The Use of Over-the-Counter (OTC) Skin-Lightening Agents and Their Side Effects Among the Residents of Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: Over-the-counter (OTC) skin-lightening agents are topical products in the form of lotions, creams, oils, soaps, and serums designed to alter skin pigmentation primarily for cosmetic purposes. The growing misuse and overuse of these products has become a serious public health concern due to their potential adverse effects on human health and their quality of life. METHODS: This study was cross-sectional in nature, adopting a convenience sampling technique utilizing data from a sample of 408 residents of Arar, Northern Saudi Arabia. The participants completed online questionnaires, distributed through social media means like Telegram, WhatsApp, and Facebook ensuring anonymity. Data was analyzed using SPSS Version 27 to obtain important insights. RESULTS: The sample of the study had a predominance of females 304 (74.5%) while only 104 (25.5%) were males. A substantial proportion of 170 (41.7%) of the participants were aged between 20 and 35 years with more than half (229 (56.2%)) being single and the majority (266 (65.2%)) having university and above level of education. More than half (259 (63.5%)) of them indicated that they had bought skin-lightening products without a doctor's prescription. Twenty-eight (10.8%) of the participants had been diagnosed with a condition that increased skin pigmentation before with a substantial proportion (11 (39.3%)) noting that the product contained hydroquinone cream ingredients. The overall prevalence of OTC skin-lightening agents among the participants of Arar, Northern Saudi Arabia was 63.5% (259/408). The study found a significantly high prevalence of use of OTC skin-lightening agents among participants aged 20-35 years (87 (71.3%)) (p=0.031) as well as those who had a university level of education and above (129 (71.3%)) (p=0.001). The findings show that 39 (40.6%) of the female respondents and eight (30.8%) of the male participants experienced adverse effects associated with irritation and redness. CONCLUSION: Overall, the study found a considerably high prevalence of the use of OTC skin-lightening agents among the participants of Arar, Northern Saudi Arabia. The use of OTC skin-lightening agents was significantly greater among female participants than male participants. The commonly used products contained hydroquinone cream ingredients, which presented adverse effects and complications associated with irritation, redness, and darkening of the skin. It is imperative to launch targeted public awareness campaigns to educate the community, especially women, about the risks associated with OTC skin-lightening agents, promote safer alternatives, and advocate for stricter regulation and control over the sale and distribution of skin-lightening products containing harmful ingredients.

A 3D printed tensile testing system for micro-scale specimens.

Mechanical property characterization of micro-scale material systems, such as free-standing films or small diameter wires (<20 µm), often requires expensive, specialized test systems. Conventional tensile test systems are usually designed for millimeter scale specimens with the force sensing capability of >1N while microdevice-based testers are intended for micro-/nano-scale specimens operating within a much smaller force range of <10 mN. This disparity leaves a technology gap in reliable and cost-effective characterization methods for specimens at the intermediate scale. In this research, we introduce the cost-effective and all-in-one tensile testing system with a built-in force sensor, self-aligning mechanisms, and loading frames. Owing to the advantages of 3D printing technologies, the ranges of force measurement (0.001-1 N) and displacement (up to tens of millimeters) of our 3D printed tensile tester can be readily tailored to suit specific material dimension and types. We have conducted a finite element simulation to identify the potential sources of the measurement error during tensile testing and addressed the dominant errors by simply modifying the dimension/design of the loading frames. As a proof-of-concept demonstration, we have characterized fine copper (Cu) wires with 10-25 µm diameters by the 3D printed tensile tester and confirmed that the measured mechanical properties match with the known values of bulk Cu. Our work shows that the proposed 3D printed tensile testing system offers a cost-efficient and easily accessible testing method for accurate mechanical characterization of specimens with cross-sectional dimensions of the order of tens of micrometers.

In-Process Orbiting Laser-Assisted Technique for the Surface Finish in Material Extrusion-Based 3D Printing.

Material extrusion-based polymer 3D printing, one of the most commonly used additive manufacturing processes for thermoplastics and composites, has drawn extensive attention due to its capability and cost effectiveness. However, the low surface finish quality of the printed parts remains a drawback due to the nature of stacking successive layers along one direction and the nature of rastering of the extruded tracks of material. In this work, an in-process thermal radiation-assisted, surface reflow method is demonstrated that significantly improves the surface finish of the sidewalls of printed parts. It is observed that the surface finish of the printed part is drastically improved for both flat and curved surfaces. The effect of surface reflow on roughness reduction was characterized using optical profilometry and scanning electron microscopy (SEM), while the local heated spot temperature was quantified using a thermal camera.

[Pseudotumoral sublingual leishmaniasis caused by Leishmaniainfantum]. / Leishmaniose sublinguale pseudotumorale à Leishmaniainfantum.

INTRODUCTION: Mucosal leishmaniasis is endemic in certain parts of Latin America and are usually absent in Morocco. Herein we report a case of Leishmaniainfantum in a Moroccan patient. PATIENTS AND METHODS: A 61-year-old male patient working as a tourist bus driver presented with a sublingual endobuccal tumor. He reported a history of treated cutaneous leishmaniasis of the lower lip in 2009 and had presented the sublingual oral tumor since December 2011. The histopathological findings as well as the species-specific PCR analysis confirmed the diagnosis of sublingual mucosal leishmaniasis due to L. infantum. HIV serology was negative. Our patient was then treated with intra-muscular meglumine antimoniate for 25 days, resulting in complete disappearance of the oral lesion. CONCLUSION: Our case thus has several peculiarities: the strictly mucosal character of the lesion, occurring in an immunocompetent subject, the unusual pseudotumoral form, and the causative agent, L. infantum, not known for its mucosal tropism in our country.

[Pediatric cutaneous leishmaniasis in Morocco: Clinical and epidemiological features]. / La leishmaniose cutanée de l'enfant au Maroc : particularités cliniques et épidémiologiques.

INTRODUCTION: Cutaneous leishmaniasis (CL) is a parasitic disease caused by a flagellate protozoa of the genus Leishmania and is a public health problem throughout the world. In Morocco, CL may be sporadic or endemic depending on the species of Leishmania and the region involved. Casablanca is a non-endemic city but many children with CL come from elsewhere in the country. The aim of our study is to describe the clinical and epidemiological particularities of CL diagnosed in children at the Casablanca University Hospital. MATERIALS AND METHODS: A cross-sectional study was conducted between 2010 and 2016. All patients with one or more skin lesions suggestive of CL underwent parasitological and molecular investigation. Epidemiological and clinical data from patients with positive genotyping were collected and analyzed. A comparative study was made of epidemiological and clinical variables between children and adults and between different species found in children. RESULTS: One hundred and six cases of CL were diagnosed, of which 40 in children (37.7%): 29 due to L. tropica (72.5%), 7 due to L. major (17.5%), and 4 due to L. infantum (10%). CL caused by L. tropica was significantly associated with children (P=0.009) and was distinguished by the predominance of the nodular form (P=0.04) and a facial location (P=0.007). Compared to adults, childhood CL lesions were characterized by their small size (P=0.001) and facial location (P=0.003). Children were treated mainly with pentavalent antimonials, with good safety and clinical response. CONCLUSION: In our series, CL due to L. tropica was predominant in children, reflecting the epidemic nature and wide geographical distribution of this species in Morocco. CL due to L. tropica was significantly associated with facial location and nodular form in children.

[Cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa]. / Leishmaniose cutanée du vermillon avec atteinte muqueuse de la lèvre supérieure.

BACKGROUND: Cutaneous leishmaniasis is endemic in Morocco. Mucosal involvement is rare. We report a case in Morocco of cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa due to Leishmania tropica. PATIENTS AND METHODS: A 15-year-old girl was seen with 2 ulcerated lesions, present for 4 months, situated on the left cheek and vermilion border and extending to the oral mucosa. The diagnosis of leishmaniasis was confirmed by direct examination revealing high numbers of Leishmania amastigotes. Culture of the offending organism in NNN medium and isoenzymatic characterization resulted in identification of L. tropica. Treatment with meglumine antimoniate (Glucantime) was ineffective. The outcome was good after treatment with fluconazole. CONCLUSION: In Morocco, cutaneous leishmaniasis with mucosal involvement is rare, and usually develops as a complication of cutaneous leishmaniasis via direct extension.

Comparison of PCR-based methods for the diagnosis of cutaneous leishmaniasis in two different epidemiological scenarios: Spain and Morocco.

BACKGROUND: Cutaneous leishmaniasis (CL) is a disfiguring and stigmatising disease occurring in more than 70 countries across the world including Spain and Morocco. The use of sensitive tests that can differentiate Leishmania species is advised. OBJECTIVE: To evaluate the influence of the epidemiological scenario on the reliability of the PCR techniques and contribute to the selection of the most efficient one for CL diagnosis. METHODS: The sensitivities of parasitological methods and four PCRs were compared in cutaneous samples from 77 patients from Spanish (PSH) and Moroccan hospitals (PMH). Exudates and fresh or paraffin-embedded tissue biopsies were used. RESULTS: None of the PCRs used in this study allowed the diagnosis of all CL cases, showing also some drawbacks. Lmj4/Uni21-PCR displayed the best sensitivity with PMH, but it did not provide positive results in PSH with CL confirmed by other PCRs. Conversely, JW13/JW14-PCR and L. infantum-PCR-ELISA displayed good sensitivities with PSH that were not achieved with PMH. Nested-ITS-1-PCR did not show enough sensitivity with paraffin-embedded tissue biopsies. False-negative results were obtained in 19% of PSH due to unspecific hybridizations of ITS-1 primers with human chromosome1. CONCLUSIONS: PCR should be routinely used in patients with cutaneous lesions compatible with CL and furthermore, the combination of two PCR techniques is advisable. The selection of these PCRs will be influenced by the epidemiological scenario: In areas where L. infantum is endemic, the use of the PCR-ELISA joint with JW13/JW14-PCR seems an appropriate choice, whereas in areas such as Morocco, Lmj4/Uni21 and ITS-1 provide satisfactory results.

Increased systemic low-grade inflammation in high altitude native rats mediated by adrenergic receptors.

OBJECTIVE: To compare the serum levels of inflammatory mediators in high altitude (HA) native rats, and to search for the possible underlying mechanism(s). METHODS: The study was carried out between January and April 2013. Fifty male rats from the same genetic pool were bred at either a HA or low altitude (LA) area. The study was carried out in 2 stages. In the first stage, serum levels of inflammatory markers, adhesive molecules, lipid profiles, catecholamines, magnesium (Mg+2), and lipid peroxidation were compared between theses 2 groups. In the second stages, inflammatory response and lipid peroxidation were analyzed in HA native rats after treatment with either alpha (Prazosin) or beta (propranolol) adrenergic blockage. RESULTS: The HA native rats showed significant increases in the serum levels of inflammatory cytokines, lipid profiles, as well as a significant increase in the urinary norepinephrine with a concomitant decrease in the serum levels of Mg+2 and increased lipid peroxidation. Blockage of the beta and alpha adrenergic receptors of the HA rats caused partial or complete decreases in both inflammatory and oxidative stress mediators. CONCLUSION: Living under HA conditions results in an increased systemic inflammatory reaction; an effect that is mediated through the sympathetic nervous system mainly via alpha-adrenergic receptors and could be attributed to low Mg+2 levels.

Resveratrol reverses cadmium chloride-induced testicular damage and subfertility by downregulating p53 and Bax and upregulating gonadotropins and Bcl-2 gene expression.

This study was performed to investigate the protective and therapeutic effects of resveratrol (RES) against CdCl2-induced toxicity in rat testes. Seven experimental groups of adult male rats were formulated as follows: A) controls+NS, B) control+vehicle (saline solution of hydroxypropyl cyclodextrin), C) RES treated, D) CdCl2+NS, E) CdCl2+vehicle, F) RES followed by CdCl2 and M) CdCl2 followed by RES. At the end of the protocol, serum levels of FSH, LH and testosterone were measured in all groups, and testicular levels of TBARS and superoxide dismutase (SOD) activity were measured. Epididymal semen analysis was performed, and testicular expression of Bcl-2, p53 and Bax was assessed by RT-PCR. Also, histopathological changes of the testes were examined microscopically. Administration of RES before or after cadmium chloride in rats improved semen parameters including count, motility, daily sperm production and morphology, increased serum concentrations of gonadotropins and testosterone, decreased testicular lipid peroxidation and increased SOD activity. RES not only attenuated cadmium chloride-induced testicular histopathology but was also able to protect against the onset of cadmium chloride testicular toxicity. Cadmium chloride downregulated the anti-apoptotic gene Bcl2 and upregulated the expression of pro-apoptotic genes p53 and Bax. Resveratrol protected against and partially reversed cadmium chloride testicular toxicity via upregulation of Bcl2 and downregulation of p53 and Bax gene expression. The antioxidant activity of RES protects against cadmium chloride testicular toxicity and partially reverses its effect via upregulation of BCl2 and downregulation of p53 and Bax expression.

Cutaneous leishmaniasis caused by Leishmania major in morocco: still a topical question.

In the past decade in Morocco, there has been a reactivation of zoonotic cutaneous leishmaniasis (ZCL) foci with an unusual long outbreak episode. The aims of this review article were to update our knowledge of this disease in Morocco, to compare the situation with that prevailing in the other countries of the Maghreb region and to highlight factors that could be responsible for the current situation. The data indicate a global increase of ZCL incidence in the other Maghreb countries. Several factors could be influencing this increase but most of them will depend on human activities. On the other hand, ZCL is particularly sensitive to climate changes acting on the vector and the reservoir. An analysis of prevention strategies against the disease in Morocco and the other Maghreb countries highlights the need for integrated regional control measures in all the countries of the region.

Cutaneous leishmaniasis caused by Leishmania major in Morocco: still a topical question

In the past decade in Morocco, there has been a reactivation of zoonotic cutaneous leishmaniasis [ZCL] foci with an unusual long outbreak episode. The aims of this review article were to update our knowledge of this disease in Morocco, to compare the situation with that prevailing in the other countries of the Maghreb region and to highlight factors that could be responsible for the current situation. The data indicate a global increase of ZCL incidence in the other Maghreb countries. Several factors could be influencing this increase but most of them will depend on human activities. On the other hand, ZCL is particularly sensitive to climate changes acting on the vector and the reservoir. An analysis of prevention strategies against the disease in Morocco and the other Maghreb countries highlights the need for integrated regional control measures in all the countries of the region

[Unusual clinical presentation of cutaneous leishmaniasis in three diabetic patients]. / Leishmanioses cutanées d'aspect clinique inhabituel chez trois patients diabétiques.

INTRODUCTION: Cutaneous leishmaniasis (CL) is a parasitic infection characterized by significant clinical variability. Unusual and atypical clinical aspects of infection have been reported in immunodeficient patients or associated with particular parasite species. We report three cases of CL from foci of Leishmania major with a particular clinical presentation in diabetic patients. OBSERVATIONS: Patient 1: a 37-year-old man was admitted to the dermatology department for cutaneous vegetative ulcers spreading to the dorsal surface of the foot. History-taking revealed a stay in Er-Rachidia (East of Morocco, a known focus of CL L. major) six weeks earlier. Diabetes mellitus type I was discovered during hospitalization. The patient's 43-year-old sister (patient 2), diabetic for 6 years, consulted for a single leg ulcer appearing 3 months after the same trip to Er-Rachidia. Patient 3: a 61-year-old patient with a 7-year history of diabetes and under oral antidiabetics presented an extended vegetative lesion of the posterior surface of the leg 2 months after staying in Er-Rachidia. A diagnosis of CL was retained on the basis of epidemiology and history (living in an endemic areas of leishmaniasis), coupled in patients 1 and 3 with microbiological evidence involving identification of Leishmania bodies in skin smears or skin biopsies. All patients were treated with two intra-lesional injections per week of meglumine antimony (Glucantime(®)) for 6 weeks. The outcome was marked in all cases by healing of lesions and persistent pigmented scarring. DISCUSSION: We described three particular clinical aspect of CL emerging from a known focus of L. major, where infection is classically associated with vegetative or ulcero-vegetative lesions. This unusual profile suggests the role of factors related to parasite species and/or diabetes found in our three patients.

Analysis of flunarizine in the presence of some of its degradation products using micellar liquid chromatography (MLC) or microemulsion liquid chromatography (MELC)--application to dosage forms.

The separation of flunarizine hydrochloride (FLZ) and five of its degradation products--1-[bis(4-fluorophenyl)methyl]-4-(3-phenyl-2-propenyl)piperazine, 4-oxide (A), bis(4-fluorophenyl)methanone (B), bis(4-fluorophenyl)methanol (C), 1-(3-phenyl-2-propenyl)piperazine(D), and 1-[bis-4-fluorophenyl) methyl] piperazine (E)--could be accomplished by reversed phase liquid chromatography using either micellar or microemulsion mobile phases. Cyanopropyl-bonded stationary phase has been used with UV detection at 254 nm. Microemulsion mobile phase consisting of 0.15 M SDS, 10% n-propanol, 1% n-octanol, and 0.3% triethylamine in 0.02 M phosphoric acid of pH 7.0, has been used for the separation of FLZ and its degradation products (B, C, D, and E). Micellar mobile phases consisting of 0.15 M sodium dodecyl sulphate (SDS), 10% n-propanol, 0.3% triethylamine (TEA) in 0.02 M phosphoric acid of pH values either 4.0 or 6.8 have been used for the separation of FLZ from its degradation products, i.e. either from (B, C, D, and E) or from (A, B, C, and D), respectively. Micellar liquid chromatography (MLC) was applied to the determination of FLZ in pure form as well as in dosage forms; the calibration graph was linear over the concentration range of 0.15-50 microg/mL with detection limit of 0.02 microg/mL (4.19 x 10(-8)M).

[Leishmania tropica cutaneous leishmaniasis in an emerging focus in North Morocco: new clinical forms]. / Leishmaniose cutanée à Leishmania tropica dans un foyer émergent au nord du Maroc: nouvelles formes cliniques.

INTRODUCTION: Leishmania tropica cutaneous leishmaniasis is usually described as dry, small and self-healing lesions, mainly located on the face and occurring in stable endemic foci. In 1989, similar aspects were observed in a rural hypoendemic focus in center Morocco where about 60 cases were diagnosed. In contrast, an epidemic urban focus in Taza-North Morocco--was identified in 1995 with peculiar clinical aspects. Our objectives is to describe these clinical characteristics. PATIENTS AND METHODS: From October 1995 to November 1996, 132 cases were diagnosed from this new focus during a monthly active survey. Age, sex, duration of lesions, clinical aspects and therapeutic regimen were detailed for each patient. RESULTS: Among the patients, 56.8 p. 100 were women. Mean age was 24.6 +/- 21.5 years (range: 8 months to 85 years). The mean duration of lesions was 6.9 +/- 6.5 months and 91.4 p. 100 evoluted for less than one year. Impetiginized, ulcerocrusted and noduloulcerative forms were predominant (61 p. 100). Furthermore, severe, vegetant inflammatory and multiple lesions were observed in infants and elderly patients. Limbs were involved in 30 p. 100 of cases. Eighty-six patients were treated with intralesional glucantime regimen and cured in 72 p. 100 of cases. Intramuscular treatment by glucantime was required in case of multiple lesions and failure of local therapy. DISCUSSION: In this study, the high frequency of severe lesions in infants and elderly patients suggests that the introduction of the parasite occurred recently in this area. The brief duration of lesions confirms the acute character for cutaneous leishmaniasis related to L. tropica in this epidemic focus. The host immune status associated with parasite intrinsic factors probably plays a role in these perculiar clinical manifestations.

Immune response against Leishmania antigens in dogs naturally and experimentally infected with Leishmania infantum.

Cell-mediated and humoral immune response in naturally and experimentally infected dogs was studied using crude and pure antigens. Both types of infections induced severe signs of visceral disease, but the symptoms observed in natural infections were more pronounced than in experimental infections. In addition, asymptomatic infections were not observed in experimentally infected animals. Disease evolution in laboratory infections was rapid and an increase in antibody titer to crude parasite antigen was correlated with the appearance and aggravation of clinical symptoms. Peripheral blood lymphocyte proliferation to crude antigen and pure gp63 was observed early following experimental infection, but was abolished once the infected dogs began to exhibit clinical signs. A similar pattern was observed in naturally infected dogs. Serum from all patent dogs showed high antibody titers to rK39 in enzyme-linked immunosorbent assays (ELISA), and reacted by western blotting with several antigens, 12 to 120 KDa, including gp63 and gp70. In the case of asymptomatic dogs. antibody titers to crude antigen were low and only a few antigens were identified by western blotting. None of the pure proteins examined, gp63, gp70, and rK39 were recognized by western blotting or ELISA. However, asymptomatic dogs exhibited specific lymphocyte proliferation to both crude antigen and the potential vaccine candidate gp63.

Short report: Leishmania tropica: etiologic agent of a case of canine visceral leishmaniasis in northern Morocco.

The domestic dog has been previously demonstrated to be the reservoir of Leishmania infantum, the etiologic agent of human visceral leishmaniasis around the Mediterranean Basin. It can also be infected with L. tropica, the etiologic agent of anthroponotic cutaneous leishmaniasis in Morocco. We report a canine L. tropica visceral infection for the first time in Morocco.

Epidemiology of human visceral leishmaniasis in Taounate, a northern province of Morocco.

We report the preliminary results of an epidemiological survey carried out in the locality of Ouled Hcein, province of Taounate (North Morocco) around one visceral leishmaniasis infant case. The strain isolated from the child was characterized by three methods as Leishmania infantum and its isoenzyme pattern was indistinguishable from zymodeme MON-1. The human survey in the locality of origin of the index case did not show any additional case and the serology was negative for the whole people sampled. The canine survey showed that the highest seroprevalence of the canine disease was found in the locality of Ouled Hcein (27.1%) when compared to 4 surrounding localities. The entomological survey showed that amongst the demonstrated L. infantum vectors around the Mediterranean Basin, Phlebotomus longicuspis was the predominant species. Furthermore, the survey led to the identification of one female of P. ariasi naturally infected with L. infantum, so this species should be at least one of the vectors of this parasite in this area. Thus, this study confirms that the transmission cycle of L. infantum in North Morocco is similar to the cycle found in the remaining Mediterranean area.

Cutaneous leishmaniasis: an emerging epidemic focus of Leishmania tropica in north Morocco.

Cutaneous leishmaniasis in Morocco occurs mainly in the south and is caused by Leishmania major and L. tropica. In 1995, for the first time, 4 autochthonous cases were confirmed by smear and/or culture from the province of Taza in north Morocco. An active survey revealed 128 more cases. The number had increased gradually since 1994. Most of the cases (86%) came from the suburbs of the city of Taza. All cultured and typed parasites were characterized as L. tropica MON-102. A leishmanin skin test survey among a random sample of the exposed population showed an overall positivity rate of 19.9%, with no correlation with age or gender. The spatial distribution of the cases and skin test positivity, their occurrence in all age groups, the highly variable clinical picture, the severity and large size of lesions in older patients, the slow recovery of some treated patients, and the isoenzymic monomorphism of the parasite, all suggested that cutaneous leishmaniasis caused by L. tropica is an emerging disease in Taza.