Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome?

Discoid lupus erythematosus (DLE) is a chronic inflammatory erythematous skin disease that can be triggered by several factors. Rosacea is another skin disease that causes facial redness and tenderness. Demodex mites have been reported in rosacea and DLE patients commonly in the literature. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors. To assess demodex mite infestation in both clinical and histopathological findings in DLE patients. We retrospectively evaluated the files of 42 patients with DLE who had been diagnosed DLE based on clinical and histopathological findings between August 2018 and August 2019. Demodex positivity was detected 50% of patients (n = 21). Neutrophile percentages in the dermal and perivascular area were higher in the demodex positive patients (4.43%) than in the Demodex negative patients (2.19%). The intensity of demodex mites correlated positively with dermal neutrophile percentages. ANA was negative in 29 patients (69%) and positive in 13 patients (31%). Anti‐dsDNA was negative in serology and follicular plugging was positive in histopathology in all 42 patients (100%). This was a retrospective study. DLE and rosacea share common features in etiopathogenesis and clinical presentation. Inflammation and exacerbations caused by the demodex mites may increase the clinical severity of DLE. Although the position of demodex mites in DLE etiopathogenesis is not known exactly, the presence of high demodex in DLE patients has been determined. Standard skin surface biopsy can be a routine procedure for the evaluation of DLE patients in daily clinical practice.     

Venous Thromboembolism Prophylaxis after Head and Spinal Trauma: Intermittent Pneumatic Compression Devices Versus Low Molecular Weight Heparin

Although there are alternative methods and drugs for preventing venous thromboembolism (VTE), it is not clear which modality is most suitable and efficacious for patients with severe (stable or unstable) head/spinal injures. The aim of this study was to compare intermittent pneumatic compression devices (IPC) with low-molecular-weight heparin (LMWH) for preventing VTE. We prospectively randomized 120 head/spinal traumatized patients for comparison of IPC with LMWH as a prophylaxis modality against VTE. Venous duplex color-flow Doppler sonography of the lower extremities was performed each week of hospitalization and 1 week after discharge. When there was a suspicion of pulmonary embolism (PE), patients were evaluated with spiral computed tomography. Patients were analyzed for demographic features, injury severity scores, associated injuries, type of head/spinal trauma, complications, transfusion, and incidence of deep venous thrombosis (DVT) and PE. Two patients (3.33%) from the IPC group and 4 patients (6.66%) from the LMWH group died, with their deaths due to PE. Nine other patients also succumbed, unrelated to PE. DVT developed in 4 patients (6.66%) in the IPC group and in 3 patients (5%) in the LMWH group. There was no statistically significant difference regarding a reduction in DVT, PE, or mortality between groups (p = 0.04, p > 0.05, p > 0.05, respectively). IPC can be used safely for prophylaxis of VTE in head/spinal trauma patients.     

Flow-cytometric analysis of T-lymphocyte subsets in sinistral and dextral patients with gingivitis

The aim of this study was to determine whether there was any change in T-lymphocyte subsets in sinistral and dextral patients with gingivitis. The study was carried out on 36 patients (16 males and 20 females) with gingivitis. The age of the patients ranged from 16 to 25 (mean age = 18.50 +/- 3.85). Patients were divided into two equal groups according to their right or left hand use. Being right- or left-handed was determined with Edinburgh Handedness Inventory (Oldfield). At the beginning of the study, gingival index (GI-L?e-Silness) and plaque index (PI-Silness-L?e) scores were recorded in order to assess the gingival tissue health in patients. At the same time, the biopsy samples were taken from the gingival pocket wall tissues at sites of gingivitis. Then, CD4+ and CD8+ lymphocyte and CD4/CD8 ratio values were determined using flow-cytometry in the biopsy samples. The two groups were compared by using Student's t-test. The normal value in peripheral blood of CD4+ lymphocyte and that of CD8+ lymphocyte are 25-29% and 19-48%, respectively. According to flow cytometry findings, in both sinistrality and dexterity with gingivitis, CD+ and CD8+ lymphocyte values were under the normal value while the CD4/CD8 rate was within normal distribution interval. CD4+ lymphocyte values observed in the sinistral patients were found to be lower than those in the dextral patients. The difference between the CD8+ lymphocyte values in left-handed patients and that obtained in right-handed patients was not found to be statistically significant while the difference between the CD4+ lymphocyte values in left-handed patients and that obtained in right-handed patients was found to be statistically significant (p < .05). In addition, the difference between the CD4/CD8 rate obtained in left-handed patients and that obtained in right-handed patients was found to be statistically very significant (p < .001). Consequently, these findings suggested CD4+ lymphocyte value and CD4/CD8 rate was lower in sinistrality. Sinistrality and dexterity may play an important role in local immune response.     

β2-Adrenergic agonists augment air pollution–induced IL-6 release and thrombosis

Acute exposure to particulate matter (PM) air pollution causes thrombotic cardiovascular events, leading to increased mortality rates; however, the link between PM and cardiovascular dysfunction is not completely understood. We have previously shown that the release of IL-6 from alveolar macrophages is required for a prothrombotic state and acceleration of thrombosis following exposure to PM. Here, we determined that PM exposure results in the systemic release of catecholamines, which engage the β₂-adrenergic receptor (β₂AR) on murine alveolar macrophages and augment the release of IL-6. In mice, β₂AR signaling promoted the development of a prothrombotic state that was sufficient to accelerate arterial thrombosis. In primary human alveolar macrophages, administration of a β₂AR agonist augmented IL-6 release, while the addition of a beta blocker inhibited PM-induced IL-6 release. Genetic loss or pharmacologic inhibition of the β₂AR on murine alveolar macrophages attenuated PM-induced IL-6 release and prothrombotic state. Furthermore, exogenous β₂AR agonist therapy further augmented these responses in alveolar macrophages through generation of mitochondrial ROS and subsequent increase of adenylyl cyclase activity. Together, these results link the activation of the sympathetic nervous system by β₂AR signaling with metabolism, lung inflammation, and an enhanced susceptibility to thrombotic cardiovascular events.