Superficial cryotherapy using dimethyl ether and propane mixture versus microneedling in the treatment of alopecia areata: A prospective single-blinded randomized clinical trial.

To verify and compare the therapeutic efficacy and safety of superficial cryotherapy using dimethyl ether and propane (DMEP) mixture vs. microneedling in the treatment of mild scalp alopecia areata (AA). In a prospective randomized single-blinded clinical trial, 80 patients with clinically evident scalp mild AA were randomly assigned into two groups of 40 patients each. Group (1) was treated by superficial cryotherapy using DMEP in three freeze-thaw cycles of 5 s each. Group (2) was treated by microneedling. Both groups were treated every 2 weeks for 6 sessions and followed up for 3 months after the last session. Patients were assessed by photographic documentation, trichoscopic evaluation, severity of alopecia tool (SALT) score, and alopecia areata symptom impact scale (AASIS). An excellent response was achieved in 15 (37.5%) of group (1) compared with 14 (35%) of group (2) patients, while a good response was achieved in 23 (57.5%) of group (1) compared with 21 (52.5%) of group (1) patients, with a statistically insignificant difference. The mean SALT score change percentage was a statistically significantly higher in group (2) patients. The mean AASIS change percentage was higher in group (1) patients, but this was a statistically insignificant. In both groups, the mean numbers of trichoscopic signs of AA significantly decreased from baseline to the end of follow-up period. Both therapeutic modalities were well-tolerated, with no recurrence after the follow-up period. Both superficial cryotherapy using DMEP mixture, and microneedling are simple, effective, and safe therapeutic options for mild scalp AA, however, microneedling showed higher efficacy.

Medicolegal evaluation of the erectile function of patients referred from the Forensic Medicine Authority of the Ministry of Justice in Upper Egypt.

OBJECTIVES: In Upper Egypt, the Forensic Medicine Authority of the Ministry of Justice transfers patients with marital conflicts or accusation of rape for proper sexual function evaluation, which helps in making its decisions according to the law. Therefore, our study aims to evaluate the pattern of 40 cases referred for sexual function evaluation, their clinical, laboratory, imaging characteristics and finally the decisions of these cases. METHODS: The study included 40 patients who referred from the Forensic Medicine Authority for erectile function evaluation. Initial evaluation was done through history taking, general & genital examination. Hormonal profile including total testosterone, free testosterone, follicle stimulating hormone, luteinizing hormone, prolactin, estradiol and random blood sugar were done. Penile color doppler with intracorporeal injection of PGE1 was done. RESULTS: The final decision for erectile function cases was considered as normal evaluation, venogenic, arteriogenic, and psychogenic erectile dysfunction were 35% (14/40), 25% (10/40), 15% (6/40) and 12.5% (5/40), respectively. CONCLUSIONS: There is a great diversity in patients referred for medicolegal evaluation in Upper Egypt; with the erectile function problems are the commonest. A more meticulous well-designed approach is needed for proper evaluation of those patients as serious legal consequences result from this evaluation.

Evaluation of the role of Chlamydia trachomatis in primary male infertility.

AIMS: This study aimed to find out the potential role of Chlamydia trachomatis (C. trachomatis) in male primary infertility and to recommend an easy, rapid, and sensitive diagnostic tool for its detection. METHODS: Semen samples were collected from male patients who presented with primary infertility and from age-matched healthy controls. These samples were analysed according to the World Health Organization guidelines. Infection with C. trachomatis in those patients and controls was detected by two methods; assay of anti-chlamydia IgA antibodies level in seminal plasma and detection C. trachomatis deoxyribonucleic acid (DNA) by real-time polymerase chain reaction (RT-PCR) technology. RESULTS: Positive detection of anti-Chlamydia IgA antibody was found in 28 (14%) patients and in 6 (9.2%) controls. Positive detection of C. trachomatis-cryptic plasmid gene was found in 15 (7.5%) patients and in zero of controls. Detection of anti-chlamydia IgA by enzyme-linked immunosorbent assay (ELISA) has a sensitivity of 100% and specificity of 92.97%. There were significant associations between C. trachomatis infection and asthenozoospermia (P = .05), and abnormal vitality (P = .003). CONCLUSION: C. trachomatis infection adversely affects the fertility potential in males because of its effect on the motility and vitality of sperms. We can rely on the detection of anti-chlamydia IgA antibodies in seminal plasma as a rapid sensitive diagnostic test for the detection of C. trachomatis infection.

In vitro antifungal susceptibility testing of fungi in patients with onychomycosis.

Onychomycosis is the most common nail disorder. To examine in vitro antifungal susceptibility of fungi among onychomycosis patients. The study included 68 patients with onychomycosis. Nail specimens were cultured on Sabouraud dextrose agar and Dermasel agar base-media. Isolated fungi were subjected to antifungal susceptibility tests against terbinafine, itraconazole, fluconazole, and griseofulvin. Candida species (Candida spp.) were detected in 32.4% of the cases of candidal onychomycosis (n = 37), 23.5% of the cases of distal and lateral subungual onychomycosis (n = 17), and 21.4% of the cases of total dystrophic onychomycosis (n = 14). Candida spp. were sensitive to fluconazole in 73.5%, itraconazole in 58.8%, and terbinafine in 5.9% of the cases. Aspergillus spp. were sensitive to itraconazole in all cases, and terbinafine in 87.5% of cases. Penicillium spp. were sensitive to itraconazole and terbinafine in 88.9% and 77.8% of cases, respectively. Trichophyton spp. were sensitive to terbinafine and resistant to itraconazole. Microsporum spp. were sensitive to itraconazole and resistance to terbinafine. All isolated fungi were resistant to griseofulvin. An increasing proportion of Candida spp. was observed among patients with different clinical varieties of onychomycosis. Candida spp. were highly sensitive to fluconazole and a lesser extent to itraconazole.

Comparison of the clinical efficacy of daily use of L-arginine, tadalafil and combined L-arginine with tadalafil in the treatment of elderly patients with erectile dysfunction.

This study aimed to evaluate the efficacy of the daily oral administrations of L-arginine, tadalafil and combined L-arginine with tadalafil in treatments of elderly patients with erectile dysfunction (ED). It was designed as a single-blind placebo-controlled clinical trial. It was conducted on 120 male patients aged ≥60 years old with ED. Patients were randomised classified into four groups (n = 30 each). Oral daily use of L-arginine (5 g), tadalafil (5 mg), combined L-arginine (5 g) with tadalafil (5 mg) and placebo were taken for 6 weeks in each group of patients respectively. Patients were assessed before and after treatments using the Sexual Health Inventory for Men (SHIM) questionnaire and total serum testosterone. The means of Q1-5, total scores of SHIM and total testosterone, in L-arginine, tadalafil and combined L-arginine with tadalafil groups were significantly higher after treatments (p = .001). Combined L-arginine with tadalafil group had the highest SHIM scores and levels of total testosterone. This clinical trial deduced that the combined daily use of L-arginine with tadalafil therapy for elderly male patients with ED could significantly increase the SHIM scores and levels of total testosterone in comparison to L-arginine, or tadalafil alone.

Possible role of interleukin 21 and interleukin 33 in patients with genital warts.

Genital warts (GWs) are most prevalent sexually transmitted infections, presenting especially among the sexually active young population of both sexes. Efficient cell-mediated immunity is needed for regression of GWs. To clarify the reactivity of cellular immunity among patients with GWs by means of measurements of their levels of serum interleukin (IL)-21 and IL-33, hence, to identify the possible role of IL-21 and IL-33 in GWs, this study aimed to evaluate serum levels of IL-21 and IL-33 among patients with GWs in comparison with the results of the controls. Levels of serum IL-21 and IL-33 were assayed utilizing commercially enzyme-linked immune-sorbent assay kits in 45 patients with GWs and 45 healthy control subjects. Levels of serum IL-21 and IL-33 were significantly decreased among patients with GWs in comparison with the controls (p < .0001). There was a highly significant positive correlation between IL-21 and IL-33 (r = .73, p < .0001). Low levels of serum IL-21 and IL-33 could have a contributive role in development, persistence, severity, and recurrence of GWs which rely basically on the defectiveness of cell-mediated immunity. This could receive new light on nonconventional strategies for the prospective medical therapies of GWs by means of regulation of IL-21 and IL-33.

Evaluation of pubertal onset and characteristics in Egyptian boys: A cross-sectional study.

The objective of this study was to evaluate pubertal onset and characteristics in Egyptian boys. Examination of schoolboys (9-18 years) included height (cm), penile length (cm) and testicular volume (ml). Pubertal onset was considered at gonadal (G) stage 2 (G2 indicated testicular volume from 4-8 ml). Out of 1,078 boys, 270 (25%) were residents in urban areas, 414 (38.4%) in suburban areas and 394 (36.5%) in rural areas. The mean (±SD) age of G2 was 11.1 ± 1.2 years (5th and 95th percentiles were 10 and 13 years respectively). The age of 10.5 years was predictive of G2 with 89.9% sensitivity and 86.2% specificity (95% confidence interval; p < 0.001). The changes in testicular volumes and penile lengths, at the age interval from 16 to 18 years, were not significant. Pubertal onset was earlier among Egyptian boys in urban areas, with smaller family size, less crowding conditions, adequate illumination and good ventilation, although the difference was not statistically significant (p > 0.05). In conclusion, the mean age of pubertal onset among Egyptian boys was 11.1 years. A tendency towards earlier pubertal onset was observed in Egyptian boys who lived in urban areas and had better socio-demographic conditions.

Henna Tattoo: From Cosmetic Purposes to Dermatological Reactions.

Introduction: Henna, commonly used as a hair dye, is also used for temporary tattoos. It is commonly mixed with para-phenylenediamine (PPD) to enhance color intensity, which may induce cutaneous sensitization. Aim: This study aimed to describe the clinicodemographic features of patients with dermatological reactions to henna tattoos. Materials and Methods: This cross-sectional study, included patients with dermatological reactions to henna tattoos. All the patients were subjected to entire medical history including clinicodemographic data and general and dermatological examinations. Results: This study included 17 female patients with a mean age of 26.88 ± 6.6 years. Of these 17 patients; 41.2% were suburban residents, 58.8% were housewives, 70.6% were married, and 47.1% were middle socioeconomic class and 53% had type IV Fitzpatrick skin. All used black color and commercial henna for cosmetic purposes, 41.2% used market henna, and 35.3% used coiffeur henna. Many (70.6%) had localized reactions with 23.5% presenting with reaction of hands, 64.7% had acute eczematous reactions, and all had a progressive course. The mean duration of the reaction was 6.76 ± 2.6 days. The mean latency time of the reaction was 2.7 ± 0.85 days. Conclusion: This study concluded that public awareness of possible cutaneous reactions to henna tattoos should be increased. The health authority legislation should control the use of black henna to minimize the consequences.

A case of resistant multiple plantar warts cured with combined autologous platelet-rich plasma injection and topical salicylic acid 30.

BACKGROUND: Plantar warts are common benign cutaneous lesions affecting the plantar aspects of the feet; they are caused by infection of the keratinocytes by the human papillomavirus (HPV). The effective treatment of plantar warts is still a therapeutic challenge. AIM: This study aimed to assess the possible clinical efficacy and safety of the combined intralesional autologous platelet-rich plasma (PRP) injection with local application of salicylic acid 30% solution in the treatment of multiple resistant plantar warts. METHOD: In the present case, a 54-year-old immunocompetent male patient presented with multiple, bilateral resistant plantar warts. RESULTS: A complete clearance of the plantar warts was observed after three sessions of intralesional autologous PRP injections with one-month interval, combined with twice-daily local application of salicylic acid 30% solution between sessions. No recurrence was recorded after a nine-month follow-up from the last session. There were no reported side effects during or after the sessions. CONCLUSION: The combined intralesional autologous PRP injection with topical salicylic acid is an effective, economic, and safe modality of treatment for multiple resistant plantar warts.

Clinical, dermoscopic, and histopathological evaluations of patients with nail disorders.

OBJECTIVE: This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis. METHODS: This study included 104 patients with nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine clinically ambiguous nail disorders. RESULTS: The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%) and nail lichen planus (3.8%). CONCLUSION: Clinical evaluation was important in the diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. The histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was a good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.

Effectiveness and tolerability of lidocaine 5% spray in the treatment of lifelong premature ejaculation patients: a randomized single-blind placebo-controlled clinical trial.

This study aimed to appraise the effectiveness and tolerability of lidocaine 5% spray in the treatment of patients with premature ejaculation (PE). The current study has been designed as a randomized single-blind placebo-controlled clinical trial. It was done on 150 lifelong PE patients with normal erection. They were randomized evenly categorized into two treatment groups. Group 1 (n = 75); was given on demand lidocaine 5% spray for 8 weeks. Group 2 (n = 75); was given placebo in the form on demand alcohol spray for 8 weeks. All medications were applied on the glans penis for 10-20 min, and then cleaned before planned sexual intercourse. Patients were evaluated with the Arabic Index of Premature Ejaculation (AIPE) scores, intravaginal ejaculatory latency times (IELTs), and frequency of sexual intercourse before and after treatments. The mean values of the AIPE scores, IELTs, and sexual intercourse frequency in the lidocaine 5% spray group were statistically significant increased than the group of placebo after treatment (P value 0.0001). The present study deduced that local use of lidocaine 5% spray on glans penis 10-20 min prior to sexual intercourse could significantly improve PE patients, with tolerated local adverse effects.

An update on the treatment of premature ejaculation: A systematic review.

To analyse the current therapeutic options for patients with premature ejaculation (PE) and highlight their mechanism(s) of action, effectiveness, advantages and limitations. A literature search was conducted using the PubMed database searching for articles exploring different PE treatment modalities. A Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) approach was used to report the results of the literature search. A total of 149 articles were included in this review. The currently available treatment methods for PE include behavioural therapy, local anaesthetics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and selective phosphodiesterase inhibitors. Most PE treatments are either experimental or used off-label. New treatments are certainly warranted to overcome this exasperating sexual dysfunction. Abbreviations: AIPE: Arabic Index of Premature Ejaculation; CNS: central nervous system; CYP: cytochrome P450; ED: erectile dysfunction; FDA: United States Food and Drug Administration; H1: histamine receptors; 5-HT: 5-hydroxytryptamine; IELT: The intravaginal ejaculation latency time; IPE: Index of Premature Ejaculation; M1: muscarinic receptors; OCD: obsessive-compulsive disorder; PDE5: phosphodiesterase type 5; PE: premature ejaculation; PEP: Premature Ejaculation Profile; PRO: patient-reported outcome; RCT: randomised controlled trial; SS: Severance Secret (cream); SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic antidepressants.

Possible clinical efficacy and tolerability of platelet-rich plasma in the treatment of patients with recalcitrant plane warts: The first clinical study.

BACKGROUND: Plane warts are prevalent cutaneous diseases, caused by different serotypes of human papillomavirus. AIMS: This study aimed to assess the possible clinical efficacy and tolerability of platelet-rich plasma (PRP) in the treatment of patients with multiple recalcitrant plane warts. METHODS: This prospective cohort clinical study was carried out on 25 patients with clinical and dermoscopic evident multiple recalcitrant plane warts. The patients were treated with autologous intralesional PRP injections every month until a complete clearance or for a maximum of two sessions. Then, patients were clinically evaluated one month after every session and after a six-month follow-up from the last injection. RESULTS: Of the included patients, 20 (80%) patients had facial plane warts, 3 (12%) patients had plane warts in the dorsum of hands, and 2 (8%) patients had plane warts in the dorsal aspect of feet. 60% of the patients have more than 100 plane warts, and all the patients had plane warts than 1 cm in size. The complete improvement was observed in 20% and 100% of the patients after the first and second sessions, respectively. No recurrence was detected after a six-month follow-up. No side effects were recorded after the treatment sessions. CONCLUSION: Intralesional injection of PRP could be potentially effective and well-tolerated immunotherapy for the treatment of multiple recalcitrant plane warts. Whatever, more studies are needed with a larger sample size and a longer period of follow-up. Also, randomized and controlled studies are required to evaluate its efficacy in treating different clinical types of warts.

Biochemical Assessments of Seminal Plasma Zinc, Testis-Expressed Sequence 101 and Free Amino Acids and Their Correlations with Reproductive Hormones in Male Infertility.

The role of the male factors in the couple's infertility has been significantly increased in recent years due to a sententious assessment of male reproductive functions and enhanced diagnostic tools. We investigated the correlations among the seminal plasma (SP) levels of each of zinc, testis-expressed sequence 101 (TEX101), and free amino acids levels with reproductive hormones in adult fertile and infertile men. The study included 100 infertile men categorized into 50 non-obstructive azoospermic patients and 50 patients with idiopathic oligoasthenoteratozoospermia (iOAT), in addition to 50 fertile controls. Semen analyses, serum ELISA assays for male reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, and prolactin), colorimetric assays of SP zinc and total proteins, SP free amino acids using high-performance liquid chromatography (HPLC), and ELISA assays of SP TEX101 were performed for all subjects. Infertile men with azoospermia had significantly lower SP median levels of zinc, TEX101, and many SP free amino acids compared to both men with iOAT and fertile controls (P Ë‚ 0.05 for all). There were lower SP levels of zinc and some free amino acids among men with iOAT compared to the fertile controls (P Ë‚ 0.05 for all) with non-significant difference regarding to SP TEX101 (P Ëƒ 0.05). Azoospermic men exhibited negative correlations between FSH, LH, and prolactin with some SP free amino acids (P Ë‚ 0.05 for all), and a positive correlation between glycine with total testosterone (P Ë‚ 0.05). Among iOAT patients, LH and FSH were positively correlated with SP zinc, TEX101, and some measured free amino acids (P Ë‚ 0.05 for all). Total testosterone was positively correlated with some amino acids, while prolactin was negatively correlated with glycine (P Ë‚ 0.05 for all). iOAT and azoospermic men exhibited low SP zinc and some free amino acids levels that were more pronounced in azoospermic men and were significantly associated with the reproductive hormones. TEX101 could be a helpful confirmatory test for azoospermia.

High levels of Helicobacter pylori antigens and antibodies in patients with severe acne vulgaris.

BACKGROUND: Helicobacter pylori (H pylori) may play a role in the pathogenesis of extra-intestinal disorders including dermatological diseases. AIMS: This study aimed to assess the levels of H pylori antigen and antibody in patients with acne vulgaris (AV). METHODS: This cross-sectional study compared the levels of fecal H pylori antigen and serum H pylori antibody in 100 patients with AV and 100 age and sex-matched healthy volunteers. Patients with AV were classified into mild, moderate, and severe according to the Global Acne Grading Scale. Levels of fecal H pylori antigen and serum H pylori antibodies were assessed using commercially available enzyme-linked immune-sorbent assay. RESULTS: The patients with severe AV had significantly higher levels of fecal H pylori antigen as compared to the patients with mild AV, moderate AV, and healthy controls (P < .001). The patients with severe AV had significantly higher serum H pylori antibody as compared to the patients with mild AV, moderate AV, and healthy controls (P = .001). The levels of fecal H pylori antigen and serum H pylori antibody in the patients with mild AV were not significantly different from those in the patients with moderate AV (P = .49 and P = .05, respectively). CONCLUSION: The patients with severe AV had higher levels of fecal H pylori antigen and serum H pylori antibody as compared to the patients with mild and moderate AV and with healthy controls. The indicators of H pylori infection were positively correlated with the severity and duration of AV.

Serum YKL-40 in patients with psoriasis vulgaris treated by narrow-band UVB phototherapy.

Background: Psoriasis is a common chronic and immune-mediated inflammatory skin disease. Objectives: This study aimed to investigate the serum levels of Chitinase-3-like protein 1 (YKL-40) in patients with psoriasis vulgaris before and after narrow-band ultraviolet B (NB-UVB) phototherapy. Methods: This study was designed as a cross-sectional case-control. This study included 30 patients with psoriasis vulgaris and 20 healthy individuals. Psoriasis Area and Severity Index (PASI) score were used to evaluate the patients with psoriasis vulgaris before and after treatment. All patients were treated 2 times per week for 3 months with NB-UVB phototherapy. Enzyme-linked immunosorbent assay (ELISA) was used to assess serum levels of YKL-40 of the healthy control subjects and psoriatic patients before and after treatment by NB-UVB phototherapy. Results: The serum level of YKL-40 was significantly higher in patients with psoriasis vulgaris versus healthy control subjects (p value<.001). There were significant reductions in the serum levels of YKL-40 and PASI scores after 3 months of treatment with NB-UVB phototherapy in patients with psoriasis vulgaris (p value<.001). Conclusions: This study concluded that NB-UVB phototherapy for three months in patients with psoriasis vulgaris was an essential method for decreasing the serum levels of YKL-40 and PASI scores.

A comparative study between suction blistering graft, mini punch graft, and hair follicle transplant in treatment of patients with stable vitiligo.

Background: Vitiligo is an acquired disfiguring common depigmented skin disease. Objectives: This study aimed to compare the clinical efficacy and safety of suction blistering graft, mini punch and hair follicle techniques in treatment of patients with stable vitiligo. Methods: Thirty patients with stable vitiligo were included. Patients were divided into 3 groups, in group (A) 10 patient underwent suction blistering technique, in group (B) 10 patients underwent mini punch technique and in group (C) 10 patients underwent hair follicle technique. Then all patients in the three techniques were subjected to narrow-band ultraviolet B (NB-UVB) phototherapy for 3 months. All patients were assessed by determining the percentage of repigmentation and Dermatology Life Quality Index (DLQI) before and 3 months after the operation. Results: The percentage of repigmentation of vitiligo in suction blister technique was significantly higher than both mini punch and hair follicle techniques (p value .001 and .0001 respectively). There was a statistically significant difference between the three techniques regarding DLQI score after operation (p value = .0001). Conclusion: This study concluded that suction blistering technique is more effective and safe than mini punch technique and hair follicle technique in treatment of stable vitiligo.