Introduction: Sister Mary Joseph Nodule (SMJN) is a metastatic umbilical lesion secondary to a primary malignancy of any viscera, stomach and colon being most common in men, and ovary in women. Case report: In this article, we present the case of SMJN in a 54-year old female patient. An urgent diagnostic workup was performed with a computerized tomography of abdominal cavity and pelvis showing an expansive tumorous formation covering uterus with a carcinomatosis of peritoneum. After biopsy, immunohistochemical profile suggested adenocarcinoma of the ovarian origin. The patient was then referred to the Oncology Consilier of Gynecology Department and further continued followed by the Oncology team.

There are differences with respect to the commonly isolated Malassezia species, not only between healthy individuals and the patients with various skin diseases, but also between different countries. We investigated the species composition of Malassezia microflora on the skin of patients with Malassezia-associated diseases and of healthy subjects (HS). Two hundred and fifty skin scrapings from patients with pityriasis versicolor (PV), seborrheic dermatitis (SD), atopic dermatitis (AD), psoriasis (PS), and healthy subjects (HS), fifty each, were inoculated into Sabouraud dextrose agar and into modified Dixon agar and identified using conventional culture-based methods. In PV and PS lesions, the most common species was M. globosa (62% and 52%, respectively), while M. restricta was predominant in SD lesions (28%). M. sympodialis was the most common species recovered from AD (52%) and healthy trunk skin (30%). Fewer cultures were positive for Malassezia growth in patients with AD than in patients with other skin conditions, and even in controls. Our data are in agreement with other studies and suggest that the pathogenic species of PV is M. globosa. The evidence that any given species is clinically important in the pathogenicity of SD, AD and PS is still lacking.

The genus Malassezia comprises lipophilic species, the natural habitat of which is the skin of humans and other warm‐blooded animals. However, these species have been associated with a diversity of dermatological disorders and even systemic infections. Pityriasis versicolor is the only cutaneous disease etiologically connected to Malassezia yeasts. In the other dermatoses, such as Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis, and psoriasis, these yeasts have been suggested to play pathogenic roles either as direct agents of infection or as trigger factors because there is no evidence that the organisms invade the skin. Malassezia yeasts have been classified into at least 14 species, of which eight have been isolated from human skin, including Malassezia furfur, Malassezia pachydermatis, Malassezia sympodialis, Malassezia slooffiae, Malassezia globosa, Malassezia obtusa, Malassezia restricta, Malassezia dermatis, Malassezia japonica, and Malassezia yamatoensis. Distributions of Malassezia species in the healthy body and in skin diseases have been investigated using culture‐based and molecular techniques, and variable results have been reported from different geographical regions. This article reviews and discusses the latest available data on the pathogenicity of Malassezia spp., their distributions in dermatological conditions and in healthy skin, discrepancies in the two methods of identification, and the susceptibility of Malassezia spp. to antifungals.

Aplasia cutis congenita (ACC) is a rare inborn lesion, presenting with absence of skin. The etiology is unknown and is probably not attributable to a single cause but to a combination of genetic factors. Multiple causes have been suggested for ACC: syndromes and teratogens, intrauterine infection--varicella zoster virus, herpes simplex virus--fetal exposure to cocaine, heroin, alcohol, or antithyroid drugs. The most common site is the scalp. We report a case with multiple lesions on the trunk, resembling an instance with ACC group 5. This form of ACC occurs in association with the in utero death of a twin or more (in this case triple) fetus. Histological findings are available in very few reports. Therapy options depend on the characteristics of the lesion, but conservative treatment is usually chosen.

Introduction: There are limited numbers of studies which focused on the identification of Malassezia yeasts to a species level in onychomycosis. Therefore, the aim of our study was to determine the prevalence and species composition of Malassezia yeasts in patients with clinically suspected onychomycosis and to examine if the range of species varies with patient gender, age, site of involvement and clinical pattern of onychomycosis. Methods: Specimens were taken from 785 patients presenting signs of onychomycosis and then incubated on Sabouraud dextrose agar and modified Dixon agar. The yeasts isolated were identified according to their macroscopic and microscopic features and physiological characteristics. Results: Malassezia species were diagnosed both by microscopy and culture in fourteen (1.8%) patients. M. globosa was the predominant, if not only, species identified from nail samples. Mixed cultures were observed in five cases: in 4 cases Malassezia was co-isolated with Candida albicans and in one case with dermatophyte. Fingernails were affected more frequently than toenails (85.7%) and distolateral subungual onychomycosis was the most common clinical type (78.6%). Conclusion: No significant differences were found in the distribution of Malassezia species isolated according to demographic parameters.

AIM To determine the incidence and etiological agents of dermatophytosis of male genitalia in Sarajevo area, Bosnia and Herzegovina, during a 5-year period (2009-2013). METHODS A total of 313 male patients with confirmed dermatophyte infection elsewhere in the body was analyzed. All samples (skin scrapings and hairs) were treated with lactophenol to detect a possible presence of fungal elements and then cultured on Sabouraud glucose agar. Dermatophytes species were identified based on macroscopic and microscopic morphology. RESULTS Dermatopyte infection of penis and/or scrotum was confirmed by positive cultures in 17 (5.4%) patients, of which four had lesions on the penis alone, five had lesions on scrotum and eight patients had lesions on both penis and scrotum. Majority of patients, 12 (70.0%) belonged to the age group 21-40. Fifteen patients (88.2%) had associated foci of dermatophyte infection, but the inguinal area was most frequently affected, in 10 (66.6%) patients. Microsporum canis was the most frequent dermatophyte found on culture, in 10 (58.8%) patients. CONCLUSION Dermatophytosis of male genitalia is a rare entity, occurring more often in young males and the main causative species is Microsporum canis.

Original article 1 Mean platelet volume predicts the glycemic control deterioration in diabetes mellitus type 2 patients 36 Can a finding of cervical vestibular evoked myogenic potentials contribute to vestibular migraine diagnostics? 50 Does odor and taste identification change during hyperemesis gravidarum? 62 Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer ABSTRACT Aim To investigate association of mean platelet volume (MPV) and glycemic control markers, and whether MPV could be used as a predictor of deterioration of glucoregulation in Diabetes mellitus type 2 (DMT2) patients. Methods The cross-sectional study included 106 DMT2 patients, treated at the Primary Health Care Centre in Zenica, distributed into groups according to glycated haemoglobin (HbA1c) values: A (n=44, HbA1c ≤7.0%) and B (n=62, HbA1c>7.0%). Spearman's correlation coefficients were calculated to evaluate the relationships between MPV and glycemic control markers. Binomial logistic regression analysis was performed to estimate the relationship between glycemic control, as dichotomous outcome, and MPV as the main predictor. Diagnostic value of MPV as a marker for poor glucoregulation was estimated by using ROC analysis. Results Mean platelet volume was significantly higher in the group B compared to the group A (p<0.0005). Significant positive correlations of MPV with fasting blood glucose and HbA1c were found in the total sample (rho=0.382, p<0.0005; rho=0.430, p<0.0005, respectively). Mean platelet volume was positively associated with the risk of inadequate glycemic control, with 2 times increased odds of inadequate glycemic control per femtoliter The area under ROC curve for MPV was 0.726 (95% CI: =0.628-0.823, p <0.0005). At the best cutoff value 9.55 fL, MPV showed sensitivity of 82% and specificity of 54.5%. Conclusion Mean platelet volume correlates with glycemic control markers in DMT2 patients. It could be used as a simple and cost-effective predictor of deterioration of glucoregulation.

Background and Objectives The genus Malasezia currently includes fourteen species that have been isolated from healthy and diseased human and animal skin. However, there were differences with respect to the species most commonly isolated, not only in patients with various skin diseases but also between healthy individuals. The aim of this study was to analyze the prevalence of Malassezia species from clinically normal skin of the scalp and trunk of healthy individuals and to examine if the range of species varies according to body site, gender and age. Materials and Methods The study was conducted at the Department of Dermatovenerology, University Clinical Center in Sarajevo, Bosnia and Herzegovina from December 2012 to May 2013. One hundred healthy men and women with no skin diseases and aged from <1 to 82 years were studied. The samples were obtained by scraping the skin surface from the upper and middle part of trunk and from scalps of all subjects and then incubated on modified Dixon agar. The yeasts isolated were identified by their morphological and physiological properties according to Guillot et al. method. Results M. sympodialis was the predominant species on trunk skin in older subjects, M. restricta on scalp skin in age groups 21-35 years, while M. globosa was identified as common species in adults (36-50 years), both from scalp skin and trunk skin. From the trunk skin M. furfur was the most frequent in children. Conclusion This study confirmed that cutaneous Malassezia microbiota in healthy subjects varies by body part and age but not by gender.

Currently, the genus Malassezia includes 14 species, which have been identified traditionally based on their morphology and biochemical features (Cafarchia et al., 2011). Since the description of new species a number of studies have evolved to elucidate the role of the different species in the ecology and pathogenicity in a range of dermatoses, in which variable results have been reported from different geographical regions.

Currently, the genus Malassezia includes 14 species, which have been identified traditionally based on their morphology and biochemical features (Cafarchia et al., 2011). Since the description of new species a number of studies have evolved to elucidate the role of the different species in the ecology and pathogenicity in a range of dermatoses, in which variable results have been reported from different geographical regions.

Background: Alopecia areata (AA) is a common form of localized, nonscarring hair loss. It is characterized by the loss of hair in patches, total loss of scalp hair (alopecia totalis, AT), or total loss of body hair (alopecia universalis, AU). The cause of AA is unknown, although most evidence supports the hypothesis that AA is a T-cell-mediated autoimmune disease of the hair follicle and that cytokines play an important role. Aims: The aim of the study was to compare the serum levels of tumor necrosis factor-alpha (TNF-α) in patients with AA and the healthy subjects and also to investigate the difference between the localized form of the disease with the extensive forms like AT and AU. Materials and Methods: Sixty patients with AA and 20 healthy controls were enrolled in the study. Forty-six patients had localized AA (LAA), and 14 patients had AT, AU, or AT/AU. The serum levels of TNF-α were measured using enzyme-linked immunoassay techniques. Results: Serum levels of TNF-α were significantly higher in AA patients than in controls (10.31 ± 1.20 pg ml vs 9.59 ± 0.75 pg/ml, respectively). There was no significant difference in serum levels of TNF-α between patients with LAA and those with extensive forms of the disease. Conclusion: Our findings support the evidence that elevation of serum TNF-α is associated with AA. The exact role of serum TNF-α in AA should be additionally investigated in future studies.

Background. Vitiligo is a common skin disorder characterized by macular depigmentation of the skin. The etiopathogenesis of the disease is still unclear, but there is evidence that autoimmunity and endocrine disfunction may be involved. Objective. The aim of this study was to determine whether vitiligo is statistically associated with thyroid autoimmunity. Method. In a prospective case-control study, we compared the frequency of thyroid autoantibodies (thyroglobulin antibody, anti-Tg and thyroid peroxidase antibody, and anti-TPO) in 33 patients with vitiligo and in 33 healthy volunteers. Thyroid autoantibodies and thyroid hormones (thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH) were measured in all subjects. Results. Thyroid functional abnormalities were found in 6 (18.18%) patients. Anti-Tg and anti-TPO were positive in 9 (27.27%) and 8 (24.24%) patients, respectively. In control group, only one subject (3.03%) had abnormalities in thyroid hormonal status, and two subjects had positive thyroid autoantibodies. Compared with the control group, the frequency of both anti-Tg and anti-TPO was significantly higher in those with vitiligo (P < .05). Conclusion. This study shows a significant association between vitiligo and thyroid autoimmunity, and that tests to detect thyroid autoantibodies are relevant in patients with vitiligo.