Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients.

BACKGROUND: Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. AIM: To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. METHODS: We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. RESULTS: In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). CONCLUSION: Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

The effects of systemic steroid therapy on macrophage migration inhibitory factor concentrations in patients with nasal polyps.

OBJECTIVES: This study aimed to compare serum macrophage migration inhibitory factor concentrations before and after oral steroid therapy in nasal polyps patients, and determine whether there is a difference between pre-treatment macrophage migration inhibitory factor concentrations and healthy individuals. METHODS: The study included 24 patients with nasal polyps and 25 healthy individuals. The patient group received 1 mg/kg oral steroid. RESULTS: The mean macrophage migration inhibitory factor concentration before oral steroid therapy was 3889.79 pg/ml in the patient group and 2334.52 pg/ml in the control group. Macrophage migration inhibitory factor concentrations were statistically significantly higher in the pre-oral steroid therapy patient group than in the control group (p = 0.017). The mean pre- and post-oral steroid therapy serum macrophage migration inhibitory factor concentrations were 3889.79 pg/ml and 2451.25 pg/ml, respectively. The reduction in macrophage migration inhibitory factor concentrations was statistically significant (p = 0.010). CONCLUSION: These findings suggest that concentrations of macrophage migration inhibitory factor may play a role in the pathogenesis of nasal polyps.

Cutaneous atypical papular CD8+ lymphoproliferative disorder at acral sites in a renal transplant patient.

A 20-year-old woman presented with a 2-month history of an acute symmetrical eruption, manifesting as asymptomatic ill-defined erythematous macules and hyperkeratotic papules on the palms. The patient was a renal transplant recipient, and the lesions had developed 2 months post-transplantation. Histologically, the eruption shared features of a reactive inflammatory condition called papular eruption of atypical CD8+ lymphocytes as well as primary cutaneous acral CD8+ T-cell lymphoma (a provisional indolent entity in the new World Health Organisation classification of lymphoid neoplasms, 2016). The latter disorder has been described to occur at acral sites in immunocompetent patients, whereas the former has previously been described only in patients infected with human immunodeficiency virus. The lesions in our patient healed after topical treatment with corticosteroids and alteration of immunosuppressive therapy, supporting the role of immunosuppression in this case. We classified our patient's condition as lying in the spectrum of the aforementioned two conditions, but the relationship between both diseases remains to be clarified. Awareness of these unusual conditions may prevent the use of unnecessary aggressive therapies in similar patients.

An update on cutaneous melanoma in Turkey: evaluation of 19-year data in a single tertiary centre and review of the literature.

BACKGROUND: Information on frequency of melanoma and its clinicopathological subtypes derived from dermatology clinics in Turkey is limited. OBJECTIVE: As data about melanoma show clear differences due to geographic and ethnic distribution, we scrutinized the rich data of our dermatology centre in Istanbul. METHODS: Consecutive patients diagnosed with melanoma in a tertiary dermatology clinic during the last 19 years were retrospectively investigated about the clinical presentation of the skin lesions during admission, frequency of subtypes and localization of the tumour. RESULTS: There were 227 patients with melanoma showing five different clinical presentations: 200 of them had totally 207 primary cutaneous melanoma (PCM) lesions, nine had PCM lesions associated with metastatic skin lesions, three presented with local recurrence, eight with only skin metastases and seven with regressed skin melanoma following systemic melanoma metastases. Histologically, 23.19% of the PCM lesions were intraepidermal (in situ) and Breslow thickness was less than 1 mm in 30.9% of the patients with invasive melanoma. The most common subtype was superficial spreading melanoma (SSM) (37.19%), followed by lentigo malignant melanoma (LMM) (31.4%), acral lentiginous melanoma (ALM) (19.32%) and nodular melanoma (NM) (6.76%). Head and neck region was the most common (34.78%) localization of PCM lesions. CONCLUSIONS: Different clinical presentations, including various types of cutaneous melanoma metastases, were seen. However, a great proportion of our patients were relatively early diagnosed, either having an in situ or an invasive PCM with a Breslow thickness ≤1 mm. Even though SSM was the most common subtype of PCM in our series, its rate was lower compared to many European countries. Furthermore, the rate of NM subtype was also low, while LMM and ALM rates were higher in comparison to studies originating from European countries. This striking discrepancy requires further studies to explain the probable causes.

Effects of Potentilla fulgens on tuba uterina in ovariectomized rats / Efectos de Potentilla fulgens en la tuba uterina de ratas ovariectomizadas

A total of 32 Wistar rats were divided into four equal groups: (I) sham, (II) ischemia, (III) reperfusion and (IV) Potentilla fulgens. In groups I and II, ovary torsion was not performed and no drug was administered. In group III, 1 h of ischemia and 2 h of reperfusion were performed and no drug was given. Group IV received 400 mg/kg/day Potentilla fulgens intraperitoneally 5 days before Ischemia-reperfusion. All the parameters were observed to be significantly decreased (P<0.05) in all the experimental groups compared to the control group. In the sections of the ischemia-reperfusion group, degeneration of epithelium, dilation of blood vessels were observed. Potentilla fulgens administration reduced the morphological changes by induced I/R; in particular, infiltration, hemorrhage and vascular dilatation were decreased. Potentilla fulgens application during torsion, it plays an important role in maintaining the epithelial structure with E-cadherin expression. We suggest that PECAM-1(CD31) are a regulator of the microvascular response of the tubal mucosa.

Un total de 32 ratas Wistar fueron divididas en cuatro grupos: (I) Sham, (II) isquemia, (III) reperfusión y (IV) Potentilla fulgens. En los grupos I y II, no se realizó la torsión de ovario y ni se administró ningún tipo de fármaco. En el grupo III, se produjo isquemia por 1 h seguido de reperfusión por 2 h (I/R), sin administracion de fármacos. El grupo IV recibió 400 mg/kg por día de Potentilla fulgens vía intraperitoneal durante cinco días previo al protocolo de isquemia-reperfusión. Se observó que todos los parámetros disminuyeron significativamente (P <0,05) en todos los grupos experimentales en comparación con el grupo control. En las secciones del grupo de isquemia-reperfusión, se observó degeneración del epitelio y dilatación de los vasos sanguíneos. La administración de Potentilla fulgens reduce los cambios morfológicos inducidos por I/R; en particular, la infiltración, la hemorragia y la dilatación vascular. La aplicación de Potentilla fulgens durante la torsión, desempeña un papel importante en el mantenimiento de la estructura epitelial con la expresión de E-cadherina. Sugerimos que PECAM-1 (CD31) es un regulador de la respuesta microvascular de la mucosa tubárica.

The effects of maternal low protein and estrogen on sexual behavior and testicular maturation in male rats / Efectos de niveles maternos bajos de estrógeno y proteína sobre el comportamiento sexual y maduración testicular en ratas macho

In recent years, disorders related to the development and function of the male reproductive tract has increased, thus generating a surprising decrease in semen volume and sperm count. We examined the effects of low protein and estrogen on sexual behavior and testicular maturation in male rats. We also examined FSH, LH and testosterone levels and histological damage of testis tissue. The male rats were subjected to standard long-term treatment with estradiol by oral and paranteral delivery. The number of mounts, copulatory efficiency and ejaculation latencies for the paranteral protein diet (PPD) group was significantly lower than those in a group nourished with a low protein diet (LPD) and oral protein diet (OPD) groups (P<0.05). Testes and epididymis sections were examined by four grades, according to the level of damage of epithelium in the testes and epididymis. Higher histological damage was also detected in the PPD group. In conclusion, the present study confirmed that unwanted estrogen effects were higher in the paranteral administered group on examination of sexual behavior and histological damage of epithelium in the testes and epididymis of male rats.

En los últimos años, los trastornos relacionados con el desarrollo y la función del tracto reproductivo masculino han aumentado, lo que genera una disminución importante en el volumen de semen y el conteo de espermatozoides. Se examinaron los efectos de niveles bajos en proteínas y estrógeno en el comportamiento sexual y la maduración testicular en ratas macho. También se examinaron FSH, LH y los niveles de testosterona y el daño histológico de tejido testicular. Las ratas macho fueron sometidas al tratamiento y administración estándar a largo plazo con estradiol por vias oral y parenteral. El número de montajes, eficiencia de copulación y latencias de eyaculación para el grupo de dieta de proteínas parenteral (DPP) fue significativamente menor que los del grupo con una dieta baja en proteínas (PBD) y de proteína oral baja (POB) grupos (P<0,05). Fueron examinados los testículos y epidídimo de acuerdo a cuatro grados, en relación al nivel de daño del epitelio en los testículos y epidídimo. También se detectó un mayor daño histológico en el grupo DPP. En conclusión, se confirma que los efectos no deseados del estrógeno fueron mayores en el grupo con administración parenteral en el examen de conducta sexual y en el daño histológico del epitelio en los testículos y el epidídimo de ratas macho.

Prognostic analysis of patients with operable gastric cancer and tolerability to adjuvant radio-chemo-therapy.

The aim of this study is to evaluate the tolerability and toxicity of adjuvant chemoradiotherapy (CRT) and to analyze the prognosis in patients with operable gastric cancer. The retrospective analysis included 723 patients with operable gastric cancer; stage IB-IV (M0), received adjuvant CRT from 8 Medical Centers in Turkey between 2003 and 2010. The patients' age, sex, tumor localization, Lauren classification, grade and stage of the disease, type of dissection, the toxicity and tolerability status and survival rate were analyzed. All patients were divided into two groups as tolerable group to adjuvant CRT and intolerable group to adjuvant CRT .Among the patient, 73.9% had stage III-IVM0 disease; 61.0% had the intestinal type of gastric cancer, 51.1% had the distal type, and 61.4% had undergone D2 dissections. The number of patients who completed the entire course of the adjuvant CRT was 545 (75.4%).The median follow-up period was 20.8 months (range: 1.5-107 months). Overall Survival (OS) rates were 80% and 52%, while the relapse free survival (RFS) rates were 75% and 48% at 1 and 3 years, respectively.In the univariate analysis of the groups based on the the age defined as <65 or ≥ 65 (p=0.16 / p=0.003), Lauren classification (p=0.004 / p<0.001), localization of tumor (p=0.02 / p=0.04), tumor grade (p=0.06 / p=0.003), disease stage (p<0.001 / p<0.001), type of dissection (p=0.445 / p=0.043), presence or absence of toxicity (p=0.062 / p=0.077) and tolerability of the therapy (p=0.002 / p=0.001). In the cox regression analysis, tumor stage (Hazard Ratio (HR): 0.332; 95% confidence interval (CI): 0.195-0.566; p<0.001), and tolerability (HR: 0.516; 95% CI: 0.305-0.872; p=0.014), were found to be related with the OS. Tumor stage (HR: 0.318; 95% CI: 0.190-0.533; p=<0.001) and tolerability (HR: 0.604; 95% CI: 0.367-0.995; p=0.048) were observed to be statistically significant in terms of the RFS.We have observed that whether a patient can or cannot tolerate adjuvant CRT due to its toxicity is an independent prognostic factor besides the known prognostic factors like tumor stage and Lauren classification. We are of the opinion that the treatment of patients who cannot tolerate adjuvant CRT should be replaced with less toxic adjuvant therapies.