (users: 73.5%; non-users: 26.5%, p = 0.001); and graduate or post-graduate degrees (undergraduate≤%62.8, graduate≥%76.8, p < 0.0001). The rate of cosmetic procedures was higher in those with higher CADI scores (users: 7.8 ± 3.8; non-users: 7.1 ± 3.96, p < 0.0001); older patients (users: 22.7 ± 10.7 years; non-users: 21.3 ± 5 years, p < 0.0001); high school (25.6%); and graduate (28.9%) education (p = 0.043), those with lower disease severity (FDA-1: 31.1%; FDA-2: 28.5%, FDA-3: 27.1%, FDA-4: 20.4%, p = 0.022); smokers (smokers: 32.5%; non-smokers: 25.5%, p = 0.020), and those with AV in the family (present: 29.8%; absent: 24.2%, p = 0.009). The patients most frequently used cleansers (85.2%) as cosmetic products, and most commonly underwent skincare treatment (71%) as an interventional procedure. They mostly learned about such products and methods from the Internet, and 33.3% of the participants had undergone procedures performed by non-physicians. CONCLUSION: The patients generally choose skincare products as a result of their Internet search and sometimes have these procedures performed by non-physicians. Dermatologists should be aware of this situation and inform their patients about appropriate products and procedures.

Has the COVID-19 pandemic changed attitudes and behaviors concerning cosmetic care and procedures among patients presenting to the dermatology outpatient clinic? A multicenter study with 1437 participants.

BACKGROUND: The rate of cosmetic procedures and use of skincare products is considered to be affected during the pandemic period; however, this has not been investigated yet. OBJECTIVE: To determine whether the ongoing pandemic has changed people's habits related to skincare products and cosmetic procedures. METHODS: We conducted a multicenter survey study covering both private and public hospitals. Sociodemographic characteristics and clinical diagnoses of the patients were noted by dermatologists. A survey was used to determine the type and application areas of skincare products and cosmetic procedures before and during the pandemic, whether the patients were concerned about being infected, and any change in the make-up habits of female patients. RESULTS: Of the 1437 patients, 86.7% presented to the hospital due to dermatological complaints and 13.3% for cosmetic procedures. The rate of those that did not use skincare products was 0.05% before and 0.06% during the pandemic. Of the participants, 43.2% had undergone cosmetic procedures before and 38.1% during the pandemic. For both periods, the most frequent cosmetic procedure applied was laser epilation, followed by skincare treatment and chemical peeling. While undergoing these procedures, 34.9% of the patients were concerned about contracting coronavirus. CONCLUSION: There was no significant difference in the use of skincare products and cosmetic procedures before and during the pandemic. The majority of the patients continued to undergo these procedures despite their fear of being infected. This shows that during the pandemic period, patients are concerned with their appearance and continue to undergo cosmetic procedures and pay attention to their skincare.

Could endocrine disruptors be a new player for acne pathogenesis? The effect of bisphenol A on the formation and severity of acne vulgaris: A prospective, case-controlled study.

BACKGROUND: Acne is one of the most common skin diseases in the adolescent period. Bisphenol A (BPA) is the most frequently observed endocrine-disrupting chemicals that we are exposed to in daily life. BPA can affect acne pathogenesis with similar biological activity on androgenic receptors. AIMS: To investigate whether BPA levels play a role in the development and severity of acne in adults. METHODS: Fifty-one adults with acne and 50 healthy controls, whose ages varied between 18 and 25 years and applied to our dermatology outpatient clinic, were evaluated. A questionnaire containing dietary and lifestyle habits for BPA exposure was filled. BPA and BPA glucuronides were analyzed in the LC-MS/MS system in the first-morning urine samples of the patients. Statistical significance was set at p < 0.05. RESULTS: The median levels of total BPA were significantly higher in the acne group compared with the control group (7.94 (4.69-20.32) vs. 5.62 (1.52-21.05) µg/g creatinine, respectively; p = 0.04)). The acne severity was positively associated with the BPA values (p = 0.00 rs = 0.534). Higher BPA level was noticed in younger acne onset age (p = 0.012 r = -0.349) When the inquiry questions were evaluated, no difference was found between the study groups regarding BPA exposure risk (p > 0.05). CONCLUSION: BPA could be a factor in acne development and its severity. Therefore, it may be beneficial to prevent BPA exposure and raise awareness in the adolescence and post-adolescence period, in which industrial products such as junk food and plastic bottled water are used more frequently.

Social media use in patients with acne vulgaris: What do patients expect from social media?

BACKGROUND: Acne vulgaris (AV) may affect external appearance and significantly deteriorate the quality of life of patients. Therefore, patients make various inquiries about their disease and seek treatment options. AIMS: To investigate the social media usage habits of patients with AV concerning their diseases, and their recommendations for dermatologists related to social media use. METHODS: A total of 1609 patients with AV completed the survey prepared by the authors and the Cardiff Acne Disability Index questionnaire. The Food and Drug Administration severity scores and clinical information of the patients were noted by their physicians. RESULTS: Of the 1,489 patients who stated that they used social media, 46.31% regularly and 28.77% sometimes referred to these sources to make inquiries about AV. Social media usage for AV was statistically significantly higher in women, participants with short term and severe disease, those with a moderate income level, and those using topical treatment and cosmetics. They mostly used Google (67%), Instagram (54%), and YouTube (49%). While 76% of the participants stated that they did not share what they saw on the Internet with their doctor. Of the respondents, 18.5% were trying to contact their dermatologists through the Internet, and 69.73% would prefer experts such as dermatologists to post-AV-related content. CONCLUSIONS: Our study shows that patients frequently resort to social media to seek information about AV. In the changing digital world order, it is observed that there is a need for dermatologists to use social media more actively to share accurate information about AV.

Risk assessment of obstructive sleep apnea syndrome and other sleep disorders in multiple sclerosis patients.

BACKGROUND: The aim of the present study was to determine the possible risk of OSAS in patients with MS through the STOP-BANG questionnaire, and to confirm the pre-diagnosis of OSAS by recording polysomnographic investigation in individuals with high risk. In addition, the relationship between OSAS risk and fatigue, sleepiness, depression, and disability status will be examined. METHODS: Totally 97 patients with multiple sclerosis including 36 males and 61 females with an age average of 39.92 ± 9.11 years. All participants completed the following questionnaires: STOP-Bang, Fatigue Severity Scale (FSS), Epworth sleepiness scale (ESS), Beck Depression Inventory (BDI); disability status of the participants was assessed by Expanded Disability Status Scale (EDSS). Polysomnographic sleep record was applied to the patients with high risk of OSAS according to STOP-BANG test scores. RESULTS: The STOP_BANG questionnaire revealed that 24.7% of the patients were screened as high risk for OSA. Approximately 11.3% of the patients were detected positive for OSAS based on PSG recording. Comparison of MS patients with high risk of OSA with others suggested a significant difference in terms of the age (p = 0.01). ESS positive scores were significantly correlated with positive STOP BANG outcomes (p < 0.001). ESS positive scores were negatively correlated with positive PSG outcomes. CONCLUSION: The prevalence of OSAS in MS patients based on questionnaire and PSG was found consistent with literature. Similar to the general population, increasing age was found as a risk factor for OSAS in patients with MS. STOP-BANG test may not be an adequate test to diagnose OSAS, especially in MS patients with high fatigue scores.

Dermoscopic Findings of Rosacea and Demodicosis.

BACKGROUND: Rosacea is a common chronic inflammatory disorder affecting the facial skin. OBJECTIVES: Dermoscopy is a noninvasive procedure that is commonly used for the diagnosis of dermatological diseases. This article aims to determine the clinical and dermoscopic manifestations of the rosacea patients and the presence of the accompanying Demodex. MATERIALS AND METHODS: The study evaluated 23 patients who were diagnosed with rosacea through clinical and dermoscopic findings. The patients were clinically and dermoscopically photographed and were classified according to the rosacea classification. The presence of Demodex was demonstrated both dermoscopically and through biopsy. RESULTS: There were a total of 23 participants (17 females and 6 males). The ages of the participants ranged between 28 and 75, with an average of 49. Among the 23 participants, 14 were erythematotelangiectatic, 7 were papulopustular, and 2 were rhinophyma. A total of 12 participants (4 males and 8 females) had ocular involvement. The most common dermoscopic finding was a linear vascular structure. A total of 15 patients (11 females and 4 males) had the demodicosis finding. CONCLUSION: The diagnosis of rosacea and demodicosis through dermoscopic findings is as reliable as a biopsy and it has the advantage of being noninvasive.

Is there a role of toothpastes in the development of recurrent aphthous stomatitis? A prospective controlled clinical trial with skin patch testing.

OBJECTIVES: The oral mucosa is exposed to a large number of antigenic agents contained in toothpastes. These agents are reported to stimulate recurrent aphthous stomatitis (RAS) pathogenesis, and toothpastes that do not contain probable allergenic substances reduced the number and frequency of aphthous ulcers. We aimed to determine whether the skin patch test (SPT) can be used to determine if toothpaste allergens play a role in the etiology of RAS. STUDY DESIGN: Sixty-three patients with RAS and 47 healthy volunteers were skin patch tested with sodium lauryl sulfate, cocamidopropyl betaine, propylene glycol, aluminum chloride hexahydrate, menthol, triclosan, and titanium dioxide, which are present in most of the toothpastes. Fisher's exact test and the Yates chi-square test were used to compare categorical variables and patch test results between 2 groups. RESULTS: The SPT was positive in 8 (22.2%) patients with RAS and 11 (23.4%) control subjects, and the difference between the groups was not statistically significant (P < .05). Sodium lauryl sulfate, titanium dioxide, and menthol were the most common positive allergens in both groups. CONCLUSIONS: Allergens in toothpastes did not appear to stimulate the formation of RAS. However, in order to determine a clearer relationship, a study in a larger patient series employing intraoral patch testing with more toothpaste ingredients is suggested.

Acne in pregnancy: A prospective multicenter, cross-sectional study of 295 patients in Turkey.

BACKGROUND: There are only a few studies on acne in pregnancy. This study was aimed to investigate the demographic, clinical, and familial characteristics of acne in pregnancy, triggering factors including endocrine diseases, and association of these findings with acne in different trimesters of pregnancy. METHODS: Pregnant women aged 18 years and older with acne at any stage of pregnancy were consecutively interviewed at the participating centers during the study period from 2016 to 2019. Acne severity was evaluated using the Comprehensive Acne Severity Scale. RESULTS: A total of 295 pregnant women with acne were included, with 167 (56.6%) patients showing mild, 87 (29.5%) moderate, six (12.2%) severe, and five (1.7%) very severe acne. Truncal acne was significantly higher in the third trimester than in the other stages (P < 0.001). Onset of acne before pregnancy, prepubertal, pubertal or adult onset, or acne history in previous pregnancies did not influence acne severity in pregnancy. Women with irregular menstruation before pregnancy, polycystic ovary syndrome, hirsutism, and higher body weight index tended to show severe acne in pregnancy. CONCLUSIONS: Severe acne during pregnancy is generally uncommon, while severity of facial acne, truncal acne, and hirsutism is higher in the third trimester than in other trimesters. Acne in pregnancy shares many characteristics with female adult acne. Substantial changes in different kinds of hormones play a more complex role in acne during pregnancy, but the pathogenesis remains to be determined.

Medial plantar-to-radial amplitude ratio: does it have electrodiagnostic utility in distal sensory polyneuropathy?

PURPOSE OF THE STUDY: We proposed a new electrophysiological parameter medial plantar (MP)-to-radial amplitude ratio (MPRAR), similar to sural-to-radial amplitude ratio (SRAR), in the diagnosis of distal sensory polyneuropathy (DSP), based on the concept that distal nerves are affected more and earlier than proximal nerves in axonal neuropathies. We aimed to investigate the diagnostic sensitivity of this parameter in diabetic DSP, together with sensitivities of SRAR and MP nerve action potential (NAP) amplitude. MATERIALS AND METHODS: In 124 healthy controls and 87 diabetic patients with clinically defined DSP and normal sural responses, we prospectively performed sensory nerve conduction studies (NCS), and evaluated the MP NAP amplitude, MPRAR and SRAR values. We determined the lower limits of normal (LLN) of these parameters in the healthy controls and calculated their sensitivities and specificities in detecting DSP in diabetic patients. RESULTS: MP nerve amplitude and MPRAR values were significantly lower in the patient group, compared to controls. However, SRAR values did not differ significantly between the two groups. The LLN of MP NAP amplitude was found to be 4.1 µV. The cutoff values for SRAR and MPRAR were determined as 0.24 and 0.16, respectively. MPRAR was abnormal in 21.8% of patients. However, the most sensitive parameter in detection of DSP was MP NAP amplitude, which showed a sensitivity of 31% and a specificity of 100%. CONCLUSIONS: Although MPRAR is more sensitive than SRAR in detecting DSP, it does not provide additional diagnostic yield to the assessment of MP NCS alone in diabetic DSP patients with normal sural responses.

Assessment of subclinical cardiac damage in chronic plaque psoriasis patients: a case control study.

INTRODUCTION: Epidemiological studies have suggested that patients with psoriasis are at an increased risk of developing cardiovascular diseases. Chronic inflammation may play a role in the pathogenesis of atherosclerosis in psoriasis patients. Recent studies have evaluated the expression of plasma endocan and homocysteine levels. Endocan is a marker of vascular endothelial damage, and homocysteine plays a role in the development of atherosclerosis. Plasma endocan and homocysteine levels, as well as echocardiographic parameters, were evaluated in patients with psoriasis to assess cardiovascular disease risk. MATERIAL AND METHODS: This was a prospective cohort analysis of 40 patients who were diagnosed with psoriasis and 40 healthy controls matched to the patient group according to demographic and biochemical parameters. RESULTS: Serum endocan and homocysteine concentrations were significantly higher in the psoriasis group than the control group (p < 0.001). Serum endocan concentrations correlated positively with disease duration (p < 0.001; r = 0.725). The Tei index (myocardial performance) was elevated in psoriasis patients (p < 0.001). Additionally, the E/A (mitral valve early diastolic peak flow velocity/mitral valve late diastolic peak flow velocity) and E/Em (early diastolic myocardial velocity) ratios were reduced in psoriasis patients (p < 0.001). Parameters indicative of left ventricular asynchrony were elevated significantly in the psoriasis group versus the control group (p < 0.001). CONCLUSIONS: We observed a substantial increase in serum endocan and homocysteine concentrations, and significant differences in key parameters of cardiac function, in psoriasis patients relative to controls. These results are consistent with the hypothesis that subclinical cardiac damage is increased in patients with psoriasis and that psoriasis itself may be a cardiovascular risk factor.