| 1. |
- Agarwal, Nisha Rani, 1987, et al.
(författare)
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Investigation of psoriasis skin tissue by label-free multi-modal imaging: a case study on a phototherapy-treated patient
- 2019
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Ingår i: Psoriasis: Targets and Therapy. - 2230-326X. ; 9, s. 43-57
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psoriasis is a systemic inflammatory disease characterized by epidermal proliferation in the skin. Altered lipid metabolism is considered to be a central factor in the psoriatic etiopathogenesis. Thus, it is necessary to visualize chemical specificity of the samples for better medical diagnosis and treatment. Here, we investigate its role in the development of psoriatic lesions, before and after ultraviolet phototherapy, in a case study. Methods: The distribution and morphology of different lipids and fibrous proteins in psoriatic (lesional) tissues were visualized by two complementary label-free imaging techniques: 1) non-linear microscopy (NLM), providing images of lipids/proteins throughout the skin layers at submicrometer resolution; and 2) mass spectrometry imaging (MSI), offering high chemical specificity and hence the detection of different lipid species in the epidermal and dermal regions. A conventional method of histological evaluation was performed on the tissues, with no direct comparison with NLM and MSI. Results: Psoriatic tissues had a higher lipid content, mainly in cholesterol, in both the epidermal and dermal regions, compared to healthy tissues. Moreover, the collagen and elastin fibers in the psoriatic tissues had a tendency to assemble as larger bundles, while healthy tissues showed smaller fibers more homogeneously spread. Although phototherapy significantly reduced the cholesterol content, it also increased the amounts of collagen in both lesional and non-lesional tissues. Conclusion: This study introduces NLM and MSI as two complementary techniques which are chemical specific and can be used to assess and visualize the distribution of lipids, collagen, and elastin in a non-invasive and label-free manner.
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| 2. |
- Andersch-Björkman, Ylva, et al.
(författare)
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Effects of brodalumab on psoriasis and depressive symptoms in patients with insufficient response to TNF-α inhibitors
- 2023
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Ingår i: Journal of Dermatology. - : WILEY. - 0385-2407 .- 1346-8138. ; 50:11, s. 1401-1414
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to evaluate emotions of depression and anxiety in psoriatic patients that due to insufficient response to tumor necrosis factor-alpha inhibition (TNF-alpha), underwent a treatment switch from TNF-alpha to interleukin 17 inhibition using brodalumab. The Self-rated Montgomery-Asberg Depression Rating Scale and the Hospital Anxiety and Depression Scale were used to assess depression and anxiety. A total of 20 patients with psoriasis were enrolled in the study. They were monitored for a period of 3 months following the transition to brodalumab treatment. The results showed a significant improvement in both the Psoriasis Area and Severity Index as well as symptoms of depression; anxiety symptoms showed a reduction, though not statistically significant. Perhaps of more interest, the positive effects on depression and anxiety seem to be independent of the reduction in skin related psoriatic lesions. These findings highlight the importance of addressing depressive and anxiety symptoms, together with psoriasis severity and quality of life, when managing patients with psoriasis.
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| 3. |
- Armstrong, P. M., et al.
(författare)
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Prevalence of Vitamin D Insufficiency and Its Determinants among Women Undergoing In Vitro Fertilization Treatment for Infertility in Sweden
- 2023
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Ingår i: Nutrients. - 2072-6643. ; 15:12
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of research on women with infertility in the northern latitudes, where vitamin D insufficiency is high. Therefore, this study aimed to assess the prevalence and determinants of vitamin D insufficiency (serum 25(OH)D concentration < 50 nmol/L) among women undergoing in vitro fertilization (IVF) treatment. Thus, 265 women scheduled for IVF/intracytoplasmic sperm injection (ICSI) between September 2020 and August 2021 at Sahlgrenska University Hospital in Gothenburg, Sweden, were included. Data on serum 25(OH)D concentration, vitamin D intake, and sun exposure were collected via questionnaires and blood samples. Approximately 27% of the women had 25(OH)D insufficiency, which was associated with longer infertility duration. The likelihood of insufficiency was higher among women from non-Nordic European countries (OR 2.92, 95% CI 1.03-8.26, adjusted p = 0.043), the Middle East (OR 9.90, 95% CI 3.32-29.41, adjusted p < 0.001), and Asia (OR 5.49, 95% CI 1.30-23.25, adjusted p = 0.020) than among women from Nordic countries. Women who did not use vitamin D supplements were more likely to have insufficiency compared with supplement users (OR 3.32, 95% CI 1.55-7.10, adjusted p = 0.002), and those who avoided sun exposure had higher odds of insufficiency compared to those who stayed "in the sun all the time" (OR 3.24, 95% CI 1.22-8.62, adjusted p = 0.018). Women with infertility in northern latitudes and those from non-Nordic countries who avoid sun exposure and do not take vitamin supplements have a higher prevalence of 25(OH)D insufficiency and longer infertility duration.
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| 4. |
- Balieva, F. N., et al.
(författare)
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Treatment Preferences in Young Adults with Moderate to Severe Psoriasis: A Qualitative Study from the Nordic Countries
- 2023
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Ingår i: Dermatology and Therapy. - 2193-8210. ; 13:8, s. 1873-1887
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe purpose of this study is to explore treatment preferences and identify patient characteristics in young bio-naive adults with moderate to severe psoriasis in the Nordic countries (Norway, Finland, Sweden, and Denmark).MethodsPatients were 18-45 years old and bio-naive but referred for biologic treatment of moderate to severe psoriasis. Patients were included at eight Nordic dermatology clinics. Patients with significant comorbidity or psoriatic arthritis were excluded. The Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were assessed along with basic patient information.A semistructured interview guide was used in individual qualitative interviews, asking patients about their treatment preferences and reasons, disease journey, and disease management. The interviews were analyzed using thematic content analysis. Twenty-four patients sufficed to reach saturation in this qualitative study.ResultsThe patient sample characteristics represented a qualitative variation in age, sex, symptoms, duration of disease, and country. We included a total of 12 male and 12 female patients. The mean age was 34 years (range 18-45 years), the mean age at diagnosis was 20 years (range 6-34 years), the mean & PLUSMN; standard deviation (SD) time since diagnosis was 13 & PLUSMN; 8 years, PASI was 9.5 & PLUSMN; 4.7, and DLQI was 15.2 & PLUSMN; 6.4.Interviews suggested that both the burden of disease as well as the burden of treatment influenced patient preferences regarding treatment attributes, hence getting alleviation from symptoms did not alone influence patient preferences. Time, effort, and inconvenience related to psoriasis treatments also influenced patient preferences.ConclusionsThis first in-depth, qualitative study in young bio-naive adults with psoriasis suggests that patient preferences are focusing not only on symptom relief but also on alleviating the burden of psoriasis treatment. Understanding the reasons for patient preferences and the perspectives of young adults is needed to guide individual shared decision-making in psoriasis management. Plain Language SummaryNot much research has been done on understanding the disease burden and treatment needs of young adults suffering from psoriasis. This is an interview study with young adults from Nordic countries suffering from moderate to severe psoriasis with an active lifestyle. The adult patients were all referred for biologic treatment of psoriasis but had not yet started treatment when they were interviewed. The aim was to explore treatment preferences in this group.The study showed that treatment goals depended upon both alleviation of symptoms and obtaining a low treatment burden. The most influential symptoms were scaling, itching, and visible plaques. The most important treatment burden features were efficacy, durability, speed of response, safety, and convenience. Understanding the reasons behind these different treatment preferences is essential to help shared-decision psoriasis management that matches individual needs.
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| 5. |
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| 6. |
- Demeke, T., et al.
(författare)
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Comorbidity and health-related quality of life in Somali women living in Sweden
- 2019
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 37:2, s. 174-181
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Tidskriftsartikel (refereegranskat)abstract
- - Objective: To explore the relationship between low serum vitamin D levels and comorbidity in Somali women, immigrants to Sweden. Design and setting: Cohort study in a Primary Health Care Center and a University Hospital. Subjects: Somali women skin type V, n = 114, aged 18–56 years, from latitude 0–10 ○ N, living in Sweden, latitude 57 ○ N > 2 years were compared with women from a population sample, skin type II-III, n = 69, aged 38–56 years, the WHO MONICA study, Gothenburg, Sweden. Main outcome measures: Serum (S)-25(OH)D, S-parathyroid hormone (PTH), comorbidity and Health-Related Quality of Life (HRQoL) using the Short Form-36 (SF-36) and part of the EQ-5D questionnaires. All calculations were corrected for age. Results: Vitamin D deficiency (S-25(OH)D < 25 nmol/l) was found in 73% of the Somali women and in 1% of the controls (p <.0001). S-PTH was elevated (>6.9 pmol/l) in 26% and 9%, respectively (p <.004). Somali women used less medication, 16% vs. 55%, p <.0001) but more allergy medication, 11% vs. 7% (p =.006), had fewer fractures, 2% vs. 28% (p <.0001) and lower HRQoL in 7 out of 9 scales (p <.05–.001), than native controls. There were no differences in the prevalence of diabetes mellitus, hypothyroidism, positive thyroid peroxidase antibodies, vitamin B12 deficiency, celiac disease or hypertension. Conclusions: Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity was low. Both mental, and especially physical HRQoL scores were lower in the Somali women. The effects of long-lasting deficiency are unknown.Key points The aim was to explore the relationship between vitamin D deficiency (S-25(OH)D < 25 nmol/l) and comorbidity in immigrants. Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity of hypothyroidism, diabetes mellitus, hypertension, fractures and use of medications was low. Both mental, and especially physical, Health-Related Quality of Life were lower in the Somali women than in native Swedish women. The effects of long-lasting deficiency are unknown. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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| 7. |
- Demeke, Taye, et al.
(författare)
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Lower bone mineral density in Somali women living in Sweden compared with African-Americans.
- 2015
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Ingår i: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 10:4
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Tidskriftsartikel (refereegranskat)abstract
- Vitamin D deficiency can lead to osteomalacia. Bone mineral density was lower in Somali women, living in Sweden, in relation to both the American and the African-American reference populations. The majority, 73 %, had vitamin D deficiency, and supplementation should be considered to prevent from osteomalacia, osteoporosis and future fractures.Low vitamin D can lead to osteomalacia. The hypothesis was that bone mineral density (BMD) in Somali women living in Sweden was lower in comparison with different ethnic reference populations.Women from Somalia, n=67, median age 35.8 years (range 18 to 56), latitude 0-10° North living in Gothenburg, Sweden, latitude 57° North, >2 years were studied. All wore traditional Islamic clothing and had skin photo type V. BMD was recorded as the Z-score and compared with white American and African-American women, respectively, using standard data from the dual energy X-ray absorptiometry (DXA) manufacturer (Lunar Prodigy enCORETM, GE Healthcare, LU44663). A fasting blood test was drawn for analysis of serum 25(OH)D.The median Z-score compared with the American white population was -0.9 SD of the lumbar spine (p<0.00001), 0.1 SD of the left hip and 0.0 SD of the right hip (ns). The median Z-score compared with the African-American population was -1.6 SD of the lumbar spine (p<0.00001), -0.9 SD of the left hip and -0.9 SD of the right hip (p<0.001). The majority, 73 %, had vitamin D deficiency, serum 25(OH)D <25 nmol/l (<10 ng/ml). BMD did not correlate to vitamin D levels or to the number of years in Sweden. One wrist fracture was reported.BMD was lower in these fairly young immigrant women from Somalia, living in Sweden, in relation to both the American and the African-American reference populations. Vitamin D supplementation should be considered to prevent from osteomalacia, osteoporosis and future fractures.
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| 8. |
- Elmelid, Andrea, 1986, et al.
(författare)
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Effects of Phototherapy on Free Vitamin D Levels in Ten Patients with Atopic Dermatitis
- 2022
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Ingår i: International Journal of Translational Medicine. - : MDPI AG. - 2673-8937. ; 2:4, s. 586-596
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Tidskriftsartikel (refereegranskat)abstract
- The role of vitamin D in atopic dermatitis (AD) is controversial. Conflicting data could be due to the use of inadequate markers for assessing vitamin D status. So far, directly measured free 25(OH)D concentrations have not been reported in AD patients. Ten adults with AD were treated with narrow band ultraviolet light B (NB-UVB) for 10–12 weeks. SCORing atopic dermatitis (SCORAD) and the visual analogue scale (VAS) were used to assess disease severity before and after NB-UVB therapy. Total and free 25(OH)D and 1,25(OH)2D serum levels were analyzed before and after treatment. Free 25(OH)D concentrations were measured with a two-step immunosorbent assay (ELISA). The majority of patients had sufficient levels of 25(OH)D before treatment (mean 76.4 nmol/L). Mean free 25(OH)D was 11.9 pmol/L and mean 1,25(OH)2D was 108.9 pmol/L. Median SCORAD decreased from 37.1 to 19.8 and VAS improved significantly after phototherapy. Total and free 25(OH)D increased in all subjects. No correlations between disease severity and vitamin D levels were found. There was no correlation between total and free 25(OH)D levels. Larger studies are needed to test the applicability of the free hormone hypothesis in AD pathogenesis.
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| 9. |
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| 10. |
- Inerot, Annica, 1949, et al.
(författare)
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Unusual presentation and progression of CD30 positive anaplastic large cell lymphoma
- 2015
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Ingår i: In a memory stick, given to all attendeces of this conference.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction and Objectives: Unexpected pathology in a skin lesion on one finger growing during one year, preliminary dermatology diagnosis were among others mycobacterium marinum and leishmaniasis. Materials and methods: A 69 year old male was referred to our dermatology clinic because of a slowly growing mass on one of his fingers. He was otherwise healthy. He has lived in Sweden for many years, but was born in southwest Asia, last visit there was in 2012. He had an aquarium at home. Results: At first visit he had a big mass on his left forth finger but no other skin lesions and his general health was good. The preliminary dermatology diagnosis was mycobacterium marinum infection and he was put on antibiotics and a skin biopsy was taken. Three weeks later there were no signs of improvement. A second diagnosis was considered, leishmaniasis. Histopathology showed normal epidermis. In the dermis there was very dense pleomorphic large cell infiltrates with blastlike morphology. Immunohistochemistry revealed these cells to be Tlymphocytes with CD30 +, CD2 +, CD3 +, CD4 +, CD5 +. ALK and EMA were negative as well as test for Mycobacteria and leishmaniasis. Radiation therapy was started. He received 40 Gy with good regression of the tumour mass. Only few weeks later numerous skin tumours developed over the body, mostly arms and legs. Methotrexate was given, 15-20 mg per week, initially a tendency to response but after 6 months several tumours were dramatically enlarged with ulcerations progressing into oozing, eruptive and bad smelling wounds. General health was still good but he suffered from skin tumor pain. He was hospitalized for further evaluation and to alleviate the pain. Blood test now showed some anemia, but no other significant alterations. CTscan showed enlarged lymph nodes in the groin area, but not accessible for punction or excision. In one of the nose cavities a tumour mass gave him problems with nasal congestion. Tissue sample from this nasal tumor showed high malignant Tcell lymphoma. Treatment with CHOP was given for six sessions during 2 months. He had a complication with septicemia after the first session but could continue the treatment and already after the third session the skin tumours started to regress. After completion of the CHOP a new CTscan revealed also regress of the lymph nodes in the groin, from 18 to 11 mm and a total regress of the mass in the nose cavity. The patient is at home with his family and will have future checkups in the hospital. Conclusion: Anaplastic large cell lymphoma (CD30+) is considered indolent and sometimes selfhealing. This case illustrates both an unusual presenting symptom and shortly thereafter widespread tumours, not selfhealing and without response to methotrexate. With help from colleagues in haematology the patient got treatment with CHOP with good response. Follow up time is only 4 months.
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