Frequency of resistance to systemically administered meglumine antimoniate [Glucantime] in patients with acute cutaneous leishmaniasis: a cross-sectional study

Pentavalent antimony compounds are the first line of treatment for cutaneous leishmaniasis. Clinical resistance to pentavalent antimony in the form of meglumine antimoniate [Glucantime] has been recognized as a problem in leishmaniasis. Herein, clinical response to Glucantime was studied in patients suffering from cutaneous leishmaniasis. In a cross-sectional study 370 patients with cutaneous leishmaniasis were treated with systemic Glucantime, 50 mg/kg/day, for 2 to 3 weeks. They were visited weekly for 3 weeks and also followed up for 3 months after treatment was completed. The clinical and parasitological response to this treatment was evaluated, and classified into partial and complete response and failure to treatment. Two hundred forty-seven men and 123 women were followed up. The mean age was 36.7 +/- 16 years. There were 64.1% partial response after 2 weeks and 73% partial response at the third week of treatment. 11.6% of lesions were not cured after 3 weeks of treatment and 8.1% were not still cured 12 weeks thereafter. Clinical resistance to Glucantime is an important problem. The mechanisms of resistance and using drug combinations are needed to be considered

Comparison of insulin resistance in obese women with and without acanthosis nigricans

Acanthosis nigricans [AN] is characterized by hyperpigmented velvety plaques of body folds and neck. Insulin can have a role in the pathogenesis of this disease and hyperinsulinemia as a consequence of insulin resistance may stimulate the formation of the characteristic plaques of AN. In this study insulin resistance was compared in obese women with and without AN. Glucose tolerance test [GTT] and fasting blood insulin were measured in two groups of obese women [BMI>30 kg/m[2]] with AN [32 cases] and without AN [34 cases] and insulin resistance was determined using HOMA formula. The mean fasting blood insulin in two groups with and without AN were 15.5 +/- 8.5 and 12.2 +/- 4.1 micro IU/mL; respectively [P<0.05]. The mean of insulin resistance in two groups with and without AN were 3.5 +/- 1.9 and 2.6 +/- 0.9; respectively [P<0.05]. The results of GTT showed that the mean fasting blood sugar was 89.5 +/- 12 mg/dl and following using glucose were 144 +/- 7 mg/dl after 30 minutes, 132 +/- 45 mg/dl after 60 minutes, 107 +/- 30 mg/dl after 120 minutes in persons with AN and in the other group were 87 +/- 8, 130 +/- 3, 122 +/- 26 and 100 +/- 26 mg/dl; respectively. The difference between two groups was only significant after 60 minutes. Acanthosis nigricans maybe a marker of insulin resistance in obese women

Patch test results in patients with clinical diagnoses of contact and/or atopic dermatitis in Isfahan

Patch testing is an important diagnostic tool to confirm allergic contact dermatitis. Determination of the validity and usefulness of a standard patch test allergen series with consideration of age, sex and race difference can reduce diagnostic errors in patients with allergic contact dermatitis. This study was done to determine the frequency of contact sensitization to 28 common allergens in patients with clinical diagnoses of contact and/or atopic dermatitis. Materials and In a cross sectional study during 6 months, 250 patients with contact and/or atopic dermatitis were patch tested with DKG standard patch test series and evaluated after 24, 48 and 72 hours after application of patch test. Data were analyzed using SPSS. 11 software by X[2], Fisher's exact and t tests. Positive patch test results were seen in 32% of all evaluated patients. 45.8% of patients with age above 40 years and 28.0% of patient with age below 40 years had a positive patch test. Potassium dichromate and nikel sulfate were the most common allergens in our study. In this study only 13 of 18 [46.4%] tested allergens showed positive reaction. Low positive rate of standard DKG series in this study shows that allergen series of standard patch test should be revised based on reginal conditions, allergens and social habits

[ efficacy of topical treatment with concentrated boiled extract and hydroalcoholic extract of cassia fistula in comparison with intralesional injection of glucantime in the treatment of acute leishmaniasis]

Cutaneous leishmaniasis is an endemic disease in Iran. Although there are many different treatments for this disease, there is not any effective treatment yet. Since there has been a number of different reports on the effectiveness of Cassia fistula plant in the treatment of leishmaniasis, the efficacy of concentrated boiled extract and hydro alcoholic extract of Cassia fistula on the leishmaniasis disease was compared with intralesional injection of Glucantime in this study. In this randomized clinical trial a total of 165 patients, 6 to 60 years old, who had a positive leishmania smear refered to the Isfahan Skin and Leishmaniasis Research Center were divided into three groups using list of random numbers and were treated with: concentrated boiled extract of Cassia fistula, hydroalcholic extract of Cassia fistula, or intralesional injection of Glucantime. The patients were treated for 4 weeks and followed for three months after the study started. The efficacy of treatment was reported as complete cure, partial improvement and no improvement on the basis of clinical and parasitological evidence. In the present study 63/6% of patients treated with the concentrated boiled extract, 52/7% of the hydroalcoholic extract and 45/5% of the Glucantime group were men. 22 patients [40%] of the concentrated boiled extract of Cassia fistula, 20 pateints [36/4%] of the hydroalcoholic extract of Cassia fistula group and 36 patients [65/5%] of the Glucantime group showed complete cure. The efficacy in the third group was much more than the first [P<0.02] and second groups [P<0.005], but there was not any difference between concentrated boiled extract and hydroalcoholic extract of Cassia fistula. The results of this study showed that this plant might be used topically along with Glucantime for decreasing the time and dose of treatment with Glucantime

[Efficacy of combination of topical honey with intralesional injection of glucantime in the treatment of acute cutaneous leishmaniasis]

Cutaneous leishmaniasis [CL] is an edemic disease widely spread in Iran. Although several treatments have been tried, none has been found as simple and effective. Honey has been used in the treatment of chronic ulcers and its anti-leishmanial effects have also been reported. So we assessed the efficacy of honey in acute CL. In a randomized clinical trial, 100 patients with CL referred to Skin and Leishmaniasis Research Center were treated with either weekly intra-lesional injection of Glucantime alone or combined with twice daily topical application of honey. The patients were evaluated clinically 2,3 and 4 months after treatment. Ninety patients completed the study, forty-five patients were treated in each group. At the end of trial, 32 patients [71/1%] of these treated with Glucantime alone and 23 patients [51/1%] treated with honey were cured [P=0.04]. Drug interference and inhibition of bioavailability of Glucantime by honey may decrease the efficacy of Glucantime in treatment of CL