Disease severity and poor mental health are the main predictors of stigmatization in patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) causes significant psychological distress in patients. We aimed to investigate the stigmatization level of HS patients and to determine the related physical, social, and psychological factors. A questionnaire with 22 questions about the physical and psychosocial problems related to HS was administered to 29 male and 34 female patients between the ages of 18 and 66 to evaluate the thoughts, emotions, attitudes, and behaviors of patients. Each patient filled Dermatology Life Quality Index, Beck Depression Inventory, Liebowitz Social Anxiety Scale, Body Image Scale, and 6-item Stigmatization Scale. Hurley classification was used to assess severity of disease. Patients with HS feel stigmatized depending on physical and psychosocial problems caused by the disease. Higher stigmatization scores correlated with higher scores of depression (r: .437, P < .001), social anxiety (r: .263, P: .03), and worse life quality (r: .522, P < .001), and body image perception (r: .696, P < .001). The degree of stigmatization was closely associated with the presence of painful lesions and disruption of socializing (P: .021 and .033, respectively). Disease severity (ß: 5.12, P: .003 for moderate disease) and reporting feeling psychologically negatively affected due to HS (ß: 4.26 P: .007) were the two main predictors of stigmatization in patients with HS. Cross-sectional nature of the study is the limitation. In conclusion, the stigmatization level of patients with HS is strongly related to disease severity and poor mental health.

[Plasmodium falciparum malaria: evaluation of three imported cases]. / Plasmodium falciparum sitmasi: Yurt disi kaynakli üç olgunun degerlendirilmesi.

Among Plasmodium species the causative agent of malaria in Turkey is P.vivax, however the incidence of imported falciparum malaria cases is steadily increasing. P.falciparum may cause severe malaria with the involvement of central nervous system, acute renal failure, severe anemia or acute respiratory distress syndrome. Furhermore most of the casualties due to malaria are related with P.falciparum. There is recently, a considerable increase in malaria infections especially in tropical areas. In this report, three cases, who have admitted to our hospital with three different clinical presentations of falciparum malaria, and all shared common history of travelling to Africa were presented. First case was a 27 years old, male patient who returned from Malawi seven days ago where he stayed for two weeks. He admitted to our hospital with the complaints of sensation of cold, shivering and fever. In physical examination his body temperature was 37.9°C, C-reactive protein level was high, and the other systemic results were normal. The second case was a 25 years old, male patient who returned from Gambia two weeks ago. He was suffering from fever, headache, shivering and unable to maintain his balance. The patient's body temperature was 38°C. Laboratory tests revealed hyperbilirubinemia and thrombocytopenia. Parasitological examination of the Giemsa-stained peripheral blood smear of these two patients demonstrated ring forms compatible with P.falciparum. Treatment was commenced with arthemeter plus lumefantrine, resulting with complete cure. Third case was a 46 years old, male patient who had been working in Uganda, and returned to Turkey two weeks ago. He had sudden onset of fever, headache, nausea and vomiting and impaired consciousness. His peripheral blood smear revealed ring-formed trophozoites and banana-shaped gametocytes of P.falciparum. Arthemeter plus lumefantrine therapy was started, however, he developed severe thrombocytopenia and jaundice under treatment. His general condition was detoriated and the patient lost his consciousness. As the patient's clinical signs were compatible with sepsis ceftriaxone plus clindamycin were added to the antiparasitic treatment emprically. Due to the development of acute tubular necrosis, the patient have undergone hemodialysis. On the 9th day of therapy the complaints and laboratory findings of the patient have improved, so he was discharged. However, visual defects due to retinopathy and severe neurocognitive impairment that were thought to be the complications of malaria continued in his follow-ups. As a result, it should be keep in mind that both the African students who have come to our country for education from endemic regions and as well as the returned citizens of our country who have gone to work in endemic areas, are under risk of malaria and it is very important to consider malaria in the distinctive diagnosis of patients with the complaints of fever, headache, nausea, vomiting and muscle pain.

Patients With Hidradenitis Suppurativa Negatively Perceive Both Medical and Euphemistic Appellations of Their Disease: A Study From Turkey.

BACKGROUND: The use of medical terms and folk names (euphemisms) affect a patient's understanding of diseases and perceptions of severity. OBJECTIVES: We determine the psychological effects on patients with hidradenitis suppurativa of medical and folk names of their disease. METHODS: This was a cross-sectional and exploratory study conducted at a tertiary referral university hospital in Turkey. A questionnaire on the medical and folk names of hidradenitis suppurativa was administered to 31 males and 25 females. RESULTS: The patients expressed that they found the medical term hidradenitis suppurativa to be incomprehensible because it is a foreign term. When hearing it for the first time, it evoked negative responses such as confusion and worry about their health. Half of the patients preferred their doctors to use a more understandable and pronounceable name. More than 80% of patients expressed feeling depressed and stigmatized by the folk name of their disease. They preferred the terms boils, abscesses, or hidradenitis when referring to their disease. CONCLUSION: Both medical and folk names for hidradenitis suppurativa have negative effects on patients, and most patients feel stigmatized by either term.

Evaluation of Social Anxiety Levels and Related Factors in Psoriasis Patients: A Controlled, Cross-Sectional Study.

INTRODUCTION: Psoriasis patients usually feel shame over their appearance and suffer from poor self-esteem, social anxiety, and avoidance. However, little is known about factors affecting social anxiety levels in these patients. We sought to examine the psychological, as well as disease-related factors which may affect social anxiety levels in psoriasis patients. METHODS: Our study consisted of 50 psoriasis outpatients and a corresponding 50 age and sex-matched healthy control volunteers who filled out the Liebowitz Social Anxiety Scale (LSAS), the Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS), Ways of coping questionnaire (WCQ) and Eysenck Personality Questionnaire Revised: abbreviated form (EPQR-A). The patients also completed the Dermatology Life Quality Index (DLQI). The extensiveness and severity of the disease were examined by employing the Psoriasis Area and Severity Index (PASI). RESULTS: Compared with our controls, psoriasis patients displayed significantly higher degrees of social anxiety. Both social fear/avoidance subscale scores of LSAS showed a significant correlation to impairment in quality of life (r: 0.373, p: 0.008, r: 0.336, p: 0.018). No appreciable correlation was observable among the PASI and LSAS scores. Regression analysis showed that EPQR-A-extraversion and neuroticism subscale scores had significant influence on LSAS-Social Anxiety scores, accounting for 41.5% of the variance. EPQR-A-extraversion was found to have significant influence on LSAS-Social avoidance scores, accounting for 26.8% of the variance. CONCLUSION: Our results indicate that psoriasis causes increased levels of social anxiety which is closely related to impaired quality of life. Personality characteristics might contribute considerably in expressing psychosocial morbidity among individuals living with psoriasis.

Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: a case study and overview.

While many physicians are familiar with the sexual or physical abuse of children, there is little awareness about Munchausen syndrome by proxy (MSBP). As case reports of MSBP increase, awareness among physicians is thought to increase as well. We thus present herein a 16-month-old girl who admitted to Hacettepe University Ihsan Dogramaci Children's Hospital with the complaint of seizure, recurrent apnea and thigh abscess, who was later diagnosed as MSBP. The case was being followed by the Child Protection Team of the hospital (Haceteppe University Child Protection Unit [HU-CPU]). HU-CPU contributed to the early detection of this case and protected the child from a possible fatal outcome. The mother was confronted for MSBP and refused to take responsibility for her child's symptoms. As seen in this case, when MSBP is suspected, psychiatric evaluation of the mother, evaluation of the mother-child interaction and collection of a detailed family and social history can have a positive impact on the prognosis in these cases. This case report underlines the importance of multidisciplinary team work to share the responsibility and reduce the burden during the treatment process of these difficult and complicated cases.