Assessing the reliability of the Modified Wash Test.

AIM: The aim of this paper was to find a simple method to evaluate reliably diagnosis and severity of androgenetic alopecia (AGA) and telogen effluvium (TE). METHODS: We adopted the modified wash test (MWT), which accomplishes such task through assessing the number of shed hair and the vellus percentage. To evaluate its reliability, 25 subjects were submitted to MWT once a week for 4 consecutive weeks according to the procedure published elsewhere. The data were analysed by the intraclass correlation coefficient and ROC curves. RESULTS: The subjects were diagnosed as having TE (7 subjects), AGA (6 subjects), AGA+TE (4 subjects) and normal subjects (8 patients). An almost perfect reliability was found in AGA group for both total hair and vellus hair percentage, and in normal and TE groups for vellus hair count. Good reliability were found in all other cases, but in the total hair count in normal subjects in which it was only moderate. The areas under the ROC curve showed a sensitivity and specificity ranging from 50% to 100%. CONCLUSION: MWT can be employed with confidence in the office. It is simple, non-invasive and non-expensive and helps to distinguish TE from AGA, to identify cases of association TE+AGA, to assess the severity of the three conditions and, in TE+AGA association, to select which one is the most important and should be treated first. Possible biases and drawbacks are discussed.

The quality of life in Italian psoriatic patients treated with biological drugs.

AIM: Psoriasis is well known to affect negatively daily activities, occupational and sexual functioning. We investigated whether the improvement of skin lesions obtained with the new biological drugs comes with by a better Quality of Life (QoL) as well. METHODS: Thirty patients with moderate to severe psoriasis treated with either anti-CD11 (13) or anti-TNF-α molecules (17) were studied. The severity of skin lesions was evaluated, before the biological therapy (T0) and after 6 months of treatment (T1), by the Psoriasis Area and Severity Index (PASI) and the Body Surface Area (BSA). QoL was evaluated by the Dermatology Life Quality Index (DLQI) and by the Psoriasis Quality of Life (PsoriQoL). RESULTS: DLQI and PsoriQoL mean scores shifted significantly from 16.5 to 2 respectively. At T0, PASI did not correlate significantly with DLQI. DLQI nor PsoriQoL correlated significantly with age and with the duration of the disease. PASI correlated significantly with DLQI of patients with arthropathy only, but did not with DLQI of patients without arthropathy. At T1, PASI was not correlated significantly with DLQI nor with PsoriQoL. CONCLUSION: The patient affected by psoriasis suffer an impairment of their QoL which seems to be independent from many obvious factors, such as age, duration of the disease and, mainly, its severity. QoL does not seem to be influenced significantly by arthropathy. Other factors, of both genetic or environmental nature, could play a determinant role in depriving psoriatics of a good QoL.

Reliability of hamilton-norwood classification.

BACKGROUND: Hamilton-Norwood scale (HNS) has been largely used to assess clinically the severity of androgenetic alopecia (AGA), especially for therapeutical trials and even to establish its association with important diseases such as ischemic heart disease and prostate cancer. OBJECTIVE: To study HNS reproducibility in the hands of dermatologists and dermatology residents. MATERIALS AND METHODS: Seven dermatologists and 16 residents in dermatology classified 43 photographs of male heads with different degrees of AGA. In a second study, 8 appraisers (3 dermatologists and 5 residents in dermatology) examined 56 pictures with the same procedure and repeated the observation 3 months later. In the first study, the inter-rater agreement was estimated by calculating an intra-class correlation coefficient (ICC). In the second study, for intra-rater repeatability, each rater's scores from session 1 were paired with his/her scores for the same subjects in session 2, and the ordinary least products linear regression was calculated. RESULTS: In the first study, the concordance of appraisers was unsatisfactory (ICC = 0.63-0.68)]. In the second study, repeatability was poor, without any significant difference between dermatologists and dermatology residents. COMMENT: Reliability of HNS is unsatisfactory even in the hands of expert appraisers. To obtain better reliability, the number of classes should be reduced, but with such reduction HNS would be usable to classify patients only in a broad way.

Size- and shape-dependent separation of TiO2 colloidal sub-populations with gravitational field flow fractionation.

The simplest field flow fractionation technique, which uses the earth's gravity as the external field is applied to isolate two populations, which differ in both shape and size, from a polydisperse sub-micron TiO2 powder of homogenous density. The fraction eluted first is spherical with an average diameter of 0.31 microm while the second fraction is ellipsoidal and can be associated with a 0.45 microm hydrodynamic diameter. Elution conditions appeared to be very sensitive to electrolyte and surfactant characteristics in the carrier phase as well as on the sample concentration. Using 25 microl (1%, w/w) sample suspension, separations of spherical from ovoid particles was performed in almost 2 h with a mobile phase of 0.001 M KNO3-0.01% (v/v) Fl-70 in water in a 0.025-cm thick channel made of polystyrene walls.

Age as limiting factor of the efficacy of itraconazole for treatment of onychomycosis.

A clinical study was carried out involving 24 patients between 18 and 64 years of age with disto-lateral onychomycosis of finger and/or toenail in whom intermittent therapy with itraconazole was orally administered for 4 months. A follow-up period of 9 months was instituted to monitor the efficacy of the treatment. Clinical and mycological outcome at the end of the study was correlated with a checklist that included age and sex of the patient, site of infection and species of the causative agent. Nails that were free of disease in both gross and mycological examinations were achieved in 58% of our patients. Age was shown to be the only parameter, among those taken into consideration, that was correlated with the cure rate. The association was found to be statistically significant.

Antibodies to beta(2)-glycoprotein I in ischemic stroke.

Antibodies to beta(2)-glycoprotein (beta(2)-GPI) have been associated with recurrent thrombotic events in patients with systemic lupus erythematosus. The present study investigated the prevalence of antibodies to beta(2)-GPI in an unselected group of patients with ischemic stroke. One hundred and twenty-one sera from patients with ischemic stroke and 174 control sera from patients with nonischemic neurological disorders (n = 43) and healthy subjects (n = 131) were tested for antibodies to beta(2)-GPI by a solid-phase ELISA. Twenty-nine stroke patients (24%) had antibodies to beta(2)-GPI. Of the 43 patients in the neurological control group, 2 were positive. For comparison between the groups, Fisher's exact test was used for categorical variables and ANOVA for antibody titers. Antibody levels and frequencies of positivity were significantly different between the study groups. None of the sera from the healthy control group had abnormal antibody levels. When risk factors and associated diseases were taken into account, a marginal association was found between the presence of antibodies to beta(2)-GPI and hypertension (p = 0.036). This study demonstrates a significant prevalence of antibodies to beta(2)-GPI in an unselected stroke population.

Identification of sequence similarities between Mycobacterium leprae and the myelin proteolipid protein by computational analysis.

This study was undertaken under the assumption that antigenic mimicry plays a role in the pathogenesis of neuropathy in leprosy, a unique feature among mycobacterial diseases. The SWISS-PROT protein sequence databank was scanned using a computer programme based on an identity matrix algorithm, to identify common amino acid regions between human myelin and mycobacterial proteins. The highlighted motifs were back-tested against a database of MHC-binding peptides (MHCPEP). Of the 28 common sequences between mycobacterial and human myelin proteins, only two were found to yield some matches with MHC-presenting peptides. Both motifs were from M.leprae. The myelin proteolipid protein was the human protein containing the identified similarities. We believe that this theoretical approach can provide a way to predict potentially "mimetic" motifs by search for antigenic regions in protein sequence databases without screening a large number of synthetic peptides.

beta 2-Glycoprotein I-dependence of anticardiolipin antibodies in multibacillary leprosy patients.

This study was undertaken to investigate the influence of beta 2-glycoprotein I (GPI) on anticardiolipin antibody (aCL) titration in leprosy. The study group consisted of 140 sera from patients with multibacillary leprosy (46 borderline, 94 lepromatous). The group included newly diagnosed, previously untreated patients, patients under treatment and patients released from treatment. GPI addition enhanced significantly the aCL titres in sera from lepromatous leprosy but not in those from borderline leprosy. Moreover, when the patients were classified according to their bacteriological status, aCL titres were found to be significantly higher in skin smear positive patients compared to bacteriologically negative patients. Thus, the present study demonstrates that aCL in multibacillary leprosy patients are mainly of the GPI-dependent type and emphasizes the importance of GPI addition for aCL titration in leprosy.

Comparison of two methods for the recognition of guanine and cytosine rich regions on human gene sequences.

The authors compared two methods to recognise cytosine and guanine rich zones on 19 DNA sequences. The computer method based on an artificial neural network algorithm indicated presence of guanine and cytosine rich regions also in genes not previously known to contain CpG islands.

Potentially functional regions of nucleic acids recognized by a Kohonen's self-organizing map.

Computer recognition of short functional sites on DNA, such as promoter regions or intron-exon boundaries, has recently attracted much interest. In this paper we have focused our attention on the automatic recognition of relevant features of human nucleic acid sequences by means of an unsupervised artificial neural network model. Sixty messenger RNA and 31 genomic DNA sequences were analysed. The results showed that in mRNA, the minimal similarity 60 base pattern was guanine- and cytosine-rich and located in most sequences in a range of 250 bases from either the middle point of the signal peptide coding region or from the start of the coding region. On DNA sequences a region defined by a cluster of minimal similarity patterns was present in many of the analysed genes. This zone may be related to alternative splicing and DNA methylation.

Patients with erosive lichen planus may have antibodies directed to a nuclear antigen of epithelial cells: a study on the antigen nature.

Two patients with erosive lichen planus and latent HBV infection who had circulating antibodies directed to nuclei of epithelial cells are described. The nature of such antigen has been investigated by indirect immunofluorescence, double immunodiffusion, counterimmunoelectrophoresis, enzyme-linked immunosorbent assay, enzyme treatments, and immunoblotting. The antigen cannot be identified as RNP, histone, soluble nuclear protein, nDNA, or ssDNA. It may be a DNA protein complex and preliminary immunoblotting data support the thesis that it may be a multimolecular complex.

[Anti-nDNA antibodies in lupus erythematosus]. / Gli anticorpi anti-nDNA nel lupus eritematoso.

Using the ELISA technique we have tested anti-nDNA antibodies in 79 patients affected with Lupus Erythematosus. The same patients have previously been tested for anti-cardiolipin antibodies. According to the literature, cross inhibition ELISA tests show no cross reactions between these two auto-antibodies families. Patients with highest anti-nDNA antibodies show a production of polyclonal (IgG, IgM, IgA) antinuclear antibodies responsible for a homogeneous pattern detected by indirect immunofluorescence.

Falsely elevated urinary level of vanillylmandelic acid induced by griseofulvin.

A 6-year-old girl with mild hepatitis was found to have an elevated urinary level of vanillylmandelic acid (VMA), but no cause for the elevation was found. The patient was receiving griseofulvin for treatment of tinea capitis, and this drug was suspected of causing a falsely elevated urinary VMA level. Four other patients receiving griseofulvin were also found to have elevated urinary VMA levels. In one patient, urinary VMA level determined by an alternate method was normal.

[Anti-cardiolipin antibodies in lupus erythematosus]. / Gli anticorpi anti-cardiolipina nel lupus eritematoso.

Anti-cardiolipin antibodies (ACA) were investigated in the serum of 79 patients with lupus erythematosus by means of ELISA method. 34 patients (43%) had ACA in their serum. 63.6% of the patients with ACA had 4 or more ARA criteria and 75% of them had malar rash. None of our patients had the "anti-cardiolipin antibodies syndrome" but three of them with thrombocytopenia had ACA.