Topical 4% nicotinamide vs. 1% clindamycin in moderate inflammatory acne vulgaris.

Nicotinamide and clindamycin gels are two popular topical medications for acne vulgaris. This study aimed to compare efficacy of the topical 4% nicotinamide and 1% clindamycin gels in these patients. In this randomized, double-blind clinical trial, patients with moderate inflammatory facial acne vulgaris were randomly allocated to receive either topical 4% nicotinamide (n = 40) or 1% clindamycin gels (n = 40) twice daily. In each group, they were further categorized in two subgroups with oily and non-oily types of facial skin. The Cook's acne grade was determined at baseline and at weeks 4 and 8 post treatment. Acne grade decreased from an average of 5.93 ± 0.83 at baseline to 4.03 ± 1.33 at week 4 and 2.08 ± 1.59 at week 8 in nicotinamide receivers, and from an average of 5.70 ± 0.94 at baseline to 3.85 ± 1.66 at week 4 and 2.03 ± 1.53 at week 8 in the clindamycin group (within-group P < 0.001, between-group P > 0.05). Comparing with each other, nicotinamide and clindamycin gels were significantly more efficacious in oily and non-oily skin types, respectively. No major side effect was encountered by any patient. Skin type is a significant factor in choosing between topical nicotinamide and clindamycin in patients with acne vulgaris.

Intravitreal clindamycin plus dexamethasone versus classic oral therapy in toxoplasmic retinochoroiditis: a prospective randomized clinical trial.

Both oral and intraocular routes have been recommended for medication administration in toxoplasmic retinochoroiditis; however, available data, in support or against, are scarce. The objective of this study was to compare the efficacy of intravitreal clindamycin plus dexamethasone (IVCD) and conventional oral therapy (COT) including pyrimethamine, sulfadiazine, folinic acid and prednisone in active toxoplasmic retinochoroiditis. In this prospective randomized single-blind clinical trial, patients with active toxoplasmic retinochoroiditis received either IVCD (n = 32), or COT (n = 34) for 6 weeks. Changes of best-corrected visual acuity, retinal lesion size, and vitreous inflammation before and after treatment, as well as complications/side-effects and recurrence rate within at least 2 years of follow-up were compared between groups. Although all the variables improved significantly at 6 weeks within each group, changes were comparable between the IVCD and COT receivers. There was only one case with hepatotoxicity in the COT group which responded favorably to drug change. No injection-related complication was observed. Recurrence rates were 12.5 and 14.7 % in the IVCD and COT groups, respectively (p = 0.54). In conclusion, both IVCD and COT are equally effective against active toxoplasmic retinochoroiditis but the former is apparently safer and more convenient.

Characteristics and clinical presentations of pediatric retinoblastoma in North-western Iran.

AIM: To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran. METHODS: In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n=40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student's t test, Mann-Whitney U-test, Chi-square or Fishers' Exact test was used for analysis where appropriate. RESULTS: There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range: 5-62) months. The mean diagnosis delay was 7.4±9.6 months (range: 10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group. CONCLUSION: This is the first study evaluating a series of Iranian children with retinoblastoma.

Hyaluronidase in sub-Tenon's anesthesia for phacoemulsification, a double-blind randomized clinical trial.

AIM: To investigate the effect of hyaluronidase use on the quality of sub-Tenon's anaesthesia for phacoemulsification. METHODS: This was a randomized, double-blind clinical trial which was conducted at Nikookari Eye Hospital for 5 months. Forty-two eyes of candidates for phacoemulsification under sub-Tenon's anaesthesia were randomly allocated to two equal groups and received either 2 mL of lidocaine 2% solution with (LH), or without (L) addition of hyaluronidase (150IU/mL). Akinesia was assessed 15 minutes after sub-Tenon's injection. Patients and surgeon's satisfaction, as well as the postoperative pain (the visual analogue scale, VAS) were investigated after operation. The contingency tables (including the Chi-square or Fisher's exact tests, when appropriate) and parametric analysis (the independent samples t test) were used for statistical analysis. RESULTS: Complete akinesia (33.3% vs 4.8%, P=0.04), as well as the patients (85.7% vs 57.1%, P=0.04) and surgeon's satisfaction (87.5% vs 52.4%, P=0.02) were significantly more frequent in LH than in L group. The mean VAS was significantly lower in the same group (1.90±1.45 vs 3.00±1.55, P=0.04). CONCLUSION: Addition of hyaluronidase to lidocaine solution for sub-Tenon's anesthesia significantly improves the ocular akinesia, enhances the intra-operative patients and surgeons' satisfaction, and attenuates the postoperative pain.

Association between the proportion of sclerotic glomeruli and serum creatinine in primary focal segmental glomerulosclerosis.

OBJECTIVE: To evaluate the possible correlation between the extent of sclerotic glomeruli and the level of serum creatinine and its clearance rate in patients with primary focal segmental glomerolusclerosis. MATERIAL AND METHOD: In a cross-sectional study, 50 patients with biopsy-proven primary focal segmental glomerolusclerosis were recruited. The proportion of globally and segmentally sclerosed glomeruli was determined during the first histopathological examination of renal biopsy specimens. Correlations of these variables with on admission serum level of creatinine and its clearance rate were investigated. RESULTS: Twenty-four males and 26 females with a mean age of 39.82±16.45 (range: 16-85) years were enrolled in the study. In a significant fashion, the proportions of segmental and global glomerulosclerosis were directly correlated with the serum level of creatinine and inversely with its clearance rate (r=-0.43 with p=0.002 and r=-0.45 with p=0.001, respectively). CONCLUSION: Apart from the degree of interstitial fibrosis, the serum level of creatinine and its clearance rate are well correlated with the proportions of both segmentally and globally sclerosed glomeruli in primary focal segmental glomerulosclerosis.

Atherosclerotic changes in common carotid artery, common femoral artery, and ascending aorta/aortic arch in candidates for coronary artery bypass graft surgery.

We assessed the association between common carotid and common femoral artery intima-media thickness (ccIMT and cfIMT, respectively), histopathologic severity of atherosclerosis in the ascending aorta/aortic arch, and the extent of coronary artery disease (CAD) in 150 candidates for elective coronary artery bypass grafting (CABG). One-, 2-, and 3-vessel diseases were present in 20%, 25.9%, and 54.1%, respectively. Although no significant relationship was present between the ccIMT and the number of occluded coronary vessels (P = .41), both the cfIMT and severity of atherosclerosis in the ascending aorta/aortic arch were predictive of more extensive CAD (P = .03 and .01, respectively). Neither the ccIMT nor the cfIMT was correlated with the severity of aortic atherosclerosis (P = .81 and .63, respectively). In conclusion, both cfIMT and atherosclerosis of ascending aorta/aortic arch are independent predictors of CAD extent. However, interrelationships between these 2 variables as well as the ccIMT are complex in CABG candidates.

Scoliosis after thoracotomy/sternotomy in children with congenital heart disease.

CONTEXT: Congenital heart disease (CHD) patients bear a higher risk of scoliosis during their lifetime compared to their normal counterparts. On the other hand, operation on chest wall has been shown to increase the risk of scoliosis. However, the data are inconclusive. The present retrospective analysis is undertaken to determine the frequency of post-thoracotomy/sternotomy scoliosis in children with CHD. MATERIALS AND METHODS: One hundred and eighty children with CHD who underwent thoracotomy/sternotomy and had a minimum followup of 3 years in a teaching center from 1997 to 2010 were recruited. After operation, all the patients were regularly examined for the development of scoliosis. 102 patients underwent thoracotomy and 78 sternotomy. Student's t test, Chi-square test, Fisher's exact test were used for statistical analyses. RESULTS: Eighty-eight males and 92 females with a mean age of 9.95 ± 2.31 (range: 5-15) years were enrolled. The mean age at operation was 2.59 ± 1.66 (range: 0-9) years and the mean follow-up period was 7.36 ± 2.12 (range: 5-13) years. Scoliosis was confirmed in two patients (1.1%): 1 (1%) in the thoracotomy group (a 12-year-old female operated 2 years earlier with a spinal 22° convexity to the right and 78° kyphosis) and another (1.1%) in the sternotomy group (an 8-year-old female operated during her neonatal period with a spinal 23° convexity to the left). CONCLUSION: Scoliosis is not a common finding among the operated children with CHD in our center.

Topical steroids versus PUVA therapy in moderate plaque psoriasis: a clinical trial along with cost analysis.

BACKGROUND: Psoriasis is a common chronic disease. It is estimated that between US$1.6 billion and US$3.2 billion is spent per year to treat psoriasis. OBJECTIVE: To compare psoralen plus UV-A (PUVA) therapy with topical steroids in moderate plaque psoriasis. METHODS: In this randomized, clinical trial with cost analysis, 88 patients with moderate plaque psoriasis were recruited in two equal groups to receive either PUVA therapy or topical steroids. The induction phase was applied for 4 months and the patients were followed-up for another 3 months, while the maintenance therapy continued. Outcome, direct cost (related to medications, phototherapy, laboratory tests, and medical consultation), indirect cost (related to transportation and other extra expenditures) and total cost (direct plus indirect costs) were compared between the two groups. RESULTS: The outcome was equally satisfactory in both groups. The indirect cost was significantly higher in the PUVA group, while the direct and total costs as well as the patients' satisfaction rate were comparable. Recurrence was significantly more frequent in the topical group. CONCLUSION: Although both PUVA therapy and topical steroids are equally efficient and cost-effective in moderate plaque psoriasis, the recurrence rate is higher in the latter group.

Subconjunctival bevacizumab immediately after excision of primary pterygium: the first clinical trial.

PURPOSE: To investigate the effect of subconjunctival bevacizumab immediately after excision of primary pterygium. METHODS: Eighty patients (80 eyes) with primary pterygium were included in this double-blind clinical trial. The pterygia were excised by the bare sclera technique. Then, the patients were randomized in 2 equal groups; group A received subconjunctival bevacizumab (1.25 mg/0.1 mL) injected immediately after surgical excision of the pterygium, and placebo was administered in the same way in group B. Patients were followed-up for 9 months after the operation, and the possible complications and recurrence rate were documented. Thirty-three patients (33 eyes) completed the study in each group. RESULTS: The rate of complications was comparable between the 2 groups (57.6% in group A versus 63.6% in group B; P = 0.61). None of these complications was clinically significant, and they resolved spontaneously or by using conservative measures. The recurrence rate was higher in group B compared with group A (57.6% vs. 45.5%); however, this difference was not statistically significant (P = 0.33; odds ratio, 1.63; 95% confidence interval, 0.62-4.31). CONCLUSIONS: Subconjunctival injection of bevacizumab immediately after surgical excision of primary pterygium is well-tolerated, but it cannot significantly prevent the recurrence of this condition.

Comparison of therapeutic effects of oral doxycycline and azithromycin in patients with moderate acne vulgaris: What is the role of age?

BACKGROUND: Acne vulgaris is the most common dermatological disorder in adolescence and young adults. In past decades, systemic antibiotics have had the main role in the treatment of acne patients with inflammatory papules and cysts. They are sometimes associated with side effects, contributing to reduced compliance. OBJECTIVE: This study aimed at comparing the efficacy and safety of oral azithromycin and doxycycline in the treatment of moderate acne vulgaris, considering the age of patients as an influencing parameter. METHODS: In a randomized, double-blind, clinical trial, 100 patients with moderate acne vulgaris who attended the outpatient dermatology clinic were evaluated during a 15-month period. They were randomized into two equal groups: A and D. Patients in group A received oral azithromycin (500 mg daily, 4 consecutive days per month for 3 consecutive months) and patients in group D took doxycycline (100 mg daily for 3 consecutive months). The number and types of lesions (all over the body) were determined at baseline and at the end of each month for 90 days afterwards. Michaelson's acne severity score was also determined at baseline and at the end of the third month after initiating treatment. Patients were followed up for another 3 months after discontinuation of treatment to determine the recurrence rate. RESULTS: Both antibiotics were comparably effective in the treatment of moderate acne vulgaris. There was no significant side effect in the A group and the complications were minor in the D group. Doxycycline was significantly more effective in patients older than 18 years. CONCLUSION: Azithromycin is at least as effective as doxycycline in the treatment of moderate acne vulgaris; however, in patients older than 18 years doxycycline is better.

Common carotid artery intima-media thickness and atherosclerotic plaques in carotid bulb in patients with chronic kidney disease on hemodialysis: a case-control study.

The Common Carotid artery Intima-Media Thickness (CCIMT) can reflect systemic atherosclerosis in renal patients on hemodialysis. This study aimed to compare CCIMT measured by color Doppler ultrasonography between two groups including dialytic patients and normal subjects. In this case-control setting, 48 patients with Chronic Kidney Disease (CKD) on hemodialysis (case group) and 46 age and sex-matched healthy subjects (control group) were enrolled in this study. Color Doppler ultrasound was used to measure CCIMT and determine presence of atherosclerotic plaques in carotid bulb in both groups. Various laboratory parameters were also determined. Serum levels of triglyceride, total cholesterol, low-density lipoprotein, fasting sugar, ionized calcium, inorganic phosphorus and magnesium were comparable between the two groups. Hypertension and elevated levels of serum C-reactive protein, as well as the mean levels of serum non-fasting homocysteine and phosphate were significantly higher in the case group. Mean levels of serum high-density lipoprotein and albumin were significantly higher in the controls. Mean maximum CCIMT was significantly higher in the case group than in controls (0.73 +/- 0.15 vs. 0.68 +/- 0.08 mm, p = 0.01) even after adjusting for other confounding variables. Frequency of patients with atherosclerotic plaques in carotid bulbs was not significantly different between case and controls. In conclusion, this study showed that CCIMT is significantly higher in CKD patients on hemodialysis comparing with matched normal counterparts. Furthermore, this difference was independent of other conventional risk factors for atherosclerosis.

Common carotid intima-media thickness in patients with late rheumatoid arthritis; what is the role of gender?

This study aimed to evaluate color Doppler sonographic findings in carotid arteries in RA patients under pharmacological treatments and to compare them with normal population. Forty nine patients with late RA and 48 healthy age and sex-matched controls were recruited. The two groups were matched for other known risk factors of atherosclerosis including serum lipid abnormalities, smoking status, diabetes mellitus and hypertension. High resolution B-mode color Doppler ultrasound with a 7 MHZ transducer was used for measuring the Common Carotid Intima-Medial Thickness (CCIMT) in both sides in all subjects. Presence of atherosclerotic plaque was also investigated. The mean left and maximum CCIMT was significantly higher in the case group (0.72 vs. 0.62 mm for the left artery; p < 0.01; 0.72 vs. 0.64 mm for the maximum reading; p = 0.01). No atherosclerotic plaque was found in common carotid arteries. There were 3 (6.1), 7 (14.3) and 9 (18.4%) plaques in left internal carotid artery, right carotid bulb and left carotid bulb in the case group, respectively with no atherosclerotic plaques in the controls (p = 0.24, 0.01 and < 0.001, respectively). Comparing the findings by gender in the case group with the controls, the mentioned significant differences were only between the male patients and the controls. The process of atherosclerosis in RA patients is similar to that in normal population. However, it is apparently accelerated and more advanced in these patients.

Therapeutic effects of biguanide vs. statin in polycystic ovary syndrome: a randomized clinical trial.

Various classes of medication are currently being used in Polycystic Ovary Syndrome (PCOS) patients including the biguanides and the statins. However, their efficacies are rarely compared. This study aimed to compare efficacy ofa biguanide and a statin in treating PCOS. In a randomized double-blind clinical trial, 400 women with PCOS were recruited within 15 months in Taleghani Hospital. They randomly received either a biguanide (metformin 500 mg three times daily) or a statin (simvastatin 20 mg daily) for three consecutive months. Changes of clinical and laboratory variables were compared. In the biguanide group the serum glucose status (abnormal fasting and non-fasting sugar and insulin levels and percentage of hyperinsulinemic cases) and menstrual abnormalities improved significantly after treatment (p < 0.05). In the statin group the lipid profile status (abnormal total cholesterol, high and low density lipoproteins), C-Reactive Protein (CRP), serum dehydroepiandrosterone sulfate, hyperinsulinemia, severity of acne and menstrual abnormalities improved significantly after treatment (p < 0.05). Comparing the two groups, the improvements in fasting blood sugar and serum insulin levels were significantly better in the biguanide group (p = 0.04 for both parameters); whereas the improvements in serum total cholesterol (p < 0.001), low density lipoprotein (p < 0.001), CRP (p < 0.001) and acne status (p = 0.04) were significantly superior in the statin receivers. Based on these results, each medication is only effective on some aspects of the disease. Overall, the simvastatin was superior to metformin with regard to the number of beneficial effects.