Selma Korkmaz

Evaluation of serum sCD40L and homocysteine levels with subclinical atherosclerosis indicators in patients with psoriasis: a pilot study

Psoriasis is a chronic inflammatory process associated with an increased risk of cardiovascular risk factors. sCD40L has been suggested to have a possible role in the pathogenesis, of psoriasis and is known to be associated with inflammation, atherogenesis and cardiovascular events. This study investigated cardiovascular risk factors (sCD40L and homocysteine) as well as subclinical atherosclerosis indicators in psoriatic patients and control subjects. The study included 56 consecutive patients with chronic plaque‐type psoriasis and 53 age and gender matched healthy controls admitted to a university hospital. Serum sCD40L and homocysteine levels were measured by ELISA. Carotid artery intima‐media thickness and brachial artery flow mediated dilatation (FMD) measurements were determined ultrasonographically. Subjects who had a history of cardiovascular diseases and cardiovascular risk factors and receiving any systemic treatment were excluded from the study. Plasma sCD40L levels were significantly higher in psoriasis patients compared with healthy controls (1.33 ± 0.72 vs. 0.98 ± 0.70 ng/ml P = 0.012), whereas plasma homocysteine levels did not differ significantly between the two groups. FMD was significantly reduced in the psoriasis group compared to the controls (3.83 ± 5.03 vs. 8.45 ± 7.27% P = 0.0001). Multiple linear regression analyses indicated a significant association between psoriasis, sCD40L, and FMD. Psoriatic patients had higher sCD40L levels than healthy controls, which may lead to an increase in cardiovascular diseases. sCD40L may be a more reliable and early predictive marker of cardiovascular events in psoriatic patients. New treatment options that will be developed over sCD40L will benefit in prevention of psoriasis and its cardiovascular comorbidities.

Braf v600 mutation profile of metastatic melanoma in the thrace region of turkey

OBJECTIVE BRAF is the most common mutation in melanoma. The most common subtype is BRAF V600E, followed by V600K. Initially, the authors aimed to investigate whether clinicopathological features of melanoma are associated with BRAF mutations. We then aimed to present the relationships between the clinicopathological features and the mutated subtype (V600E vs V600K). MATERIAL AND METHOD 61 patients with metastatic malignant melanoma (affecting the lymph node or other distant sites) were selected. Patient data regarding age at the time of diagnosis, sex, metastatic site (lymph node, distant metastasis or both) and primary tumour site were obtained from the hospitals database. Tissue samples containing at least 30% tumour cells were isolated from the specimens of 61 patients (24 samples from primary tumours and 37 from metastatic foci) for BRAF analysis. Comparisons between the BRAF V600 mutation and clinicopathological and histopathological features were performed. RESULTS BRAF V600 mutation was detected in 34 (55.7%) patients. The subtype was BRAF V600E in 22 (64.7%) patients, BRAF V600K in 11(32.4%) patients and BRAF V600R in 1(2.9%) patient. The crucial results of the present study may be summarized as follows: i) BRAF V600 mutation was more common in older patients and tumors with BRAF V600 mutation revealed necrosis and LVI more commonly than wild-type tumors, ii) BRAF V600K mutation was more common in older patients and BRAF V600K mutated tumors exhibited ulceration more commonly than tumors with BRAF V600E mutation (close to significant). CONCLUSION The BRAF V600 mutation may have interactions with prognostic clinicoptahological features of melanoma including necrosis and lymphovascular invasion. V600K mutation may be more common than expected and may have different associations with properties of the tumor such as tumor ulceration and patient age. Investigation of the mutated subtype of the BRAF gene may therefore reveal more detailed data about the management of melanoma and may also prevent missing of candidates for BRAF inhibitor therapies.

Metabolic Syndrome May Exacerbate Macular and Retinal Damage in Psoriasis Vulgaris

ABSTRACT Purpose: To evaluate whether cases with both psoriasis and metabolic syndrome are prone to retinal and macular changes. Materials and Methods: A total of 174 eyes of 87 subjects were evaluated. Of the 87 subjects, 24 had psoriasis, 19 had psoriasis and metabolic syndrome, 18 had metabolic syndrome only and 26 were healthy subjects. Biochemical analysis, anthropometric, blood pressure and optical coherence tomography measurements and thickness analysis were obtained for each case. Results: The superior retinal nerve fibre layer thickness was significantly lower in the psoriasis and metabolic syndrome group than in the psoriasis group. For all parafoveal quadrants, the ganglion cell complex thickness was statistically significantly lower in the psoriasis group than in the healthy group. The central macula was thinnest in the healthy group among the four groups. Conclusions: Psoriasis can cause retinal changes, and metabolic syndrome may cause additional damage in the retina and macula in cases with psoriasis.

Effects of IVIG and Pulse Steroid Therapy in a Case of Allopurinol Induced DRESS Syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a drug reaction that causes peripheral eosinophilia and primarily renal and hepatic insufficiency and dysfunction of other visceral organs with skin rash as noticeable symptom. Early diagnosis and discontinuation of the culprit drug along with rapid treatment are required to reduce mortality rate. Herein, a case of allopurinol-induced DRESS syndrome is presented in which the patient was resistant to medium dose systemic steroid therapy and was treated with pulse steroid and IVIG treatment successfully. Pulse steroid therapy may be an alternative treatment option in refractory DRESS syndrome.

Onychophagia Induced Melanonychia, Splinter Hemorrhages, Leukonychia, and Pterygium Inversum Unguis Concurrently

Onychophagia, which refers to compulsive nail-biting behavior, is common among children and young adults. Onychophagia can cause destruction to the cuticle and nail plate, leading to shortening of nails, chronic paronychia, and secondary infections. Relatively uncommon effects include pigmentary changes, such as longitudinal melanonychia and splinter hemorrhages. We report a case of a young adult with longitudinal melanonychia, splinter hemorrhages, punctate leukonychia, and pterygium inversum unguis, concurrently induced by onychophagia. Importantly, patients usually do not report this behavior when asked about nail-related changes. Even upon questioning, they may deny nail-biting behavior. As in many other dermatological disorders, dermoscopy can be helpful in the diagnosis of nail disorders.

Mean platelet volume and platelet distribution width levels in patients with mild psoriasis vulgaris with metabolic syndrome

Introduction Psoriasis vulgaris (PV) is a common inflammatory skin disease characterized by incomplete differentiation and hyperproliferation of epidermal keratinocytes. Platelets play a role in inflammatory reactions and the immune response and may be activated by a variety of stimulants. Studies in recent years have shown increased incidence of metabolic syndrome (MetS) in psoriasis patients. However, the mean platelet volume (MPV) and platelet distribution width (PDW) values have not been assessed in PV accompanied by MetS. Aim To evaluate MPV and PDW levels and their association with metabolic parameters in the presence of MetS in PV patients. Material and methods A total of 76 patients with mild PV, including 38 with MetS and 38 without MetS, 38 patients with MetS without PV and 35 healthy individuals were enrolled in the study. The number of platelets, MPV, PDW, fasting blood glucose, urea, creatinine, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, thyroid stimulating hormone, free triiodothyronine, and the free thyroxine levels were evaluated. Results Mean platelet volume and PDW levels were significantly higher in the mild PV with MetS group compared to the mild PV without MetS group, MetS without PV patients and the healthy control group (p < 0.05, for all). There was no significant difference between the mild PV without MetS group and the healthy control group in terms of MPV and PDW levels (p > 0.05, for all). There was no significant difference between the groups with MetS and without MetS in terms of the psoriasis area and severity index (PASI) (p > 0.05). The PASI was not correlated with MPV and PDW. In addition, metabolic parameters were not correlated with MPV and PDW in mild PV patients. Conclusions Mean platelet volume and PDW levels showing platelet activation increase significantly in the presence of MetS in patients with mild PV.

Calprotectin can play an inflammatory role in acne vulgaris

Introduction Acne vulgaris (AV) is a chronic inflammatory disorder of the pilosebaceous unit. Although various mechanisms have been indicated in the etiopathogenesis of acne vulgaris, the exact pathophysiology is still unknown. Aim To investigate the level of calprotectin in acne vulgaris and its levels relationship with disease severity. Material and methods A total of 66 AV patients, who were divided into 33 mild and 33 moderate–severe cases, and 30 healthy controls were enrolled in the study. Disease severity was assessed using the Global Acne Score. According to this scale, patients whose Global Acne Score was 1–18 had mild acne, those with a score of 19–30 had moderate acne, those with a score of 31–38 had severe acne, and those with a score greater than 39 had very severe acne. Serum calprotectin levels of all participants were measured by enzyme-linked immunosorbent assay method. Results The serum calprotectin levels in the moderate–severe AV group were significantly higher than that of the mild AV group (p < 0.001). In addition, the serum calprotectin level in the mild AV group was significantly higher than that of the healthy control group (p = 0.047). However, in the Spearman’s correlation analysis, the serum calprotectin level and GAS were not correlated in AV patients (p = 0.171, r = 0.179). Conclusions Serum calprotectin levels are increased in mild and moderate AV patients.

Neonatal Lupus Eritematozlu Bir Olgu

Neonatal lupus erythematosus is a rare disease of infants, that are born of a mother with systemic lupus erythematosus (SLE), Sjogrens syndrome and other collagen vascular diseases. The occurrence of the disease is due to transplacental transmission of anti-SSA/Ro, anti-SSB/La, and less frequently anti-U1RNP antibodies during pregnancy. The main clinical symptoms of the patient are dermatological, hematological, hepatic and cardiac manifestations. Although the skin is involved in 15-25% of patients, a variety of systemic involvement other than skin can be seen. NLE, can lead to morbidity and mortality with systemic involveament. Therefore, NLE should also be considered in the differential diagnosis of neonatal annular lesions. Here, a 22-day old male patient, who was diagnosed with NLE, accompanied by clinical and laboratory findings, was presented.