Abnormal nailfold videocapillaroscopic findings in heart failure patients with preserved ejection fraction.

BACKGROUND: Microvascular dysfunction is one of the pathophysiological mechanisms in heart failure. Nailfold videocapillaroscopy is a noninvasive technique used to examine the microvasculature. OBJECTIVE: In this study, we aimed to investigate the nailfold capillaroscopic abnormalities in heart failure patients with reduced and preserved ejection fraction and compare those with control group. METHODS: Three groups of patients were recruited for the study: HFrEF group includes the patients with heart failure with reduced ejection fraction (HFrEF), HFpEF group, patients with heart failure with preserved ejection fraction (HFpEF) and control group, healthy asymptomatic individuals. Nailfold videocapillaroscopy was performed with a videodermatoscope and all nailfold images were evaluated for enlargement and hemorrhages. RESULTS: Abnormal videocapillaroscopic findings including enlargement and/or hemorrhages were present in 7 (24%) patients in HFrEF group, 19 (66%) patients in HFpEF group and 11 (37%) in control group. The number of patients with abnormal videocapillaroscopic findings were significantly greater in HFpEF group compared to HFrEF (p < 0.05) and control groups (p < 0.05). However, no significant difference was observed in videocapillaroscopic findings between HFrEF and control groups. CONCLUSIONS: Our study showed that microvascular abnormalities demonstrated by videodermatoscopic examination of nailfold capillaries are considerably more common in HFpEF patients compared to HFrEF and control groups.

Increased Demodex Density in Patients Hospitalized for Worsening Heart Failure.

Infection is an important factor leading to the exacerbation of heart failure (HF), resulting in hospitalization. Demodex species are obligatory parasites in human skin, and increased density was reported in immunocompromised patients. In this study, we aimed to investigate the Demodex density in hospitalized HF patients compared to that of healthy controls. METHODS: This study included 36 HF patients and 36 age and sex-matched healthy controls. Five standardized biopsies were taken from the face of participants and assessed for Demodex by a light microscope. RESULTS: At least one Demodex mite was detected in 20 HF patients and nine of the control group. The number of Demodex mites was significantly higher in the HF group (median 1; min. 0 and max. 10) compared to the control group (median 0; minimum. 0 and maximum. 3). Demodicidosis was positive in 14 of the HF patients. Demodicidosis was not detected in the control group. CONCLUSIONS: This study showed that Demodex positivity is more common in HF patients hospitalized for HF exacerbation. Demodicidosis should be considered in hospitalized HF patients.

Microvascular abnormalities in asymptomatic chronic smokers: A videocapillaroscopic study.

Cigarette smoking is reportedly associated with coronary, cerebral, and peripheral vascular diseases. Nailfold videocapillaroscopy is a noninvasive imaging technique used to examine the microvasculature. In this study we aim to investigate the capillaroscopic abnormalities of asymptomatic chronic smokers (N = 30), and compare findings to those of healthy nonsmokers (N = 30). Nailfold videocapillaroscopy was performed with a videodermatoscope, with images recorded at 40× magnification. Capillary morphologies were assessed as normal, enlargement, tortuosity, and microhemorrhages. Capillaroscopic abnormalities were seen in 16 (53.3%) of subjects within the smoker group and seven (23.3%) within the nonsmoker group (p < 0.05). Six smokers had only capillary enlargement; another 10 had both capillary enlargement and microhemorrhages. In comparison, enlarged capillaries and both enlarged capillaries and microhemorrhages were observed in three and four nonsmokers, respectively. In conclusion, nailfold capillaroscopic abnormalities were more common among asymptomatic chronic smokers than healthy nonsmokers, with the enlargement of nailfold capillaries being the most common abnormality. Nailfold videocapillaroscopic examination may serve as an efficient tool in determining microvascular abnormalities in asymptomatic chronic smokers not only for risk stratification purposes, but also to take the measures needed to preclude future vascular events.

Evaluation of inhomogeneities of repolarization in patients with psoriasis vulgaris.

INTRODUCTION: The arrhythmia potential has not been investigated adequately in psoriatic patients. In this study, we assessed the ventricular repolarization dispersion, using the Tp-e interval and the Tp-e/QT ratio, and investigated the association with inflammation. MATERIAL AND METHODS: Seventy-one psoriasis vulgaris patients and 70 age- and gender-matched healthy individuals were enrolled in the study. The severity of the disease was calculated using Psoriasis Area and Severity Index scoring. The QTd was defined as the difference between the maximum and minimum QT intervals. The Tp-e interval was defined as the interval from the peak of the T wave to the end of the T wave. The Tp-e interval was corrected for heart rate. The Tp-e/QT ratio was calculated using these measurements. RESULTS: There were no significant differences between the groups with respect to basal clinical and laboratory characteristics (p > 0.05). The Tp-e interval, the corrected Tp-e interval (cTp-e) and the Tp-e/QT ratio were also significantly higher in psoriasis patients compared to the control group (78.5 ±8.0 ms vs. 71.4 ±7.6 ms, p < 0.001, 86.3 ±13.2 ms vs. 77.6 ±9.0 ms, p < 0.001 and 0.21 ±0.02 vs. 0.19 ±0.02, p < 0.001 respectively). A significant correlation was detected between the cTp-e time and the Tp-e/QT ratio and the PASI score in the group of psoriatic patients (r = 0.51, p < 0.001; r = 0.59, p < 0.001, respectively). CONCLUSIONS: In our study, we detected a significant increase in the Tp-e interval and the Tp-e/QT ratio in patients with psoriasis vulgaris. The Tp-e interval and the Tp-e/QT ratio may be predictors for ventricular arrhythmias in patients with psoriasis vulgaris.

Ecthyma gangrenosum in a previously healthy patient.

Ecthyma gangrenosum is a rare skin infection caused by Pseudomonas aeruginosa. It is usually seen in immunocompromised and critically ill patients. We report one such case in a previously healthy 20-year old male. Ecthyma gangrenosum can occur in healthy patients without bacteremia.

Herpes zoster ophthalmicus reactivation following maxillary sinus lift operation: A case report.

PURPOSE: To present a case of Herpes Zoster Ophtalmicus (HZO), which was reactivated postoperatively after a sinus lift operation. MATERIALS AND METHODS: A 39-year-old male was referred to our clinic for implant-supported dental rehabilitation. He had maxillary missing teeth in positions 13, 14, 15 and 16 and a pneumatised right maxillary sinus with a bone height of 2 mm. Lateral sinus lifting and bone block grafting was performed before implant insertion. Twelve days after the sinus lift, the patient complained of pain and itching at the infraorbital area extending to the forehead. Clinical examination revealed no signs of infection or allergy. The patient received consultation from a dermatologist in order to rule out a possible dermatological disorder. Finally he was diagnosed with HZO. RESULTS: HZO was managed with systemic acyclovir treatment. Vesicular rashes and ptosis was seen 3 days after the medical treatment. After 1 month no postoperative skin or orbital sequela was seen. Three implants were inserted at the right posterior maxilla 5 months after sinus lift. One-year followup was uneventful. CONCLUSIONS: Dermatological diseases should always be kept in mind during the differential diagnosis of orofacial pain. In this case the proximity of the operation site and affected area gave rise to the idea that surgical trauma had a possible role in the reactivation of the virus. However, the process of reactivation is not entirely understood and requires further investigations. Early diagnosis is essential for HZO in order to avoid debilitating complications such as postherpetic neuralgia and blindness.

Assessment of atrial electromechanical delay and left atrial mechanical functions in patients with psoriasis vulgaris.

OBJECTIVES: Increased frequency of atrial fibrillation (AF) has been demonstrated in psoriasis cases. Prolongation of the duration of atrial electromechanical delay (AEMD) is a well-known characteristic of the atrium, which is vulnerable to AF. In the current study, our aims are to investigate AEMD durations and mechanical functions of the left atrium (LA) in patients with psoriasis. METHODS: A total of 90 patients, 45 with psoriasis vulgaris and 45 as the control group, were included in the study. Atrial electromechanical coupling (PA) and intra- and inter-atrial electromechanical delay (IA-AEMD) were measured with tissue Doppler echocardiography. P-wave dispersion (PWD) was calculated from the 12-lead electrocardiogram. The severity of the disease was evaluated by the Psoriasis Area and Severity Index. RESULTS: The durations of PA lateral and PA septal were significantly high in the psoriasis group when compared with the control group (47.7 ± 9.8 vs. 57.1 ± 8.4 msec, P < 0.001 and 38.6 ± 9.9 vs. 43.6 ± 8 msec, P = 0.016, respectively). The durations of IA-AEMD, intra-right electromechanical delay, and intra-left electromechanical delay in the psoriasis group were significantly prolonged compared with the control group (15.2 ± 4.1 vs. 21.7 ± 5.6 msec, P < 0.001; 6 ± 2.5 vs. 8.7 ± 2.7 msec, P < 0.001; and 9.1 ± 3.9 vs. 13.5 ± 5.2 msec, P < 0.001; respectively). PWD was significantly higher in patients with psoriasis vulgaris compared with controls (36.1 ± 7.9 vs. 40.2 ± 9.1 msec, P = 0.043). CONCLUSION: In the present study, we found prolongation in the durations of AEMD and PWD in the psoriasis group compared with the control group. These results might be an early predictor of AF and other arrhythmias.

Evaluation of effects of platelet-rich plasma on human facial skin.

INTRODUCTION: Platelet-rich plasma (PRP) has been used for rapid healing and tissue regeneration in many fields of medicine. This study was conducted to evaluate the effects of PRP application procedure on human facial skin. METHODS: PRP was applied thrice at 2-week intervals on the face of ten healthy volunteers. It was applied to individual's forehead, malar area, and jaw by a dermaroller, and injected using a 27-gauge injector into the wrinkles of crow's feet. Participants were asked to grade on a scale from 0 to 5 for general appearance, skin firmness-sagging, wrinkle state and pigmentation disorder of their own face before each PRP procedure and 3 months after the last PRP procedure. While volunteers were evaluating their own face, they were also assessed by three different dermatologists at the same time by the same five-point scale. RESULTS: There was statistically significant difference regarding the general appearance, skin firmness-sagging and wrinkle state according to the grading scale of the patients before and after three PRP applications. Whereas there was only statistically significant difference for the skin firmness-sagging according to the assessment of the dermatologists. CONCLUSION: PRP application could be considered as an effective procedure for facial skin rejuvenation.

Effects of paroxetine on cutaneous wound healing in healthy and diabetic rats.

OBJECTIVE: The aim of this study was to evaluate the histologic effects of acute paroxetine administration on wound healing in healthy and streptozotocin-induced diabetic rats. DESIGN: This study has a randomized controlled experimental design. SETTING: Healthy (n = 32) and diabetic (n = 32) rats were further divided into 2 groups of saline or paroxetine administration. PARTICIPANTS: Sixty-four male Sprague-Dawley rats were used in this study. INTERVENTIONS: Paroxetine was injected intraperitoneally every day. Full-thickness excision wounds were created with a 4-mm dermal punch on the back of all rats. The healing wound area was removed with a 6-mm dermal punch at postwounding days 1, 3, 7, and 14. MAIN OUTCOME MEASURES: Polymorphonuclear leukocyte, mononuclear inflammatory cell, fibroblast, and blood vessel counts and epithelialization were evaluated under light microscope. MAIN RESULTS: There was no statistically significant difference observed in the polymorphonuclear leukocyte, mononuclear inflammatory cell, and blood vessel counts in the healthy and diabetic rats with and without paroxetine administration. The number of fibroblasts was significantly higher at postwounding day 14 of the paroxetine-administered healthy rats compared with the saline-administered healthy rats (P = .04). However, the number of fibroblasts did not show any difference by paroxetine administration in the diabetic rats. There was no statistically significant difference in epithelialization regarding all the postwounding days, but complete epithelialization was observed in all rats on postwounding day 14 in the healthy and paroxetine-administered group. CONCLUSION: Short-term paroxetine administration may enhance cutaneous wound healing by increasing the number of fibroblasts and causing better epithelialization over time in healthy rats but not in diabetic rats.

Cancer-free survival of psoriasis patients treated with methotrexate and cyclosporine combination.

CONTEXT: Combination of methotrexate and cyclosporine was used and reported to be effective for recalcitrant psoriasis patients. Also each agent is accused for development of malignancies. OBJECTIVE: To evaluate the cancer-free survival of psoriasis patients who received methotrexate and cyclosporine treatment at the same time. METHODS: Psoriasis patients who had been treated with combination of cyclosporine and methotrexate between March 2000 and April 2005 were questioned in 2011. A diagnosis of new cancer during follow-up period was asked and also each patient was evaluated by a questionnaire. RESULTS: Seventeen psoriasis patients were not treated due to a diagnosis of new cancer during the follow-up period. Also none of them complained of possible symptoms of skin or lymphoproliferative malignancies. The median follow-up time was 76 months. CONCLUSION: Psoriasis patients who had been treated with methotrexate and cyclosporine combination did not report a detected malignant disease.

Diffuse giant tendon xanthomas in a patient with familial hypercholesterolaemia.

Familial hypercholesterolaemia is a genetic disease that provides the best evidence for the causal role of low-density lipoprotein cholesterol in human atherosclerosis. The disease was first described by Muller in 1939 and is characterised by high cholesterol levels from birth, and the subsequent development of tendon and cutaneous xanthomas and premature atherosclerosis. In this case report, we described an 18-yearold female patient who was admitted to the out-patient clinic with swellings on various parts of her body. Her family history, physical examination and laboratory evaluation revealed that these swellings were giant tendon xanthomas caused by familial hypercholesterolaemia. In this report we also discuss the pathogenesis, clinical manifestations, complications and treatment of familial hypercholesterolaemia.

Evaluation of 532-nm KTP laser treatment efficacy on acne vulgaris with once and twice weekly applications.

BACKGROUND: Light-based therapies and lasers have been proposed for the treatment of acne vulgaris but the efficacy and application periods of 532-nm KTP laser treatment are not clear. OBJECTIVE: To evaluate the efficacy and safety of 532-nm KTP laser and compare the effects of once and twice weekly applications in the treatment of mild to moderate acne vulgaris. METHODS: Totally 38 patients were treated once weekly and twice weekly in group I and in group II respectively. One half of the face of each patient was treated with 532-nm KTP and the other half was remained as untreated. Patients were evaluated at the beginning, one and four weeks after the last treatment session with Michaëlsson acne severity grading score (MASS). RESULTS: Statistically significant improvement was found at second control (p = 0.005) in group I, and at the first (p = 0.004), and second (p < 0.001) controls in group II for treated sides. For both groups, changes of MASS were insignificant for untreated sites. Improvement of MASS of treated sides was not statistically significant between two treatment groups for both controls. CONCLUSION: 532-nm KTP laser treatment may be an alternative method in selected acne vulgaris patients. No significant difference was noted between once and twice weekly applications.

Comparison of the efficacy of narrow band ultraviolet B and narrow band ultraviolet B plus topical catalase-superoxide dismutase treatment in vitiligo patients.

Accumulation of free radicals in the epidermis and the role of oxidative stress have been demonstrated in the pathogenesis of vitiligo. So, new treatment modalities that support antioxidant systems may be a choice for treatment. We sought to determine the clinical efficacy of narrow band ultraviolet B plus topical formulation including Cucumis melo superoxide dismutase and catalase (Vitix), over the narrow band ultraviolet B treatment alone. Thirty vitiligo patients (18 female, 12 male; mean age 34 +/- 13 years) were included in this study. 15 patients in Group 1 were treated only with narrow band ultraviolet B whereas 15 patients in Group 2 were treated with narrow band ultraviolet B plus topical Vitix for 6 months. Areas of 21 lesions from each group were measured by point counting methods at the beginning and at the end of the treatment. Efficacy of treatment was graded as perfect, good, moderate and poor according to healing percentages of measured areas and both groups were compared statistically. In Group 1 two moderate; in Group 2 one perfect, four moderate healings were observed at the end of the treatment. There was no statistically significant difference according to healing percentages between the two groups (p > 0.05). No adverse effect was reported in either group. The superiority of narrow band ultraviolet B plus topical Vitix treatment over narrow band ultraviolet B treatment could not be demonstrated statistically. There is a need for further studies involving large case series to clarify the results of our preliminary study.

A practical method for the estimation of vitiligo surface area: a comparison between the point counting and digital planimetry techniques.

The accurate measurement of vitiligo surface area is fundamental to the evaluation of treatment efficacy. Digital photography, planimetry and clinical evaluation by the clinician have been used for assessment. Although digital photography with computerized planimetry is a reliable and accurate method, it is labour intensive and expensive. The aim of this study was to evaluate the accuracy and reliability of the point counting method and to compare it with digital planimetry techniques for the estimation of vitiligo surface area. Surface areas of 31 vitiligo lesions of five volunteers were estimated using the point counting and digital planimetry methods. Three independent observers evaluated the outlined areas twice using the point counting technique with an interval of 2 weeks. The same lesions were also measured by one observer applying digital planimetry. The estimation results of three observers were compared using inter and intra-observer correlation analysis test. There was significant inter- and intra-observer agreement for all measurements. There was also significant coincidence between each observer's estimation of the point counting and digital planimetry method. No significant differences on the results of surface area obtained using the two methods were found (p > 0.05). The point counting method may be used as a direct and reliable technique to measure the vitiligo surface area.