Muzaffer Bilgin

Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair.

Background: Psoriasis and seborrheic dermatitis are both chronic erythemato-squamous dermatoses that can involve the scalp. It may be difficult to differentiate these two diseases when there is isolated scalp involvement. Recently, trichoscopy is commonly used to differentiate noncicatricial alopecias including psoriasis and seborrheic dermatitis that can lead to telogen effluvium (TE). Objectives: The objective of this study is to evaluate the trichoscopic figures that may help to differentiate scalp psoriasis and seborrheic dermatitis. Materials and Methods: Thirty one with scalp psoriasis and 112 patients with seborrheic dermatitis were enrolled. Trichoscopic examinations were performed using a videodermatoscope (MoleMax 3®). Trichoscopic findings of scalp psoriasis and seborrheic dermatitis were compared with each other, with 100 healthy individuals and with other noncicatricial alopecias including female androgenetic alopecia (FAGA) (n: 138), male androgenetic alopecia (n: 63), FAGA of male pattern (FAGA.M) (n: 5), alopecia areata (39), TE (n: 22) and trichotillomania (n: 4). Results: Atypical red vessels, red dots and globules (RDG), signet ring vessels (SRV), structureless red areas and hidden hairs (HH) were statistically more common in psoriasis while twisted red loops and comma vessels (CV) in seborrheic dermatitis. RDG were considered as the characteristic videodermatoscopic figure for psoriasis and arborizing red lines and CV for seborrheic dermatitis. In comparison with previous reports, our study yielded two new trichoscopic structures supporting the diagnosis of psoriasis; HH and SRV. Besides, according to our study, CV were described for the first time in seborrheic dermatitis and considered to be specific for seborrheic dermatitis. Conclusion: This study confirmed that trichoscopy might be useful in differentiating scalp psoriasis and seborrheic dermatitis from each other and from other noncicatricial alopecia with three trichoscopic structures as HH, SRV and CV.

Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients

Background: Studies have reported the presence of sleep disorders in approximately 50–70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels). Methods: We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. Results: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders. Conclusions: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.

Long‐term oncological and reproductive outcomes of fertility‐sparing cytoreductive surgery in females aged 25 years and younger with malignant ovarian germ cell tumors

To evaluate the long‐term oncological and reproductive outcomes of patients aged 25 years and younger who were treated by fertility‐sparing cytoreductive surgery (FSCS) plus adjuvant chemotherapy (ACT) or observation alone for malignant ovarian germ cell tumors (MOGCT).

Scalp Dermatoscopic Findings in Androgenetic Alopecia and Their Relations with Disease Severity

Background Clinicians are searching for new methods to diagnose and predict the course of androgenetic alopecia noninvasively. Objective Our aim is to evaluate trichoscopic findings and their relations with disease severity in androgenetic alopecia. Methods The videodermatoscopic findings of 143 female and 63 male patients with androgenetic alopecia were compared with each other, with those of healthy subjects (n=100), and with those of patients with other nonscarring alopecias (n=208). Mann-Whitney U-test, χ2 analyses, and logistic regression analysis were used for statistical analysis. Results No statistically significant relation was found between trichoscopic findings and severity in male androgenetic alopecia (MAGA) on the basis of the modified Hamilton Norwood scale (among 7 degrees); however, multihair follicular unit and perifollicular pigmentation were related to low severity whereas white dots, honeycomb pattern pigmentation, and brown dots were related to high severity. On the other hand, according to the Ludwig classification, arborizing red lines were related to low severity and brown dots were related to high severity, whereas there was no difference in stages between the Ebling and Olsen classifications in female androgenetic alopecia (FAGA). In the characteristic trichoscopic findings in this study, perifollicular pigmentation was found as a normal feature of the scalp, whereas multihair follicular unit and honeycomb pigment pattern, which were previously considered as normal features, were observed to be related to androgenetic alopecia. Conclusion No relation was found between MAGA severity and trichoscopic findings, as well as between FAGA severity according to different disease severity classifications and trichoscopic findings.

Trichoscopic findings in alopecia areata and their relation to disease activity, severity and clinical subtype in Turkish patients

Trichoscopic studies of alopecia areata are helpful in the non‐invasive diagnosis and prediction of the course of the disease. The objective was to determine the relationship of trichoscopic findings in alopecia areata with disease activity, severity and clinical subtype in Turkish patients.

Methotrexate treatment in progressive tubal ectopic pregnancies and hCG-related clinicosurgical implications

Our aim was to evaluate the relationship between the success of methotrexate treatment and β‐hCG levels in progressive tubal ectopic pregnancies. We defined a retrospective cohort of 394 progressive tubal ectopic pregnancy patients treated with methotrexate. A single‐dose methotrexate protocol using 50 mg/m2 was administered to patients with progressive tubal ectopic pregnancy. Surgery was performed in patients who exhibited signs of acute abdomen due to tubal rupture. Of 394 patients that received methotrexate treatment, 335 (84.6%) responded to medical treatment, while the remaining 59 (15.36%) underwent surgery due to treatment failure. β‐hCG levels in the failure group were significantly higher as compared with the success group at Day 1, Day 4, and Day 7 (2116 ± 3157 vs. 4178 ± 3422, 2062 ± 3551 vs. 4935 ± 4103, and 1532 ± 3007 vs. 3900 ± 4783, respectively). The receiver operating characteristics curve for β‐hCG levels at Day 1 was 0.738, with a cutoff value of 1418 mIU/mL, while sensitivity and specificity values reached the optimum for treatment success (83.1% and 59.4%, respectively). Medical treatment with methotrexate achieved an 85.02% success rate for the treatment of progressive tubal ectopic pregnancy, while success rates for medical treatment decreased significantly when initial β‐hCG levels were >1418 mIU/mL.

Osmangazi University score to reduce ionizing radiation in renal colic patients in emergency department

Objective: Computerized tomography remains the gold standard imaging in renal colic patients. In this study, we develop a scoring system to select patients in emergency department for unnecessary computerized tomography imaging in order to decrease radiation exposure. Methods: Computerized tomography imaging of patients with renal colic in emergency department were retrospectively reviewed. Symptoms, laboratory results were recorded. Significant parameters were determined by univariate and multivariate analysis. Coefficients were found to obtain score points and receiver operating curve was used to find a cut-off value. Results: A total of 123 patients with a mean age of 42 years (18–75 years) were enrolled in the study. About, 20.3% of patients were stone-free in computerized tomography. Mean stone size was 6.1 ± 1.89 mm. According to analysis, four parameters were significant; nausea, stone history, creatinine, and hematuria with a total score 9 called as Osmangazi University STONE score. Cut-off value was found as >3, which computerized tomography imaging is recommended. Conclusion: Osmangazi University STONE score is useful and simple tool in emergency department to reduce unnecessary computerized tomography imaging in renal colic patients and also lowers cost and ionizing radiation exposure.

The Evaluation of Contact Sensitivity with Standard and Cosmetic Patch Test Series in Rosacea Patients

Background Rosacea is a common dermatosis characterized by erythema, telangiectasia, papules and pustules. Objective We aimed to evaluate contact sensitivity in the rosacea patients. Methods We included 65 rosacea patients and 60 healthy volunteers in the study. The patient and control groups were patch tested with European baseline series and cosmetic series. Results A positive reaction to at least 1 allergen in the European standard series was found in 32.3% of rosacea patients and 20.0% of subjects in the control group while the relevant numbers were 30.8% of rosacea patients and 10% of controls with the cosmetic series (p=0.08). In total, we found a positive reaction to at least 1 allergen in 38.5% of patients and 25.0% of controls (p=0.15). We did not find a statistically significant relationship between a positive reaction to 1 allergen in total and the gender, skin type, rosacea type, ocular involvement, age and disease duration. There were more symptoms in patients with a positive reaction to allergens (p<0.001). Conclusion Contact sensitivity was detected more common in rosacea patients. Patch testing may be useful in the treatment and follow up of rosacea patients especially if symptoms such as itching, burning and stinging are present.

Advanced oxidation protein products and serum total oxidant/antioxidant status levels in rosacea

Introduction Rosacea is a chronic, inflammatory dermatosis which develops due to the effect of genetic and environmental factors. Aim To evaluate the oxidative stress in rosacea patients by measuring serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and advanced oxidation protein products (AOPP) levels in our study. Material and methods Our study included rosacea patients and healthy volunteers aged between 18 and 65 years. Total antioxidant status, TOS and AOPP levels were measured and OSI was calculated. Results The study included 70 rosacea patients and 30 healthy volunteers as a control group. When TAS, TOS, OSI and AOPP levels were compared between rosacea and control groups, there was no difference for OSI levels; while TAS, TOS and AOPP levels were significantly higher in the rosacea group (p = 0.151, p = 0.013, p = 0.034, p = 0.017, respectively). In the rosacea group, there was no correlation between TAS, TOS, OSI and AOPP levels and disease duration. Besides there was no difference between family history, rosacea type, symptom frequency and ocular involvement and TAS, TOS, OSI and AOPP levels in the rosacea group. Conclusions We observed that serum TAS, TOS and AOPP levels were significantly higher in rosacea patients, but there was no significant difference among the disease activity parameters. These results can support the role of oxidative stress in the pathogenesis of rosacea.

Eskişehir Osmangazi Üniversitesi Tıp Fakültesi araştırma görevlisi doktorlarının uyku kalitelerinin ve uyku kalitelerine etki edebilecek faktörlerin değerlendirilmesi

Hekimler meslek hayatlari boyunca, ozellikle de arastirma gorevlisi olarak calistiklari donemde uzun ve yorucu calisma sureleriyle bas etmek zorunda kalirlar. Bu donemde uyku kaliteleri bircok sebepten olumsuz etkilenebilir. Calismamizda Eskisehir Osmangazi Universitesi (ESOGU) Tip Fakultesi arastirma gorevlisi hekimlerin uyku kalitelerinin saptanmasi ve uyku kalitelerine etki edebilecek faktorlerin arastirilarak uygun istatistiksel yontemlerle degerlendirilmesi amaclandi. Calismamiza ESOGU Tip Fakultesi’nde Eylul 2015 - Aralik 2015 tarihleri arasinda gorev yapan 189 arastirma gorevlisi hekim dahil edilmistir. Hazirlanan sosyodemografik veri formu, uyku kalitesini etkileyebilecek faktorler formu ve Pittsburgh Uyku Kalitesi Olcegi (PUKO) arastirma gorevlisi hekimlerle yuzyuze gorusulerek doldurulmustur. Veriler IBM SPSS Versiyon 21.0 istatistiksel paket programi ile degerlendirilmistir. Arastirma gorevlisi hekimlerin ortalama uyku suresi 6,41±1,15 saat, PUKO puan ortalamalari 6,75±3,08 olarak belirlenmistir. Calismamiza katilan 189 arastirma gorevlisi hekimin 46 (%24,3)’sinin uyku kalitesinin iyi oldugu, 143 (%75,7)’unun uyku kalitesinin kotu oldugu saptanmistir. Calismamizda arastirma gorevlisi hekimlerin medeni durumlari, bazi aliskanliklari ve calisma kosullari, meslek memnuniyet durumlari ile uyku kaliteleri arasinda istatistiksel olarak anlamli iliski (p<0,05) oldugunu belirledik. Arastirma gorevlisi hekimlerin dortte uc gibi buyuk bir bolumunun uyku kalitelerinin kotu oldugu tespit edildi. Arastirma gorevlisi hekimlerin uyku kalitelerinin iyilestirilmesi, dolayisiyla daha kaliteli uzmanlik egitimi alip daha kaliteli saglik hizmeti sunabilmeleri icin, arastirma gorevlisi hekimlerin ve calisma duzeni programlayicilarinin uyku kalitesini bozabilecek olumsuzluklarin duzeltilmesinde daha fazla cabalarina gereksinim oldugu kanaatindeyiz.