ASST and autoimmunity in patients with chronic spontaneous urticaria

Objective:To invest possible association between HSU and: i) ASST ii) autoimmune diseases, iii) autoimmune serology, iv) atopy and dermographism. Methods:This is a perspective study. Patients with CSU (chronic spontaneous urticaria) were studied. UAS7 was applied to all of them.ASST and the following blood analyses were performed: anti- TPO, anti-nuclear antibodies (ANA) and rheumatoid factor (RF). Results: We analyzed 48 patients with CSU; most of them were women, angioedema was associated with CSU in more than half of the patients, ASST was positive in more than one third of the patients and almost the same number of patients had positive autoimmune status.Almost half of the patients had a personal history of atopy and presence of dermographism. Conclusions: This study brings additional evidences of interest in patients with CSU as they could be associated to ASST and autoimmunity. Keywords: Chronic spontaneous urticaria, ASST, autoimmunit

Body Dysmorphic Disorder and Aesthetic Surgery

ОСÐОВÐ: Дизморфофобија, или на англиÑки Body Dismorphic Disorder (BDD)  е релативно чеÑто и многу тешко заболовање кое многу пати поминува недијагноÑтицирано. Со вакви пациенти во контакт Ñе како  пÑихијатрите така и плаÑтичните хирурзи и дерматолозите затоа што ваквите пациенти многу чеÑто Ñе обраќаат кај нив барајќи еÑтетÑка корекција која најчеÑто не е решение на нивниот проблем. Ова заболување е битно, треба да Ñе помиÑли на него за да Ñе дијагноÑтицира затоа што е проблем за плаÑтичните хирурзи затоа што овие пациенти прават проблеми, никогаш не Ñе задоволни, ги тужат Ñвоите доктори, така претÑтавува проблем е и за Ñамите пациенти затоа што овие пациенти Ñе Ñериозно болни. Тоа Ñе пациенти кои не Ñе задоволни Ñо Ñвојот изглед, најчеÑто Ñе Ñо ÑамоубиÑтвени идеи, некои веќе имаат во минатото обиди за ÑамоубиÑтво, а дел и завршуваат Ñо ÑамоубиÑтво. Затоа ова заболување е важно, не Ñмее да Ñе потцени и треба да Ñе помиÑли на него за да Ñе дијагноÑтицира.ЦЕЛ: Од Ñевкупно иÑкориÑтената литература, произлезе целта на иÑтражувањето, а тоа е да го покаже процентот на заÑтапеноÑÑ‚ на БДД иÑпитуван по Ñтудии во еÑтетÑката хирургија, да Ñе види на која возраÑÑ‚ пациентите најчеÑто бараат еÑтетÑка корекција, и да Ñе презентира понатамошниот тек на ова заболување кај пациенти кои Ñе јавиле и добиле хируршки третман.  Во заклучокот Ñе диÑкутира за процентот на БДД кај пациенти кои побарале еÑтетÑка операција и околу тоа дали такви пациенти треба да Ñе третираат хируршки.ÐœÐТЕРИЈÐЛИ И МЕТОДИ: Беше направено пребарување во базите на податоци Ñо отворен приÑтап Pub Med, Embase Medline. Пребарувањето беше направено Ñпоред клучните зборови “body dysmorphic disorder, BDDâ€, “aesthetic surgeryâ€, “prevalenceâ€, “outcomeâ€. Беа вклучени Ñите трудови каде беше опишана БДД во еÑтетÑка хирургија и иÑходот на еÑтетÑките процедури кај БДД пациенти. ИÑклучувачки критериуми: Студии на детÑка популација, Ñтудии кои не беа на англиÑки јазик, Ñтудии каде БДД Ñе разгледа во нехируршки еÑтетÑки Ñтудии, Ñтудии каде Ñе објаÑнува БДД и коморбитетот, Ñтудии кои не Ñе дадени во целоÑÑ‚. Во прегледот беа вклучени проÑпективни, преÑечни и ретроÑпективни Ñтудии кои беа доÑтапни во целоÑен текÑÑ‚. Беше направен и преглед на референтните лиÑти од Ñтудиите кои беа вклучени во овој ревиÑки труд за добивање на дополнителни релевантни податоци.РЕЗУЛТÐТИ: Резултатите добиени од литературните и научните иÑтражувања укажуваат на фактот дека Ñтепенот на заÑтапеноÑÑ‚ на БДД во еÑтетÑка хирургија варира во поединечни Ñтудии. Воочена е најниÑка заÑтапеноÑÑ‚ од 3.2, а највиÑока заÑтапеноÑÑ‚ од 53.6% што укажува на јаÑна врÑка меѓу пациенти Ñо БДД кои бараат еÑтетÑка хируршка интервенција. Во проÑек овие пациенти Ñе околу 40-та година од животот. Во Ð¾Ð´Ð½Ð¾Ñ Ð½Ð° резултат од еÑтетÑкиот третман на лицата Ñо БДД разгледани Ñе 2 Ñтудии и како заклучок може да Ñе каже дека еÑтетÑките интервенции во еден одреден лимитиран дел водат до подобрување на Ñимптоматологијата на БДД.ЗÐКЛУЧОЦИ: БДД е чеÑто пÑихијатриÑко заболување кое чеÑто води до еÑтетÑка хируршка интервенција. Битно е да поÑтои предоперативен Ñкрининг на вакви пациенти за нивно правилно дијагноÑтицирање, наÑочување и третман.BACKGRAUND: Body Dismorphic Disorder (BDD) is a relatively common and severe illness which usually goes misdiagnosed. BDD patients often presents to both mental health professionals and no psychiatric doctors such as plastic surgeons and dermatologists, seeking aesthetic treatment which usually is not the answer to their problem. This disorder matters, and it is a problem for the plastic surgeons because their patients are always unsatisfied with their appearance, they always make problems and even sue their doctors. This disorder is bigger problem for the patients because they are often markedly ill and functionally impaired, and they appear to have unusually high rates of suicidal ideation, suicide attempts, and completed suicide. This is why Body Dismorphic Disorder is important to be diagnosed and properly treated.AIM: From a total of used literature, emerged the goal of the research, to show the prevalence, the age of patients with BDD, and the outcome of patients that asked for aesthetic operative treatment, and were operated. In the conclusion we discuss about the percent of BDD patients that were treated surgicly, and is operative treatment cure for their actual disorder.MATERIAL AND METHODS: We based our search strategy on PubMed, Embase Medline and Google Scholar using the search terms 'body dysmorphic disorder', aesthetic surgery', 'prevalence', and 'outcome'. Exclusion criteria were articles that were not on English language, non surgical aesthetic articles, articles where BDD was explained, and articles about BDD comorbidity. In the search were included prospective and retrospective studies, and also studies based on the reference lists of the included articles in order to get more information.RESULTES: The results of scientific research suggest that BDD is noticeable in patients that ask for aesthetic treatment. The lowest percent is 3.2 %, and the highest percent is 53.6 %. The average age of the patients that have Body dismorphic disorder according to the studies included is 40. Only two studies were found where the outcome of the surgical aesthetic treatment of patients with BDD was evaluated, and can be concluded that in low percent, some interventions can help in symptoms improvement in the patients that have Body Dismorphic Disorder.CONCLUSION: Body Dismorphic Disorder is a common psychiatric disorder that often leads to aestetic surgery. However, pre-operative screening of BDD patients is vital so that efficient treatment can be initiated, patients diagnosed and successfully treated

ELECTROSURGICAL MICRONEEDLE VERSUS SCALPEL SKIN INCISIONS IN THE FACIAL REGION

Objective: Electrosurgery is widely used in surgical procedures, but mainly for subcutaneous and deep layer dissections. The aim of this study was to clinically evaluate the results of routine use of electrosurgical microneedle in performing skin incisions in the facial regions. Material and methods: Eighty patients with both benign and malignant skin lesions in the facial regions undergoing surgery were enrolled in this study. In group A comprising 40 patients, cold steel surgical scalpel №15 was used for the surgical procedure. Electrosurgical microneedle with 0.06 mm tip radius and generator unit KLS Martin Electrosurgical Unit ME MB 2 set on cutting mode, power 12 W was used for performing the surgery in group B including the same number of patients. Differences between incision time, excision time, blood loss and the wound related complications were evaluated. Results: The two groups did not significantly differ in the speed of incision and speed of excision although both the speed of incision and the speed of excision were found to be slightly faster in the electrosurgery group. There was significantly less blood loss in the electrosurgery group compared with the scalpel group.Statistical analysis did not confirm as significant the difference in complications between the two groups although most of the complications were associated with the patients operated with scalpel. Conclusion: Electrosurgery presents safe and effective way of work. In that manner, it is very important to choose the right generator unit's settings and the right type of electrode

Hydroxyurea Associated Cutaneous Lesions: A Case Report

BACKGROUND: Hydroxyurea (HU) is an antimetabolite agent that interferes with the S-phase of cellular replication and inhibits DNA synthesis, with little or no effect on RNA or protein synthesis. It is used in the treatment of many myeloproliferative disorders (MD) and is particularly a first line treatment drug for intermediate to high-risk essential thrombocythemia. Although safe and very well tolerated by the patients suffering from MD, there have been numerous reports of a broad palette of cutaneous side effects associated with prolonged intake of the medication. These may include classical symptoms such as xerosis, diffuse hyperpigmentation, brown-nail discolouration, stomatitis and scaling of the face, hands, and feet or more serious side effects such as actinic keratosis lesions, leg ulcers and multiple skin carcinomas.CASE REPORT: We report a case of a 52-year-old man, on long-term therapy with HU for essential thrombocytosis, with several concurrent skin lesions. Despite the perennial use of HU, the cutaneous changes were neglected. The local dermatological examination revealed oval perimalleolar ulcer on the right leg, with dimensions 6 x 4 cm, clearly demarcated from the surroundings with regular margins, periulcerous erythema, with very deep and highly fibrinous bed of the ulcer, positive for bacterial infection. The ulcer was treated with topical wound therapy with alginate and parenteral antibiotics. The extended dermatological screening also showed two nummular lesions in the right brachial region, presenting as erythematous papules with sharp margins from the surrounding skin, gritty desquamation and dotted hyperpigmentations inside the lesion. Further dermoscopy and biopsy investigations confirmed a diagnosis of basal cell carcinoma. Nasal actinic keratosis was also noted. The patient was advised for discontinuing or substituting the HU therapy.CONCLUSION: We present this case to draw attention to the various cutaneous side effects that occur with perennial HU use and suggest an obligatory reference to a dermatological consult

Improvement of Chronic Spontaneous Urticaria with Levothyroxine and Autohemotherapy (A case report)

Chronic spontaneous urticaria (CSU) is a mast cell-driven skin disease characterized by the recurrence of transient wheals, angioedema, or both for more than 6 weeks. Patients with chronic spontaneous urticaria (CSU) are widely held to often have other autoimmune disorders, including autoimmune thyroid disease. CSU can improve in response to treatment with levothyroxine or other thyroid drugs. Some studies revealed that notably autologous serum skin test (ASST)-positive CSU patients may benefit from autohemotherapy; however, the mechanisms of action remain unknown. We presented a case of a patient suffering from CSU with angioedema, positive ASST test and a newly diagnosed Hashimoto’s thyroiditis in which levothyroxine in combination with autohemotherapy completely resolved the symptoms of urticaria. Laboratory investigations showed a high thyroid stimulating hormone (TSH) level and a normal free thyroxine (T4) level. She had elevated levels of antithyroid peroxidase (anti-TPO) and raised lever of free thyroxine (T3) , Thyroid peroxidase antibody test ( Anti TPO). She was diagnosed as a case of Hashimoto's thyroiditis and started on levothyroxine therapy and autohemotherapy. She noticed that her uncontrolled recurrent urticaria started to get better and after a few months of therapy, she stopped taking her topical ointments and antihistamines