Religiousness, Anxiety and Depression in Patients with Glaucoma, Age-Related Macular Degeneration and Diabetic Retinopathy.

BACKGROUND: Many chronic medical conditions such as glaucoma, senile macular degeneration and diabetic retinopathy are further complicated by emotional and psychological disorders. Religiousness represents a part of a social culture and has a significant role in the prevention of mental difficulties of the patients, especially those belonging to older population. The aim of this study was to investigate the connection between religiousness, anxiety, and depression in patients with glaucoma, age-related macular degeneration and diabetic retinopathy and to test their connection related to different diagnosis. SUBJECTS AND METHODS: This cross-sectional study included 163 patients divided into three groups (glaucoma group, senile macular degeneration group and diabetic retinopathy group). Respondents voluntarily agreed to participate in the study and with assistance they fully completed the Scale of Religiousness, Hospital Anxiety and Depression Scale, General Health Questionnaire and demographic information (age, gender, education, employment and marital status). RESULTS: The results showed noticeable religiosity of the respondents (M=18.31, SD=5.28), but also the presence of anxiety (M=7.55, SD=3.73), especially in patients with glaucoma, as well as impaired mental health in AMD patients (M=19.56, SD=4.14). No differences were found in the severity of anxiety, depression, general health and religiosity between groups, but the presence of depression in subjects with age-related macular degeneration significantly affects the level of religiosity (p=0.032). CONCLUSION: These results unequivocally point to the need for further research and raising awareness of all health professionals about the importance of a holistic approach to the patient regardless of his diagnosis in order to identify the possible effective ways to deal with chronic disease considering all levels of patient's needs.

Orthopedic and Cutaneous Reactions to Nickel after Total Hip Replacement.

Implant degradation products have shown signs of a cutaneous allergic response after implantation of a metal orthopedic replacement, loosening and failure of the joints as well as skin rashes, general fatigue, pain, and impaired wounds and bone healing. The prevalence of contact skin sensitivity in patients with a joint replacement device is higher than that in the general population. This delayed hypersensitivity to metallic orthopedic implants is more clearly defined and is a contributing factor to implant failure. Nickel was associated with hypersensitivity responses as the first cause in metallic orthopedic implants as early as 1966 by Foussereau and Laugieru and is a commonly used metal in alloys because it grants necessary strength and durability to the implant. Herein we report on delayed hypersensitivity to nickel sulfate in a patient with pain, fatigue, and contact allergic dermatitis in both inguinal regions, with instability of the left acetabular part and with five hip replacements from 1987 to 2013. The findings of this report support that primary sensitization to a metal due to an implant itself might develop. Proper investigation in patients with history or prior hypersensitivity reactions to metals and test evaluation before orthopedic device implantation is needed. before orthopedic device implantation is needed.

[EFFECTS OF PLATELET-RICH PLASMA IN THE TREATMENT OF CHRONIC ULCER]. / UCINCI PRIMJENE PLAZME BOGATE TROMBOCITIMA (PRP) U LIJECENJU KRONICNOG VRIJEDA.

A venous ulcer is area of discontinuity of the skin, usually localised in distal parts of the lower legs. The aetiology is associated with chronic venous disease-venous hypertension. The size and shape of venous ulcer can be different and it may even cover all circumferential of extremity. Additionally, along with basic therapy possibilities, there are many different dressings. Therefore the knowledge of each characteristic of dressing on process of epithelisation is essential as well as treating the biofilm that is responsible for complications and persistence of ulcer. One of additional therapy possibility is platelet-rich plasma.

Drug-Induced Rosacea-like Dermatitis.

Rosacea is a common, chronic cutaneous disorder with a prevalence of 0.5-10%, predominantly affecting women. The disease presents with a heterogeneous clinical picture characterized by transient flushing, persistent facial redness, telangiectasias, and, in more severe clinical forms, the presence of inflammatory papules and pustules in the central third of the face. Although its pathophysiology is complex and still remains unknown, factors that exacerbate the disease are well defined. They include genetic predisposition as well as external factors such as exposure to UV light, high temperature, and diet. Besides these well-known factors, recent studies suggest that drugs and vitamins could also be possible factors inducing rosacea-like dermatitis or aggravating pre-existing rosacea. Although these are less common possible triggering factors, the aim of this article is to present the current knowledge on the association between use of certain drugs or vitamins and rosacea.

Erlotinib-induced Rosacea-like Dermatitis.

Skin and skin adnexa toxicities are the most common side effects associated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and occur in most patients receiving this therapy. The majority of these cutaneous side effects are transient, reversible, and dose dependent. Although these symptoms are in general not severe, they significantly affect quality of life and can have a serious effect on treatment compliance as well as the treatment regimen. The most common early symptoms present as papulopustules on an erythematous base, usually localized in seborrheic areas. This clinical presentation is commonly described as "acneiform", although these adverse reactions have clinical presentations, such as rosacea-like and seborrheic-like dermatitis. In this context, we report a case of a 77-year-old man with a medical history of planocellular lung cancer with ipsilateral pulmonary metastasis and mediastinum infiltration who received erlotinib as a third-line therapy, presenting with centrofacial rosaceiform rash as a side effect associated with the use of EGFR-TKIs. The patient had a negative previous history of rosacea. Therefore, symptoms probably occurred as an adverse reaction due to the oncological therapy. Current terminology of early cutaneous adverse reactions caused by EGFR-TKIs refers to "acneiform" or "papulopustular" lesions, excluding less common side effects such as rosacea-like dermatitis so these symptoms might be overlooked and misdiagnosed. Thus, we would like to emphasize the importance of developing a more accurate classification of terms in order to provide early detection of all possible cutaneous side effects, including less common ones, providing specific and timely treatment, and allowing continuation of drug therapy.

Advanced Pyoderma Gangrenosum Previously Treated as Squamous Cell Carcinoma.

Pyoderma gangrenosum is a rare, neutrophilic ulcerative skin disease of unknown etiology often associated with an underlying systemic disease. We present a case of a pyoderma gangrenosum that was initially misdiagnosed and treated as squamous cell carcinoma in another hospital. Multiple surgical treatments triggered postoperative exacerbations and further rapid progression of the lesions. History of pathergy, clinical findings, and histopathological features examined at our Department indicated pyoderma gangrenosum. The diagnosis was confirmed by excluding other diseases that could cause similar-appearing cutaneous lesions. No associated underlying disease was determined. After the diagnosis was confirmed, corticosteroid therapy was initiated until complete remission of ulcerations.

Pyridoxine induced rosacea-like dermatitis.

Rosacea is a common chronic inflammatory cutaneous disease of unknown etiology, characterized by remissions and exacerbations, presenting with centrofacial erythema and telangiectasias. It affects mainly adults around the age of 30 years and classically predominates in females. The pathophysiology of rosacea has not yet been fully understood. Risk factors are positive family history, very light skin phototype, sun exposure and consumption of spicy food or alcohol. Recently, there has been some evidence that some drugs or vitamins could be potential factors that can aggravate rosacea or induce rosacea-like symptoms. In this context, we present a 53-year-old female developing rosacea-like dermatitis due to a fixed combination of isoniazid and pyridoxine, which she was receiving along with rifampicin for the treatment of pulmonary tuberculosis.

Dermoscopy and Early Melanoma.

The lack of effective therapies for patients with advanced melanoma establishes an early recognition as the aim of clinical and dermoscopic examination, which is the most important factor for improving patient survival and decreases the treatment and management costs. Melanoma in situ is the earliest stage of melanoma. The features of early melanomas, especially in those lesions smaller than 3mm, can be very subtle clinically, dermoscopically and pathohistologically, and it is often impossible to discriminate between a melanoma and nevus. Clinically, de novo melanomas are small brown to black macula with an irregular outline. In melanomas developing in a nevus, there is an asymmetry of the lesion with marked change in color and/or shape of the pre-existing nevus. Dermoscopically, early stages of melanoma show the same global features as thicker melanomas, but in a more subtle way. Asymmetry is the most important parameter; multiple colors are rare. Significant local melanoma-specific criteria, especially when present at the periphery, are irregular pigment network, irregular streaks, and irregular dots/globules, while blue-white structures are rarely found.

Cutaneous adverse drug reactions caused by antituberculosis drugs.

Multidrug antituberculosis regimen is associated with diverse clinical patterns of cutaneous adverse drug reactions (CADR), ranging from mild and moderate such as pruritus, maculopapular exanthems, lichenoid eruptions, fixed drug eruptions and urticaria to severe and even life threatening ones like acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These adverse reactions to antituberculosis drugs are commonly observed adverse events. This is of particular importance for high HIV prevalence settings and developing countries where tuberculosis is common infection resulting in higher occurrence rate of these reactions. There is still significant heterogenity in definition and classification of CADR, as well as diversity in treatment modalities following adverse reactions and rechallenge management. The aim of this review is to discuss clinical presentation, occurrence of CADR caused by antituberculosis drugs, to identify risk factors for intolerance of the standard therapy as well as to draw attention to importance of multi-disciplinary approach, early detection, prompt diagnosis and in time management of antituberculosis drugs associated CADR. CADR can cause significant treatment interruption and alteration, resulting in increased risk of treatment failure, drug resistance, relapses and increased risk of complications including even lethal outcome. Finally, it can be concluded that it is of great importance to identify the best possible treatment and preventive regimens in order to enable continuity of the antituberculosis therapy to the full extent.

Significance of dermatoscopy in genital dermatoses.

Dermatoscopy as a non-invasive technique has become an integrative part in the evaluation of pigmented and non-pigmented skin lesions, particularly for the early detections of melanoma. Although dermatoscopy improves diagnosis of pigmented and nonpigmented lesions of the skin, it is unknown if dermatoscopy improves the diagnostic accuracy of pigmented mucosal lesions. The "entodermatoscopy" is used for the dermatoscopy of skin infections and infestations and revised as entomodermatoscopy, as it connects the research fields of dermatology and entomology, with its roots being found in these two words. In genital dermatology along with the clinical examination, dermatoscopy is also used for the diagnosis and treatment follow-up of pediculosis pubis, genital warts, molluscum contagiosum, and scabies.

Palisaded neutrophilic and granulomatous dermatitis in association with subcutaneous nodular and systemic sarcoidosis.

Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare entity that has been clearly defined neither clinically nor histopathologically. PNGD has been associated with some immune-mediated disorders such as rheumatoid arthritis, systemic lupus erythematosus, systemic vasculitis, Behçet's disease, as well as with lymphoproliferative conditions, bacterial endocarditis, sarcoidosis, and various drugs. We present a 44-year-old Caucasian woman with roundish erythematous-livid plaque and erythematous papules on the left calf that were present for three months. Histopathology of plaque lesion showed palisading neutrophilic and granulomatous dermatitis. Subsequently, she developed a firm and tender nodule on the right calf. Histopathology of the nodule showed typical naked sarcoid granulomas in the dermis and subcutis. Additionally, the patient developed non-tender subcutaneous nodules on the cheeks, submandibular region and left breast with normal overlying skin, which were histopathologically diagnosed as sarcoid granuloma. Red eyes and lower visual acuity on the right eye were diagnosed as anterior uveitis. Therefore, systemic sarcoidosis was established. This is a case of PNGD described in an adult patient with sarcoidosis with cutaneous, breast, eye and lung involvement established by clinical, radiographic, laboratory, and histopathologic criteria.

Risk factors for acute respiratory tract infections in children.

Acute respiratory tract infections (ARTI) are the most common cause of childhood morbidity and an important public health problem. The aim of this study was to identify the significant risk factors for ARTI in children. The study took place in Ivankovo which is a rural area of Eastern Slavonia and with small socio-economic differences. The study population were 159 children who were 3-5 years old at the time of the study, and who were registrated at doctor's office Ivankovo. The study was conducted retrospectively through a questionnaire from January 2008 to December 2008. The risk factors studied were the gender, breastfeeding history, any atopic manifestation in the form of atopic eczema, rhinoconjuctivitis and/or asthma, the size of the family, parents smoking habits and main form of childcare. The number of ARTI requiring the consultation of a doctor throughout 2007 were measured; and whether ARTI had been treated with antibiotic or there were recommendation for symptomatic treatment only. Results of this research show that the risk factor for consulting a doctor because ofARTI in children was passive exposure to cigarette-smoke. For receiving antibiotics because of ARTI in children, the risk factors were passive exposure to cigarette-smoke and atopic manifestation. By giving the available evidence, parents must be told that ceasing smoking offers a significant opportunity to reduce the risk of ARTI in their children.

Photodynamic therapy in dermatology: current treatments and implications.

This article provides an update on photodynamic therapy by discussing each of the essential components in sequence: mechanisms of action, common photosensitizers, typical light sources, and indications. In dermatology, photodynamic therapy (PDT) is mainly used in the treatment of superficial skin cancers: actinic keratoses, Bowen's disease and superficial basal cell carcinomas. However the range of indications has been expanding continuously. PDT is also used for the treatment of other oncological indications and non-malignant conditions such as acne vulgaris and photoaged skin. The 5-aminolevulinic acid (ALA) or its methyl ester (MAL) is applied topically as photosensitizer before activation with visible light. The advantages of topical PDT are: ability to treat multiple lesions simultaneously, low invasiveness, good tolerance and excellent cosmetic results.

Exercise-induced anaphylaxis after ingestion of sandwich with soy containing canned tuna: case report.

We report a case of a 17-year-old female adolescent who experienced an episode of exercise-induced anaphylactic reaction following ingestion of tuna sandwich (from soy containing canned tuna). Her medical history revealed that she had previously had one episode of urticaria after ingestion of sulfamethoxazole with trimethoprim and anaphylactic reaction after ingestion of sunflower nuts. Skin prick tests and specific immunoglobulin E antibody to tuna were negative, and to soy were positive. Treadmill exercise induced test in fasting state and 1 hour after a fresh tuna meal and meal not containing soy were negative. However, an exercise challenge test one hour after soy ingestion resulted in pruritus of hands, shoulders and back, urticarial lesions of the face and neck with angioedema of the lips and eyelids, hoarseness, tachycardia and anxiety.

Pyoderma chronica vegetans treated with mesh skin grafting.

Pyoderma chronica vegetans is a rare condition clinically characterized by large verrucous plaques with elevated borders and multiple pustules. Although the etiology is unknown, it is generally believed that vegetating reaction is due to an immune system dysfunction or immunosuppressive state. We report on a 72-year-old man with pyoderma chronica of the buttocks. The lesion on the left buttock worsened two years before with gradual onset of fistulas, scarring and verrucous plaques. Laboratory test revealed medium high erythrocyte sedimentation rate, anemia, shift to left in differential white blood cell count, and polyclonal hyperglobulinemia. Streptococcus species and Escherichia coli were detected in tissue samples. T-cell functional tests for mitogens were decreased. Flow cytometry analysis of phagocytic capability of monocytes and granulocytes by was normal. Inflammatory bowel diseases were excluded with clinical and radiological examination. Anti-HIV test was negative. Histology revealed hyperplasia and irregular acanthosis of the epidermis, sinus and abscess formation, fibrosis and diffuse infiltration of inflammatory cells such as plasma cells, lymphocytes, histiocytes, eosinophils and neutrophils. Surgery was chosen as a therapeutic option as conservative treatment proved ineffective. Therefore, complete excision of the lesion was performed and skin grafting was required to close the defect because of extensity of the lesions. The skin-graft donor site was normal skin. Good postoperative result was achieved, without recurrence of the pyodermatic process.