Association of Higher Defensin ß-4 Genomic Copy Numbers with Behçet's Disease in Iraqi Patients.

OBJECTIVES: Behçet's disease (BD) is an immune-mediated small vessel systemic vasculitis. Human ß-defensins are antimicrobial peptides associated with many inflammatory diseases and are encoded by the ß-defensin family of multiple-copy genes. However, their role in BD necessitates further investigation. The aim of the present study was to investigate the possible association of BD in its various clinical forms with defensin ß-4 (DEFB4) genomic copy numbers. METHODS: This case-control study was conducted from January to September 2011 and included 50 control subjects and 27 unrelated Iraqi BD patients registered at Baghdad Teaching Hospital, Bagdad, Iraq. Copy numbers of the DEFB4 gene were determined using the comparative cycle threshold method by duplex real-time polymerase chain reaction technology at the Department of Dermatology of Jena University Hospital, Jena, Germany. RESULTS: DEFB4 genomic copy numbers were significantly higher in the BD group compared to the control group (P = 0.010). However, no statistically significant association was found between copy numbers and clinical variables within the BD group. CONCLUSION: The DEFB4 copy number polymorphism may be associated with BD; however, it is not associated with different clinical manifestations of the disease.

The therapeutic role of isotretinoin in the management of Behçet's disease: a single-blinded, controlled therapeutic study.

OBJECTIVES: To evaluate the long-term remission efficacy and safety of isotretinoin in the treatment of Behcet's disease (BD). PATIENTS AND METHODS: This single-blind, controlled therapeutic study was conducted in the Department of Dermatology and Venereology at Baghdad Teaching Hospital from February 2011 to January 2012. Thirty patients with BD were included in this work. Each patient received isotretinoin 20 mg orally once daily for 3 months. They were assessed at week 2 and then monthly depending on the Clinical Manifestation Index (CMI) and to record any side effects. At week 12, isotretinoin was stopped and patients were given placebo therapy in a form of glucose capsules for another 3 months. RESULTS: Thirty patients were treated, 14 (46.6%) males and 16 (53.3%) females, with a male to female ratio of 1:1. Their ages ranged from 16 to 64 years (mean +/- standard deviation [SD], 38.4 +/- 10.9 years). During the first 3 months of therapy, the pathergy test, oral pathergy test, and C-reactive protein were significantly minimized. The CMI before isotretinoin therapy ranged between 2 and 8 (mean +/- SD, 4.933 +/- 1.91). After therapy, within the first 14 days, the mean CMI started to decline to a lower level, and it continued to decline significantly until week 12. It then started to increase through week 4 of placebo therapy, but remained statistically significant until the second month of placebo therapy. Isotretinoin therapy also had a statistically significant effect in reducing oral ulcers and skin manifestations. CONCLUSION: Isotretinoin is an effective therapeutic and prophylactic drug in the management of BD.

The therapeutic and prophylactic role of oral zinc sulfate in management of recurrent aphthous stomatitis (ras) in comparison with dapsone.

OBJECTIVE: To evaluate the therapeutic and prophylactic effectiveness of oral zinc sulfate in recurrent aphthous stomatitis (RAS) in comparison with dapsone. METHODS: A double-blind placebo controlled study, conducted in the Department of Dermatology, Baghdad Teaching Hospitals, Baghdad, Iraq between May 2005 and October 2006, in which 45 patients with RAS were recruited and divided into 3 equal groups: group A (on zinc sulfate 150 mg twice daily), group B (on dapsone 50 mg twice daily), and group C (on glucose 250 mg as placebo). The drugs were prepared in identical capsules, and the patients were instructed to take the capsules twice daily after meals (in a double-blind manner). Assessment of each patient was carried out by the Oral Clinical Manifestation Index (OCMI) and the diameter of the ulcers at day 0, day 4, and at the second, fourth, sixth, eighth, tenth, and twelfth weeks of therapy. RESULTS: Forty-five patients were included in the study (25 males and 20 females), and their ages ranged between 16-45 years (mean+/-SD 31.24+/-8.14). In group A, the mean of OCMI and diameter of ulcers improved, with a p=0.0001 for OCMI, and 0.0001 for the diameter for ulcers at the end of the twelfth week of therapy, which was statistically significant. Group B, also showed significant improvement, however, the action was lower and slower (p=0.0001 for OCMI, and 0.001 for the diameter for ulcers). Group C revealed slight non-significant improvement (p=0.028 for OCMI, and 0.034 for the diameter of ulcers). In the sixth week of therapy, zinc sulfate was more effective than dapsone in reducing the OCMI of the ulcers (p=0.007). CONCLUSION: The present study showed that both zinc sulfate and dapsone had significant therapeutic and prophylactic effects in controlling RAS, however, zinc sulfate had much more rapid and sustained action.

Oral zinc sulfate in the treatment of Behcet's disease: a double blind cross-over study.

This was a randomized, controlled, double-blind trial of zinc sulfate in the treatment of Behcet's disease. Patients with Behcet's disease were recruited in this study between November 2001 and February 2003. A clinical manifestations index (CMI) was calculated for each patient. Serum zinc was estimated in all patients both at the beginning and monthly throughout the trial. Serum zinc levels were estimated from 30 healthy normal subjects matched for age and sex as a control group. Patients were randomly allocated to receive either 100 mg zinc sulfate or identical placebo tablet three times daily in a double-blind manner. After 3 months of starting treatment, patients were crossed over, that is, patients on placebo received zinc sulfate and vice versa. Mean serum zinc level in Behcet's disease patients was statistically significantly lower than mean serum zinc levels in healthy the control. In group A (started with zinc sulfate), the mean CMI started to decline directly after the first month of therapy with zinc sulfate to significantly lower levels. After shifting to placebo treatment in the fourth month, the mean of CMI started to rise again gradually but remained significantly lower than levels before therapy for the fourth and fifth months. In group B (started with placebo), the mean of CMI remained high for the first 3 months. After crossing over to zinc sulfate in the fourth month, the mean of CMI started to decrease after the fourth month. An inverse correlation between CMI and serum zinc level was found. No side-effects were seen in either group. In conclusion, zinc sulfate was found to be a good option in the treatment of Behcet's disease.

Lactic acid 5 percent mouthwash is an effective mode of therapy in treatment of recurrent aphthous ulcerations.

BACKGROUND: Recurrent aphthous ulcerations (RAU) are the most common oral mucosal disease among the general population including in Iraq. There is no uniformly effective therapy for this disease. OBJECTIVE: To evaluate the therapeutic efficacy and safety of 5-percent lactic acid mouthwash in the treatment of patients with recurrent aphthous ulcerations. METHODS: This is a single-blind controlled therapeutic study. We recruited 80 subjects with early-onset oral aphthosis from patients who attended Baghdad Teaching Hospital Department of Dermatology and Venereology in the period between April 2004 and April 2005. Of those subjects, 10 defaulted; the remaining 70 patients were divided into two groups, A and B. Subjects in group A (36 patients) were instructed to use 5-percent lactic acid mouthwash, one teaspoonful three times daily before meals. Subjects in group B (34 patients) were instructed to use placebo (distilled water mouthwash) in a similar way. Assessment of each patient of both groups was done by using oral clinical manifestation index (OCMI) before, after 3 days and after 7 days of therapy. RESULTS: The mean of OCMI in group A started to decline after 3 days of therapy and attained statistically significant lower level after 7 days of therapy (p <0.05). The change in the mean OCMI of group B after 3 and 7 days of therapy was also statistically significant (p <0.05). However, the response rate (percentage of change in the mean) after 3 days of therapy in group A was 63.6 percent and in group B was 8.8 percent, and the response rate after 7 days of therapy in group A was 90.8 percent and in group B was 35.7 percent. The difference in the response rates after 3 and 7 days between groups A and B was statistically significant (p <0.05). No significant side effects were noticed apart from mild irritation in two patients using lactic acid. CONCLUSIONS: Lactic acid 5 percent mouthwash is a new effective mode of therapy for patients with RAU and had significantly reduced the signs and symptoms of the disease, especially when compared with placebo. The mechanism of action may be related to increasing spontaneous secretion of endothelial growth factor from keratinocytes.

Colchicine and benzathine penicillin in the treatment of Behçet disease: a case comparative study.

Behçet disease is a chronic relapsing disease characterized by multiple signs and symptoms such as recurrent orogenital ulceration, eye involvement, skin manifestations, and other systemic involvement. Multiple therapeutic modalities have been used to treat Behçet disease. These agents act through different mechanisms and are associated with a variety of side effects. We performed a case-comparative study to evaluate efficacy of combined colchicine and benzathine penicillin in the treatment and prophylaxis of Behçet disease. Sixty-six patients who fulfilled the international study group criteria for diagnosis of Behçet disease were included. The patients were divided into three groups: group 1 (20 patients) received 1.2 Mu benzathine penicillin injection monthly; group 2 (21 patients) received two tablets of colchicine daily (each tablet contained 0.5 mg); and group 3 (25 patients) received both 1.2 Mu benzathine penicillin injection monthly and two tablets of colchicine daily. Each patient was followed up monthly for 5 months, 4 months on treatment and 1 additional month followup. The clinical manifestation index (CMI), the numerical sum of the clinical features, was calculated for each patient initially and then monthly. Pathergy test was performed for each patient monthly. The CMI was reduced by colchicine and benzathine penicillin treatment, and the reduction was highly significant. The reduction in the CMI remains satisfactory and good for 1 month after stopping the treatment. When each colchicine and benzathine Penicillin are used alone the index is also reduced significantly, but this reduction is much less than when both drugs are used together and there is also rapid and earlier relapse. Based on our findings, the combination of colchicine and benzathine penicillin appears to be of greater efficacy in the treatment of Behçet disease than the use of either drug alone.