Fat grafts enriched with ex-vivo expanded adipose stem cells improve hyperpigmentation of face.

Facial contour deformities associated with pigmentary changes are of major concern for plastic surgeons being difficult to treat. No definite ideal treatment option is available to address simultaneously both the contour defects as well as related hyperpigmentation. The aim of the current study is to compare long-term effects of conventional adipose tissue grafting and ex-vivo expanded ASC-enriched adipose tissue grafting for the treatment of contour deformities related pigmentary changes on the face. In this study, 80 patients of contour deformities of face with hyperpigmentation were recruited after informed consent. Two techniques, that is, conventional fat grafting (C-FG) and fat grafts enriched with expanded adipose stem cells (FG-ASCs) were used to address the pigmentation. Both techniques were explained to patients and enrolled patients were divided into two groups, that is, C-FG and FG-ASCs as per patients' choice and satisfaction. Patients of the FG-ASCs group were treated with FG-ASCs while patients of C-FGs group were treated with C-FG (without expanded ASCs). Patients were followed for 12 months and improvement in face pigmentation was assessed clinically as well as measured objectively. Patients' satisfaction was also documented as highly satisfied, satisfied, and unsatisfied. This clinical trial was registered at www.clinicaltrials.gov with ID: NTC03564808. Mean age of patients was 24.42 (±4.49), 66 patients were females. Forehead was involved in 61.20% cases, cheek in 21.20% cases, chin in 11.20% cases, and nose in 6.20% cases. In GF-ASCs group, the integrated color density was decreased (1.08 × 106 ± 4.64 × 105 ) as compared with C-FG group (2.80 × 105 ± 1.69 × 105 ). Patients treated with fat grafts enriched with expanded ASCs were significantly more satisfied as compared with patients treated with C-FG only. In conclusion, ASC-enriched autologous fat grafting is preferred option for improving the contour deformities related increased pigmentation of face skin.

Adipose Tissue Grafting Improves Contour Deformities Related Hyperpigmentation of Face.

Contour deformities of face are commonly associated with overlying skin hyperpigmentation. Such hyperpigmentation causes aesthetic problems as well as makes contour deformities more prominent. Conventional surgical and cosmetic approaches to treat hyperpigmentation have limitations and therefore it is imperative to use other innovative techniques to simultaneously heal the contour deformity and also to remove hyperpigmentation. The current study aims to evaluate the effect of autologous adipose tissue in improving contour deformities related hyperpigmentation of face. One hundred patients with contour deformities related hyper-pigmentation of overlying skin were enrolled from February 2017 to January 2018. Adipose tissue was harvested from each patient and processed under sterilized conditions. Purified fat collected in a 10cc Luer-Lok syringe was transferred to 1cc syringes and injected into affected areas of face. The patients were followed for 12 months after adipose tissue injections. Both subjective and objective assessment was performed before treatment and 12 months after adipose tissue injections. Results indicated that after adipose tissue grafting, there was a statistically significant improvement in hyperpigmentation of skin. Most of the patients were highly satisfied after use of adipose tissue injections. Image J scanning also showed significant changes in hyperpigmentation of face after adipose tissue use. In all parameters, the patient exhibited statistically significant improvement. In conclusion, autologous fat grafting is a promising and effective therapeutic approach for hyperpigmentation associated with contour deformities of face.

Comparative safety and efficacy of conventional interferon versus pegylated-interferon based therapy for HCV: A retrospective cohort study from Gujranwala, Pakistan.

Numerous studies on risk factors, clinical presentation and treatment of hepatitis C are known to the world. However, no data is available about the safety and efficacy of anti-hepatitis C therapy among the patients of Gujranwala, Pakistan. This retrospective study compared two dosage forms of interferon; conventional interferon (IR) and Pegylated interferon (PIR) in 370 Hepatitis C patients selected through non probability convenient sampling technique. Clinical data were collected related to therapy outcomes at the start of therapy, after each follow up and at the end of therapy. The study indicated that HCV 3 was the most prevalent genotype of hepatitis C. Main side effects associated with therapies were pain at injection site (PIR; 49%, IR; 48%), inflammation at injection site (PIR; 34%, IR; 48%), fever (PIR; 56.12%, IR; 61.5%), myalgia (PIR; 24.5%,IR; 22.99%), malaise (PIR; 7.14%, IR; 5.75%), anorexia (PIR; 46%, IR; 39%), vomiting (PIR; 43%, IR; 41%), irritability (PIR; 4%, IR; 11.5%) and impaired concentration (PIR; 13%, IR; 21). The sustained viral response rate was significantly better in PIR group as compared to IR group (PIR; 80.61%, IR; 66.67%). In conclusion Pegylated interferon based therapy showed better clinical response with less adverse events as compared to conventional interferon based therapy. However, there is dire need to shift from these intravenous dosage forms to relatively new oral dosage forms for the treatment of hepatitis C to further improve clinical outcome and minimize the risks of adverse events.

Association of hypertension and dyslipidaemia with increasing obesity in patients with Type 2 Diabetes Mellitus

The study was performed to estimate the association of hypertension and dyslipidaemia with increasing body weight and obesity in Type II diabetics of Lahore, Pakistan. An observational study was conducted by enrolling 2708 obese diabetics from four diabetes care centres of Lahore, Pakistan. Data was collected for a period of 7 months. Associations were estimated using chi-square, binary and multinomial logistic regression. Data suggested that blood pressure, systolic and diastolic, exhibited continual increase with increasing body weight and obesity class in diabetes patients with 41.8% increase in the prevalence of hypertension in obesity class III subjects (OR; 1.91, p=0.02). Likewise, triglycerides and total cholesterol exhibited continual increase in their mean values with increasing obesity, i-e., an overall increase in the prevalence of dyslipidaemia of 27.2% in obesity class 3 subjects (OR; 1.94, p=0.29). Taken together, this data suggested that hypertension is potentially associated with increasing obesity in diabetics, while dyslipidaemia demonstrated plausible association only with obesity class 3.

Outcome of Conventional Adipose Tissue Grafting for Contour Deformities of Face and Role of Ex Vivo Expanded Adipose Tissue-Derived Stem Cells in Treatment of Such Deformities.

OBJECTIVES: To evaluate the outcomes of conventional fat grafting for facial contour deformities and to describe clinical outcome of a patient with contour deformity of face treated with ex vivo expanded adipose tissue-derived mesenchymal stem cells (ASCs) enriched fat graft. PLACE AND DURATION OF STUDY: The Department of Plastic Surgery and Tissue Engineering and Regenerative Medicine Laboratory, King Edward Medical University/Mayo Hospital, Lahore, from September 2015 to September 2017. METHODS: Patients with contour deformities of face requiring soft tissue augmentation were included. Fat was harvested, processed, and injected following a standard protocol. Both subjective and objective assessments were performed and complications were also noted. RESULTS: Twenty-five patients underwent 51 fat-grafting sessions over a period of 24 months. Eighteen (72%) patients underwent multiple fat-grafting sessions. Mean (standard deviation) soft tissue thickness after 72 hours and 6 months of first fat graft session was 18.62 (7.2) and 12.88 (6.21) mm, respectively, which corresponds to 30.77 (13)% reduction of transplanted fat. Physician and patient assessment scores were 3.42 (0.92) and 4 (1.04), respectively. Few minor complications were observed. In the patient undergoing ex vivo expanded ASCs enriched fat graft, there was minimal decrease in soft tissue thickness of treated area (44 mm vs 42 mm) 6 months postoperatively and patient was highly satisfied with the outcome after the single session. CONCLUSION: Conventional fat grafting is safe for correction of facial contour deformities. However, procedure needs to be repeated multiple times to produce satisfactory results. Beneficial effects of ex vivo expanded ASCs enriched fat grafting have a potential to alter the current treatment paradigm of fat grafting for soft tissue reconstruction.