The Coexistence of Coeliac Disease, Psoriasis and Vitiligo

It has been defined that coeliac disease is associated with most of the autoimmune diseases including psoriasis and vitiligo. Here, a 26-year-old woman who was diagnosed palmoplantar pustular psoriasis and already had coeliac disease and vitiligo is reported. According to our opinions, this is the first report describing the development of these three disorders in one patient, even though vitiligo, psoriasis and coeliac disease are common disorders, and the coexistence of the two of them has been previously reported in the literature. This case has been presented to emphasize the importance of considering and inquiring the possible coeliac disease in chronic and autoimmune dermatoses, although psoriasis and vitiligo may have coincidental associations with coeliac disease

INEFFICACY OF DAPSON TREATMENT IN A PATIENT WITH ERYTHEMA DYSCHROMICUM PERSTANS

Eritema diskromikum perstans gövde, ekstremiteler, yüz ve boyunda simetrik dağılım gösteren, asemptomatik ve yavaş ilerleyen kül grisi renginde maküllerle karakterize nadir görülen, benign, kronik ve idiyopatik bir pigmentasyon bozukluğudur. Bu hastalıkta tamamen etkili olan bir tedavi seçeneği henüz mevcut değildir. Birçok tedavi seçeneğinin denendiği görülmüş, ancak klofazimin ve dapson dışındaki tedavilerin büyük çoğunluğunun etkisiz olduğu bildirilmiştir. Burada dapson tedavisine yanıtsız EDP'lu 36 yaşında bir erkek olgu sunulmaktadır Erythema dyschromicum perstans is an uncommon, benign, chronic, idiopathic pigmentary disorder characterized by asymptomatic, slowly progressive, ashy-gray macules over the trunk, extremities, face and neck with symmetrical distribution. No consistently effective treatment is yet available for this disease. Many therapeutic options have been tried, but the majority of them have been ineffective except clofazimine and dapson. Herein, we report a 36-year-old male of EDP who did not response to dapson treatment

Lupus band test in patients with borderline systemic lupus erythematosus patients with discoid lesions

Patients with lupus erythematosus (LE) that have discoid lesions who fulfill the four diagnostic criteria of systemic lupus erythematosus (SLE) with only mucocutaneous findings and antinuclear antibody (ANA) positivity were classified as borderline SLE in the literature. Objective of this study was to determine the place of borderline SLE with discoid lesions on the LE spectrum according to the lupus band test (LBT). Lesional and sun-protected non-lesional (SPNL) skin LBTs of 94 patients with LE that had discoid lesions were retrospectively evaluated. Firstly, patients were divided into two main groups: discoid LE (DLE; group A) and SLE (Group B); three subgroups were then classified as DLE (Group A), borderline SLE (Group B1) and SLE (Group B2) using another method. Each group had its own comparisons. Immunoreactant (IR) deposition was observed on the lesional skin in all patients and on the SPNL skin in 42 (44.7%). In patients with borderline SLE, the deposition of IgM was lower on the lesional LBTs, whereas isolated IgG was higher than SLE; thus, it shows similarity with DLE. Additionally, it was also closer to DLE because of the low deposition of C3, multiple IRs, and a double conjugate of IRs on the SPNL skin. However, it showed similarity with SLE in the high percentage of LBT positivity and more immunoglobulin M (IgM) and immunoglobulin G (IgG) deposition on the SPNL skin. The deposition of multiple conjugates on SPNL skin in patients with LE with discoid lesions may reflect systemic involvement. Despite the fact that LBT positivity on SPNL skin in borderline SLE was higher than DLE, less deposition of multiple conjugates compared to SLE indicates that the classification of borderline SLE with discoid lesions in the LE spectrum is questionable.  </p

Suprachoroidal drainage of aqueous humour with a novel implant: Suprajet

AIM: To evaluate the efficacy and safety of a new implant, Suprajet(VSY Biotechnology, Istanbul, Turkey), which is developed for supraciliary and suprachoroidal drainage of aqueous humour.METHODS: Five rabbits were included in the study. One Suprajet shunt was implanted in one eye of each rabbit. Implantation was performed by a superior clear corneal incision through the anterior chamber into the suprachoroidal space. Proximal end of the implant was placed in the iris root resting against the scleral spur, distal end was placed in the suprachoroidal space. Rabbits were followed for 4wk. Preoperative and postoperative intraocular pressure(IOP)levels were measured with Tonopen AVIA. At last follow-up visit animals were sacrificed and eyes were enucleated. Macroscopic and histopathologic evaluation of the eyes were made. RESULTS: Mean preoperative IOP was 18.6±6.1 mmHg. Mean postoperative IOP was 8.4±1.1 mmHg, at one week. At the 2nd week of the follow-up period one rabbit died. Thereafter, only 4 rabbits were followed. Mean postoperative IOP was 11.0±2.8 mmHg at the 2nd week, 9.50±3.1 mmHg at the 3rd week and 11.3 ±3.3 mmHg at 4th week after the operation. When mean preoperative IOP was compared with the postoperative IOP values, only the IOP at the first week was found as significantly lower(P=0.042). There was no statistically significant difference between mean preoperative IOP level and mean IOP level at 2, 3 and 4wk postoperatively(P=0.66, P=0.66 and P=0.102, respectively). As an intraoperative complication, minimal hyphema was noted in three eyes during the surgery. However, the next day hyphema cleared completely. Macroscopic evaluation of the enucleated material showed that in one eye the distal end of the implant was in the vitreous instead of suprachoroidal space, in the other 3 eyes the distal end of the implant was noted in the suprachoroidal space. In all eyes, proximal end of the implant was localized in the anterior chamber angle. Histopathologic evaluation of the enucleated eyes showed deposition of irregular collagen bundles and fibroplasia including numerous fibroblastic and histiocytic cells around the implant.CONCLUSION: This preliminary animal study showed that implantation of Suprajet in glaucoma is a promising procedure. Further studies are needed to evaluate its efficacy and safety profile

Remission of Ulcerated Necrobiosis Lipoidica Diabeticorum after Bariatric Surgery

A 32-year-old woman with type 2 diabetes mellitus suffering from morbid obesity with BMI 45,14 kg/m(2) was operated on. Not only the type 2DM but also one of its complication known as necrobiosis lipoidica diabeticorum remitted postoperatively. Obesity should no longer be regarded simply as a cosmetic problem affecting certain individuals but an epidemic that threatens global well-being. It causes or exacerbates many health problems, and in particular, it is associated with the type 2 diabetes. Necrobiosis lipoidica is a granulomatous skin disease of unknown etiology, associated mainly with diabetes mellitus. We presented in this paper a morbid obese case of necrobiosis lipoidica diabeticorum with dramatic good response to bariatric surgery

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries