The importance of metabolic syndrome and insulin resistance in patients with chronic plaque psoriasis

Cilj istraživanja: Ciljevi ovog istraživanja bili su istražiti povezanost metaboličkog sindroma (MetS) s kliničkom slikom vulgarne psorijaze (PV), uključujući analizu pojedinih sastavnica MetS i PV. Glavni cilj bio je evaluirati teže kliničke slike PV kao predstanja za razvoj inzulinske rezistencije (IR), neovisno o postojanju MetS. Nacrt studije: case control studija. Ispitanici: U istraživanje je uključeno 128 ispitanika po dvije skupine od 64 ispitanika. Jedna skupina imala je 64 ispitanika sa PV i MetS, a druga kontrolna 64 ispitanika sa PV bez MetS (odgovarajući po dobi i spolu). Materijali i metode: Opći podatci, klinički i laboratorijski podatci prikupljeni su za obje ispitivane skupine. Analizirana je težina kliničke slike PV i kvaliteta života svih ispitanika putem PASI indeksa i DLQI indeksa. Utvrđivanje MetS provedeno je prema revidiranoj definiciji NCEP ATP III. Za uvid u metabolizam glukoze analizirani su GUK natašte, HbA1c, inzulin, C-peptid, indeks inzulinske rezistencije (HOMA-IR) i indeks beta stanične funkcije (HOMA-B). Rezultati: Ispitanici s PV imaju značajnu prisutnost MetS. Analizirajući prisustvo MetS, nalazimo statistički značajno prisustvo MetS u grupi oboljelih od srednje teškog oblika PV. Vrijednosti PASI indeksa značajno su više kod ispitanika s MetS u odnosu na ispitanike bez MetS. Izrazito je jaka povezanost PASI i HOMA-IR indeksa, koja perzistira i nakon isključivanja povišenog ITM. Nije nađena povezanost između ITM i opsega struka s težinom PV, što ukazuje na to da je IR povezana s težinom kliničke slike PV neovisno o većoj tjelesnoj težini. Visoke vrijednosti HOMA-IR kod ispitanika sa srednje teškim i teškim oblikom PV, a bez MetS i veće vrijednosti HOMA-B indeksa kod ispitanika bez MetS upućuju na to da je težina kliničke slike PV neovisan čimbenik IR, bez obzira na prisustvo MetS i na još očuvanu funkciju ß stanica. Zaključak: Težina PV je neovisni rizični faktor IR kod osoba s težim oblikom PV. Ne smiju se zanemariti oboljeli od PV, a bez MetS, a osobito oni sa srednje teškom PV. Nužan je probir na inzulinsku rezistenciju (HOMA-IR) jer kad jednom dođe do razvitka MetS tada više IR ne služi kao neovisni pretkazatelj težine PV.Objectives: The aim of this study was to investigate correlation between metabolic syndrome (MetS) and clinical presentation of vulgar psoriasis (PV), including the analysis of the metabolic syndrome components and PV. The primary outcome was to evaluate more severe clinical forms of psoriasis as preconditions for insulin resistance development (IR), irrespective of the MetS presence. Study Design: case control study. Participants: The study included a total of 128 patients divided into two groups of 64 patients. One group consisted of 64 patients with both PV and MetS and the other, control group had 64 patients suffering from PV but without presence of MetS. The two groups were matched in terms of age and gender. Material and methods: For both groups the following data were obtained: demographic, clinical and laboratory data. Severity of the PV and quality of life of all patients were assessed by PASI and DLQI index. The presence of MetS was determined by revised NCEP ATP III definition. For glucose metabolism evaluation, fasting blood glucose, HbA1c, insulin, C-peptide, HOMA-IR and HOMA-B were analysed. Results: Significant presence of MetS was found in patients suffering from PV. Statistically significant MetS presence was found in the group of patients suffering from moderate form of PV. PASI index values were significantly higher in patients with MetS compared to the patients without MetS. Correlation between PASI and HOMA-IR index was extremely strong, persisting even after adjustment for BMI. Correlation between BMI and waist circumference with PV severity was not found, confirming correlation between IR and PV severity form irrespective of obesity. Based on higher HOMA-IR values found in patients suffering from moderate and severe form of PV but without presence of MetS and higher level of HOMA-B index found in patients without MetS, the results indicate that the severity of PV is an independent risk factor for IR, irrespective of the MetS presence and preserved beta-cell function. Conclusion: Severity of PV is the independent IR risk factor in patients suffering from a severe form of PV. One should not ignore patients suffering from PV but without MetS, especially not those suffering from moderate form of PV. It is necessary to perform insulin resistance screening (HOMA-IR) because once MetS has developed, HOMA-IR cannot be considered as an independent predictor of psoriasis severity

Imbalanced Concentrations of Serum Lipids and Lichen Planus

The aim of this study was to analyze possible connection between the lichen planus and imbalanced concentrations of serum lipids and to evaluate the impact of various dietary regimes (used in the regulation of imbalanced concentrations of serum lipids) on the regression of lichen planus lesions. Research was conducted as a case-control study comprised of 72 patients with Lichen Planus and 30 participants from control group, treated at the Clinic for Dermatology and Venereology of the Clinical-Hospital Centre Osijek, Eastern Croatia, during 2010 and 2011. LP cases were diagnosed with both a clinical examination conducted by a dermatovenerology consultant and by patohistological diagnostic. Serum lipid levels (total cholesterol, LDL-cholesterol, triglycerides, HDL-cholesterol) were determined by the classic laboratory diagnostics in both investigated groups (LP patients and control group). The present study has confirmed that there is a strong connection between the imbalanced concentrations of one or more serum lipids (cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) and the occurrence of LP which is important in the therapeutic approach to patients with this disease

Imbalanced Concentrations of Serum Lipids and Lichen Planus

The aim of this study was to analyze possible connection between the lichen planus and imbalanced concentrations of serum lipids and to evaluate the impact of various dietary regimes (used in the regulation of imbalanced concentrations of serum lipids) on the regression of lichen planus lesions. Research was conducted as a case-control study comprised of 72 patients with Lichen Planus and 30 participants from control group, treated at the Clinic for Dermatology and Venereology of the Clinical-Hospital Centre Osijek, Eastern Croatia, during 2010 and 2011. LP cases were diagnosed with both a clinical examination conducted by a dermatovenerology consultant and by patohistological diagnostic. Serum lipid levels (total cholesterol, LDL-cholesterol, triglycerides, HDL-cholesterol) were determined by the classic laboratory diagnostics in both investigated groups (LP patients and control group). The present study has confirmed that there is a strong connection between the imbalanced concentrations of one or more serum lipids (cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) and the occurrence of LP which is important in the therapeutic approach to patients with this disease

Polymorphisms of Vitamin D Receptor Gene in the Population of Eastern Croatia with Psoriasis vulgaris and Diabetes mellitus

The aim of this study was to evaluate the possible association between polymorphisms in the Vitamin D receptor gene (VDR gene) and tendency for development of psoriasis vulgaris and diabetes mellitus in the population of Slavonia, which is a region in the Eastern Croatia. In order to conduct the mentioned evaluation the restriction fragment length polymorphisms (ApaI, BsmI and TaqI) in the Vitamin D receptor gene were researched in three groups of patients: patients suffering only from psoriasis vulgaris, patients suffering only from diabetes mellitus, and patients suffering at the same time from both diseases. Four most common genotypes were found in all standardized control patients: triple heterozygotes BbAaTt (in 29.3% of the studied patients), bbAaTT (in 18.6% of the studied patients), bbaaTT (in 12.9% of the studied patients) and BbAATt (in 8.6% of the studied patients). Three most common VDR 3’-RFLP haplotypes determined in this study were: three-component baT, Bat and bAT haplotype. Results of the Hardy-Weinberg equilibrium showed presence of BsmI polymorphism genotype frequencies disequilibrium in the group of patients suffering from psoriasis and ApaI polymorphism in the group of patients suffering from both diseases. According to the same statistical test all conditions for TaqI polymorphism genotype frequency were fulfilled in all groups of studied patients. There was no significant difference in distribution of BsmI, ApaI or TaqI polymorphism genotype frequencies between control patients and any of the subgroup of studied patients. In studied population none of analysed polymorphisms individually was associated with the risk of development of psoriasis, diabetes or combined phenotype

Smjernice za dijagnostiku i liječenje gnojnog hidradenitisa (hidradenitis suppurativa) [Guidelines for the diagnostics and treatment of hidradenitis suppurativa]

Croatian dermatovenerologic society and Croatian society for plastic, reconstructive and esthetic surgery of the Croatian Medical Association formed the working group which consists of physicians with experience in diagnostics and treatment of hidradentitis suppurativa. After a critical analysis of relevant scientific papers, the working group has developed practice guidelines for the diagnosis and treatment

GUIDELINES FOR THE DIAGNOSTICS AND TREATMENT OF HIDRADENITIS SUPPURATIVA

Hrvatsko dermatovenerološko društvo i Hrvatsko društvo za plastičnu, rekonstrukcijsku i estetsku kirurgiju ­Hrvatskoga liječničkog zbora ustrojili su radnu skupinu liječnika s kliničkim iskustvom u dijagnostici i liječenju gnojnog hidradenitisa (hidradenitis suppurativa). Skupina je kritički proučila mjerodavnu znanstvenu literaturu te je donijela smjernice za dijagnostiku i liječenje.Croatian dermatovenerologic society and Croatian society for plastic, reconstructive and esthetic surgery of the Croatian Medical Association formed the working group which consists of physicians with experience in diagnostics and treatment of hidradentitis suppurativa. After a critical analysis of relevant scientific papers, the working group has developed practice guidelines for the diagnosis and treatment

The importance of metabolic syndrome and insulin resistance in patients with chronic plaque psoriasis

Cilj istraživanja: Ciljevi ovog istraživanja bili su istražiti povezanost metaboličkog sindroma (MetS) s kliničkom slikom vulgarne psorijaze (PV), uključujući analizu pojedinih sastavnica MetS i PV. Glavni cilj bio je evaluirati teže kliničke slike PV kao predstanja za razvoj inzulinske rezistencije (IR), neovisno o postojanju MetS. Nacrt studije: case control studija. Ispitanici: U istraživanje je uključeno 128 ispitanika po dvije skupine od 64 ispitanika. Jedna skupina imala je 64 ispitanika sa PV i MetS, a druga kontrolna 64 ispitanika sa PV bez MetS (odgovarajući po dobi i spolu). Materijali i metode: Opći podatci, klinički i laboratorijski podatci prikupljeni su za obje ispitivane skupine. Analizirana je težina kliničke slike PV i kvaliteta života svih ispitanika putem PASI indeksa i DLQI indeksa. Utvrđivanje MetS provedeno je prema revidiranoj definiciji NCEP ATP III. Za uvid u metabolizam glukoze analizirani su GUK natašte, HbA1c, inzulin, C-peptid, indeks inzulinske rezistencije (HOMA-IR) i indeks beta stanične funkcije (HOMA-B). Rezultati: Ispitanici s PV imaju značajnu prisutnost MetS. Analizirajući prisustvo MetS, nalazimo statistički značajno prisustvo MetS u grupi oboljelih od srednje teškog oblika PV. Vrijednosti PASI indeksa značajno su više kod ispitanika s MetS u odnosu na ispitanike bez MetS. Izrazito je jaka povezanost PASI i HOMA-IR indeksa, koja perzistira i nakon isključivanja povišenog ITM. Nije nađena povezanost između ITM i opsega struka s težinom PV, što ukazuje na to da je IR povezana s težinom kliničke slike PV neovisno o većoj tjelesnoj težini. Visoke vrijednosti HOMA-IR kod ispitanika sa srednje teškim i teškim oblikom PV, a bez MetS i veće vrijednosti HOMA-B indeksa kod ispitanika bez MetS upućuju na to da je težina kliničke slike PV neovisan čimbenik IR, bez obzira na prisustvo MetS i na još očuvanu funkciju ß stanica. Zaključak: Težina PV je neovisni rizični faktor IR kod osoba s težim oblikom PV. Ne smiju se zanemariti oboljeli od PV, a bez MetS, a osobito oni sa srednje teškom PV. Nužan je probir na inzulinsku rezistenciju (HOMA-IR) jer kad jednom dođe do razvitka MetS tada više IR ne služi kao neovisni pretkazatelj težine PV.Objectives: The aim of this study was to investigate correlation between metabolic syndrome (MetS) and clinical presentation of vulgar psoriasis (PV), including the analysis of the metabolic syndrome components and PV. The primary outcome was to evaluate more severe clinical forms of psoriasis as preconditions for insulin resistance development (IR), irrespective of the MetS presence. Study Design: case control study. Participants: The study included a total of 128 patients divided into two groups of 64 patients. One group consisted of 64 patients with both PV and MetS and the other, control group had 64 patients suffering from PV but without presence of MetS. The two groups were matched in terms of age and gender. Material and methods: For both groups the following data were obtained: demographic, clinical and laboratory data. Severity of the PV and quality of life of all patients were assessed by PASI and DLQI index. The presence of MetS was determined by revised NCEP ATP III definition. For glucose metabolism evaluation, fasting blood glucose, HbA1c, insulin, C-peptide, HOMA-IR and HOMA-B were analysed. Results: Significant presence of MetS was found in patients suffering from PV. Statistically significant MetS presence was found in the group of patients suffering from moderate form of PV. PASI index values were significantly higher in patients with MetS compared to the patients without MetS. Correlation between PASI and HOMA-IR index was extremely strong, persisting even after adjustment for BMI. Correlation between BMI and waist circumference with PV severity was not found, confirming correlation between IR and PV severity form irrespective of obesity. Based on higher HOMA-IR values found in patients suffering from moderate and severe form of PV but without presence of MetS and higher level of HOMA-B index found in patients without MetS, the results indicate that the severity of PV is an independent risk factor for IR, irrespective of the MetS presence and preserved beta-cell function. Conclusion: Severity of PV is the independent IR risk factor in patients suffering from a severe form of PV. One should not ignore patients suffering from PV but without MetS, especially not those suffering from moderate form of PV. It is necessary to perform insulin resistance screening (HOMA-IR) because once MetS has developed, HOMA-IR cannot be considered as an independent predictor of psoriasis severity

Syphilitic Hepatitis: Rare or just Unrecognized?

Syphilis is a chronic, infectious, sexually transmitted disease caused by Treponema pallidum and can affect all tissues and all organs. Untreated syphilis progresses through four stages: primary, secondary, latent and tertiary. Among the less common manifestations of the secondary stage is syphilitic hepatitis; syphilis remains one of the unrecognized etiologies of liver dysfunction. Timely treatment as well as effective control of disease are only possible with the early diagnosi

GUIDELINES FOR THE DIAGNOSTICS AND TREATMENT OF HIDRADENITIS SUPPURATIVA

Hrvatsko dermatovenerološko društvo i Hrvatsko društvo za plastičnu, rekonstrukcijsku i estetsku kirurgiju ­Hrvatskoga liječničkog zbora ustrojili su radnu skupinu liječnika s kliničkim iskustvom u dijagnostici i liječenju gnojnog hidradenitisa (hidradenitis suppurativa). Skupina je kritički proučila mjerodavnu znanstvenu literaturu te je donijela smjernice za dijagnostiku i liječenje.Croatian dermatovenerologic society and Croatian society for plastic, reconstructive and esthetic surgery of the Croatian Medical Association formed the working group which consists of physicians with experience in diagnostics and treatment of hidradentitis suppurativa. After a critical analysis of relevant scientific papers, the working group has developed practice guidelines for the diagnosis and treatment

GUIDELINES FOR THE DIAGNOSTICS AND TREATMENT OF HIDRADENITIS SUPPURATIVA

Hrvatsko dermatovenerološko društvo i Hrvatsko društvo za plastičnu, rekonstrukcijsku i estetsku kirurgiju ­Hrvatskoga liječničkog zbora ustrojili su radnu skupinu liječnika s kliničkim iskustvom u dijagnostici i liječenju gnojnog hidradenitisa (hidradenitis suppurativa). Skupina je kritički proučila mjerodavnu znanstvenu literaturu te je donijela smjernice za dijagnostiku i liječenje.Croatian dermatovenerologic society and Croatian society for plastic, reconstructive and esthetic surgery of the Croatian Medical Association formed the working group which consists of physicians with experience in diagnostics and treatment of hidradentitis suppurativa. After a critical analysis of relevant scientific papers, the working group has developed practice guidelines for the diagnosis and treatment