A comparative study of the genetics of Behcet's disease in Iraq: international collaboration to transfer clinical and laboratory skills to Baghdad medical school and hospitals.

A collaborative project funded by the Iraqi Research Fellowship Programme of the Council for Assisting Refugee Academics was set up to transfer laboratory and clinical skills in between three clinical research teams in the UK, Jordan and Iraq. The project was set up to study the genetics of the potentially debilitating condition, Behçet's Disease (BD). Blood samples were collected from: 38 BD patients, 28 patients with oral ulcers not related to BD and 32 healthy controls. All samples were analysed using Micro SSP HLA Class I B locus kit (B locus, generic). Logistic regression analysis revealed that samples positive for HLA-B51 were 7.4 times more likely to have BD than the healthy control subjects. The results of this study make a valuable addition to the scientific literature. Additional valuable outcomes include the intellectual exchange and transfer of skills in between the collaborating teams, which led to the establishment of an international research collaboration.

Possible mechanisms of action of the compounds injected intralesionally in the treatment of cutaneous leishmaniasis, in addition to their direct effects on the parasites.

By injecting uninfected rabbits intradermally with one of the test compounds or the isotonic saline (0.9% NaCl) used as a control, the possible mechanisms of the indirect action of some drugs used intralesionally in the treatment of human cutaneous leishmaniasis [sodium stibogluconate, 2% zinc sulphate, and hypertonic (7% NaCL) saline] were explored. The 24 injected rabbits (six for the control and six for each test compound) were followed up for 30 days, both macroscopically, with checks for erythema and increases in skin thickness, and microscopically, with the histopathological examination of sections of biopsies from the injection sites. Although the microscopy revealed inflammatory-cell infiltration, beginning with eosinophils, followed by lymphocytes and finally by the proliferation of fibroblasts, at all of the injection sites, these changes were most intense with the sodium stibogluconate and 2% zinc sulphate, less marked with the hypertonic saline, and minimal and relatively short-lived with the isotonic saline. Presumably as a result of their metal content, sodium stibogluconate and zinc sulphate each probably induce tissue damage and, subsequently, severe inflammatory changes. The antileishmanial activity of hypertonic saline, however, may be entirely attributable to its osmotic effects.

Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial.

BACKGROUND: Viral warts are common dermatological diseases; although the rate of spontaneous recovery is high, it usually takes a long time, and some patients might not show this spontaneous healing. Zinc has an important effect on the immune system and it has been used as an immunomodulator to treat a variety of skin disorders. OBJECTIVE: To assess whether oral zinc was effective in treating viral warts of patients evaluated between May 1999 and April 2000. PATIENTS AND METHODS: This was a placebo-controlled clinical trial. Eighty patients with viral warts (common, plantar and plane) were all resistant to all forms of treatment. Each patient had > 15 warts. Forty patients were treated by oral zinc sulphate at a dose of 10 mg kg(-1) daily up to 600 mg day(-1) and followed-up for resolution of their warts and for any evidence of recurrence for 2-6 months. Another 40 patients were given a placebo oral treatment in the form of glucose, and followed-up for the same period. RESULTS: Only 23 patients of the first group (zinc treated) and 20 patients of the second group (placebo treated) completed the study. In all patients the serum level of zinc was low. In the zinc-treated group, the overall response was complete clearance of warts observed in 20 patients (86.9%) after 2 months of treatment. Fourteen patients (60.9%) showed complete disappearance of their warts after 1 month. Three patients (13.3%) failed to respond to the treatment after 2 months of therapy. The response to treatment was directly related to the increment in serum zinc level. No patient of the placebo-treated group showed any response. CONCLUSIONS: We conclude that zinc sulphate at a dose of 10 mg kg(-1) daily seems to be a highly efficacious therapeutic option for recalcitrant viral warts and proved to be safe with few adverse effects.

Frictional dermal melanosis (lifa disease) over bony prominences.

Seventy-one patients (70 females and one male) were studied. Their ages at presentation ranged from 16-43 years with a mean of 24.4 years. The duration of disease varied from three months to ten years with a median of 2.7 years. All patients were slim and had recorded using a washing agent (Lifa) during bathing with vigorous friction. Family history of the same disease was present in 11 (15.5%) patients. The pigmentation was brown-black with a rippled pattern and showed no contrast under Wood's light. The areas commonly affected were clavicles (71.8%), shins (36.6%), upper back (32.4%), Adam's apple (31%), lateral aspects of the arms (31%) and other areas. The histopathology of biopsies from 24 patients showed marked dermal melanosis. Amyloid deposits in the papillary dermis were present in one patient. This clinical and histopathological picture suggests that this common condition is related to frictional melanosis.

Oral zinc sulphate in the treatment of acute cutaneous leishmaniasis.

A clinical trial to evaluate the efficiency of oral zinc sulphate in the treatment of cutaneous leishmaniasis was conducted. One-hundred and four patients with parasitologically proven cutaneous leishmaniasis were included in the trial. Patients were assigned randomly to receive 2.5, 5 or 10 mg/kg of zinc sulphate orally, and a control group of patients did not receive any treatment. All patients were followed up for 45 days. At the end of the follow-up period, lesions were assessed and parasitological proof of cure or otherwise was sought. Results showed that the cure rate for the 2.5 mg/kg group was 83.9%, for the 5 mg/kg treatment group it was 93.1% and for the 10 mg/kg treatment group it was 96.9%. No lesions in the control group showed any sign of healing during the follow-up period. Therefore, oral zinc sulphate can be recommended as a very safe therapy for cutaneous leishmaniasis.

The antibacterial activity of tea in vitro and in vivo (in patients with impetigo contagiosa).

A total number of 104 patients with impetigo contagiosa was included in this study. They were 47 females (45.2%) and 57 males (54.8%). Their ages ranged from one month to 40 years with a median of 4 years. This study was divided into two parts: PART I (in vitro): Thirty-five patients were swabbed to determine the microbiology of impetigo contagiosa which included 33 isolates of pure S. aureus (94.3%) and 2 of a combination of S. aureus and Streptococcus pyogenes (5.7%). The antibacterial effect of tea liquor (lotion) against S. aureus proved very effective. Antibiotic sensitivity was done for all bacterial isolates of S. aureus. PART II (in vivo): The antibacterial effects of tea liquor and ointment were tested by treating 64 patients with impetigo contagiosa. Tea ointment was very effective with a cure rate of 81.3%. Forty patients were taken as controls and divided into two groups. The first one was given an ointment containing Framycetin and gramicidin (soframycin) with a cure rate of 72.2%; the other group was given oral cephalexin with a cure rate of 78.6%. To the best of our knowledge, this study was the first one which demonstrated the anti-bacterial action of crude tea in vivo, against impetigo contagiosa. Clinical data about impetigo are also included in this study.

Reinfestation in cutaneous leishmaniasis: a new look at predisposing conditions.

OBJECTIVE: A prospective study of cases of reinfestation with cutaneous leishmaniasis is carried out to try to identify if there is any associated condition which might predispose to reinfestation. METHODS: Over a 2 year period, cases of reinfestation with cutaneous leishmaniasis presenting in the Department of Dermatology, were collected. RESULTS: Thirteen cases showing a typical scar with a parasitologically proven new infection were included. The mean age of patients was 54.69+/-2.65 years. The time lapse between the two infections was 52.38+/-2.60 years. The scar of the primary infection was mainly on the face while the lesion was mostly on the limbs. Six patients had diabetes mellitus, one patient was pregnant and three received either oral corticosteroids or other immunosuppressive drug treatment. CONCLUSION: It is concluded that in patients with reinfestation it is important to take a careful medical history and send for a fasting blood glucose, as there is a chance of one in two that the patient may be diabetic.

Treatment of cutaneous leishmaniasis by direct current electrotherapy: the Baghdadin device.

Electrical stimulation has been used as a mode of therapy for a number of clinical conditions. However, it has not been used for the treatment of cutaneous leishmaniasis (CL). For this purpose, we designed the "Baghdadin device". A total of 146 lesions of acute CL in 54 patients were treated by this device. Twenty-one lesions in the same patients were left untreated as controls. In addition, 36 lesions in 15 patients were treated with intralesional sodium stibogluconate. Treatment by the Baghdadin device consisted of weekly sessions of 10 minutes of direct current electrical stimulation. The intensity of the direct current ranged between 5 and 15 milliamperes, and the voltage was kept below 40 volts. Of the 146 lesions, 135 (92.5%) showed total clearance or marked improvement in 4-6 weeks time. Approximately 67% of the lesions needed only one or two sessions. Scarring was not observed after resolution. None of the untreated lesions showed any signs of improvement in 6 weeks. Of the lesions treated with sodium stibogluconate, 32 lesions (88.9%) showed total clearance or marked improvement, which was not significantly different from the results with the Baghdadin device.

Zinc sulphate in the treatment of cutaneous leishmaniasis: an in vitro and animal study.

This study was designed to evaluate the effectiveness of zinc sulphate both in vitro and in an animal model against both strains of old world cutaneous leishmaniasis. The in vitro sensitivities of promastigotes and axenic amastigotes of both Leishmania major and L. tropica to zinc sulphate was determined, the LD50 calculated and compared to the standard treatment for cutaneous leishmaniasis pentavalent antimony compounds. The results show that the two forms of both strains were sensitive to zinc sulphate and their respective LD50 were lower compared to the pentavalent antimony compound. Furthermore the sensitivities of the forms of both strains were tested using a simple slide method and compared to results of the standard method. To confirm this result, zinc sulphate was administered orally to mice infected with cutaneous leishmaniasis both therapeutically and prophylactically. Results showed that oral zinc sulphate was effective in both treatment and prophylaxis for cutaneous leishmaniasis. These results encourage the use of oral zinc sulphate in the treatment of cutaneous leishmaniasis clinically.

A comparative controlled trial of intralesionally-administered zinc sulphate, hypertonic sodium chloride and pentavalent antimony compound against acute cutaneous leishmaniasis.

A comparative clinical trial between two newly introduced intralesional treatments for acute leishmaniasis and the established treatment of intralesionally-administered pentavalent antimony compounds was performed. Treatments were allocated randomly to a total of 63 patients who received 2% zinc sulphate, 7% sodium chloride solutions or sodium stibogluconate intralesionally. A number of patients were left without treatment as controls. Patients were followed-up for 45 days, the results showing that the three treatments gave comparable cure rates by the end of the follow-up period. However, zinc sulphate gave a high cure rate (94.8%) usually with a single injection.

A new intralesional therapy of cutaneous leishmaniasis with hypertonic sodium chloride solution.

One hundred and fifty-eight lesions of acute cutaneous leishmaniasis in 70 patients were treated with hypertonic sodium chloride solution "HSCS" (88 lesions) or sodium stibogluconate (50 lesions); 20 lesions were left untreated as controls. The injections were given at 7-10 day intervals, and patients were followed-up for 42 days. "HSCS" was shown to be a very effective local therapy (96.05% cure rate) and was as effective as local sodium stibogluconate (96.42% cure rate). With both types of therapy, most lesions needed only one injection. Mild improvement was noticed 7-10 days after the first injection, and the cure was complete within 2-6 weeks (mean 4 weeks) of follow-up. None of the control lesions showed a cure within the six weeks follow-up. The mechanisms of action of both "HSCS" and sodium stibogluconate probably involve interference with the osmotic pressure of the cell cytoplasm of the parasites and lesional tissues. Scarring was either absent or minimal following healing of the treated lesions with both types of treatment. Post-inflammatory hyperpigmentation was observed in all patients. We strongly recommend intralesional "HSCS" as a cheap, safe, and effective local method for treating cutaneous leishmaniasis.

The prevalence of hirsutism in Iraqi females.

A random total of 325 females was collected and studied for the presence of hirsutism. Ages ranged from 16 to 45 years with a mean 27.2 +/- 7.4 SD. According to the Mcknight method [2], 59% of females had hirsutism in different areas, single or in combination and most, according to the Ferriman-Gallwey [4], scoring system were 20 to 34 years of age. The incidence of associated diseases such as melasma, acne vulgaris, and female pattern alopecia were not much different in the total females and in the hirsute group studied.

Intralesional therapy of cutaneous leishmaniasis with sodium stibogluconate antimony.

One hundred and thirty lesions of cutaneous leishmaniasis in 60 patients were treated with intralesional injections of Pentostam and 30 lesions were left untreated as controls. The injections were given at 8-day intervals and the patients followed-up for 42 days. One hundred and four lesions (80%) needed one injection only, 20 (15.4%) needed two and six (4.6%) needed three injections. One hundred and twenty three of the treated lesions (94.6%) showed a good clinical response with complete healing or marked improvement within the follow-up period. None of the control lesions showed marked improvement or complete healing. Scarring was minimal or absent following healing of treated lesions. The only side-effect was some localized pain following the injection. We recommend intralesional Pentostam as a safe and effective method of treating acute cutaneous leishmaniasis.

Behçet's disease in Iraqi patients.

The clinical features of 60 patients (45 male, 15 female) with Behçet's disease (BD) are reported in this prospective study. Ninety seven per cent had mouth ulceration, 83% genital ulceration, 75% skin lesions, 48% ocular involvement, 48% synovitis, 17% thrombophlebitis, and 22% of the male patients had epidiymitis, while constitutional symptoms were reported by 63%. The arthritis was intermittent, self limiting, and non-destructive, involving large joints, mainly the knees and ankles. The pathergy test was positive in 37 of 52 patients with BD, and negative in all 120 healthy controls and in 20 healthy volunteers who possessed the HLA-B51 antigen. HLA-B51 was present in 32 of 52 (62%) patients with BD compared with 51 of 175 (29%) unrelated normal controls. Both the pathergy and HLA-B51 tests were negative in four of 52 patients with BD. Behçet's disease is not uncommon in Iraq. Practising physicians, dermatologists, and ophthalmologists must be more aware of its existence.