Clinical and Dermoscopic Evaluation of Trichloroacetic Acid 20% Versus Long-Pulsed 1064-nm Nd-YAG Laser in the Treatment of Keratosis Pilaris.

BACKGROUND: Keratosis pilaris (KP) is a common disorder of keratinization with different therapeutic modalities; however, none of them is completely satisfactory. OBJECTIVE: Assess and compare the efficacy of trichloroacetic acid (TCA) 20% and long-pulsed 1,064-nm Nd:YAG laser in the treatment of KP. MATERIALS AND METHODS: Twenty patients with symmetrically distributed areas of KP were enrolled in this study. In each patient, 2 symmetrical KP areas were randomly assigned to receive 4 sessions of either long-pulsed Nd:YAG laser or TCA 20%. Clinical evaluation by Investigator Global Assessment (IGA) was done by 2 blinded physicians after treatment. Dermoscopic assessment was done at baseline and at the end point of the study. RESULTS: Investigator Global Assessment of laser-treated area showed that 2 patients (10%) had moderate improvement, 10 patients (50%) had marked improvement, and 8 patients (40%) had excellent improvement. Investigator Global Assessment of TCA-treated area showed that 9 patients (45%) had marked improvement and 11 patients (55%) had excellent improvement. Dermoscopic score of KP showed a significant reduction with both modalities. The IGA and reduction in dermoscopic scores were comparable between the 2 modalities. CONCLUSION: Both long-pulsed 1,064-nm Nd:YAG laser and 20% TCA are effective in the treatment of KP. CLINICAL TRIAL REGISTRATION: Name of the trial register: clinicaltrial.gov . Registration number: NCT04797663.

Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars.

BACKGROUND AND OBJECTIVE: New and improved treatment modalities, including lasers and energy-based devices, are promising treatment options for hypertrophic scars. This study aimed to assess the efficacy and safety of fractional microneedle radiofrequency (FMR) compared with fractional carbon dioxide (CO2 ) laser in the treatment of postburn hypertrophic scars. PATIENTS AND METHODS: Twenty patients with hypertrophic scars were enrolled in the study. Two areas in each patient were randomly assigned to fractional CO2 laser or FMR. Four sessions, 6-8 weeks apart were performed. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation, H & E and orcein-stained samples were examined for histopathological assessment, and tissue transforming growth factor beta 1 (TGFß1 ) levels were measured for biochemical evaluation. RESULTS: Both fractional CO2 and FMR-treated areas showed significant improvement in all parameters 1 month after treatment. Fractional CO2-treated areas showed a higher degree of improvement compared with FMR in OSAS (p = 0.025), elastin grading (p = 0.004), and TGFß1 levels (p = 0.000). Patients reported less downtime and showed less postinflammatory hyperpigmentation with FMR compared with fractional CO2, but this did not reach statistical significance (p = 0.327, p = 0.231; respectively). CONCLUSION: Our results demonstrate the value of FMR as an effective alternative to fractional CO2 in the treatment of hypertrophic scars, with a potentially favorable safety profile.

Preparation, spectroscopic, characterizations and biological studies of new charge transfer complexes formed between fluconazole drug with various acceptors.

Charge transfer complexes developed during the interaction of Fluconazole drug (FLU) as an electron donor with different types of electron acceptors, including σ-type as iodine (I2), and π-types as 2,3-dinitrosalsylic acid (HDNS), Tetracyanoethylene (TCNE) and 2,3-dichloro-5,6-dicyano-1,4-benzoquinone (DDQ). The formed complexes were characterized using various techniques as UV-Vis spectra, Thermal analyses, spectrophotometric measurements, 1H NMR and FTIR Spectroscopy. It was found that the stoichiometry of all developed complexes was a 1:1 M ratio between fluconazole and acceptors (I2, HDNS, TCNE and DDQ). The characteristic physical parameters data such as ionization potential (ID), The oscillator strength (ƒ), formation constant (KCT), transition dipole moment (µ), free energy (ΔG), and energy of interaction (ECT) of the formed CT-complexes have also been reported. Eventually, the synthesized complexes were screened for their microbial and antioxidant activities.

Medical tourism in emerging markets: The role of trust, networks, and word-of-mouth.

ABTRACT Despite the growing popularity of medical tourism (MT) in emerging markets (EMs), little is known about how healthcare providers operationalize. This article analyzes how healthcare providers meet different challenges to market MT in an EM setting. A qualitative method was used for data collection and conducting case studies on healthcare services in the Philippines. The results show that trust and network building are necessary for mitigating the unfavorable characteristics, instability and lack of legitimacy caused by institutional constraints in EM. Word-of-mouth is found to be important to attract new customers and disseminate information about MT services.

Transforming growth factor-ß1 gene polymorphism in psoriasis vulgaris.

BACKGROUND: Increased transforming growth factor beta 1 (TGF-ß1) in the epidermis and serum has been found in psoriatic patients. The mechanism for this increase remains unclear. OBJECTIVE: To study the TGF-ß1 gene polymorphism at codon 10 and its relation to psoriasis susceptibility in a sample of Egyptian patients. MATERIALS AND METHODS: This cross-sectional study involved 70 patients with psoriasis vulgaris and 100 age- and sex- comparable healthy volunteers as a control group. Genomic DNA was prepared from peripheral blood lymphocytes from all subjects using QIAamp DNA mini kit (QIAGEN Inc., Germany). The TGF-ß1 polymorphism was genotyped by PCR-based restricted fragment length polymorphism (PCR-RFLP) analysis. Amplification of codon 10, located in exon 1 of TGFß1 gene was done through PCR reaction using gene-specific primers. RESULTS: Statistically significant difference was found between psoriasis patient and controls as regards TGF-ß1 (T869C) polymorphism (P=0.045). The presence of TT genotype was associated with a 3-fold risk of psoriasis compared to CC genotype (P=0.016, OR: 3.13 95% CI: 1.24-7.88). T allele was significantly more frequent in psoriasis patients (P=0.017). TGF-ß1 gene mutation was significantly higher among psoriasis patients with positive family history (P=0.007). CONCLUSION: TGF-ß1 gene polymorphism at codon 10 (T869C) is significantly associated with susceptibility to psoriasis in Egyptian patients. This polymorphism is more common in patients with a positive family history of psoriasis.

P16INK4a: a potential diagnostic adjunct for prediction of high-grade cervical lesions in liquid-based cytology: with HPV testing and histological correlation.

Human papillomavirus (HPV) is a necessary cause of cervical cancer and its precursors. Increased expression of high-risk hrHPV viral oncogenes in abnormal cells might increase the expression of p16INK4a. We aimed to determine the role of p16INK4a in detecting hrHPV-transformed epithelial cells in liquid-based cervical cytology, and compared the results with hrHPV DNA testing by realtime polymerase chain reaction (RT-PCR). Fifty-seven cytological samples were tested for p16INK4a immunomarker and hrHPV DNA. Test performance of both tests was determined by comparing sensitivity, specificity and predictive values using available histological follow-up data as gold standard. Of 57 samples, 36 (63.2%) showed immunoreactivity for p16INK4a and 43 (75.4%) were hrHPV-infected. A fairly low concordance rate (k = 0.504) between p16INK4a immunolabelling and hrHPV DNA status was noted. For prediction of cervical intraepithelial neoplasia (CIN) II and worse lesions, p16INK4a had a sensitivity and specificity of 93.5% and 60%; whereas hrHPV DNA testing had a sensitivity and specificity of 100% and 20%. Dual testing by combining p16INK4a and hrHPV showed sensitivity and specificity of 100% and 33.3%. In conclusion, p16INK4a is useful in predicting severity of the cytological abnormalities. Although p16INK4a is more specific but less sensitive than hrHPV in detecting high-grade cervical lesions, a combination of both tests failed to demonstrate significant improvement in diagnostic sensitivity, specificity and predictive value. Larger-scale prospective studies are required to assess further whether this biomarker should be routinely used as primary screening tool independently or in combination with hrHPV testing to improve diagnostic accuracy in cervical cytology.

Preparation, spectroscopic and antibacterial studies on charge-transfer complexes of 2-hydroxypyridine with picric acid and 7,7',8,8'-tetracyano-p-quinodimethane.

The reactions of electron acceptors such as picric acid (HPA) and 7,7',8,8'-tetracyano-p-quinodimethane (TCNQ) with 2-hydroxypyridine (HPyO) have been investigated in EtOH at room temperature. Based on elemental analysis and IR spectra of the solid CT-complexes along with the photometric titration curves for the reactions, the data obtained indicate the formation of 1:1 charge transfer complexes [(H2PyO)(PA)] and [(PyO)(HTCNQ)], respectively. The infrared and (1)H NMR spectroscopic data indicate a charge transfer interaction associated with a proton migration from the acceptor to the donor followed by intramolecular hydrogen bonding in [(H2PyO)(PA)] complex. Another charge transfer interaction was observed in [(PyO)(HTCNQ)] complex. The formation constants (KCT) for the CT-complexes are shown to be strongly dependent on the type and structure of the electron acceptors. Factors affecting the CT-processes and the kinetics of thermal decomposition of the complexes have been studied. The CT complexes were screened for their antibacterial activities against selected bacterial strains.

Endoscopic biopsy of cystic intracerebral tumours.

This technical note describes the application of neuroendoscopy for decompressing and obtaining tissue samples from cystic intracerebral tumours. The method provides for visualisation of the solid tumour component prior to biopsy and retains the advantages of being a burr hole procedure.

The possible role of trauma in skin tags through the release of mast cell mediators.

BACKGROUND: Skin tags (ST) are common benign tumors of the skin but their etiopathogenesis is not well understood. STs arise in sites subjected to trauma. It was proved that mast cells are recruited to sites of skin trauma and increase their tumor necrosis factor-α (TNF-α) content. AIM: STs are linked to obesity and frictional sites, but this has not been studied at the molecular level. We hypothesized that mast cells, TNF-α and its family member, TNF-related apoptosis-inducing ligand (TRAIL) might play a role in the pathogenesis of STs as a response to trauma. MATERIALS AND METHODS: A study was done on 15 patients with STs. Two STs and a snip of normal skin were obtained in each subject. We counted the mast cells after Toluidine blue staining. Enzyme-linked immunosorbant assay was used to measure TNF-α level while reverse transcriptase polymerase chain reaction was used to evaluate the level of TRAIL mRNA expression. RESULTS: Mast cell count in all STs was significantly higher than that in control (P=0.0355). There was a highly significant increase in the level of TNF-α in all STs as compared to its level in controls (P<0.0001). Expression of TRAIL mRNA was significantly higher in STs as compared to its expression in controls (P<0.0001). CONCLUSION: Our study suggests that mast cells, TNF-α and TRAIL may play a role in the pathogenesis of STs.

Increased tissue leptin hormone level and mast cell count in skin tags: a possible role of adipoimmune in the growth of benign skin growths.

BACKGROUND: Skin tags (ST) are common tumors. They mainly consist of loose fibrous tissue and occur on the neck and major flexures as small, soft, pedunculated protrusions. Decrease in endocrine, hormone level and other factors are thought to play a role in the evolution of ST. Leptin is an adipocyte-derived hormone that acts as a major regulatory hormone for food intake and energy homeostasis. Leptin deficiency or resistance can result in profound obesity and diabetes in humans. A role of mast cell in the pathogenesis of ST is well recognized. AIMS: To investigate the role of leptin in the pathogenesis of ST and to clarify whether there is a correlation between mast cell count and leptin level in ST. METHODS: Forty-five skin biopsies were taken from 15 patients with ST. From each patient, a biopsy of a large ST (length >4 mm), a small ST (length <2 mm) and a normal skin biopsy (as a control) were taken. The samples were processed for leptin level. Skin biopsies were stained with hematoxylin and eosin and toluidine blue-uranyl nitrate metachromatic method for mast cell count was used. RESULTS: There was a significant increased level of leptin in the ST compared to the normal skin. It was highly significant in small ST than in big ST (P = 0.0001) and it was highly significant in small and big ST compared to controls, P = 0.0001 and P = 0.001, respectively. There was a significant increase in mast cell count in the ST, which did not correlate with the increased levels of leptin. CONCLUSION: This is the first report to demonstrate that tissue leptin may play a role in the pathogenesis of ST. The significant increase in the levels of leptin and mast cell count in ST may indicate a possible role of adipoimmune in the benign skin growths.

High numbers of DC-SIGN+ dendritic cells in lesional skin of cutaneous T-cell lymphoma.

BACKGROUND: The role of dendritic cells (DCs) in disease progression of primary cutaneous T-cell lymphoma (CTCL) is not well understood. With their unique ability to induce primary immune responses as well as immunotolerance, DCs play a critical role in mediation of anti-tumor immune responses. Tumor-infiltrating DCs have been determined to represent important prognostic factors in a variety of human tumors. OBJECTIVE: To date, only circulating DC populations have been investigated in CTCL. Therefore we analyzed the expression and tissue distribution of different DC subset markers in lesional and nonlesional skin of patients with CTCL. METHODS: Twelve patients with mycosis fungoides or Sézary syndrome were included in the study. Tissue samples were obtained from lesional and nonlesional skin as a control. Immunohistochemistry was performed with different DC subset and regulatory T-cell markers and assessed using a digital image analysis system. Tissue distribution of DCs in relation to the tumor was analyzed by double immunofluorescence. RESULTS: We found a significant infiltration of CTCL lesions by immature CD209/DC-SIGN+ DCs with close contact to tumor cells. Matured and activated DCs were only rarely detected in lesions of CTCL. LIMITATIONS: The sample size was small. CONCLUSIONS: The preponderance of immature CD209/DC-DIGN+ DCs in contact with regulatory T cells in lesions of CTCL points to an important role of this subset in the host's immune reaction to the malignant T cells. Since these immature DCs are known to induce immunotolerance, they might play a role in the mediation of immune escape of the proliferating clone.

Synthesis, characterization and antimicrobial studies on cis-platinum(II) complexes of 5-nitrosouracil derivatives.

Two complexes were obtained during the reactions of 6-amino-1-methyl-5-nitrosouracil (AMNU) and 6-methylamino-1-benzyl-5-nitrosouracil (MABNU) with cis-diaquadiamineplatinum(II) nitrate complex, cis-[Pt(NH(3))(2)(H(2)O)(2)](NO(3))(2). The complexes were isolated in good yields as powdery precipitates. They were characterized through their elemental analysis, infrared, UV-vis, and (1)H NMR spectroscopies as well as thermal analyses. The obtained results indicated that, pyrimidine bases substitute easily aqua ligands and interact with Pt(II) ions as a monodentate ligand in the neutral and ionic form for the ligands AMNU and MABNU, respectively. The exocyclic oxygen atoms are the most probable binding site. Square planar structures, cis-form, were proposed in both cases. The free ligands, and their Pt(II) complexes were screened for their antimicrobial activities.

Mechanochemical synthesis and in vitro anti-Helicobacter pylori and uresase inhibitory activities of novel zinc(II)-famotidine complex.

The mechanochemical synthesis and characterization of a zinc complex with famotidine is described. The complex was characterized by microanalysis and a number of spectroscopic techniques. The complex was of M:L dihydrate type. Derivatization of famotidine with zinc appears to enhance the activity of the drug by inhibiting the growth of Helicobacter pylori (two reference and 34 clinical isolates). The complex inhibited the growth of H. pylori in an MIC range of 1-8 microg mL(-1). The anti-H. pylori activity of the zinc-famotidine complex against antibiotic-resistant strains was nearly comparable to that of antibiotic-susceptible strains. The complex was found to be far less toxic than the parent drug, as demonstrated by its higher LD(50) value. In the human urease enzyme inhibition assay the complex exhibited significant inhibition. The new complex appears to be more useful in eradicating both the antibiotic-susceptible and antibiotic-resistant strains of H. pylori.

Serum sex hormone levels in pre- and postmenopausal breast cancer patients.

INTRODUCTION: This study was conducted to determine the association between serum sex hormone levels and breast cancer. METHODS: The study was conducted on newly-diagnosed breast cancer patients who had not received any treatment. Controls were women not known to have any breast disease or hormone-related tumours. Serum hormones were divided into quartiles. Logistic regression adjusting for age and race were done to calculate the odds ratio (OR) and 95 percent confidence interval (CI). RESULTS: A total of 207 subjects were recruited; 73 premenopausal (37 cases, 36 controls) and 134 postmenopausal (68 cases and 66 controls) women. In the premenopausal women, only serum testosterone was positively associated with breast cancer (OR 1.72, 95 percent CI 0.40-7.40), but this was not a significant finding (p-value is 0.468). In the postmenopausal women, oestradiol, progesterone and testosterone were positively associated with breast cancer with a highest to lowest quartile OR of 1.48, 2.35 and 4.23 (95 percent CI 0.59-3.69, 1.11-4.95 and 1.52-11.78, respectively). The OR was significant for both progesterone and testosterone (p-values of 0.025 and 0.006, respectively). CONCLUSION: There were no statistically significant findings among the premenopausal cases. In postmenopausal women, serum progesterone and testosterone levels were significantly associated positively with the odds of having breast cancer.

Increased expression of IL-12p70 and IL-23 by multiple dendritic cell and macrophage subsets in plaque psoriasis.

BACKGROUND: Psoriasis is a chronic immune-mediated skin disease, in which interleukins 12 and 23 have been postulated to play a critical role. However, the cellular source of these cytokines in psoriatic lesions are still poorly defined and their relative contribution in inducing skin inflammation has been discussed controversially. OBJECTIVES: To investigate immunoreactivity of the bioactive forms of IL-12 and IL-23 in plaque psoriasis and to characterize the dendritic cell (DC) and macrophage subsets responsible for the production of these cytokines. METHODS: Immunohistochemistry was performed on normal skin (n=11) as well as non-lesional (n=11) and lesional (n=11) skin of patients with plaque psoriasis using monoclonal antibodies targeting the bioactive forms of IL-12 (IL-12p70) and IL-23 (IL-23p19/p40) on serial cryostat sections using the alkaline phosphatase-antialkaline phosphatase. Co-localization of IL-12 and IL-23 with different dendritic cells and macrophage cell markers (CD1a, CD11c, CD14, CD32, CD68, CD163, CD208/DC-LAMP) was performed using double immunofluorescence staining. RESULTS: Immunoreactivity for IL-12 and IL-23 was significantly enhanced in lesional psoriatic skin as compared to non-lesional and normal skin. No difference was observed between IL-12 and IL-23 immunoreactivity in any skin types. Both IL-12 and IL-23 immunoreactivity was readily detected mainly in CD11c+, CD14+, CD32+, CD68+ and some CD163+, DC-LAMP+ cells. IL-12 and occasionally IL-23 were also found in some CD1a+ dendritic cells. In addition, an enhanced expression mainly of IL-23 was observed in keratinocytes. CONCLUSIONS: Bioactive forms of IL-12 and IL-23 are highly expressed in various DC and macrophage subsets and their marked in situ production suggest that both cytokines have crucial pathogenic role in psoriasis.

Alopecia areata universalis elicited during treatment with adalimumab.

Adalimumab is a fully humanized recombinant anti-tumour-necrosis-factor (TNF-alpha) monoclonal antibody which has been approved for rheumatoid arthritis, active ankylosing spondylitis, psoriatic arthritis and Crohn's disease. We report a case of alopecia areata (AA) universalis occurring 6 months after administration of adalimumab monotherapy in a patient with a long-standing history of psoriatic arthritis and psoriasis. The diagnosis was confirmed by a scalp biopsy which showed a peribulbar infiltrate of both CD4+ and CD8+ T cells, CD1a+ dendritic cells as well as CD68+ and CD163+ macrophages. In addition, immunofluorescence staining for TNF-alpha was found in the mononuclear cell infiltrate. This case suggests a complex role of TNF-alpha in the induction of AA.

Saccharinato complexes of Ce(V) with 2-hydroxypyridine: synthesis, spectroscopic and thermal characteristics of [Ce(sac)2(SO4)(H2O)4] and [Ce(sac)2(SO4)(PyOH)2].

The synthesis of Ce(IV) complexes [Ce(sac)2(SO4)(H2O)4] (1) and [Ce(sac)2 (SO4)(PyOH)2] (2) (sac=saccharinate, PyOH=2-hydroxypyridine) starting with sodium saccharinate is described. Their vibrational and nuclear magnetic resonance (1H, 13C) spectra as well as their thermal mode of degradation were investigated. The data indicate that sac in complex 1 behaves as a monodentate ligand through the nitrogen atoms. Saccharinato ligand in complex 2 shows different mode of coordination, where it behaves as tridentate and binds Ce(IV) through its carbonylic oxygen, nitrogen and sulphonylic oxygen atoms. The most probable structure in complex 2 is that, units of [Ce(sac)2(SO4)(PyOH)2] are linked by bridges of the O- of sac sulphonyl leading to polymeric chains.

Efalizumab-associated papular psoriasis.

BACKGROUND: Efalizumab is a human anti-CD11a monoclonal antibody used in the treatment of patients with moderate to severe plaque psoriasis. Some of the patients develop new papular lesions during treatment, which are predominantly located in the flexural regions. OBSERVATION: Four patients with recalcitrant psoriasis undergoing treatment with efalizumab presented with erythematous, partly scaly papules and small plaques on previously unaffected areas after 4 to 10 weeks of efalizumab therapy. Tissue sections of biopsy specimens were stained with hematoxylin-eosin, and immunohistochemical staining was performed using monoclonal antibodies against CD3, CD4, CD8, T-cell-restricted intracellular antigen 1, granzyme B, neutrophil elastase, CD68, CD1a, CD11c, HLA-DR, CD25, CD20, and CD56. Histopathological and immunohistochemical examination of the lesions showed features consistent with psoriasis and activation of various leukocyte subtypes including T cells, dendritic cells, macrophages, and neutrophils. CONCLUSIONS: Papular eruptions appearing during efalizumab therapy represent new psoriatic lesions and could be referred to as efalizumab-associated papular psoriasis (EAPP). They usually do not necessitate termination of efalizumab therapy and may optionally be treated with topical corticosteroids. Dermatologists should be aware of these lesions and inform their patients accordingly.

Synthesis, characterization and biological activity of some platinum(II) complexes with Schiff bases derived from salicylaldehyde, 2-furaldehyde and phenylenediamine.

Four platinum(II) complexes of Schiff bases derived from salicylaldehyde and 2-furaldehyde with o- and p-phenylenediamine were reported and characterized based on their elemental analyses, IR and UV-vis spectroscopy and thermal analyses (TGA). The complexes were found to have the general formula [Pt(L)(H(2)O)(2)]Cl(2) x nH(2)O (where n=0 for complexes 1, 3, 4; n=1 for complex 2. The data obtained show that Schiff bases were interacted with Pt(II) ions in the neutral form as a bidentate ligand and the oxygens rather than the nitrogens are the most probable coordination sites. Square planar geometrical structure with two coordinated water molecules were proposed for all complexes The free ligands, and their metal complexes were screened for their antimicrobial activities against the following bacterial species: E. coli, B. subtilis, P. aereuguinosa, S. aureus; fungus A. niger, A. fluves; and the yeasts C. albican, S. cervisiea. The activity data show that the platinum(II) complexes are more potent antimicrobials than the parent Schiff base ligands against one or more microorganisms.

Clinical and immunopathologic findings during treatment of recalcitrant atopic eczema with efalizumab.

Treatment of widespread moderate to severe atopic eczema remains a challenge. The therapeutic efficacy and modifications of the immune response during treatment of atopic eczema with efalizumab are so far unknown. We hereby report the clinical findings and characterize the inflammatory infiltrate during treatment of severe recalcitrant atopic eczema with efalizumab.