Treatment of vulvar basal cell carcinoma with Slow-Mohs micrographic surgery A case report.

Vulvar Basal Cell Carcinoma (BCC) accounts for only 0.4% of all BCCs. We present a case of BCC that developed on the vulvar area with a pinkish lesion and pruritus for about 2 years and was successfully treated with Mohs micrographic surgery.

Iron oxide nanoparticles coated with polydopamine as a potential nano-photothermal agent for treatment of melanoma cancer: an in vivo study.

Melanoma is a metastatic cancer resistant to a wide range of therapies, including standard chemotherapy and radiation therapy, and cannot be treated with existing treatments owing to its intrinsic drug resistance. In terms of convenience and cheap cost of fabrication, one of the novel treatments is using polydopamine-coated iron oxide nanoparticles (IONs@PDA). Iron oxide nanoparticles (IONs) were synthesized (7.36 nm) and coated with polydopamine (15-20 nm). To examine the effect of photothermal ablation in melanoma cells (B16-F10), a Q-switched ruby laser (λ = 694 nm, spot size = 4 mm, output power = 5 J/s) was used. The prepared nanoprobe was applied to mice, and their survival after treatment was evaluated. Then histopathological studies were done on the livers and skins of the treated mice. The nanoparticles absorb the laser, raising the temperature and initiating photothermal treatment, with significant apoptosis (74%) after the 4th time of treatment. Photothermal therapy (PTT) by using IONs@PDA proved to be effective in the treatment of melanoma cells (tumor size of < 2 mm) without side effects. The lifespan of mice was significantly increased in a group of mice post-administered IONs@PDA and laser ablation. The fabricated nanoprobe (IONs@PDA) enhanced the melanoma cell apoptosis in the mice model, and it has promise for the treatment of melanoma (B16-F10) cells using photothermal therapy.

Successful treatment of Becker's nevus with dermabrasion by sandpaper: A case report.

Lasers have been widely used for treatment of Becker nevus. Here, we report a case of Becker nevus which did not respond to laser therapy and was treated successfully by dermabrasion with sandpaper with no following complications.

The Role of Bacterial and Fungal Human Respiratory Microbiota in COVID-19 Patients.

Recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), has led to a worldwide pandemic with millions of infected patients. Alteration in humans' microbiota was also reported in COVID-19 patients. The alteration in human microbiota may contribute to bacterial or viral infections and affect the immune system. Moreover, human's microbiota can be altered due to SARS-CoV-2 infection, and these microbiota changes can indicate the progression of COVID-19. While current studies focus on the gut microbiota, it seems necessary to pay attention to the lung microbiota in COVID-19. This study is aimed at reviewing respiratory microbiota dysbiosis among COVID-19 patients to encourage further studies on the field for assessment of SARS-CoV-2 and respiratory microbiota interaction.

Immune system changes during COVID-19 recovery play key role in determining disease severity.

Coronavirus disease 2019 (COVID-19), an acute respiratory infection, is largely associated with dysregulation and impairment of the immune system. This study investigated how the immune system changes were related to disease severity in COVID-19 patients. The frequencies of different immune cells and levels of pro- and anti-inflammatory cytokines in whole blood of participants were determined by flow cytometry and enzyme-linked immunosorbent assay, respectively. The values of other inflammatory agents were also studied. In the late recovery stage, unlike CD56high CD16+/- NK cells and monocytes, CD56low CD16+ NK cell numbers were increased (P < 0.0001-0.05). Th1, Th2, and Th17 cell percentages were significantly lower in patients than healthy control (P < 0.0001-0.05), while their frequencies were increased following disease recovery (P < 0.0001-0.05). The numbers of Tregs, activated CD4+ T cells, and exhausted CD8+ T cells were significantly decreased during a recovery (P < 0.0001-0.05). No significant change was observed in exhausted CD4+ T cell number during a recovery (P > 0.05). B cell showed an increased percentage in patients compared to healthy subjects (P < 0.0001-0.05), whereas its number was reduced following recovery (P < 0.0001-0.05). IL-1α, IL-1ß, IL-6, TNF-α, and IL-10 levels were significantly decreased in the late recovery stage (P < 0.0001-0.05). However, TGF-ß1 level was not significantly changed during the recovery (P > 0.05). Lymphocyte numbers in patients were significantly decreased (P < 0.001), unlike ESR value (P < 0.001). Lymphocyte number was negatively correlated to ESR value and Th2 number (P < 0.05), while its association with monocyte was significantly positive at the first day of recovery (P < 0.05). The immune system changes during the disease recovery to improve and regulate immune responses and thereby may associate with the reduction in disease severity.

Evaluation of combination therapy with peeling added to minimal invasive blepharoplasty in lower eyelid rejuvenation.

INTRODUCTION: Aging is an inevitable process in life that can pose unsatisfactory changes in appearance. Recently, rejuvenation surgeries have opened an exciting new window toward people who are vulnerable according to their facial appearance. Periocular plastic microsurgeries are among the most common aesthetic surgeries with various outcomes. The current study was aimed to compare outcomes of blepharoplasty with and without peeling regarding lower eyelid rejuvenation. METHODS: This is a randomized clinical trial study conducted on 30-patients referred for inferior lid rejuvenation in 2017-18. Patients were randomly divided into two 15-member subgroups of microinvasive blepharoplasty with and without peeling. Peeling for the group underwent blepharopeeling was performed all over the inferior periocular region using Phenol 89%. Then, skin and underlying muscle were incised superficially, and underlying fat tissue was excised. The other group underwent blepharoplasty without peeling. Patients were followed daily for 2 months to assess complications, patients' and physicians' satisfaction. RESULTS: Two assessed groups were not statistically different regarding age and gender distribution (P-value = .417 and .666, respectively). Considering patients' opinion, symmetry, scar formation, skin laxity, swelling, and total satisfaction score were not different between two groups (P-value > .05) while physicians presented similar outcomes except for better scar formation status of peeling add-on therapy (P-value = .042). Rate of adverse effects was significantly higher among those under blepharoplasty plus peeling treatment (P-value < .05). CONCLUSION: Outcomes of blepharoplasty alone versus blepharoplasty plus peeling were not significantly different regarding both patients' and physicians' assessments in general while fewer complications due to blepharoplasty without peeling were presented.

An experience of slow-Mohs micrographic surgery for the treatment of Dermatofibrosarcoma protuberans: A long-term cohort study.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare dermal mesenchymal tumor known as a low-grade, slow-growing malignancy. The local invasion and high rate of recurrence following surgical treatment are the main concerns to plan the best surgical approach of treatment. AIMS: In the current study, it is aimed to provide an experience of slow-Mohs surgery for the treatment of patients with DSFP. PATIENTS/METHODS: Number of 25 patients with the diagnosis of DFSP through histological and immunostaining study was included. The slow-Mohs was performed by excision of the tumor with margins accounting for 1-2 cm from both the tumor margins and three-dimensional thickness. The obtained tissue margins were horizontally, and if any of the specimens was not margin-free, the procedure was repeated. The patients' opinion about the procedure was assessed using Patient-Observer Scar Assessment Scale (POSAS). RESULTS: Number of 25 patients were included and followed for a median of 46.9 months. The median of the area of excision was 35.56 cm2 , and the median clinical excision margins were 19 mm (tumor excision margins + thickness of the three-dimensional excision). The surgery was performed once for 16 (64%), and postoperative skin closure within 5-7 days after the procedure was performed for 19 (76%) patients. None of the patients represented any recurrence. The patients' overall opinion and satisfaction POSAS score accounted for 2.3 ± 1.65 and 1.6 ± 0.59, respectively. CONCLUSION: The findings of the current study are in favor of slow-Mohs surgery for the management of DFSP, while more extensive studies are strongly recommended for generalization of this procedure.

Effects of the programmed cell death 1 (PDCD1) polymorphisms in susceptibility to systemic lupus erythematosus.

The failure of immunological tolerance to self-antigens plays a fundamental role in the pathogenesis of systemic lupus erythematosus (SLE). PD-1 is an inhibitory receptor for regulating the immune system and preventing development of autoimmune disorders. This study aimed to determine the role of four single-nucleotide polymorphisms (SNPs) within programmed cell death 1 (PDCD1 or PD-1) gene and haplotypes defined by these SNPs in susceptibility to SLE in the Iranian population. Blood samples were obtained from 253 SLE and 564 healthy subjects. Red blood cells were lysed and genomic DNAs were extracted using salting-out method. Genotype determinations of PD1.1, PD1.3, PD1.5 and PD1.9 SNPs were performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and 12 haplotypes were constructed by PDCD1 SNPs. Our results showed significant differences in PD1.5 genotype frequencies between patient and control groups (p < .001). The frequencies of PD1.5 C/C, C/T and T/T genotypes versus other genotypes in SLE patients significantly differed from healthy subjects (p < .001, p = .001 and p = .002, respectively). Allelic analysis indicated a significant association between the frequency of PD1.5C allele and development of SLE in our population (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.51-2.42, p < .001). At the haplotype level, GGCC, GACT and GGCT haplotypes were significantly different between SLE and control groups (OR = 2.14, 95% CI = 1.73-2.66, p < .001; OR = 9.76, 95% CI = 4.47-21.3, p < .001; and OR = 0.32, 95% CI = 0.24-0.42, p < .001, respectively). Based on these findings, PD1.5 SNP and some haplotypes of PDCD1 contribute to SLE risk in the Iranian population.

Association of programmed death-1 gene polymorphisms with the risk of basal cell carcinoma.

Environmental and genetic factors play a fundamental role in the pathogenesis of basal cell carcinoma (BCC) defined as the most common cancer of skin. Programmed death-1 (PD-1), encoded by programmed cell death-1 (PDCD1) gene, serves as an inhibitory molecule in the suppression of immune responses and a risk factor in the development of different cancers. In this study, we investigated the role of two single nucleotide polymorphisms (SNPs) within PDCD1 gene, and haplotypes defined by these SNPs, in the development of BCC in an Iranian population. Whole blood samples were obtained from 210 BCC and 320 healthy subjects. Genomic DNA was extracted from whole blood samples, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to genotype determinations of PD1.3 (rs11568821) and PD1.5 (rs2227981) SNPs, and 4 haplotypes were constructed by PDCD1 SNPs. The frequency of G allele of PD1.3 was significantly higher in BCC patients than healthy subjects (p < 0.02), while these significant differences were not observed in the frequencies of PD1.5 alleles between BCC and healthy subjects. Moreover, we found that there were no statistically significant differences in PD1.3 and PD1.5 genotypes between BCC and control groups. Of all estimated haplotypes for PDCD1, only AC haplotype was associated with BCC (OR = 0.22, 95% CI = 0.06-0.79, p < 0.01). These findings suggest that PD1.3G allele and AC haplotype of PDCD1 contribute to BCC in the Iranian population. However, further studies in different populations with larger sample size are required to confirm this study.

Regulatory T-cells and their impacts on cytokine profile of end-stage renal disease patients suffering from systemic lupus erythematosus.

Autoimmunity is an identified factor for development of end-stage renal disease (ESRD). Regulatory T-cells (Tregs) play a fundamental role in preventing autoimmunity. This study aimed to determine Treg frequency and its effects on cytokine profile of ESRD patients with and without systemic lupus erythematosus (SLE). Moreover, this study also determines how Treg number is affected by blood transfusion and gender. Peripheral blood mononuclear cells were isolated from 26 ESRD and 10 healthy subjects and stained with anti-CD4, anti-CD25, and anti-FoxP3 antibodies. Treg frequencies in ESRD patients with and without blood transfusion were determined by flow cytometry. Antibodies against human leukocyte antigens (HLAs) were investigated by panel-reactive antibodies screening. Tumor growth factor (TGF)-ß1, interleukin (IL)-4, IL-10, TNF-α, IL-17A, and interferon (IFN)-γ serum levels in participants were measured by enzyme-linked immunoasorbent assay (ELISA). ESRD patients with SLE, unlike the patients without SLE, showed a significant reduction in Treg percentage compared to healthy subjects (P < 0.01). All women had a reduced number of Tregs compared to men. Treg number was significantly decreased in ESRD patients with HLA antibodies (P < 0.05). Blood transfusion enhanced Treg development in ESRD patients without SLE, unlike the patients with SLE (P < 0.05). ESRD patients with low Treg showed a reduction in TGF-ß1 and IL-4 and an increase in TNF-α and IL-17A levels compared to control groups (P < 0.05-0.0001). However, no change was observed in IL-10 and IFN-γ levels. Treg frequency was negatively associated with the age of patients (P < 0.01), while this association was not observed in healthy subjects. Based on these findings, it can be observed that reduction in Treg number may contribute to ESRD development in patients with SLE.

Comparison between the efficacy of intralesional rituximab versus intralesional triamcinolone in the treatment refractory Pemphigus Vulgaris lesions: A randomized clinical trial.

BACKGROUND: Pemphigus Vulgaris (PV) is a vesiculobullous autoimmune disorder characterized by production of autoantibody against cellular adhesion molecules. The treatment of PV is based on the use of systemic corticosteroid along with immunosuppressive therapy, but sometimes there are limited resistant lesions not responding to conventional systemic therapy. This double-blind, randomized clinical trial was designed to evaluate the efficacy of intralesional rituximab versus triamcinolone in treatment of the refractory scalp and mucosal pemphigus lesions. METHODS: 2 refractory lesions of PV were selected in 21 patients, and they were randomly assigned to two groups to be treated with either intralesional triamcinolone or rituximab for 2 times at one-month interval. All of the patients were under treatment with prednisolone and azathioprine. Patients were visited at the baseline, 1 and 6 months after treatment, and all information including demographic characteristics of the patients, Pemphigus Vulgaris Lesion Severity Score (PVLSS), Epithelialization Index (EI) and patient's satisfaction (using Visual Analogue Scale (VAS)) were obtained. The collected data were analyzed using SPSS software (ver18). RESULTS: The results showed that, both rituximab and triamcinolone were effective in treatment of the refractory PV lesions (p < 0.05). However, there was no significant difference between the effect of intralesional rituximab and triamcinolone (p > 0.05). In addition, no side effect was observed in both groups. CONCLUSION: Regarding the results of the present study, the use of intralesional rituximab can be suggested for treatment of the resistant PV lesions as an alternative to intralesional triamcinolone or using more aggressive systemic therapy.

Efficacy of mesotherapy with tranexamic acid and ascorbic acid with and without glutathione in treatment of melasma: A split face comparative trial.

INTRODUCTION: Melasma is a prevalent annoying skin hyperpigmentation disorder that commonly involves reproductive-aged females. Variety of treatments with controversial results has been recommended. The aim of the current study was to evaluate combination therapy of tranexamic acid (TA) and vitamin C with and without glutathione with mesotherapy technique for treatment of melasma. METHODS AND MATERIALS: This is a randomized clinical trial study conducted on 30 patients referred to Dermatology Clinics. Patients were examined under wood lamp in order of melasma type (epidermal, dermal, or mixed) determination. Then, patients underwent melasma therapy using Cocktail A (TA 4 mg/mL; vitamin C 3% and glutathione 2%) on their right half of the face and Cocktail B (TA 4 mg/mL and vitamin C 3%) on their left half of the face, with mesotherapy technique. This procedure was done for six times with 2-week intervals. Patients' modified Melasma Area and Severity Scoring (mMASI) was assessed at initiation and end of the study. RESULTS: According to mMASI score changes 12 weeks after intervention, both cocktails had significant efficacy in reduction of mMASI score in each side. Mean of mMASI in left side had decrease of 1.82 ± 0.88 (P-value < 0.001) and in right side had decrease of 3.046 ± 1.25 (P-value < 0.001) from base line. Comparison between two groups 12 weeks after treatment showed significantly more reduction (1.28 ± 0.64) of mMASI score with cocktail A than B (P-value < 0.001). Erythema, edema, and ecchymosis was not significantly different among two cocktails (P-value > 0.05). CONCLUSION: Use of combination mesotherapy in treatment of melasma was accompanied with appropriate outcomes regardless of type of agents but treatment with glutathione containing cocktail A presented superior results compared with cocktail of TA and vitamin C but not glutathione.

Expression of Vascular Endothelial Growth Factor (VEGF) and Epidermal Growth Factor Receptor (EGFR) in Patients With Serous Ovarian Carcinoma and Their Clinical Significance.

BACKGROUND: Vascular endothelial growth factor (VEGF) has an essential role in tumor metastasis by inducing the construction of abnormal blood vessels. Epidermal growth factor receptor (EGFR) is involved in different parts of cancer growth such as tumor initiation, angiogenesis and metastasis. OBJECTIVES: The aim of this study was to evaluate the expression of VEGF and EGFR in ovarian cancer in southern Iran and to assess the correlation between expression of these two markers and patients' age, tumor stage, and grade. PATIENTS AND METHODS: In this cross-sectional study, 50 paraffin blocks of serous ovarian adenocarcinomas and 50 paraffin-embedded specimens from control individuals operated for reasons other than malignancy were immunohistochemically stained using anti-human VEGF and EGFR antibodies. RESULTS: A significant difference in the frequency of positive expression of VEGF was observed in ovarian cancer patients (25.0%) compared with the control group (8.0%) (P = 0.023). A significant difference between EGFR expression in patients (56.8%) and controls (24.0%) was also obtained (P = 0.001). No significant correlation between VEGF and EGFR expression and patients' age, tumor grade and stage were detected (P > 0.05). CONCLUSIONS: The significant increase in both VEGF and EGFR in the patients with ovarian cancer compared to healthy individuals could have prognostic value. Identifying these markers may be useful for chemopreventive and chemotherapeutic strategies for patients with serous ovarian cancer.