Botulinski nevrotoksin: odkritje in uporaba v dermatologiji

Botulinski nevrotoksin je izredno strupena beljakovina, ki jo tvori anaerobna po Gramu pozitivna bakterija Clostridium botulinum. Zgodba o odkritju botulinskega nevrotoksina se je pričela s pojavljanjem nepojasnjenih zastrupitev s klobasami, iz česar tudi izvira njegovo ime. Latinska beseda za klobaso je namreč botulus. Zgodba o tem se je nadaljevala s stoletji raziskav in še poteka z njegovo vedno širšo uporabo v medicini. Botulinski nevrotoksin v aktivni obliki postane proteolitični encim, izključno specifičen za fuzijske beljakovine kompleksa SNARE v presinaptičnih živčnih končičih. Prek kemodenervacije začasno zavre delovanje tarčnega tkiva, na skeletnih in gladkih mišicah povzroči npr. začasno ohlapno paralizo mišic. Botulinski nevrotoksin se uporablja v nevrologiji, za zdravljenje čezmerne aktivnosti sečnega mehurja in tudi v dermatologiji, kjer njegovo uporabo še vedno mnogi povezujejo zgolj z estetiko. Novejša dognanja pa razkrivajo, da botulinski nevrotoksin zmanjšuje bolečino in srbež ter vpliva tudi na nekatere nenevronske celice, kot npr. epidermalne keratinocite, dermalne fibroblaste, vnetne celice, lojnice, žilne endotelne celice in mezenhimske matične celice v podkožnem maščevju. Odkritja napovedujejo tudi možno razširitev nabora indikacij v dermatologiji. Članek predstavi zgodovino razvoja botulinskega nevrotoksina, njegovo sestavo, mehanizem delovanja in trenutne ter obetavne indikacije za uporabo v dermatologiji

Thorough Clinical Evaluation of Skin, as well as Oral, Genital and Anal Mucosa is Beneficial in Lichen Planus Patients

Lichen planus (LP) is a common mucocutaneous disease of unknown aetiology with various geographical prevalence, may be related to some serious disorders such as squamous cell carcinoma and often remains underdiagnosed. The aim of this retrospective study was to thoroughly determine localization and clinical characteristics of LP lesions in a cohort of 173 Slovenian patients in association to the presence of accompanying symptoms and history of potential stressful events. Isolated cutaneous lesions of LP were found in 56.6% and isolated oral LP in 3.5% of patients. Thirty-four percent presented orocutaneous LP, whereas genitocutaneous LP was noted in 1.2%, orogenito-cutaneous LP in 4% and orogenital LP in 0.5% of patients. Underlying stressful events were noted in 36 out of 137 (26.3%) patients. Despite obviously visible localization of the lesions various medical specialists should be familiar with LP and thoroughly examine the complete skin, as well as oral, genital and anal mucosa in each LP patient to avoid a delay in diagnosing this disease and possibly disclose a much serious underlying condition. Psychological support should be offered, if needed

Thorough Clinical Evaluation of Skin, as well as Oral, Genital and Anal Mucosa is Beneficial in Lichen Planus Patients

Lichen planus (LP) is a common mucocutaneous disease of unknown aetiology with various geographical prevalence, may be related to some serious disorders such as squamous cell carcinoma and often remains underdiagnosed. The aim of this retrospective study was to thoroughly determine localization and clinical characteristics of LP lesions in a cohort of 173 Slovenian patients in association to the presence of accompanying symptoms and history of potential stressful events. Isolated cutaneous lesions of LP were found in 56.6% and isolated oral LP in 3.5% of patients. Thirty-four percent presented orocutaneous LP, whereas genitocutaneous LP was noted in 1.2%, orogenito-cutaneous LP in 4% and orogenital LP in 0.5% of patients. Underlying stressful events were noted in 36 out of 137 (26.3%) patients. Despite obviously visible localization of the lesions various medical specialists should be familiar with LP and thoroughly examine the complete skin, as well as oral, genital and anal mucosa in each LP patient to avoid a delay in diagnosing this disease and possibly disclose a much serious underlying condition. Psychological support should be offered, if needed

Kronični multimorbiditet kod križobolje ili drugih kroničnih poremećaja u leđima u Republici Hrvatskoj

The aim was to assess the prevalence of chronic multimorbidity in patients with chronic low back pain or other chronic back disorders (BD). We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014- 2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥2 chronic illnesses out of 14 contained in the EHIS questionnaire, after adjustment for ten sociodemographic, anthropometric and lifestyle confounders. Amoung fourteen targeted illnesses were asthma, allergies, hypertension, urinary incontinence, kidney diseases, coronary heart disease or angina pectoris, neck disorder, arthrosis, chronic obstructive pulmonary disease, diabetes mellitus, myocardial infarction, stroke, depression, and the common category “other”. We analyzed data on 268 participants with BD and 511 without it. Participants with BD had a significantly higher relative risk of any chronic multimorbidity (RRadj=2.12; 95% CI 1.55, 2.99; p<0.001), as well as of non-musculoskeletal chronic multimorbidity (RRadj=2.29; 95% CI 1.70, 3.08; p=0.001) than participants without BD. All chronic comorbidities except for asthma and liver cirrhosis were significantly more prevalent in participants with BD than in participants without BD. In the population with BD, the participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions, whereas the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. In conclusion, the population suffering from BD has a higher prevalence of chronic multimorbidity than the population without BD and this multimorbidity is associated with unfavorable health outcomes.Cilj je bio procijeniti prevalenciju kroničnog multimorbiditeta u bolesnika s križoboljom ili drugim kroničnim poremećajima u leđima (KPL). Analizirali smo podatke populacijske presječne Europske zdravstvene ankete (EHIS) koju je u Republici Hrvatskoj tijekom 2014. i 2015. godine proveo Hrvatski zavod za javno zdravstvo. Ishod je bila trenutna prevalencija kroničnog multimorbiditeta, definiranog prisutnošću s dvije ili više kroničnih bolesti od ukupno četrnaest sadržanih u EHIS upitniku, nakon prilagodbe za deset sociodemografskih, antropometrijskih i poremećujućih varijabla povezanih sa životnim stilom. Između četrnaest ciljanih bolesti bile su obuhvaćene astma, alergije, hipertenzija, urinarna inkontinencija, bubrežne bolesti, koronarna bolest ili angina pectoris, vratobolja, artroza, kronična opstruktivna plućna bolest, moždani udar, šećerna bolest, srčani udar, depresija i zajednička kategorija „ostalo”. Analizirali smo podatke o 268 sudionika s KPL i 511 bez njih. Sudionici s KPL imali su značajno veći relativni rizik za bilo koji kronični multimorbiditet (RRadj = 2,12; 95% CI 1,55; 2,99; p<0,001) kao i za kronični ne-muskuloskeletni multimobiditet (RRadj = 2,29; 95% CI 1,70, 3,08; p=0,001) od sudionika bez KPL. Svi kronični komorbiditeti osim astme i ciroze jetre, bili su značajno zastupljeniji u sudionika s KPL nego u sudionika bez KPL. U populaciji s KPL, sudionici s multimorbiditetom imali su tri do četiri puta veće izglede za samoprijavljene nepovoljne zdravstvene ishode, nego sudionici bez komorbidnih stanja, dok postojanje samo jednog komorbiditeta nije bilo značajno povezano s lošijim ishodima u usporedbi s populacijom bez kroničnih komorbiditeta. Zaključno, populacija s KPL ima veću prevalenciju kroničnog multimorbiditeta nego populacija bez KPL i taj je multimorbiditet povezan s nepovoljnim zdravstvenim ishodima

Priporočila za obravnavo bolnikov z bazalnoceličnim karcinomom

no abstractni abstrakt

Chronic Multimorbidity of Low Back Pain or other Chronic Back Disorders in the Republic of Croatia

The aim was to assess the prevalence of chronic multimorbidity in patients with chronic low back pain or other chronic back disorders (BD). We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014- 2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥2 chronic illnesses out of 14 contained in the EHIS questionnaire, after adjustment for ten sociodemographic, anthropometric and lifestyle confounders. Amoung fourteen targeted illnesses were asthma, allergies, hypertension, urinary incontinence, kidney diseases, coronary heart disease or angina pectoris, neck disorder, arthrosis, chronic obstructive pulmonary disease, diabetes mellitus, myocardial infarction, stroke, depression, and the common category “other”. We analyzed data on 268 participants with BD and 511 without it. Participants with BD had a significantly higher relative risk of any chronic multimorbidity (RRadj=2.12; 95% CI 1.55, 2.99; p<0.001), as well as of non-musculoskeletal chronic multimorbidity (RRadj=2.29; 95% CI 1.70, 3.08; p=0.001) than participants without BD. All chronic comorbidities except for asthma and liver cirrhosis were significantly more prevalent in participants with BD than in participants without BD. In the population with BD, the participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions, whereas the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. In conclusion, the population suffering from BD has a higher prevalence of chronic multimorbidity than the population without BD and this multimorbidity is associated with unfavorable health outcomes