Impact of carbimazole combined with vitamin E on testicular injury induced by experimental hyperthyroidism in adult albino rats: oxidative/inflammatory/apoptotic pathways.

Thyroid hormones play essential roles in spermatogenesis, but their effects on infertile males remain poorly understood. This study aimed to evaluate the impact of combining carbimazole (CBZ) with vitamin E (VE) on testicular injury induced by experimental hyperthyroidism in adult albino rats, focusing on oxidative, inflammatory, and apoptotic pathways. In this experimental study, 64 adult male albino Wistar rats were divided into eight groups: Group I (control-untreated), Group II (CBZ-control), Group III (VE-control), Group IV (CBZ + VE-control), Group V (levothyroxine-induced testicular injury), Group VI (levothyroxine + CBZ-treated), Group VII (levothyroxine + VE-treated), and Group VIII (levothyroxine + CBZ + VE-treated). The study was conducted in the Faculty of Medicine, Suez Canal University (Ismailia, Egypt). After cervical decapitation, both testes and epididymis were examined histopathologically and immunohistochemically. Significant differences were observed among groups concerning malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT; all P < 0.001). Polymerase chain reaction analysis showed significant differences in tumor necrosis factor-α (TNF- α ), interleukin-10 (IL-10), Bcl-2-associated X protein (BAX), B-cell lymphoma 2 protein (Bcl2), p53, Caspase-3, Caspase-8, Caspase-9, and nuclear factor-kappa B (NF- κ B) mRNA levels (all P < 0.001). Hyperthyroid group treated with CBZ alone (Group VI) exhibited testicular side effects, affecting seminiferous tubules and spermatogenesis. However, the Group VIII showed improved spermatogenesis and a decrease in testicular side effects. The addition of VE to the treatment of hyperthyroid rats with CBZ reduced testicular side effects and seminiferous tubular affection when potentially improving spermatogenesis. Further research is needed to elucidate the underlying mechanisms fully.

Effectiveness and safety of topical application of diphenylcyclopropenone versus podophyllin in treatment of genital warts.

BACKGROUND: Many therapeutic modalities are available for treating genital warts; however, the effectiveness of both diphenylcyclopropenone and podophyllin is still controversial. AIM: To evaluate the effectiveness and safety of diphenylcyclopropenone and podophyllin in treating genital warts. METHODS: This study included 57 patients, divided randomly into two groups. Group (A): diphenylcyclopropenone (n = 29). Group (B): podophyllin 25% (n = 28). In group (A), sensitization was done with 2% diphenylcyclopropenone. Then, after 1 or 2 weeks, treatment started with a weekly application of diphenylcyclopropenone solutions ranging between 0.001 and 1% until clearance, or for a maximum of 10 sessions. In group (B), podophyllin 25% was applied weekly until clearance or for a maximum of 6 weeks. RESULTS: Higher clearance was achieved in group A, with 19 of 29 (65.5%) patients, than in group B, with 9 of 28 (32.1%) (p-value = 0.004). Also, effectiveness increases with young age in group A. Shorter wart duration was associated with better response in both groups (p-value = 0.005). No serious adverse effects occurred in either group. No recurrence was detected in group A, while seven patients (77.8%) had recurrence in group B after 1 year of follow up. CONCLUSION: Diphenylcyclopropenone shows a higher success rate than podophyllin in treating genital warts and a lower recurrence rate.

Intralesional injection of purified protein derivative versus Candida antigen in treatment of genital warts.

The Genital warts are common sexually transmitted diseases caused by definite types of human papillomavirus. There are many strategies for the treatment of genital wart and intralesional immunotherapy is considered to be a safe and effective treatment modality. However, there are lack of studies that comparing the clinical effectiveness of intralesional purified protein derivative (PPD) and Candida antigen (CA) in genital wart treatment. To investigate the effectiveness and safety of PPD and CA in the treatment of genital warts. Eighty patients were enrolled in this study and were randomly divided into 2 groups with 40 patients in each. Each antigen was injected intralesionally at a dose of 0.1 ml into the largest wart every 2 weeks until complete improvement or for a maximum of four sessions. Complete clinical response was demonstrated in 65%, 62.5% in PPD and CA groups, respectively. There was no statistically difference between both groups. After the 3-month follow-up period, 72.5%, 85% of patients showed complete clearance in PPD and CA groups respectively. Side effects were mild and insignificant in both groups. Recurrence was observed in only one patient in each group. Immunotherapy by intralesional PPD and CA injection is considered to be effective and well-tolerated modalities in treatment of genital wart with minimal side effects and recurrence rate compared to other modalities.

Interleukin 38 serum level is increased in patients with vitiligo, correlated with disease severity, and associated with signs of disease activity.

BACKGROUND: Vitiligo is an acquired cutaneous depigmenting disease caused by a T helper (Th) 1-cytotoxic T cells driven autoimmune attack against melanocytes, in which Th17 is also involved. Interleukin (IL)-38 belongs to the IL-1 family of cytokines and suppresses Th1 and Th17 activation. IL-38 protein and mRNA levels have been found to be elevated in various autoimmune disorders and correlated with disease severity and activity, including psoriasis, systemic sclerosis, rheumatoid arthritis, and atopic dermatitis. No previous studies have been performed to investigate the expression of IL-38 in patients with vitiligo. AIM: To evaluate IL-38 serum level in patients with vitiligo compared to healthy controls (Hcs) and examine the association between IL-38 level and severity and activity of vitiligo. PATIENTS AND METHODS: The study comprised 21 patients with vitiligo and 21 Hcs. Vitiligo severity and activity were evaluated via Vitiligo Extent Score (VES) and Vitiligo Disease Activity (VIDA) Score, respectively. IL-38 serum level was evaluated by enzyme-linked immunosorbent assay. RESULTS: Vitiligo patients had significantly higher serum level of IL-38 than Hcs (p < 0.001). This level was significantly higher among patients with signs of vitiligo activity (p = 0.048), correlated positively with VES (p < 0.001), and correlated negatively with the age of patients (p = 0.001) and the age of disease onset (p = 0.022). CONCLUSION: IL-38 serum level was higher in patients with vitiligo than in Hcs and was related to vitiligo severity and signs of activity.

Efficacy and tolerability of using platelet-rich plasma versus chemical peeling in periorbital hyperpigmentation.

BACKGROUND: Various therapeutic modalities for periorbital hyperpigmentation (POH) have been proposed. OBJECTIVE: This study was designed to compare the efficacy and tolerability of autologous platelet-rich plasma (PRP) and chemical peeling in POH. SUBJECTS AND METHODS: Forty-two patients were enrolled in this study and randomly subdivided into two groups. Group A patients were assigned to receive four sessions of chemical peeling using trichloroacetic acid and lactic acid, while group B was assigned to patients who received four sessions of PRP injection with 2 weeks of intervals. Patients were assessed by digital photographs. The degree of improvement included four degrees from poor to excellent, and side effects were reported. RESULTS: Females constituted 38 out of 42 patients (mean age, 28.14 ± 3.47 years). There was a significant improvement in favor of chemical peeling over PRP. Good improvement occurred in 47.6% in the group A versus 4.8% in group B (P < 0.001). None of the PRP group had excellent improvement, while 38% of chemical peeling group did. Most of group A patients reported very pleased (47.6%) to excellent (38%) degree, in contrast to group B where 52.5% were just pleased (P < 0.001). Some of group A patients experienced itching (14.3%) and redness (14.3%), while in group B, they experienced pain (23.8%) and edema (14.3%) with nonsignificant difference between both groups (P = 0.07). CONCLUSIONS: Both PRP and chemical peeling are effective for treatment of POH; however, chemical peeling is much more effective, tolerable, and satisfying procedure than PRP.

Female Genital Dialogues: Female Genital Self-Image, Sexual Dysfunction, and Quality of Life in Patients With Vitiligo With and Without Genital Affection.

Vitiligo has a major effect on sexual health because of the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not explored. This article aimed to assess the effect of vitiligo on genital self-image, sexual function, and quality of life in female patients. This cross-sectional study included 50 sexually active women with vitiligo and 25 women without vitiligo. All participants subjected to full history taking and examination. Extent of vitiligo was assessed with the Vitiligo Area Scoring Index score, sexual function with the Female Sexual Function Index, genital self-image with Female Genital Self-Image Score and quality of life with the Dermatology Life Quality Index questionnaires. The main outcome measures were correlation between Vitiligo Area Scoring Index, Female Genital Self-Image Score, Female Sexual Function Index, and Dermatology Life Quality Index domains was determined using t test and Pearson correlation. This study revealed a negative correlation between the Vitiligo Area Scoring Index score and sexual satisfaction. Vitiligo Area Scoring Index and Dermatology Life Quality Index score was significantly correlated with Arabic Version of the Female Genital Self-Image Score alone and with Arabic Version of the Female Sexual Functioning Index alone and with both the Arabic Version of the Female Genital Self-Image Score and the Arabic Version of the Female Sexual Functioning Index (p <.05). Sexual and psychological assessment of patients with vitiligo is imperative to improve outcomes and increase patients' compliance with treatment.

Carbon dioxide laser plus topical 5-fluorouracil: a new combination therapeutic modality for acral vitiligo.

BACKGROUND: Acral vitiligo (AV) is resistant to treatment. AIM: To evaluate efficacy and safety of combining carbon dioxide (CO2) laser and 5-fluorouracil (5FU) in treating AV. METHODS: This study included 68 adult patients with AV. After randomly assigning patients into 3 groups, patients in group I were treated using 5FU, group II were treated using CO2 laser, and group III were treated using CO2 laser followed by 5FU for a maximum period of 5 months. The lesions were then evaluated both qualitatively and quantitatively. RESULTS: Almost half (49.8%) of the lesions in group III achieved G4, and 6.1% of lesions achieved G3 re-pigmentation. This response was statistically significantly higher than that in the other two groups. This was not achieved in periungual areas in the hands and feet. The pain was tolerable during sessions or at sites of 5FU application. Transient hyperpigmentation, brownish spot on nail plates, itching, and infection were temporary side effects; however, Koebnerization was not detected. CONCLUSION: We concluded that prior use of CO2 laser skin ablation, followed by 5FU application for AV is a safe and tolerable technique that improves the outcome and increases patient compliance.

Female genital mutilation/cutting: will it continue?

INTRODUCTION: Female genital mutilation/cutting (FGM/C) is a prevalent, deeply rooted traditional practice in Egypt. AIMS: Specification of the motives behind the continuation of FGM/C in Egyptian community and evaluation of the sexual function in women with FGM/C. METHODS: This cross-sectional study, involved 2,106 sexually active female participants with FGM/C. Full history-taking and general examination to evaluate the type of FGM/C were conducted. Sexual function was assessed by using the Female Sexual Function Index (FSFI) questionnaire. MAIN OUTCOME MEASURES: Enumerate and specify the motivational factors and its percent among the participants. The correlation between FGM/C and FSFI domain scores was done with Pearson's correlation. RESULTS: Tradition, cleanliness, and virginity were the most common motives empowering the continuation of FGM/C (100%), followed by men's wish, esthetic factors, marriage, and religion factors (45.2-100%). Type I FGM/C was the most common, followed by type II. There was only negative correlation between the type II FGM/C and sexual satisfaction. No statistically significant difference between type I and non-FGM/C was found. CONCLUSIONS: FGM/C remains high. A variety of socio-cultural myths, religious misbelievers, and hygienic and esthetic concerns were behind the FGM/C. Overall, a large proportion of the participants supported the continuation of FGM/C in spite of adverse effect and sexual dysfunction associated with FGM/C.

Assessment of female sexual function in patients with psoriasis.

INTRODUCTION: Psoriasis has a major impact on sexual health due to the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not been fully explored. AIM: The study aims to assess sexual function in female patients with psoriasis. METHODS: This cross-sectional study included 52 sexually active female patients with psoriasis regardless of their age (group I) and 30 normal volunteers (who were age matched with the patients) who served as a control group (group II). Full history taking, general and systemic examination, including sexual history, together with clinical examination to evaluate the extent of skin disease using Psoriasis Assessment Severity Index (PASI) score and evaluation of sexual function using the Female Sexual Function Index (FSFI) Questionnaire, were done for all the subjects enrolled in the study. MAIN OUTCOME MEASURES: Correlation between PASI and FSFI domain scores was determined in matched groups using Pearson correlation. RESULTS: This study revealed a negative correlation between the PASI score and the overall sexual satisfaction in the studied group. Also, psoriatic female patients with genital psoriasis have more significantly impaired sexual function compared with either those without genital lesions or those with lesions elsewhere in the body. CONCLUSIONS: It is imperative to do full sexual and psychological assessment of psoriatic patients to improve outcomes and increase patients' compliance with treatment.

Lymphangiogenesis and angiogenesis in non-phymatous rosacea.

BACKGROUND: Our study evaluated the expression of vascular endothelial growth factor (VEGF), CD31 and D2-40 in involved and uninvolved skin of 18 patients with rosacea. METHODS: Immunostaining of facial skin specimens with VEGF, CD31 and D2-40 was compared between the lesional and the non-lesional skin of patients with erythemotelangiectatic and papulopustular rosacea. RESULTS: Significantly increased dermal expression of VEGF in lesional vs. non-lesional skin (88.9% and 55.6%) was observed. Dermal expression of CD31 and D2-40 was also increased in lesional vs. non-lesional skin. There was no statistically significant difference in cutaneous expression of VEGF, CD31 and D2-40 between patients with papulopustular and erythemotelangiectatic rosacea, and no correlation was found between disease duration and immunoreactivity of VEGF, CD31or D2-40. CONCLUSIONS: Our study showed marked immunostaining of lesional skin with VEGF, CD31 and D2-40 compared with non-lesional skin. Increased immunoreactivity of D2-40 in lesional skin is interesting, given that none of the patients had facial edema. There are no published data regarding the role of lymphangiogenesis in patients with non-phymatous rosacea; thus, our study represents a new understanding of its pathogenesis. Lack of correlation between D2-40 expression and disease duration suggests that lymphatics are involved early in the pathogenesis of rosacea and do not constitute a late event.

Sexual function in female patients with unstable angina or non-ST-elevation myocardial infarction.

INTRODUCTION: Coronary artery disease is the leading cause of death and disability for both women and men. The psychological impact of acute myocardial infarction, as well as the physiological effects of the illness and its medications, can have a major effect on a patient's ability to resume sexual activity. AIM: To assess sexual activity in female patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI), and to study the impact of cardiovascular rehabilitation (CR) on resumption of sexual activity. MAIN OUTCOME MEASURES: Doppler-echocardiographic study, exercise tolerance test (ETT), and assessment of sexual activity. METHODS: This study was conducted in the Riyadh National Hospital and included 35 female patients admitted to the intensive care unit for management of unstable angina or NSTEMI. All patients were enrolled into a CR program. All of them were interviewed for assessment of sexual activity, 12 weeks post discharge. The Arizona Sexual Experience Scale (ASEX) was used for the assessment of the severity of sexual dysfunction for patients who resumed their sexual activity. RESULTS: Results indicate that 48.57% of the patients resumed their sexual activity at the time of the interview. However, most of them were either not satisfied at all with their sexual activity or mostly dissatisfied. The remaining patients (51.43%) had not resumed sex yet. CR was completed by 70.59% of those resuming sex, and 38.89% of those not resuming sex. We estimated that rehabilitated patients were 3.77 times more likely to resume sexual activity than those who did not receive rehabilitation. ASEX score ranged from 19 to 30, with a mean of 24.118 +/- 3.42. CONCLUSION: Unstable angina and NSTEMI have a negative impact on frequency of, and satisfaction with, sexual activity, and lead to sexual dysfunction within a large number of female patients. Accurate and complete sexual instructions for both partners with specific attention paid to the woman's concerns and needs should be part of CR programs.