Assessment of treatment efficacy of diphenylcyclopropenone (DPCP) for alopecia areata

Background/aim: Alopecia areata (AA) is an inflammatory disease with a genetic and autoimmune basis. Herein, it was aimed to study the efficacy and safety of an immunomodulatory therapeutic agent, diphenylcyclopropenone, while manifesting its association with histopathological features, prognostic factors, and side effects. Materials and methods: In this retrospective study, 98 patients (60 males, 38 females) with alopecia, who were referred to the Hair Disease Polyclinic at the Department of Dermatology, between 2011 and 2015, were included. Together with medical histories and dermatological examinations, a skin biopsy for histopathological examination was conducted for all of the patients prior to therapy. Therapeutic success was evaluated on the basis of the hair regrowth percentage. Results: Regarding the overall treatment success, 33 (34%) patients had complete response, 16 (16%) had partial response (between 50% and 99%), 27 (28%) had minimal response (between 1% and 49%), and 22 (22%) were nonresponders. Both sexs were equally represented in the outcome. Conclusions: There was a significant relation between the severity of alopecia and the treatment outcome (P = 0.038). Patients with AA had significantly better response when compared to those with alopecia totalis and universalis. There was no statistically significant relation with other parameters, such as disease duration, age, sex, atopy history, age of onset, and histopathological features.

Correlation of Neck Circumference with Difficult Mask Ventilation and Difficult Laryngoscopy in Morbidly Obese Patients: an Observational Study.

PURPOSE: Mask ventilation and laryngoscopy can be challenging in morbidly obese patients because of excessive fat tissue. There are studies suggesting that neck circumference is associated with difficult mask ventilation, difficult laryngoscopy, and difficult intubation. The primary aim of our study is to evaluate predictive value of neck circumference for difficult mask ventilation and difficult laryngoscopy in female and male morbidly obese patients separately. METHODS: This observational cross-sectional study was performed in the period between March 2015 and December 2015. One hundred and twenty (37 male and 83 female) patients undergoing elective surgery were included. Neck circumference, BMI, Mallampati scores, neck movements, dentition, upper lip bite test, breast, thorax, waist, hip circumferences, mouth opening, and sternomental and thyromental distances were evaluated preoperatively. Mask ventilation was graded using four-grade classification. Laryngoscopy was evaluated by Cormack Lehane score. RESULTS: The incidence of difficult mask ventilation was 13.5% in male and 3.6% in female patients. Mouth opening ≤ 6.5 cm and inadequate flexion were found as significant predictors for difficult mask ventilation in male patients. The incidence of difficult laryngoscopy was 10.8% in male and 4.8% in female patients. Mallampati score > II was found as a significant predictor for difficult laryngoscopy in both male and female patients. Sternomental distance ≤ 16 cm and inadequate flexion were also significant predictors for difficult laryngoscopy in male patients. Neck circumference was not found statistically significant predictor for difficult mask ventilation and laryngoscopy in morbidly obese patients in our study. CONCLUSION: Neck circumference is not a statistically significant predictor for difficult mask ventilation and laryngoscopy in morbidly Turkish obese male and female patients. CLINICAL TRIALS REGISTRATION NUMBER: NCT02589015.

The effect of single dose etomidate during emergency intubation on hemodynamics and adrenal cortex.

BACKGROUND: The study aimed to evaluate and compare the effects of a single dose of etomidate and the use of a steroid injection prior to etomidate during rapid sequence intubation on hemodynamics and cortisol levels. METHODS: Sixty patients were divided into three groups (n=20). Before intubation, and at 4 and 24 hours, blood samples were taken for cortisol measurements and hemodynamic parameters (systolic-diastolic-mean arterial pressure, heart rate), and SOFA scores were recorded. Intubation was achieved with 0.3 mg/kg etomidate IV in Group I, 0.3 mg/kg etomidate following 2 mg/kg methylprednisolone IV in Group II, and 0.15 mg/kg IV midazolam in Group III. RESULTS: Mean arterial pressure values were lower in Group I at the 24th hour when compared to Groups II and III. In Group I, heart rate values were higher compared to the other Groups. Cortisol levels were lower in Group I at the 4th and at the 24th hour in Groups II and III. CONCLUSION: Administration of methylprednisolone 2-4 minutes prior to etomidate use in emergency situations can prevent adrenal insufficiency in patients undergoing rapid sequence intubation. Moreover, midazolam can be used in low induction doses as an alternative to etomidate.

Assessment of knowledge, behaviour and sun protection practices among health services vocational school students.

There has been a significant increase in the cases of skin cancer throughout the world in the last few decades. Although the mortality rate of skin cancer is relatively low, its impact on other health aspects is high and the treatment of undesired aesthetic damage is costly. According to disability-adjusted life year rates (DALY), 1.5 million days are estimated to be lost from people's lives every year worldwide due to ultraviolet (UV) radiation. The purpose of this study was to raise sun health awareness levels among health services vocational school students. A total of 414 students were included in the analysis. A questionnaire form was used to evaluate knowledge, attitudes and behaviours among the survey sample. The average level of knowledge concerning the effects of the sun was found to be 8.64 ± 2.5 out of 15 points. All socio-demographic factors were analysed, but the only significant variables found were age and the possible presence of skin cancer within the immediate family (p < 0.05).

Metformin does not prevent DNA damage in lymphocytes despite its antioxidant properties against cumene hydroperoxide-induced oxidative stress.

Metformin (1-(diaminomethylidene)-3,3-dimethyl-guanidine), which is the most commonly prescribed oral antihyperglycaemic drug in the world, was reported to have several antioxidant properties such as the inhibition of advanced glycation end-products. In addition to its use in the treatment of diabetes, it has been suggested that metformin may be a promising anti-aging agent. The present work was aimed at assessing the possible protective effects of metformin against DNA-damage induction by oxidative stress in vitro. The effects of metformin were compared with those of N-acetylcysteine (NAC). For this purpose, peripheral blood lymphocytes from aged (n=10) and young (n=10) individuals were pre-incubated with various concentrations of metformin (10-50microM), followed by incubation with 15microM cumene hydroperoxide (CumOOH) for 48h, under conditions of low oxidant level, which do not induce cell death. Protection against oxidative DNA damage was evaluated by use of the Comet assay and the cytokinesis-block micronucleus technique. Changes in the levels of malondialdehyde+4-hydroxy-alkenals, an index of oxidative stress, were also measured in lymphocytes. At concentrations ranging from 10microM to 50microM, metformin did not protect the lymphocytes from DNA damage, while 50microM NAC possessed an effective protective effect against CumOOH-induced DNA damage. Furthermore, NAC, but not metformin, inhibited DNA fragmentation induced by CumOOH. In contrast to the lack of protection against oxidative damage in lymphocyte cultures, metformin significantly protected the cells from lipid peroxidation in both age groups, although not as effective as NAC in preventing the peroxidative damage at the highest doses. Within the limitations of this study, the results indicate that pharmacological concentrations of metformin are unable to protect against DNA damage induced by a pro-oxidant stimulus in cultured human lymphocytes, despite its antioxidant properties.

Hyperhomocysteinemia: an additional risk factor in white coat hypertension.

The association between homocysteine and sustained hypertension (HT) has been studied. The aim of this study was to assess homocysteine levels in white coat hypertension (WCH) as an indicator of increased risk in the development of cardiovascular diseases. WCH was defined as clinical hypertension and a daytime ambulatory blood pressure of < 135/85 mmHg. Plasma levels of homocysteine were determined in patients with WCH, hypertension, and normotension (NT). The study group included 100 subjects, 33 with WCH (16 males, 17 females) aged 49.1 +/- 1.9; 35 sustained hypertensives (17 males,18 females) aged 48.5 +/- 1.7 and 32 normotensive control subjects (15 males, 17 females) aged 48.8 +/- 2.2. The subjects were matched for age, gender, and body mass index. Patients with a smoking habit, dyslipidemia, or diabetes mellitus were not included in the study. Homocysteine levels were analyzed by ELISA. Plasma homocysteine levels were significantly higher in the WCH group compared to the controls (12.32 +/- 1.07 versus 5.35 +/- 1.38 micromol/L; P < 0.001) and the WCH group had significantly lower homocysteine values than the hypertensives (19.03 +/- 0.76 micromol/L P < 0.001). Total cholesterol and tri-glycerides were not different among the groups. There were no statistically significant differences in urinary albumin excretion (UAE) or creatinine clearance between the three groups. Hypertensive retinopathy was observed in the WCH group, but was less severe and less frequent compared to HTs. LVMI was greater in the WCH group compared to the NTs, but significantly less than HTs. The data demonstrate that WCH is associated with high levels of homocysteine. The increase in homocysteine level in WCH is not as high as in SHT. Since an elevated plasma homocysteine level is a strong risk factor for coronary artery disease and there was target organ damage in our WCH group, we conclude that WCH should not be considered to be an innocent trait.