Effect of Vitamin D and parathyroid hormone levels on the coronary slow-flow phenomenon.

BACKGROUND: The presence of vitamin D, and parathyroid hormone receptors has been demonstrated in the vascular endothelium. Variations in vitamin D, and parathyroid hormone levels may affect coronary flow and cause the coronary slow-flow phenomenon (CSF). METHODS: We enrolled 93 patients who had undergone coronary angiography and had near-normal coronary arteries. Blood samples were taken to determine the calcium, phosphorus, 25-hydroxy vitamin D, and parathyroid hormone levels. Vitamin D deficiency was defined as a serum 25-hydroxy vitamin D level of less than 20 ng/mL. We divided the study population into two groups according to thrombolysis in myocardial infarction frame count (TFC) levels. RESULTS: Patients with TFC ≤27 were in the control group (n = 39), and those with TFC >27 were in the CSF group (n = 54). 25-Hydroxy vitamin D levels were similar in both groups: 17.5 [3.3-36.1] ng/ml in the CSF group and 15.2 [5.3-34] ng/ml in the control group (P = 0.129). When we analyzed TFC for each of the coronary arteries, we found a weak negative correlation between vitamin D level and TFC of the right coronary artery in the CSF group (r = -0.314, P = 0.021). Parathyroid hormone levels were similar in both groups: 48 [16-140] pg/ml in the CSF group and 52 [25-125] pg/ml in the control group (P = 0.297). CONCLUSION: The study failed to demonstrate a relationship between serum parathyroid hormone level and CSF. However, a weak negative correlation was found between vitamin D level and TFC of the right coronary artery.

Diurnal characteristics of heart rate variability in patients with sarcoidosis.

BACKGROUND: The aim of this study was to evaluate autonomic nervous system function by measuring heart rate variability (HRV) in patients with sarcoidosis without known cardiac manifestations. PATIENTS AND METHODS: The study comprised 61 participants, including 31 patients with sarcoidosis without known cardiac manifestations and 30 healthy volunteers. All participants underwent echocardiographic examination, 12-channel electrocardiography (ECG), and 24-h Holter monitoring. HRV parameters were determined and compared between the groups. RESULTS: There were no differences between groups with regard to age, body mass index, systolic and diastolic blood pressure, or heart rate at the time of admission. In the time domain analyses, the 24-h, daytime, and night-time standard deviations of all normal-to-normal R­R interval (SDNN) values were significantly lower in patients with sarcoidosis than those in the controls. The frequency domain analyses showed that 24-h and daytime low-frequency (LF) values, 24-h, daytime, and night-time high-frequency (HF) values were significantly lower in the patient group compared with the control group, whereas the night-time LF/HF ratio was significantly higher. CONCLUSION: Although Holter ECG is not a diagnostic tool for cardiac sarcoidosis, the HRV parameters, especially the night-time LF/HF values, may demonstrate increased sympathetic activation in patients with sarcoidosis.

Is Demodex folliculorum an aetiological factor in seborrhoeic dermatitis?

BACKGROUND: Seborrhoeic dermatitis (SD) is a common inflammatory skin disease for which no single cause has been found, although many factors have been implicated. The mite Demodex folliculorum (DF) is most commonly seen in the pilosebaceous unit in humans. SD is located in areas that are rich in sebaceous glands, which are also preferred by DF. AIMS: To compare the number of DF parasites in patients with clinical SD and in healthy controls, and to investigate any possible relationship between the number of DF mites and the presence of SD. METHODS: The study comprised 38 patients with SD and 38 healthy controls. Standard random and lesion-specific sampling was performed in the group of patients with SD, whereas standard random sampling only was performed for controls. RESULTS: Demodex folliculorum sampling was positive in 19 patients (50%) and 5 controls (13.1%). Mean DF density was 8.16 +/- 10.1/cm(2) (range 0-40) and 1.03 +/- 2.17/cm(2) (1-7) in patient and control groups, respectively. The differences between groups for DF positivity and mean DF density were significant (P = 0.001 for each). DF was found in 13 lesional areas in the patient group, but in only 5 areas in the control group (P = 0.031). CONCLUSIONS: The number of DF mites was significantly higher in both lesional and nonlesional areas of patients with SD. This suggests that, when other aetiological causes are excluded, DF may have either direct or indirect role in the aetiology of SD.

Pseudozoster clinical presentation of Demodex infestation after prolonged topical steroid use.

A 60-year-old man presented with a plaque lesion on the upper right half of the face, which had developed after ophthalmic varicella zoster infection about 2 years previously. The lesion, which was burning and itchy, included a few tiny erythematous pustules, and was slightly squamous and infiltrated. The lesion covered the upper two-thirds of the right trigeminal nerve dermatome, involving half of the face with the forehead, the periorbital area, upper part of the cheek and the nose. The lesion became more marked after continuous topical anaesthetic and corticosteroid use. A standardized skin-surface biopsy was taken, and revealed a large number of Demodex folliculorum (38/cm(2)) in the lesion area. The lesions completely abated after topical 5% permethrin treatment, and no recurrence was observed during follow-up. Demodicosis may have atypical clinical presentations, other than the well-known classic forms. To our knowledge, this is the first unilateral trigeminal, pseudozoster presentation in the literature.