Effect of isotretinoin treatment on inflammatory and hematological parameters in patients with acne vulgaris

PURPOSE

Although the inflammatory and anti-inflammatory effects of isotretinoin (ISO) treatment in patients with acne vulgaris have been discussed in the literature in recent years, no sensitive and specific marker has been found in studies so far. Neutrophil/HDL (high-density lipoprotein) (NHR), lymphocyte/HD L(LHR), platelet/HDL (PHR), and lymphocyte/monocyte (LMR) are new biomarkers related to inflammation. Triglyceride/HDL (TG/HDL), LDL/HDL, and total cholesterol/HDL have been shown to be cardiometabolic risk factors predicting both cardiovascular disease risk and metabolic risk, rather than just a simple dyslipidemia scale. To our knowledge, the relationship between these parameters and ISO treatment has never been studied before. We aimed to evaluate the immuno-inflammatory response of ISO treatment in patients with acne vulgaris with NHR, LHR, PHR, LMR, TG/HDL, LDL/HDL, and total cholesterol/HDL parameters.

MATERIALS AND METHODS

In this study, 153 patients who received oral ISO treatment for at least 3 months with a diagnosis of moderate-severe acne vulgaris were evaluated retrospectively. Patients were given oral isotretinoin at a dose of 0.5-1 mg/kg. Pre and post-treatment leukocyte (WBC), neutrophil (NE), lymphocyte (LY), platelet (PLT), red cell distribution width (RDW), plateletcrit (PCT), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), mean platelet volume (MPV), monocyte/lymphocyte (MLR), LMR, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, MHR, NHR, LHR, PHR, TG/HDL, total cholesterol/HDL, LDL/HDL parameters were evaluated.

RESULTS

It was found that post-treatment WBC and MPV values increased statistically significantly; NLR, neutrophil, and PCT values, on the other hand, decreased significantly (p < 0.05). No statistically significant change was detected in PLR, MLR, LMR, MHR, NHR, LHR, PHR, lymphocyte, monocyte, platelet, and RDW parameters (p > 0.05). It was determined that post-treatment total cholesterol, triglyceride, VLDL, and LDL levels increased statistically significantly; however, the HDL level decreased significantly (p < 0.05). Levels of total cholesterol/HDL, TG/HDL, and LDL/HDL were also found to increase statistically significantly (p < 0.05).

CONCLUSION

Our study suggests that the MPV and NLR ratio as biomarkers can be used as indicators of atherosclerosis-related inflammation due to ISO treatment, but the MHR, NHR, LHR, PHR, MLR, LMR ratios cannot be used. Moreover, we believe that the ratios of TG/HDL, LDL/HDL, and total cholesterol/HDL offer a new contribution as indicators of cardiovascular risk and systemic inflammation related to ISO treatment.

The effect of IL17 and IL23 inhibitors on hematological parameters and C-reactive protein in psoriasis patients

INTRODUCTION

In the quest for objective biomarkers for psoriasis, the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein (CRP), and mean platelet volume (MPV) have been used to assess disease severity, treatment efficacy, and follow-up in psoriasis, and their relationship with the Psoriasis Area Severity Index (PASI) has been investigated.

PURPOSE

The evaluation of pre-treatment, 3rd and 6th-month levels of NLR, PLR, MPV, and CRP along with PASI scores in psoriasis patients treated with secukinumab, ixekizumab, risankizumab, and guselkumab.

MATERIALS AND METHODS

In our study, 83 patients aged 18 and over, who were followed up with moderate-severe plaque type psoriasis vulgaris and psoriatic arthritis and received secukinumab, ixekizumab, risankizumab, and guselkumab treatment in the chronic skin diseases clinic of Fırat University Faculty of Medicine Hospital between January 2019 and 2023, were evaluated retrospectively.

RESULTS

Post-treatment leukocyte, neutrophil, lymphocyte, platelet, CRP, and PASI values were statistically significantly lower in all biological agent groups and all patients. The post-treatment NLR value was statistically significantly higher in all patients and in the group using ixekizumab. The post-treatment PLR value was statistically significantly higher in the group using guselkumab and ixekizumab and in all patients. The post-treatment MPV was statistically significantly higher in all patients and in the group using secukinumab. No correlation was found between post-treatment PASI and other values (p > 0.05). There was no statistically significant difference between the post-treatment 6-month values among all biological agent groups. The effects of different drugs on outcomes after treatment were found to be similar (p > 0.05).

CONCLUSION

Our study supports the view that MPV and CRP can be used in patients with psoriasis using IL17 and IL23 inhibitors, while NLR and PLR parameters derived from blood count may not be used to evaluate treatment response, contrary to other studies.

Evaluation of the relationship of digital phototrichogram findings of patients with diffuse hair loss with blood TSH, ferritin and vitamin B12 levels

OBJECTIVE

Telogen effluvium (TE) is a type of alopecia that is frequently seen in women. Among factors resulting in hair loss, many reasons such as endocrine diseases, nutrition disorders, stress, anemia, low ferritin levels, vitamin B12 deficiency, and thyroid diseases are found. A digital phototrichogram is one of the non-invasive methods of diagnosis in the evaluation of alopecia. In this study, it was aimed to compare biochemical parameters of female patients with diffuse hair loss with phototrichogram findings.

METHODS

108 female patients with diffuse hair loss were included in the study. Patients were divided into two groups: acute and chronic TE, and a hair pull test was applied. Total blood count, blood biochemistry, iron, iron binding capacity, ferritin, thyroid stimulating hormone (TSH), sT3, sT4, folic acid, and vitamin B12 levels were examined. The telogen/anagen ratios and hair densities of patients were determined with a phototrichogram.

RESULTS

The serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, urea, creatinine), TSH, sT3, sT4, and folic acid levels of patients were within normal limits. Telogen ratio, anagen ratio, hair density, number of shed hairs, family history, blood ferritin, TSH, and vitamin B12 levels were found to be similar between groups having acute and chronic TE. In our study, while mean anagen and telogen ratios with trichoscan were similar to literature data, no statistically significant correlation was determined between patients' ages and examined trichoscan findings (p>0.05). The hair pull test positivity of patients with chronic TE was higher compared to patients with acute TE (p<0.05). In patients with positive hair pull tests, the telogen ratio and hair density were found to be higher. In the group with <40 ng/mL ferritin level, the mean telogen ratio was detected to be significantly higher than the mean anagen ratio (p<0.05). No significant correlation was determined between vitamin B12 and TSH levels in patients and phototrichogram findings (p>0.05).

CONCLUSION

The findings of this study showed that ferritin has an important role in diffuse hair loss, and the phototrichogram method is an auxiliary method for the physician in the diagnosis of TE.

Antimicrobial and antioxidant activities of the various extracts of Verbascum pinetorum Boiss. O. Kuntze (Scrophulariaceae)

BACKGROUND AND OBJECTIVES

The present study was performed to evaluate the in vitro antimicrobial and antioxidant properties of various extracts of Verbascum (V.) pinetorum, a member of Scrophulariaceae family. While the antimicrobial activity of various extracts of V. pinetorum was determined with agar-well diffusion method, the antioxidant activity was examined with two complementary test systems, namely 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging and beta-carotene/linoleic acid test systems.

RESULTS

The hexane extract exhibits antimicrobial activity against few microorganisms. However, dichloromethane, direct methanol and methanol/chloroform extracts are effective on a broad range of microorganisms. Among the tested bacteria Haemophilus influenzae was found to be the most sensitive bacterium. The 50% (IC50) inhibition activity of the methanolic extract of V. pinetorum on the free radical DPPH was determined as 13.04 mg/ml. In the case of the linoleic acid system, oxidation of linoleic acid was inhibited by methanolic extract of V. pinetorum, which showed 89.39% inhibition that is quite close to the value of the synthetic antioxidant reagent butylhydroxytoluene (BHT), 92.46%. Iridoid glycosides, flavonoids and saponins were determined as the major natural compounds in the methanolic extracts. The total phenolic components of V. pinetorum were found as 42.45 mg/g gallic acid equivalent.

CONCLUSION

The results provide evidence that the extracts of V. pinetorum contained iridoid glycosides, flavonoids, saponins and phenolic compounds which may be responsible for the substantial antimicrobial and antioxidant activities.

Acute arsenic self-poisoning for suicidal purpose in a dentist: a case report

Arsenic is a classical poison that has been historically used since ancient times for homicidal purposes. More recently, episodes of deliberate or unintentional arsenic self-poisoning have been increasingly reported. We describe here a case of a 77-year old male patient with a history of major depression, who attempted suicide by ingestion of 4 g of arsenic trioxide. The man, a dentist by profession, used arsenic preparations for pulp devitalization. The patient was admitted to our hospital 5 h after arsenic ingestion with nausea and vomiting. Plain radiograph of the abdomen showed radio-opaque material in the stomach and small intestine. Nasogastric lavage, activated charcoal, and chelators were used to remove arsenic. On day 3, endoscopy disclosed the presence of gastritis and superficial ulcers. The patient developed significant anemia (Hb: 8.7 g/dL on day 7) without significant signs of hemolysis. He gradually recovered from anemia within 5 months. The patient did not suffer any adverse outcome in spite of having ingesting 4 g of arsenic, approximately 20 times the lethal dose.

Mechanisms of Staphylococcus aureus induced apoptosis of human endothelial cells

Staphylococcus aureus plays an important role in sepsis, pneumonia and wound infections. Here, we demonstrate that infection with several S. aureus strains results in apoptosis of human endothelial cells. S. aureus induced an activation of cellular caspases, the acid sphingomyelinase, a release of cytochrome c and a stimulation of Jun NH2-terminal kinase (JNK). The significance of these findings is indicated by a prevention of S. aureus triggered apoptosis of human cells deficient for ASM or upon genetic or pharmacological inhibition of JNK or caspases, respectively.

Invasion of human epithelial cells by Pseudomonas aeruginosa involves src-like tyrosine kinases p60Src and p59Fyn

Pseudomonas aeruginosa plays a major role in respiratory tract infections or sepsis in patients with cystic fibrosis or upon suppression of the immune system. Several P. aeruginosa strains have been shown to be internalized by human epithelial cells; however, the molecular mechanisms of the invasion process are poorly characterized. Here, we show that the internalization of P. aeruginosa into human epithelial cells results in and requires activation of the Src-like tyrosine kinases p59Fyn and p60Src and the consequent tyrosine phosphorylation of several eukaryotic proteins. The significance of Src-like tyrosine kinase activation is shown by an almost complete blockade of P. aeruginosa internalization, but not adhesion, upon inhibition of Src-like tyrosine kinases. Likewise, inhibition of P. aeruginosa binding to CFTR, which has been shown to block P. aeruginosa internalization, prevents Src and Fyn activation, supporting a pivotal role of Src-like tyrosine kinases for invasion by P. aeruginosa.

Blue rubber bleb nevus syndrome

A 26-yr-old man was admitted with malaise and melena. During the physical examination, six hemangiomas were spotted on the skin, and laboratory evaluations proved the existence of severe iron deficiency anemia (Hb 2.9 g/dl). Upper endoscopy and small bowel follow-through revealed no pathology. Colonoscopy documented the presence of a blue-red cavernous hemangioma, 1 cm in diameter, at the splenic flexura. The skin and colonic lesions were typical; thus, blue-rubber-bleb-nevus syndrome was diagnosed. The patient was given blood transfusions followed by oral iron supplementation. He refused further evaluation or surgery and is still fine after a follow-up period of 6 months. Here, we present a discussion of this case, together with a detailed review of the literature.