Assessing Public Awareness and Perception of Teledermatology Via Survey

INTRODUCTION

Teledermatology represents an alternative medical approach allowing for the remote assessment of a patient's clinical information without the need for face-to-face consultations.

OBJECTIVES

This study aims to gauge the public's awareness and perception of teledermatology.

METHODS

This research employed a cross-sectional observational design. Data collection was executed using an online survey. Sociodemographic attributes of all participants, such as age, gender, and occupation, were recorded. The survey, designed using Google Forms, comprised two sections: demographic information (5 questions) and queries related to teledermatology (10 questions). Questions and options in the survey were reviewed and revised by two dermatologists to eliminate potential misunderstandings, grammar, and other errors. Power analysis indicated a requirement of a minimum of 527 participants, given a 0.05 margin of error, 98% confidence level, and 0.50 response distribution.

RESULTS

A total of 873 individuals completed the survey- 47.7% were male and 52.3% were female. Students made up 48.1% of the participants, while 22.6% were civil servants. The Marmara Region had the highest participation rate at 47.7%. Remarkably, 41.9% of participants were unfamiliar with the term "teledermatology". However, 57.2% expressed a preference for consultations via teledermatology. Furthermore, 63.7% mentioned facing challenges when attempting to communicate with dermatologists for skin-related concerns. A notable 71.6% supported the formal implementation of teledermatology in our country.

CONCLUSIONS

Our survey highlighted a limited awareness of teledermatology among participants, yet a majority showed a preference for teledermatology consultations. For a comprehensive understanding of public knowledge and perception towards teledermatology, more extensive, multicentric studies are necessary.

Evaluation of plasma zonulin level and its relationship with inflammatory cytokines in patients with vitiligo

BACKGROUND

It has been proven that there is an increase in intestinal permeability in some autoimmune diseases. In our study, we purposed to assess intestinal permeability in vitiligo disease by looking at zonulin levels. At the same time, we aimed to examine the correlation of inflammatory cytokines and lipopolysaccharide (LPS) levels with zonulin.

METHODS

Forty-one patients and 41 healthy participants were involved in our study. Blood samples were taken from all patients and controls, and the levels of zonulin, tumor necrosis factor (TNF)-α, interleukin (IL)-6 and LPS were examined.

RESULTS

The mean of zonulin in the patient group was found to be statistically higher than the control group (p < 0.05). A positive correlation was found between zonulin level and IL-6, TNF-α, and LPS levels (p < 0.05). TNF-α and LPS levels in the vitiligo group were significantly higher than in the control group, but there was no such significance in terms of IL-6 levels.

CONCLUSION

We think that serum zonulin level increases and intestinal permeability increases in vitiligo disease.

Evaluation of serum TWEAK, TRAIL, and oxidative stress markers in rosacea patients

BACKGROUND

Rosacea is a chronic inflammatory skin disease of unknown pathogenesis. TWEAK and TRAIL are two cytokines thought to have a role in the pathogenesis of some inflammatory and autoimmune diseases.

AIMS

The purpose of this study was to examine TWEAK and TRAIL serum levels and oxidative stress markers in patients with rosacea.

MATERIAL AND METHOD

Forty rosacea patients and 40 sex- and age-matched healthy controls were involved in the study. Serum TWEAK and TRAIL levels were evaluated with ELISA kits. Serum total antioxidant status, total oxidant status, total thiol, native thiol, disulfide levels were evaluated, and oxidative stress index was computed.

RESULTS

Serum levels of TWEAK, TRAIL, and oxidative stress markers did not differ statistically in the patients and controls. Both TWEAK and TRAIL levels in the patients were detected to be statistically higher in male than in female.

CONCLUSION

TWEAK and TRAIL may not have a systemic effect in rosacea, unlike other inflammatory diseases. More studies are needed to investigate the role of TWEAK and TRAIL in rosacea.

Evaluation of the effect of 577-nm pro-yellow laser on demodex intensity

The skin disease of the pilosebaceous unit created by demodex mites is called demodicosis. Recently, it has been brought to the agenda that laser therapies can be effective in reducing the intensity of demodex parasite. With this study, we aimed to evaluate the effect of pro-yellow laser applied to the face on the intensity of demodex parasite. Twenty-five patients who had referred to the dermatology polyclinic with a complaint of rash on the face and who had been given proyellow laser therapy during the past year were included in the study. Average pre-laser therapy demodex number per cm² was 3.9 ± 5.0, while average post-therapy demodex number per cm² was 2.6 ± 4.9 (p = .117). The 577-nm pro-yellow laser caused a change in demodex density. We found that the number of demodex following laser therapy decreased in some patients, while it increased in some others.

AB0548 A COMPARATIVE STUDY BETWEEN THE NEUROPSYCHIATRIC INVOLVEMENTS IN ADULT-ONSET AND CHILDHOOD-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background

Neuropsychiatric(NP) manifestations in systemic lupus erythematosus(SLE) encompass a wide spectrum of neurologic and psychiatric features.The nervous system is frequently affected by adult-onset and childhood-onset SLE patients,but disease course and clinical features may differ between both groups.

Objectives

The aim of this study is to evaluate and compare NP manifestations in adult-onset and childhood-onset SLE patients.

Methods

The study included a retrospective analysis of medical records of adult-onset SLE patients and childhood-onset SLE patients following at Hacettepe University from Jan 2015 to Jan 2021.NP events were identified using the ACR established case definitions seen in SLE.Additionally, posterior reversible encephalopathy syndrome, cerebral venous thrombosis, small fiber neuropathy and pseudotumor cerebri were evaluated as having NPSLE in this study.NP were also divided into three categories:neurologic syndromes of the central nervous system, neurologic syndromes of the peripheral nervous system,and diffuse neuropsychological syndromes.

Results

1062 adult-onset and 161 childhood-onset SLE patients were followed-up median 150 (84-227) months.At least one neuropsychiatric event occurred in 101 (9.51%) adult-onset and 29 (18.01%) childhood-onset SLE patients (p=0.002). NP events were present before or around the time of SLE diagnosis 64.6% of the adult-onset patients and 72.4% of the childhood-onset patients.One-third of the patients in both groups were diagnosed with NPSLE during the follow-up.At the time of NPSLE diagnosis, 60.4% of adult-onset and 86.2% of childhood-onset patients had additional involvement other than neurologic manifestations and overall disease activity(SLEDAI-2k)was higher in childhood-onset patients (17vs.14p=0.036).

Almost all patients in the pediatric group and half of the adult patients were given pulse corticosteroids.Cyclophosphamide was the most preferred regimen and was given to 36.6% of the adult patients and 75.9% of the pediatric patients.Rituximab (11.9% and 27.6%) and mycophenolate mofetil (13.9% and 3.4%) were other induction treatments.The adult-onset and childhood-onset NPSLE patients were followed-up median 105(54-165) and 80(40-132) months, respectively.On the last follow-up visit, disease damage scores (SLICC) were similar in both groups,with a median score of 2.

Conclusion

The nervous system was more commonly involved in childhood-onset patients, and disease presentations vary significantly between adult-onset and childhood-onset NPSLE patients.Disease activity appeared to be more severe in children at diagnosis, but permanent organ damage was similar in both groups on follow-up.

Table 1.

Demographics, clinical features of adult-onset and childhood-onset NPSLE patients

Adult-onset NPSLE (n=101)Childhood-onset NPSLE (n=29)P valueCerebrovascular disease63 (62.4)8 (27.6)0.001Arterial cerebrovascular events44 (43.6)5 (17.2)0.007Central nervous system vasculitis25 (24.8)10 (34.5)0.209Parenchymal involvement18 (17.8)3 (10.3)0.256Demyelinating syndrome14 (13.9)2 (6.9)0.221Transient ischemic attack5 (5.0)-0.277Cerebral venous sinus thrombosis4 (4.0)6 (20.7)0.008Meningeal involvement5 (5.0)-0.277Posterior reversible encephalopathy syndrome3 (3.0)2 (6.9)0.310Pseudotumor cerebri7 (6.9)3 (10.3)0.393Idiopathic intracranial hypertension2 (2.0)3 (10.3)0.073Lupus headache38 (37.6)18 (62.1)0.017Acute confusional state13 (12.9)4 (13.8)0.555Cognitive dysfunction9 (8.9)1 (3.4)0.299Seizure disorders31 (30.7)11 (37.9)0.302Movement disorder (chorea)4 (4.0)2 (6.9)0.402Myasthenia gravis3 (3.0)-0.466Cranial neuropathy7 (6.9)3 (10.3)0.393Optic neuritis4 (4.0)1 (3.4)0.690Peripheral polyneuropathy9 (8.9)5 (17.2)0.173Mononeuritis multiplex1 (1.0)-0.777Myelopathy5 (5.0)2 (6.9)0.489Autonomic dysfunction---Small fiber neuropathy1 (1.0)-0.777Figure 1.

Distribution of adult-onset and childhood-onset NPSLE patients

Disclosure of Interests

None declared

POS0166 POLYARTICULAR JIA HAS A DISTINCT CO-INHIBITOR RECEPTOR PROFILE AMONG OTHER JIA SUBTYPES

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory joint disease in children, driven by continuous T-cell activation.[1] T cell activation is counter-balanced by signals generated by co-inhibitory receptors (co-IRs) such CTLA-4, PD-1, LAG-3, and TIM-3.[2]

Objectives

We aimed to identify the role of co-IRs in the pathogenesis of different subtypes of JIA.

Methods

In total, we included 107 patients with oligoarticular JIA (n=67), polyarticular JIA (n=12), enthesitis related arthritis (n=17), systemic JIA (n=11) and healthy controls (HC, n=10). We collected plasma samples from the patients during the active phase of their disease. We measured the soluble plasma levels of co-IRs by commercial pre-defined cytometric bead array kits and their cellular expression by flow cytometry in blood mononuclear cells. We compared the plasma levels and cellular expressions of different coIRs within different JIA subgroups.

Results

IL-2 levels were lower than HC in all JIA subgroups. The polyarticular JIA group distinguished from the four different JIA subgroups, by having different co-IR pattern. In this specific subgroup, CTLA4, PD-1 and 4-1BB levels were higher than other groups. Polyarticular JIA is the more chronic and severe form of JIA, especially when compared to oligoarticular JIA. (Figure 1).

Figure 1.

We investigated the correlations between disease activity markers and plasma co-IRs. Plasma TIM3 levels correlated with erythrocyte sedimentation rate, C-reactive proteins and JADAS in the polyarticular JIA group. In oligoarticular JIA group, JADASs correlated with plasma PD-1 levels, C-reactive protein with PD-L1 plasma levels. Erythrocyte sedimentation rates correlated with IL-2, CD86, PD-L1 and PD-1 plasma levels. There was no correlation between disease activity markers and co-IRs levels in the systemic JIA group and enthesitis related arthritis group.

Finally, we analysed the cellular surface expression of different co-IRs on the PBMCs of different JIA subtypes. Similar to plasma levels, both the percentage and the MFI (mean fluorescence intensity) of CTLA4 expression was higher in polyarticular JIA subgroup.

Conclusion

This is the first report studying the effects of different co-IRs in different subtypes of JIA. Polyarticular JIA patients had a different coIR profile, having more CTLA-4, PD-1 and 4-1BB in their plasma than the other subtypes of JIA

References

[1]Wedderburn, L.R., et al., Int Immunol, 2001. 13(12): p. 1541-50.

[2]Wherry, E.J. and M. Kurachi, Nat Rev Immunol, 2015. 15(8): p. 486-99.

Acknowledgements

This work was supported by a research grant from FOREUM Foundation for Research in Rheumatology

Disclosure of Interests

None declared

Platelet rich plasma application by dermapen microneedling and intradermal point-by-point injection methods, and their comparison with clinical findings and trichoscan in patients with androgenetic alopecia

Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people's self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point-by-point technique injection application methods. The study was conducted with 62 male AGA patients, aged between 18 and 55 years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II-V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point-by-point technique with a 30-gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at 2-week intervals and the fourth session 1 month after the last session. The mean age of the cases was 33.13 ± 6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p < 0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pretreatment (p < 0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair, and hair length in the dermapen treated group compared to the group treated with the point-by-point technique. In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point-by-point technique in terms of anagen, telogen, and average hair length parameters.

AB0737 THE NAIL FOLD CAPILLAROSCOPIC FINDINGS OF ADOLESCENTS WITH ANOREXIA NERVOSA AND BULIMIA NERVOSA

Background:

The nail fold video capillaroscopy (NVC) is usually performed on patients with microcirculation problems, such as Raynaud’s phenomenon. It is also used to distinguish between primary and secondary Raynaud’s Phenomenon and identify the scleroderma pattern.

Objectives:

To describe the acute phase nail fold capillaroscopic findings of adolescents with anorexia nervosa (AN) and bulimia nervosa (BN) and to compare these findings with adolescents diagnosed with primary Reynaud’s phenomenon (RP).

Methods:

We included 17 AN, 2 BN patients and 6 adolescents with primary RP as a control group. The nail fold video capillaroscopy (NVC) data of three study groups were compared. AN and BN patients were classified according to DSM-5. The participants in these two groups were assessed for the presence of Reynaud’s phenomenon/acrocyanosis and the weight loss history (amount and duration), daily calorie intake, vital signs, hydration status, amenorrhea presence and time, the presence and frequency of compensatory behaviors, and drug usage were recorded. Adolescents with primary RP were diagnosed according to ‘International consensus criteria for the diagnosis of RP. The initial NVC was performed at the acute phase of AN and BN. For AN acute phase is defined as the period where the nutritional rehabilitation has not yet taken place. The NVC analysis was be performed with a digital USB microscopy by an expert blinded to the participant’s clinical status and diagnosis. Eight fingers were evaluated for each patient and average of all fingers’ scores were used as quantitative measures.

Results:

Among adolescents with AN, 14 of them had enlarged capillaries (capillary diameter 20-50 μm) and 6 of them had mild tortuosity (<50%) which were considered as minor capillaroscopic changes. 5 patients had at least one giant capillary (>50μm), 3 of them had microhemorrhages, 4 of them had capillary ramifications, and 1 of them had capillary disorganization which were considered as major capillaroscopic changes. Two adolescents had capillary loss (6 capillaries/mm). None of them had active or late phase scleroderma findings. In the primary RP group, there were minor findings as five adolescents had mild capillary dilation (capillary diameter 20-50 μm), and 5 had mild tortuosity (<50%). However, none had scleroderma (early-active-late phase) findings. Microangiopathy assessment scores revealed no difference between the AN patients with and without RP and primary RP patients.(Table 1) A positive correlation was found between capillary ramification scores and initial daily calorie intake (r: -0.47; p=0.04).

Table 1.

Measurements of capileroscopy findings according to patient groups

AN+RP+n=4AN+RP-n=13BNn=2Primer RP kontroln=6pMicroangiopathy score0.84 (IQR 0.98)0.92 (IQR 0.96)0.710.65 (IQR0.23)0.62•Capillary loss score0.22 (IQR 0.62)0.06 (IQR 0.41)0.150.0 (IQR 0.26)0.58•Capillary ramification score0.18 (IQR 0.25)0.13 (IQR 0.25)0.090.09 (IQR 0.18)0.88•Disorganized capillaries score0.38 (IQR 0.48)0.56 (IQR 0.68)0.460.43 (0.32)0.98Enlarged capillaries score (20-50 μm)0.56 (IQR 0.78)0.31 (IQR 0.72)0.730.58 (IQR 0.42)0.60Giant capillaries score (>50 μm)0.06 (IQR 0.22)0.00 (IQR 0.03)0.180.03 (0.14)0.14Microhaemorrhage score0.000.000.000.010.67

Conclusion:

Preliminary results of our study suggest that adolescents with AN are at risk for vasculopathy especially during the acute phase of the disease.

References:

[1]Smith V, et al Autoimmun Rev. 2020 Mar;19(3):102458.

[2]American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub, Arlington

Acknowledgements:

Muserref Kasap-Cuceoglu and Melis Pehlivanturk-Kizilkan contributed equally.

Disclosure of Interests:

None declared

Comparison of patients' diagnoses in a dermatology outpatient clinic during the COVID-19 pandemic period and pre-pandemic period

AIM

In this study, we compared the current diagnoses of patients admitted to the dermatology outpatient clinic with the diagnoses during the non-pandemic period, and we examined the effect of COVID-19 on the patient profile.

METHODS

Diagnoses were compared by examining the patient files of the 3-month period when the pandemic was influential in our country and the 2-week non-pandemic period corresponding to the same season a year ago. The outpatient diagnoses in the first month and the last month of the 3-month pandemic period were also compared.

RESULTS

During the 3-month pandemic process, the most common reasons for applying to the outpatient clinic were acne, urticaria, psoriasis, and allergic/irritant contact dermatitis. Urticaria, psoriasis, allergic/irritant contact dermatitis, scabies, liken planus, mycosis fungoides, zona zoster, recurrent aphthous stomatitis and polymorph light eruption were statistically more common in the pandemic period. Moreover, acne, other eczematous dermatities, verruca, androgenic alopecia, and melanocytic nevus diagnoses were found to decrease statistically during the pandemic period when compared with the non-pandemic period.

CONCLUSION

Unlike other studies, the present study evaluated the patient diagnoses during the pandemic period and the period a year before and discussed the possible reasons for the changes in patient profiles.

Dermatological signs in liver transplant recipients

BACKGROUND

In recent years, the number of liver transplantations for advanced-stage liver diseases has considerably increased and the patients have a wide range of dermatologic manifestations.

AIM

This study aims to reveal cutaneous, mucosal, and nail lesions in liver transplant recipients in quite large patient series.

PATIENTS/METHODS

The study included 520 patients in the Inonu University Liver Transplantation Institute. New and followed-up patients attended to the study between May and October 2019. The patients were examined by a dermatologist, and their data were recorded.

RESULTS

The study included 163 female and 357 male patients with the main age of 44.20 ± 18.18 (range: 1-83 years), and 465 livers (89.4%) were taken from live donors, while 54 livers (10.4%) were taken from cadavers. A total of 314 (60.4%) patients had dermatophyte infections, 174 (33.4%) patients had pathological nail changes, and 427 (82.1%) patients had oral mucosal lesions. Graft-versus-host disease (GVHD) developed in 9 (1.73%) patients after the transplantation, and 5 patients died of GVHD. Four patients had cutaneous malignancies.

CONCLUSIONS

Tumoral and nontumoral dermatological diseases may be encountered following the transplantation depending on underlying liver disease, immunosuppressive treatment, the graft itself, or any primary cutaneous disease. Liver transplantation recipients require a multidisciplinary clinical approach, and dermatological care must be an integral part of this approach.

Evaluation of the relationship between androgenetic alopecia and blood groups and Rhesus factor

BACKGROUND/AIM

Androgenetic alopecia (AGA) is the most common type of hair loss. Androgens and genetic factors are responsible for pathogenesis. Blood groups are genetic markers that are used to identify human gene variation. The aim of this study was to evaluate the blood group distribution in patients with AGA and to compare it with healthy population.

MATERIALS AND METHODS

A total of 207 patients diagnosed with AGA in dermatology clinic and whose blood group records were available, between 2010 and 2019, were included in the study. Six hundred forty two healthy individuals who matched with the patient group in terms of age and sex, who attending to the family medicine outpatient clinic of our hospital in order to learn their blood groups were included as the control group.

RESULTS

When the results were compared, no statistically significant difference was found between the two groups (P ˃ .05).

CONCLUSION

We could not find any relationship between AGA and blood groups. However, in order to determine this relationship more clearly, further multicentre studies including more cases and investigating subgroups of the cases are needed.

Evaluation of the Dermatological Life Quality Index, sexual dysfunction and other psychiatric diseases in patients diagnosed with vitiligo with and without genital involvement

BACKGROUND

Because skin lesions affect self-image, vitiligo affects an individual's emotional and psychological well-being, sexual life and relationships with other people. The literature contains a limited number of studies regarding the localization of vitiligo with respect to its effect on certain variables.

AIM

To investigate the effects of the presence or absence of genital involvement in vitiligo on sexual dysfunction, dermatological quality of life (QoL), and susceptibility to other psychiatric disorders such as anxiety and depression.

METHODS

In total, 90 patients who were admitted to the dermatology outpatient clinic of a tertiary university hospital; the patients included 30 patients with vitiligo with genital involvement, 30 patients with vitiligo without genital involvement and 30 controls (HCs). All groups were evaluated with the Dermatological Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HAD), Arizona Sexual Experience Scale (ASEX) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

RESULTS

The HC groups exhibited lower total scores on the DLQI, HAD total score, ASEX and GRISS compared with the vitiligo groups (P < 0.05). No statistically significant difference was found between the vitiligo group with genital involvement and the vitiligo group without genital involvement in terms of DLQI, and total scores for HAD, ASEX and GRISS (P > 0.05).

CONCLUSION

The presence or absence of genital involvement in vitiligo did not have dissimilar effects on the individual's QoL, or their sexual and psychological state.

Role of Adenosine Deaminase in Patients with Erythematotelangiectatic Rosacea and Demodex folliculorum Positivity

Background

Adenosine deaminase (ADA) is an aminohydrolase involved in the catabolism of purine nucleotides and irreversibly deaminizes adenosine and deoxyadenosine to inosine and deoxyinosine. ADA enzyme deficiency results in the loss of functional properties of B and T lymphocytes. Demodex species have been reported to be transmitted between humans through close contact and to play a role in the pathogenesis of rosacea, acne vulgaris, perioral dermatitis, seborrhoeic dermatitis, micropapillary-pruritic dermatitis and blepharitis. The present study aimed to compare serum ADA levels in D. folliculorum positive patients with the healthy control individuals.

Methods

Serum ADA levels were examined for 30 patients diagnosed with erythematotelangiectatic rosacea and 40 healthy individuals in Malatya Inonu University in 2017. Standardized skin surface biopsy (SSSB) method was used to diagnose D. folliculorum. A significant decrease was found in the ADA levels of Demodex-positive rosacea patients when compared to the control group.

Results

ADA levels were decreased in the Demodex-positive group. The mean ADA level in patient group was significantly lower than the mean in the control group (P<0.001). There was no significant difference between the patient and control groups in terms of age and gender.

Conclusion

During and after treatment of Demodex-positive rosacea patients, determination of ADA levels may give more detailed information on the immune mechanisms.

Investigation of monocyte HDL ratio as an indicator of inflammation and complete blood count parameters in patients with acne vulgaris

AIMS

Acne vulgaris is a common inflammatory skin disease that affects the pilosebaceous unit. Increased sebum production, hyperkeratosis in follicular infundibulum, inflammation and Propionibacterium acnes are among aetiological factors. Complete blood count (CBC) parameters are used as diagnosis biomarkers for many diseases related with inflammatory processes. Although monocyte/HDL ratio (MHR) has been defined as an inflammatory marker recently, we did not come across any studies about MHR in acne, which is known to be an inflammatory disease. The present study was conducted to compare CBC parameters and MHR levels in acne vulgaris patients and healthy controls (HCs).

METHODS

Sixty-five acne vulgaris patients followed in our clinic between January 2018 and December 2019 and 36 HCs matching in terms of age and sex were included in the study. Patients and HCs were compared in terms of CBC parameters [neutrophil, monocyte, platelet, lymphocyte, neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), platelet/lymphocyte (PLR)], HDL and MHR ratio.

RESULTS

When compared with the HCs, acne vulgaris patients had statistically significantly higher neutrophil, NLR ratio and HDL (P = .042, P = .011 and P = .014, respectively). No statistically significant difference was found between acne vulgaris patients and the HCs in terms of other CBC parameters and MHR ratio (P > .05).

CONCLUSIONS

We believe that prospective studies consisting of large patient series are needed to understand whether CBC parameters and MHR ratio can be used as an inflammatory marker in acne vulgaris patients.

Views and experiences of dermatologists in Turkey about teledermatology during the COVID-19 pandemic

Background

Teledermatology is an alternative medical science that allows evaluation of patient's clinical information over a distance without requiring face‐to‐face examination. Due to COVID‐19, social distancing has become important these days, and teledermatology can help physicians and patients in overcoming the barriers of accessing health care.

Aim

In this study, we aim to evaluate how dermatologists in our country have viewed and experienced teledermatology during the pandemic through surveys.

Patients/Methods

The study was carried out by using an online survey for evaluating the teledermatology experiences of dermatologists in Turkey and how they have viewed teledermatology during the 2‐month pandemic period and the 2‐month prepandemic period.

Results

The number of patients evaluated with teledermatology methods was found to be significantly higher in the pandemic period when compared with the prepandemic period. The rates of using video calls with mobile phone and online video calls were found to be significantly higher in the pandemic period when compared with the prepandemic period.

Conclusion

Our study results show that the teledermatology method had a higher rate of usage compared to before the pandemic.

Recurrent angiolymphoid hyperplasia with eosinophilia during several pregnancies

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vascular tumor. Although its etiology is not clearly known, infection, hormonal factors, and trauma are the suspected reasons. There are few cases considered to be related to pregnancy described in the literature. Granulomas are rarely seen in the histopathology and only four patients with granulomas have been described. Herein, we will present a 28-year-old woman who has been pregnant three times; in every pregnancy, she developed pink nodular lesions on the back of her ear. In the first two pregnancies, the lesions had appeared during the pregnancy and regressed completely in the postpartum period. In her third pregnancy, the condition emerged again and lasted 1.5 years after birth of her child. Histopathology exhibited ALHE with granulomas. Although the relationship between ALHE and pregnancy is already known, there are few cutaneous ALHE cases associated with pregnancy reported in the literature. This association is further supported by this case having recurrent ALHE during each pregnancy period. Also, the presence of naked granuloma in histopathology, unlike most of the cases, contributes to the current histopathological data.

Intravascular lymphoma presenting with paraneoplastic syndrome

Intravascular lymphomatosis (IVL) is a rare type of B-cell non-Hodgkin lymphoma (BCNHL), which can mimic many other diseases. Fever, neurological symptoms, and skin findings are the most frequent clinical findings. Intravascular lymphomatosis may be associated with genetic factors and infection with human immunodeficiency virus (HIV), human herpesvirus 8 (HHV-8), human T-lymphotropic virus 1 (HTLV1), Epstein-Barr virus (EBV), and hepatitis B virus (HBV). A 50-year-old man was hospitalized with recalcitrant hyponatremia of unknown cause. He had also telangiectatic, indurated, slightly erythematous plaques on his trunk for the last 10 days. His past medical history was unremarkable, although he was a carrier of hepatitis B. Multiple skin biopsies were performed and were considered to be diagnostic of IVL. The hyponatremia was unresponsive to water restriction and hypertonic solution support but it resolved with B cell directed chemotherapy. A final diagnosis was made as syndrome of inappropriate antidiuretic hormone (SIADH) in the setting of IVL. This case had a relatively early diagnosis with just 10-days of skin lesions. Intravascular lymphomatosis is a very rare disease and is usually difficult to diagnose. An even more uncommon presentation is IVL complicated by a paraneoplastic syndrome. There are prior reported cases of SIADH in the setting of IVL. However, this case underscores the importance of evaluating patients with SIADH for potential IVL.

Evaluation of the effects of COVID-19 pandemic on hair diseases through a web-based questionnaire

Aim

Current quarantine conditions are a difficult process for individuals and can worsen the psychological state. Increased psychosocial stress can affect the course of many common “stress‐sensitive” skin conditions. This study examined the possible effects of coronavirus disease 2019 (COVID‐19) on hair and scalp diseases such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD) in individuals who had to stay at home for a long time and the patients' methods of dealing with these diseases.

Methods

The study was conducted using an online questionnaire. All the individuals were asked questions about pre‐ and post‐pandemic TE, AA, and SD. Participants with complaints were asked what they did for treatment.

Results

During the pandemic, TE was seen in 27.9% of the participants, AA on the scalp was seen in 2.8%, AA on the face was seen in 2.5%, and SD was seen in 19.9%. Applying to a dermatologist for complaints during the pandemic was lower than before pandemic. TE was higher in women before and during the pandemic.

Conclusion

It was found that the rates of referring to a dermatologist for the complaints before the pandemic varied between 15% and 28% and that these rates decreased significantly during the pandemic (2.5%‐12.5%).

The efficacy of a single-session pro-yellow laser in the treatment of facial telangiectasia

Facial telangiectasia (FT) is a condition in which small dilated vessels visibly protrude on the surface of the skin. The aim of this study was to evaluate the efficacy and safety of a single-session pro-yellow laser in the treatment of FT and spider angioma (SA) to compare it with a limited number of studies conducted on this subject. In this pilot study, we reviewed 41 patients who admitted to our dermatology clinic with FT and SA and were treated by using pro-yellow laser. The efficacy of the treatment was evaluated using the recorded clinical information and digital camera images. The improvement was graded as complete (90-100%), very good (75-89%), good (50-74%), moderate (25-49%), and weak (< 25%). Of the 41 patients included in the study, 37 (90.2%) had FT and four (9.8%) had SA. Twenty-two patients were female and 19 were male. Pro-yellow laser therapy was generally well tolerated by patients, and minimal pain occurred during the application. In 1-month follow-up, good, very good, or complete recovery was achieved in 51.4% of the FT patients. The new pro-yellow laser only has a yellow light wavelength. Its unique wavelength at 577-nm yellow light is ideal for vascular lesions. In this study, 51.4% of the patients with FT achieved good, very good, or complete improvement after a single session of 577-nm pro-yellow laser, and complete improvement was achieved in all the four patients with SA.

Quality of life, emotion dysregulation, attention deficit and psychiatric comorbidity in children and adolescents with vitiligo

BACKGROUND

Vitiligo is an acquired pigmentation disorder, which can have a negative effect on patient quality of life (QoL).

AIM

To evaluate QoL and psychiatric comorbidity in paediatric patients with vitiligo.

METHODS

In total, 30 patients aged 8-18 years who were diagnosed with vitiligo and 30 age- and sex-matched healthy controls (HCs) were included in the study. The Children's Depression Inventory, Screen for Child Anxiety Related Disorders, State-Trait Anxiety Inventory for Children and Child Somatization Inventory were completed for both patients and controls. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was administered to all patients by a child psychiatrist. Families were also asked to complete the Pediatric Quality of Life Inventory and Emotion Regulation Checklist for children.

RESULTS

The K-SADS-PL evaluation showed that 90% of the patients in the vitiligo group had at least one psychiatric diagnosis, whereas this rate was 20% in the HCs (P < 0.001). There were statistically significant differences between vitiligo and HCs in terms of anxiety, state and trait anxiety scores (P < 0.05). Attention deficit and hyperactivity disorder (ADHD) was detected in 36.6% of the patients.

CONCLUSION

The most important finding of this study is that anxiety disorders are more prominent than depression in childhood vitiligo. Another important finding of this study is that the prevalence of ADHD is significantly higher than the normal population.

Effectiveness of topical Nigella sativa for vitiligo treatment

Vitiligo is a pigment disease characterized by the disruption of melanocyte structure and function. Its etiology is unknown; however, genetic predisposition, biochemical factors, and neural mechanisms are thought to be effective. Although many agents are being used for its treatment, generally there is no absolute cure. The aim of the present study is to evaluate the effectiveness of topical Nigella sativa seed oil on vitiligo patients. Thirty-three vitiligo patients were included in the study. Totally 47 areas were evaluated in all patients. Cream containing N sativa seed oil was topically applied to hands, face, and genital region two times a day for 6 months. Statistically significant repigmentation was detected in hands, face, and genital region, the three treatment areas, and the p values are found .005, .001, and .004, respectively. N sativa can be used as an adjuvant therapy that can contribute to the treatment especially in sensitive skin areas like genital region.

Comparison of cone-beam computed tomography and panoramic radiography for mandibular morphometry

BACKGROUND

The aim of this study was to compare the morphological differences in the mandible between patients with six age groups and to detect the correlation between these parameters on panoramic radiography (PR) and cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

A total of 121 subjects (50 males and 71 females) were included in the study and were divided into six age groups (10-19, 20-29, 30-39, 40-49, 50-59, and 60-69) on the basis of the chronological age. CBCT and PR methods were used to record the mandibular measurements for the same 121 patients. Differences between male and female mandibular morphometric measurements, between right and left side measurements, and differences in age subgroups compared by using independent samples t-test, paired samples t-test, and one-way ANOVA test, respectively. P < 0.05 value was considered statistically significant for all analysis.

RESULTS

Males mostly have higher mandibular measurement values. There were statistically significant differences between CBCT and PR measurements (p < 0.05). PR mostly showed higher values than CBCT measurements.

CONCLUSIONS

Based on the fact that PRs showing significant differences from CBCT in the morphometric measurements made on mandible, it is recommended that forensic doctors and anthropologists consider this information in their age and gender prediction studies.

Analysis of the root canal configuration and C-shaped canal frequency of mandibular second molars: a cone beam computed tomography study

BACKGROUND

Mandibular second molars frequently show variation in root canal configurations. The patients with C-shaped canals are quite challenging in dental practice. C-shaped canals have a poor prognosis in terms of debridement, obturation, and restoration. The aim of this study was to investigate the root canal configuration of mandibular second molar teeth and to determine the frequency of C-shaped canals in mandibular second molars.

MATERIALS AND METHODS

We designed a retrospective study using cone beam computed tomography (CBCT) images and 256 CBCT images were retrieved from the archived records of Necmettin Erbakan University Faculty of Dentistry, Konya, Turkey. The root canal configurations were evaluated according to Vertucci's classification and C-shaped canal configurations were identified using the method of Fan et al. The frequency in percentages was calculated for C-shaped canals in CBCT scans.

RESULTS

Of the 444 mandibular second molars, the most frequent canal morphology in the mesial roots was Vertucci type IV (40.3%), followed by type II (27.5%). The distal roots were predominantly type I (92.9%), followed by types III (3.5%) and II (2.5%). Forty-seven (10.6%) teeth had C-shaped canals.

CONCLUSIONS

Clinicians should be concerned about the different types of canal configurations. Knowledge of these anatomical variations will facilitate the endodontic practice.

Nonspecific abdominal pain: A follow-up survey

Introduction

Little data have been published on the outcome of patients discharged from the emergency department (ED) after being diagnosed with nonspecific abdominal pain (NSAP). This study aimed to investigate short-term follow-up of patients discharged with a diagnosis of NSAP from the ED.

Materials and Methods

This prospective, observational study was conducted in the University-based ED and enrolled all consecutive adult patients who were diagnosed as NSAP out of patients presented with abdominal pain (AP). The main outcome measure was the presence of recurrent AP resulting in referral to the ED and specific diagnoses within the first 3- and 90-day postdischarge. On the 3^rd and 90^th days, all patients discharged with NSAP from the ED were asked questions, and their response entered into a questionnaire.

Results

A total of 684 patients presented with AP, of which 299 (46%) had a diagnosis of NSAP within the 4-month period. Fifty cases (16%) could not be included due to inability to access. Eighty-one out of 249 patients (32.5%) complained of recurrent AP within the first 3 days. Twenty-two cases (8.8%) were readmitted to ED once again in the meantime, and ten received specific diagnoses including three with acute abdomen. Within 90 days, additional nine patients out of 20 (45%) with recurrent AP received specific diagnoses including two with acute abdomen.

Conclusions

Certain specific underlying entities can be missed in patients considered to have NSAP and discharged from the ED. Adherence to timely follow-up and repeated examinations are of vital importance in these patients.

Evaluation of a five-year Bloomberg Global Road Safety Program in Turkey

OBJECTIVE

Turkey was included in the Bloomberg Philanthropies funded Global Road Safety Program (2010-14) with Ankara and Afyonkarahisar (Afyon) selected for interventions to manage speed and encourage seat-belt use. The objectives of this study are to present the monitoring and evaluation findings of seat-belt use and speed in Afyon and Ankara over the five years and to assess overall impact of the program on road traffic injury, and death rates in Turkey.

STUDY DESIGN

Quasi-experimental before after without comparison.

METHODS

In collaboration with the Middle East Technical University, roadside observations and interviews were coupled with secondary data to monitor changes in risk factors and outcomes at the two intervention sites.

RESULTS

The percentage of seat-belt use among drivers and front-seat passengers in Afyon and Ankara increased significantly between 2010 and 2014 with increased self-reported use and preceded by an increase in tickets (fines) for not using seat belts. There were uneven improvements in speed reduction. In Afyon, the average speed increased significantly from 46.3 km/h in 2012 to about 52.7 km/h in 2014 on roads where the speed limits were 50 km/h. In Ankara, the average speed remained less than 55 km/h during the program period (range: 50-54 km/h; P < 0.005) for roads where the speed limits were 50 km/h; however, the average speed on roads with speed limits of 70 km/h decreased significantly from 80.6 km/h in 2012 to 68.44 km/h in 2014 (P < 0.005).

CONCLUSION

The program contributed to increase in seat-belt use in Afyon and Ankara and by drawing political attention to the issue can contribute to improvements in road safety. We are optimistic that the visible motivation within Turkey to substantially reduce road traffic injuries will lead to increased program implementation matched with a robust evaluation program, with suitable controls.

The evaluation of MCI, MI, PMI and GT on both genders with different age and dental status

OBJECTIVES

The aim of this study was to measure the mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI) and cortical bone thickness in the zone of the gonial angle (GT) in panoramic radiographies from a large sample of males and females and to determine how they relate to patients' age, gender and dental status.

METHODS

910 panoramic radiographs were obtained and grouped into age, dental status and gender. The MCI, MI, PMI and GT were analysed.

RESULTS

Remarkable differences were observed for MCI and GT regarding gender, age groups and dental status on both sides (p < 0.05). While age and dental status had an effect on the MI and PMI in females, dental status had an effect on the MI and PMI in males (p < 0.05). Also, gender had an effect on the MI and PMI (p < 0.05).

CONCLUSIONS

The effects of age and tooth loss are different in females and males. In females, the harmful effects of tooth loss and age are more prominent according to the PMI and MI measurements. The effects of age and tooth loss in the GT and MCI measurements are similar, and these indices can be accepted as more reliable in studies including both genders.

The evaluation of vertebrobasilar artery system in neuro-Behçet and Behçet disease using magnetic resonance angiography

The aim of this study is the evaluation of the vertebrobasilar artery system in patients with Behçet's and Neuro-Behçet's disease. For this aim; 20 adults with clinically diagnosed Behcet's disease, 20 adults with Neuro-Behçet's disease, and 19 age- and gender-matched controls were examined by magnetic resonance angiography (MRA). During MRA, diameters of left vertebral artery (LVA), right vertebral artery (RVA), basilar artery (BA), and proximal segment (P1) of posterior cerebral artery between origin and junction with the posterior communicating artery were measured. In all groups, LVA was dominant than RVA (P < 0.05). The diameters of BA and right P1 of Neuro-Behçet's disease were larger than the other groups (P < 0.05). In addition, the diameters of left P1 of Neuro-Behçet's disease were larger but not statistically significant. There is no difference between the groups in terms of gender. Behçet's disease can affect vascular structures; therefore vertebrobasilar artery system should be examined in patients with Behçet's and Neuro-Behçet's disease.

Evaluation of total oxidant and antioxidant status in localized and generalized vitiligo

BACKGROUND

Vitiligo is an acquired depigmentation disorder, and oxidative stress is suggested to have a major role in its aetiopathogenesis.

AIM

To assess whether oxidative stress has a greater role in generalized than in localized vitiligo.

METHODS

We assessed 31 patients with active vitiligo (17 localized, 14 generalized) and 38 healthy controls. Serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were determined.

RESULTS

Patients with vitiligo had significantly lower TAS and higher TOS and OSI values than controls. Both localized and generalized vitiligo were associated with lower TAS and higher TOS and OSI values, compared with controls, and all three did not differ with vitiligo type.

CONCLUSIONS

A systemic oxidative stress exists in patients with vitiligo. These results indicate that the global antioxidant capacity of patients might have been exhausted through a defence mechanism against oxidative processes. The imbalance in TOS/TAS status may have an important role in the aetiopathogenesis of vitiligo, regardless of the clinical variant of the disease.

The interaction between actin and FA fragment of diphtheria toxin

Actin protein has many other cellular functions such as movement, chemotaxis, secretion and cytodiaresis. Besides, it have structural function. Actin is a motor protein that it has an important role in the movement process of toxin in the cell. It is known that F-actin gives carriage support during the endosomal process. Actin is found in globular (G) and filamentous (F) structure in the cell. The helix of actin occurs as a result of polymerisation of monomeric G-actin molecules through sequential rowing, is called F-actin (FA). Actin interacts with a great number of cellular proteins along with cell skeleton and plasma membrane. It is also known that some bacterial toxins have ADP-ribosylation affect on actin. Diphteria toxin is the part which has the FA enzymatic activity corresponding the N-terminal section of the toxin, which inhibits the protein synthesis by ADP-ribosylating the elongation factor 2 in the presence of NAD. FA, taken into the cell by endocytosis inhibits protein synthesis by ADP-ribosyltransferase activity and breaks the cytoskeleton. In the studies both in vitro and in vivo, actin with interaction FA of diphteria toxin has been yet to be fully elucidated. The aim of this study was to determine the three dimensional structures of actin with interaction FA of diphteria toxin by the amprical methods and in paralel with the computing technology, theoretical methods have gained significant importance. In our study, actin with interaction FA of diphteria toxin has been determined as the most possible interaction area with the theoretical method; analogy modelling. This area has been closed in the presence of polypeptides and FA-actin interactions have been tested with the gel filtration chromatography techniques. As a result of the findings, we found that 15 amino acid artificial peptides (DAMYETMAQACAGNR) corresponding to 201-215 amino acid residues of FA interacts with G-actin and closes this area. Secondly, in the model formed with the analogy modelling, it appears that the most possible interaction area is between FA (tyr204) and G-actin (gly48). Results obtained from both theoretical and experimental data support the idea that the interaction occurs in this area.

Abstract P4-01-11: Clinical Findings and Outcomes from MRI Staging of Breast Cancer in a Diverse Population

Background: Staging breast MRI can detect occult breast cancers in 1–10% of newly diagnosed patients. The performance of MRI, impact of patient factors, and resulting surgical management in underserved and diverse populations has not been well studied.

Methods We performed a retrospective analysis of consecutive patients with newly diagnosed in situ or invasive breast cancer (2006–2011) who had a preoperative staging MRI seen at our Centers that cares for an underserved and minority population. IRB approval was obtained to extract demographic and clinicopathological data, imaging studies and surgical treatment. Non-index lesions (NIL) were defined as those in breast or axillary nodes not known to be malignant or presenting with clinical, mammographic or ultrasound findings, in a different quadrant and given an MRI BIRADS score of 4 or 5. Occult cancers (OC) were those lesions found by biopsy or surgery to be invasive or in situ cancer. Logistic regression was used to examine the association between the probability of a NIL or OC and patients characteristics. Statistical computation was performed using STATA.

Results: Among 678 patients, 144 (21%) had a total of 171 NIL identified by MRI; 67 (9.8%) were ipsilateral, 44 (6.5%) contralateral and 24(3.5%)axillary nodes. 57 patients (8.4%) had a total of 62 OCs detected −34 (5%) ipsilateral, 8(1.2%) contralateral, and 9(1.3%) axillary nodes of which 49 (7.2%) were invasive and 8 (1.2%) in situ. 40% of patients with NILs were confirmed as OCs.

Neuromonitoring in traumatic brain injury

Current approaches to monitoring in severe traumatic brain injury (TBI) include a wide array of modalities, providing insight into pressure parameters, oxygenation, perfusion, electrophysiology and metabolism of the brain. The intent of "multimodality monitoring" is to obtain a better understanding of what is going on within the brain of an individual patient in order to target treatment more appropriately. In this review we highlight the current status of neuromonitoring for TBI with a specific focus on how advanced analysis and integration of these parameters may be used to implement more personalized treatment approaches. In particular, combining information from different parameters and performing dynamic testing offers the potential to better understand the pathophysiological mechanisms active in the brain of a particular patient. Rather than persisting in a standardized "one size fits all" approach to therapy or continuing down the separate tracts of goal directed therapy, we suggest to think more in terms of "individualized therapeutic strategies" more focused on the specific requirements of each patient. Given the considerable data overload in multimodality monitoring and the complexity in interpretation of signals from multiple sources, specific attention needs to be directed to data processing and user-friendly displays. Intense collaboration and interaction between clinicians, basic researchers, IT-experts, nurses and industry will be required to further advance the fields towards more personalized approaches.