Impact of Repetitive Transcranial Magnetic Stimulation on Cognitive and Psychiatric Dysfunction in Patients with Fibromyalgia: A Double-Blinded, Randomized Clinical Trial.

Few randomized controlled trials have reported that repetitive transcranial magnetic stimulation (rTMS) has controversial results for managing multiple domains of fibromyalgia-related symptoms. This work aimed to evaluate the effect of low-frequency rTMS over the right dorsolateral prefrontal area (DLPFC) on the Fibromyalgia Impact Questionnaire (FIQ) concerning psychiatric and cognitive disorders. Forty-two eligible patients with fibromyalgia (FM) were randomized to have 20 sessions of active or sham rTMS (1 Hz, 120% of resting motor threshold with a total of 1200 pules/session) over the right DLPFC. All participants were evaluated at baseline, post sessions, and 3 months after sessions with the FIQ, Hamilton depression, and anxiety rating scales (HDRS and HARS), Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning Test (RAVLT), Tower of London test (TOL), the Trail Making, and Digit Span Tests. Both groups showed improvement in most rating scales at 1 and 3 months follow-up, with greater improvement in the active group, with significant correlation between FIQ cognitive rating scales, including RAVLT and TOL. Twenty sessions of low-frequency rTMS over the right DLPFC can improve FIQ scores regarding the psychiatric and cognitive symptoms of medicated patients with FM to a greater extent than sham. Changes in RAVLT and TOL correlated with changes in FIQ results.

Granzyme B Gene Polymorphisms Are Associated With Severe Non-segmental Vitiligo.

Background: Granzyme B (GZMB) gene is related to human immunity and is considered as one of the genes indulged in vitiligo. Objective: To evaluate the association between GZMB (R55Q) and (P94Q) gene polymorphisms with vitiligo development in a sample of vitiligo Egyptian patients. Methods: This study was a case-control study which included 100 non-segmental vitiligo patients as well as a control group consisted of 100 healthy, sex and age matched vitiligo free individuals. The polymorphism of GZMB gene at (R55Q) and (P94A) were analyzed by polymerase chain reaction. Results: P94Q and R55Q gene polymorphisms were significantly associated with higher VASI scores. Conclusion: GZMB (Q55R) and P94A) gene polymorphisms are associated with the susceptibility to develop vitiligo in the Egyptian population and could help predicting more extensive forms of the disease.

Could α MSH-MIFT Axis and IDH2 be Considered Promising Predictors of Non-segmental Vitiligo Response to NB-UVB Phototherapy?

Background: The search for objective factors that help in predicting the response of vitiligo treatment is very important. Objective: We sought to evaluate the effect of NB-UVB phototherapy on both the alpha melanocyte stimulating hormone-microphthalmia-associated transcription factor (α-MSH-MIFT) axis, and isocitrate dehydrogenase 2 (IDH2) in non-segmental vitiligo (NSV). Methods: This prospective clinical trial included 50 NSV patients and 50 healthy control subjects. α-MSH tissue levels as well as MITF and IDH2 immunostaining were assessed in normal and vitiliginous skin biopsies before treatment and then in the repigmented areas following 24 NB-UVB phototherapy treatment sessions using ELISA technique and immunohistochemical study, respectively. Results: There was a significant negative correlation between baseline VASI scores and the tissue levels of α-MSH (p=0.006) and the expression of both MITF (p<0.00001) and IDH-2 (p= 0.001). The mean α-MSH tissue levels increased significantly after treatment (p<0.001). Tissue expression of both MTIF and IDH-2 was significantly upregulated following treatment (P-value <0.001). The percentage of improvement showed a significant positive correlation with the studied markers (p<0.00001). Conclusion: α-MSH- MIFT axis and the antioxidant protein IDH2 are promising objective markers of non-segmental vitiligo severity, and are suggested as predictors of vitiligo response to treatment.

Microbotox injection versus its topical application following microneedling in the treatment of wide facial pores: A split face comparative study.

BACKGROUND: Enlarged facial pores and seborrhea are common cosmetic problems. Mesobotox has been proved to be effective safe therapeutic option. OBJECTIVE: To compare the efficacy and longevity of intradermal mesobotox injection versus its topical application with microneedling for treatment of wide facial pores and seborrhea. MATERIALS AND METHODS: This split face study was conducted on 20 patients with enlarged facial pores and seborrhea. One side of the face was treated with intradermal injection of botulinum toxin, the other was treated with its topical application following microneedling. Patient evaluation was performed after 1 month then after 4 months. CONCLUSION: Microbotox can effectively and safely minimize enlarged facial pores with no downtime. Intradermal injection showed more patient satisfaction on the basis of greater efficacy, longevity of treatment than its topical application following microneedling.

Serum and salivary adipsin levels and its association with insulin resistance in acne vulgaris patients.

BACKGROUND: There is scarcity in literature about the reliability of salivary markers in acne vulgaris. AIMS: The aims were to evaluate the insulin resistance (IR) and adipsin levels in serum and saliva in a sample of acne vulgaris patients; and to correlate IR and adipsin levels with the disease severity. METHODS: This prospective case-control study included 60 acne vulgaris patients (patients Group), in addition, 60 apparently healthy individuals (control group). The severity of acne vulgaris was determined according to Global Acne Grading system (GAGS). Serum and salivary adipsin, fasting glucose, and fasting insulin levels were measured using ELISA kits. RESULTS: Fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in patients group both in serum and saliva were elevated when compared with the control group. Serum and salivary levels of adipsin and Quantitative insulin sensitivity check index (QUIKI) in patients were decreased than the control group. Adipsin serum levels show significant negative correlations with all study variables except QUIKI with which the correlation was positive both in serum and saliva. There was a significant positive correlation between serum and salivary adipsin levels (r = 0.873, p < 0.00001) and serum and salivary fasting glucose (r = 1, p < 0.00001). CONCLUSION: Adipsin could be considered as a promising biomarker for acne vulgaris and its associated insulin resistance. Moreover, the salivary measurements may be considered as useful biomarkers in acne vulgaris patients, but more studies are still required.

Methotrexate Mechanism of Action in Plaque Psoriasis: Something New in the Old View.

Background: Despite the era of biologic therapy in the management of psoriasis, methotrexate, the traditional backbone of psoriasis treatment, does not stop surprising us with what it can offer. Objective: In this study, we aimed to evaluate the peripheral expression and the serum levels of TWEAK in patients with psoriasis vulgaris before and after receiving methotrexate treatment. Methods: The study included 58 patients with moderate to severe psoriasis vulgaris, and 90 apparently healthy individuals as a control group. Before starting the treatment course, all patients were evaluated clinically using Psoriasis Area Severity Index (PASI) score and were subjected to TWEAK serum levels and peripheral expression measurement using ELISA and qRT-PCR techniques, respectively. After 12 weeks of treatment with methotrexate (intramuscular methotrexate; up to 30mg per week) the patients were re-evaluated both clinically and in the laboratory. Results: The baseline serum TWEAK levels and its peripheral mRNA expression in the patients group were significantly lower than those in the control group. After 12 weeks of treatment with methotrexate, the PASI scores were reduced significantly while the serum TWEAK levels and its peripheral expression were significantly elevated. Conclusion: Enhancing TWEAK expression and elevating its serum levels in psoriasis patients seems to be a newly observed mechanism of action of methotrexate.

Q-Switched 1064-nm Nd: YAG laser versus fractional carbon dioxide laser for post acne scarring: A split-face comparative study.

OBJECTIVES: Many treatment modalities are available for post acne scarring. However, the response to the treatment is extremely variable among patients. AIM: The aim of this study was to compare the efficacy and safety of Q-switched Nd: YAG (1064 nm) and fractional CO2 (10,600 nm) lasers in the treatment of atrophic post acne scars. METHODS: This study included 20 patients with atrophic facial post acne scars graded according to Sharquie's score. All subjects received four sessions of laser treatment with a 4-week interval between the sessions. The study was designed as a double-blinded, comparative, split-face study applying Q-switched 1064-nm Nd:YAG laser to the right side of the face and fractional CO2  laser to the left side. RESULTS: Q-switched 1064-nm Nd: YAG laser achieved significantly higher improvement percentage when compared to fractional CO2  lasers (33.33% versus 17.37% Sharquie's score reduction, respectively). There was a significant negative correlation between the percentages of improvement and the patients' age on both sides and a significant positive correlation with the baseline Sharquie scores on both sides. CONCLUSION: Q-Switched 1064-nm Nd: YAG laser could be a promising safe option for the management of atrophic post acne scars.

Factors affecting vitiligo response to treatment: do MiRNA 196a2C/T gene polymorphism and serum tyrosinase levels have any role?

BACKGROUND: Factors contributing to the pathogenesis of vitiligo and factors affecting its response to treatment are still a major area of debate. AIM OF THE WORK: The study aimed to assess the serum levels of tyrosinase and Micro-RNAs (miRNAs) gene polymorphism in a sample of Egyptian vitiligo patients, and to determine factors affecting the response of vitiligo to treatment. SUBJECTS AND METHODS: This prospective case-control interventional study included 212 non-segmental vitiligo patients and 96 control subjects. Before treatment, vitiligo was evaluated using Vitiligo Area Severity Index. Detection of miRNA 196a-2 polymorphism was done using PCR-REELP and serum tyrosinase was measured using ELISA. After treatment, patients were reevaluated clinically and serum tyrosinase levels were re-measured. RESULTS: The tyrosinase levels were significantly elevated in patients. The TT genotype was the most prevalent one in the patients. The percentage of improvement showed a significant positive correlation with patients' ages and age of the disease onset and a negative correlation with disease duration, baseline VASI scores and serum tyrosinase levels. CONCLUSION: MiRNA 196a-2 C/T (11614913) gene polymorphism and the elevated serum tyrosinase levels might be related to the pathogenesis of vitiligo and may affect its therapeutic response.

Inflammatory markers in acne vulgaris: Saliva as a novel diagnostic fluid.

BACKGROUND: Despite the wide use of saliva-based measurements in inflammatory, autoimmune and neoplastic conditions, its use in dermatology is still limited. AIMS: The aims of this study were to assess the serum and salivary levels of interleukin-1 beta (IL-1ß) and C-reactive protein (CRP) in patients with acne vulgaris. PATIENTS/METHODS: The study included 84 moderate-to-severe acne vulgaris patients, in addition to 105 healthy control subjects. Serum and salivary levels of CRP and IL-1ß were estimated using enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: Using T-test, the serum and salivary levels of both CRP and IL-1ß in the patients were significantly higher than the measured levels in the control subjects (p < 0.001). Using Pearson correlation coefficient, serum and salivary CRP and serum IL-1ß levels showed significantly positive correlation with GAGS scores (p < 0.001). The levels of IL-1ß in saliva did not show significant correlation with GAGS scores or with serum and salivary CRP. CONCLUSIONS: The current study supports the emerging role of saliva as a valid noninvasive tool for monitoring inflammation and as a reliable and stress-free tool to evaluate cytokines and other inflammatory marker levels in acne vulgaris.

Treatment of atrophic acne scars: Topical or intralesional plasma gel?

BACKGROUND: Atrophic post-acne scarring is considered to be a therapeutic challenge. OBJECTIVES: The aim was to compare the safety and efficacy of (A) FCL combined with intradermal injection of plasma gel, (B) FCL combined with topical application of plasma gel, and (C) FCL monotherapy in the treatment of atrophic post-acne scars. METHODS: Thirty patients with facial atrophic post-acne scars were enrolled in this study and randomly assigned into one of three groups. All of them underwent four treatment sessions at 4-weeks intervals. They were assessed objectively by the quantitative global scarring grading system (GSGS). This system was applied at baseline, and after 1- and 6-month follow-up (FU). Subjective assessments were performed through the global esthetic improvement scale (GAIS) and level of patient satisfaction. The DLQI questionnaire was employed at the baseline and 6-month FU. RESULTS: According to the quantitative GSGS scores, the reductions in group A (68.4%) and group B (63%) scores were comparable, and both were significantly higher than that in group C (41.2%) in all steps of evaluation. At 6-month FU, both groups A and B showed further significant improvement, while group C did not. Based on the GAIS and patients' satisfaction, there were no significant differences between all groups. The reductions in DLQI scores in groups A and B were comparable; however, both were significantly higher than group C (P < .001). CONCLUSIONS: The combination of plasma gel and FCL resurfacing was noticeably outstanding in their efficacy and impact on the patients' quality of life.

MMP-1 (519 A/G) and TIMP-1 (372 T/C) genes polymorphism in an Egyptian sample of Acne vulgaris patients.

BACKGROUND: Different Matrix metalloproteinases (MMPs) family members may be implicated in acne vulgaris development. However, there are no published data about the role of MMP-1 and TIMP-1 gene polymorphisms in acne vulgaris development. AIMS: To evaluate the association between MMP-1 (519 A/G) and TIMP-1 (372 T/C) gene polymorphisms and the risk of developing acne vulgaris among a sample of Egyptian acne patients. PATIENTS/METHODS: This case-control study included 100 acne vulgaris patients and 120 apparently healthy control subjects. Acne severity was assessed according to Global Acne Grading System (GAGS). MMP-1 (519 A/G) and TIMP-1 (372 T/C) gene polymorphisms were investigated using RFLP-PCR technique. RESULTS: The MMP-1 (519 A/G) AG and GG genotypes and G allele increase the risk of acne vulgaris~2-3 folds. In female patients, TIMP-1 (372 C/T) TT genotype and T allele showed significantly higher frequency in cases compared with the control group (p = 0.004, 0.001 respectively) with a higher risk to develop acne. On the other hand, in male patients, there was insignificant difference between the frequency of alleles in patients and control subjects. TIMP-1 (372C/T) TT genotype has been shown to be significantly detected in the studied female patients associated with the positive family history of the disease, and it increases the risk of back affection, severe acne grade development, and the liability to postacne scar formation. CONCLUSION: MMP-1 (519 A/G) and TIMP-1 (372 T/C) gene polymorphisms may be related to acne vulgaris development.

HMGB1-RAGE-moesin axis may be indicted for acne vulgaris.

BACKGROUND: High-mobility group box 1 (HMGB1)-receptor for advanced glycation end (RAGE)-moesin axis could be implicated in induction of inflammation. However, there is a scarcity in literature discussing the role of this axis in inflammatory skin disorders. AIMS: The aim of the present study was to evaluate the serum levels of HMGB1 and moesin in patients with inflammatory acne vulgaris. PATIENTS/METHODS: This comparative cross-sectional study included 66 inflammatory acne vulgaris patients classified according to Global Acne Grading System (GAGS) into three groups (22 patients each): mild, moderate, and severe acne vulgaris. In addition, 82 acne-free individuals were included as a control group. Serum HMGB 1 and moesin levels were measured using enzyme-linked immunosorbent assay kits. RESULTS: High-mobility group box 1 and moe sin serum levels in acne patients were significantly higher than the levels in control subjects (p = 0.04, 0.0005 respectively). Serum levels of both markers in severe acne patients and in those with post-acne scarring were elevated when compared to the levels in the other groups, and however, this elevation was significant only for moesin levels. There was a significant positive correlation between the serum levels of HMGB1 and moesin in the studied patient's sample (r = 0.3079, p = 0.011). CONCLUSION: High-mobility group box 1-receptor for advanced glycation end-moesin axis may be implicated in acne vulgaris pathogenesis, and it may be a promising therapeutic target.

Fluctuation in amino acids content in Triticum aestivum L. cultivars as an indicator on the impact of post-emergence herbicides in controlling weeds.

This study was carried out in a demonstrated field in El-Sharkia Governorate, Egypt, during the winter of season 2020 to evaluate the leverage of four post-emergence herbicides i.e., tribenuron-methyl, clodinafop- propargyl, pyroxsulam and pinoxaden compared to control on total protein and amino acid contents in three wheat cultivars (Shandwel 1, Giza 171, and Sakha 95). Generally, the use of foliar herbicides led to a significant decrease in essential, non-essential amino acids and protein contents. However, tribenuran-methyl herbicide signifcantly increased the levels of proline, glycine, arginine, and histidine, but cystine and threonine not affected as compared to control. On the other hand, foliar herbicide application was significantly increased physiological , biochemical parameters and yield of Shandweel cultivar as compared to the other varieties. The physiological and biochemical models of dual-herbicide-tolerant wheat cultivars add to our understanding of the crop. In recent agricultural systems, herbicide tolerant plants are important for long-term weed management. Therefore, the study recommended the safely usage of Tribenuran-methyl as foliar herbicide in weed managment.

Nuclear Factor Erythroid-2-related Factor 2 Gene Polymorphisms in Vitiligo.

BACKGROUND: Oxidative stress is now one of the accepted theories of vitiligo development. Nuclear factor erythroid-2-related factor 2 (Nrf2) regulates the expression of antioxidant proteins. OBJECTIVE: This work aimed to evaluate the association of Nrf2 gene polymorphisms with the susceptibility to vitiligo among a sample of Egyptian patients with vitiligo. METHODS: This case-control study included 100 patients with vitiligo and 50 healthy matched volunteers serving as a control group. Genotyping was carried out by real-time polymerase chain reaction. RESULTS: The frequencies of TT, CT, and combined (TT+CT) genotypes and the T allele of Nrf2 (rs35652124) were significantly increased in the studied patients with vitiligo relative to the healthy controls (p<0.001, p=0.012, p<0.001 and p<0.001, respectively). There was a nonsignificant difference between patients and controls regarding Nrf2 (rs6721961) genotypes. However, the T allele of Nrf2 (rs6721961) was significantly predominant in the studied patients compared to in the controls (p=0.029). Among the studied criteria, the T allele of Nrf2 (rs6721961) was predominant in patients with a marginal type of repigmentation (p=0.022), while the G allele of the same single-nucleotide polymorphism was associated with a higher body mass index value (p=0.034). One hundred percent of patients with vitiligo with the Nrf2 (rs6721961) GT genotype had a progressive disease course (p=0.015). CONCLUSION: Nrf2 (-617 T/G) and (-653 T/C) polymorphism might play a role in patient susceptibility to vitiligo and modify the clinical presentation of the disease.

Do the herbicides pinoxaden, tribenuron-methyl, and pyroxsulam influence wheat (Triticum aestivum L.) physiological parameters?

Herbicides reduce the unsafe effects of weeds, but they are likely to have negative impact on essential and secondary metabolism in crops. However, the combined effect of different herbicides on chemical constituents of different varieties of wheat is still not fully obvious. The current investigation was carried out to determine the effects of three post-emergence herbicides (pinoxaden, tribenuron-methyl, and pyroxsulam) on total protein, lipid, and carbohydrate concentrations of three bread wheat cultivars (Misr 1, Giza 171, and Gemmiza 11). These herbicides were added individually and in combinations at recommended and/or half recommended doses. Our findings revealed that the individual application of herbicides decreased total protein and total lipid concentrations in fresh shoots of the three studied wheat cultivars, but increased total carbohydrate concentration. Combined addition of herbicides at recommended and half recommended doses generally decreased the concentrations of total proteins, total lipids, and total carbohydrates. However, the combined addition of tribenuron-methyl and pinoxaden at recommended dose enhanced total protein and total lipid concentrations under Misr1 and Gemmiza 11 cultivars compared to control treatment. Furthermore, the combined addition of tribenuron-methyl and pyroxsulam at half recommended dose enhanced total protein concentration in Giza 171 up to 15.05% and Gemmiza 11 up to 15.09% cultivars, and total lipid concentration in Misr 1 (7.53%) and Giza 171 (9.81%) cultivars against control treatment, where it was the lowest. Total carbohydrate concentration was enhanced by the sole application of pinoxaden by 53.55%, 52.40%, and 51.79% for Misr 1, Giza 171, and Gemmiza 11 cultivars, respectively. Moreover, individual or combined additions of the studied pesticides at recommended and half recommended doses negatively affected wheat grains under all cultivars via decreasing their concentration of nutrients (nitrogen, phosphorus, and potassium) as well as total protein and total carbohydrates. The highest reduction of nitrogen, phosphorus, and potassium concentrations compared to control was observed when tribenuron-methyl+pyroxsulam was applied at the half recommended dose under the three studied cultivars. However, the combined application of tribenuron-methyl+pyroxsulam at the half recommended dose caused the great depression in total proteins and total carbohydrates of wheat grains. Under the stress effect of herbicides, individual application of pinoxaden gave the best results for nitrogen and potassium content as well as total protein and total carbohydrate concentrations in the three studied wheat grain cultivars.

DEFB1 gene polymorphisms modify vitiligo extent and response to NB-UVB phototherapy.

Human beta defensin-1(hBD-1); an antimicrobial peptide, has immune regulatory effects which may be involved in autoimmunity. The aims were to evaluate the association between defensin beta 1 (DEFB1) (-44 C/G) and (-20 G/A) gene polymorphisms with the risk of vitiligo development, the extent of the disease and the response to NB-UVB treatment in a sample of Egyptian population. 178 active nonsegmental vitiligo patients and 182 control subjects were included in this prospective case control study. Vitiligo extent was evaluated using vitiligo area scoring index (VASI). Gene polymorphisms in all participants were studied by RFLP PCR technique. Patients were treated by three narrowband UVB (NB-UVB) treatment sessions per week. After 12 weeks, the patients were reevaluated clinically to assess the extent of the disease using VASI scoring again and to evaluate the type of repigmentation, if any. AA genotype of DEFB1 (-20G/A) has a protective role against vitiligo development, while (DEFB1 -44 C/G) GG genotype and G allele increase the risk of vitiligo development about two folds. Patients carrying polymorphism in DEFB1 (-20G/A) only showed the lowest VASI scores (14.23 ± 2.77) and the highest percentage of improvement (66.12 ± 18.01%), while patients carrying polymorphism in DEFB1(-44 C/G) only showed the highest baseline VASI scores (38.87 ± 6.7) and the lowest therapeutic response (23.79 ± 19.42%) among all patients groups. Different DEFB1 gene polymorphisms may modify the risk of vitiligo development, the disease extent and the response to NB-UVB phototherapy.

Electrophoretic banding patterns of protein induced by pinoxaden, tribenuron-methyl, and pyroxsulam herbicides in wheat leaves (Triticum aestivum L.).

Herbicides are the most effective tool against weed flora in cereal crops that help to maintain and increase crop yields. This investigation was conducted in the winter season of 2018 to study the stress effect of three post-emergence herbicides including pinoxaden, tribenuron-methyl, and pyroxsulam on the biochemical changes at the molecular cell level of wheat. These herbicides were applied either lonely with a rate of 0.45 L.ha-1, 22.5 gm.ha-1, and 0.16 Ib a.i/A, respectively, or in combinations together on three Egyptian varieties of bread wheat known as Misr 1, Giza17 1, and Gemmiza 11. Firstly, the abovementioned herbicides were used at the recommended and half recommended doses with their combinations for these varieties to investigate DNA-protein linkage as a signal effect of herbicides at the molecular cell level.Our data showed that the treatment of wheat varieties with the tested herbicides induced new bands with low and high molecular weights of 37.49, 40.08, 146.55, and 147.23 KDa with relative mobility of 0.1574, 0.1603, 0.2166, and 0.2168, respectively. These bands were not presented in the control treatment, suggesting that it might be used as a biochemical marker for plant defense genes. Meanwhile, the control treatment exhibited only five or six bands in the three varieties. However, the tested varieties showed that the same number of bands, the molecular weights of bands, and their relative mobility were significantly varied between the single and the combinations treatment of herbicides. The best treatment was achieved by the combination between pinoxaden and tribenuron-methyl at a recommended dose which induced a large number of protein bands compared to the control treatment on the wheat variety cv. Misr 1, which gave one band with low molecular weight 71.44 KDa at Rf 0.1854 and other with the highest molecular weight 147.23 KDa at Rf 0.2168, compared to the control treatment.

Proteasome Subunit Beta Type-8 (PSMB8) Gene Polymorphisms in Vitiligo: A Possible Predictor of Auditory Involvement.

INTRODUCTION: Proteasome subunit beta type-8 (PSMB8) is a protein that contributes to the complete assembly of 20S proteasome complexes, which play a role in the pathogenesis of vitiligo. OBJECTIVE: The study aimed to evaluate the association between PSMB8 gene polymorphisms with vitiligo to assess its clinical significance among a sample of Egyptian patients with vitiligo. METHODS: Genomic DNA was isolated from blood samples of 100 patients with vitiligo and 100 control subjects, and detection of PSMB8 polymorphisms was done by real-time PCR. Data analysis was carried out for the entire cohort. Statistics were performed using software. Audiological evaluation was performed, including pure-tone audiometry, extended high-frequency audiometry, transient evoked otoacoustic emissions, and auditory brainstem response. RESULTS: There was a significant difference between PSMB8 genotypes and alleles distribution in patients and control groups. Ten percent of the study sample had sensorineural hearing loss. The patients with hearing loss were significantly older (P=0.0002), had significantly later age of onset (P=0.0007), longer duration (P=0.0021), higher body mass index (BMI) (P=0.045), and higher vitiligo area scoring index (VASI) scores (P=0.0015). All patients had extensive forms of vitiligo (generalized and universal). Regarding the VIT rs2071543 polymorphism, all of the patients with hearing loss were carrying the CA and AA genotypes. None of the patients carried the reference genotype, CC. The A allele of VIT rs2071543 was significantly associated with hearing affection (P=0.024). CONCLUSION: In our study, PSMB8 polymorphism was associated with the susceptibility to develop vitiligo and appeared to have clinical significance among the studied group of patients. Factors predicting auditory abnormalities should be further studied for early detection and management.

Serum Neurotensin: An Objective Mirror to Acne-induced Quality of Life and Psychological Impairment.

BACKGROUND: Acne is a multifactorial disorder, and stress potentially plays a role in its pathogenesis. OBJECTIVES: We aimed to assess the serum levels of neurotensin in patients with acne vulgaris (AV) and investigate the relationship of these levels to quality of life (QoL), depression, anxiety, and stress. METHODS: The study included 60 patients with AV classified into mild (n=20), moderate (n=20), and severe (n=20) groups and 20 healthy, age-matched, sex-matched, and body mass index (BMI)-matched individuals in a control group. Patient QoL was assessed using the Dermatology Life Quality Index (DLQI). Each participant completed the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS-10). Serum levels of neurotensin were measured with enzyme-linked immunosorbent assay (ELISA). RESULTS: Neurotensin levels and scores from the three questionnaires were significantly higher among the patients with AV than the control subjects. They were also significantly elevated in patients with post-acne scars and hyperpigmentation and in those with severe acne. CONCLUSION: It is well known that acne greatly impacts QoL and might be associated with depression, anxiety, and stress. Further, serum neurotensin could be a promising marker to objectively evaluate the psychosocial impact of AV.

Topical ß-blockers for pyogenic granulomas: A promising option for younger patients.

BACKGROUND: Topical ß-blockers, propranolol, and timolol were used for pyogenic granuloma (PG) treatment; however, their efficacies and safety profiles were not compared. AIMS: The aim was to evaluate the safety and efficacy of propranolol 1% and timolol 0.5% creams in the treatment of pyogenic granulomas. PATIENTS: The study included 30 PG patients. They were divided into three groups (10 patients each). Group I patients received propranolol 1% cream. Group II patients used timolol 0.5% l cream. Group III patients used placebo cream. Creams were applied twice daily for 2 months. Patients were followed up for 3 months to detect any recurrence. RESULTS: Complete resolution was reported in 6 patients of groups I and II, while none of the control patients reported complete resolution. Despite the absent change in lesions' size in 40% of ß-blockers treated groups, they all reported decreased bleeding tendency. There was insignificant difference between the clinical responses between ß-blockers groups. No recurrence was reported in any of the patients who achieved complete resolution after 3 months of follow-up. Younger patients respond better to ß-blockers. Three patients were deteriorated on beta-blockers treatment. CONCLUSION: ß-blockers are a promising PG treatment option in cases where invasive modalities are not desirable especially in younger patients.