Superior efficacy of azithromycin and levamisole vs. azithromycin in the treatment of inflammatory acne vulgaris: an investigator blind randomized clinical trial on 169 patients.

BACKGROUND: Different immunologic mechanisms contribute to development of inflammation in acne vulgaris and immunologic effect of levamisole has been demonstrated. OBJECTIVE: The aim of this study was to compare azithromycin and levamisole with azithromycin alone in the treatment of acne vulgaris. METHODS: An investigator-blind clinical randomized prospective 2 months study was designed. 169 acne patients presenting in our outpatients clinic were randomly allocated to two treatment groups: azithromycin and levamisole (Group 1) and azithromycin alone (Group 2). 148 patients completed the duration of the study and their clinical responses were evaluated and compared by using monthly photographic records. RESULTS: Mean reduction rates for the number of papules, pustules and both of them, in Group 1 were 73.72%, 82.69% and 76.93%, respectively, and 68.39%, 70.89% and 69.32% in Group 2 (p < 0.05). Also, mean reduction rates for the number of nodules, cysts and both of them in Group 1 were 80.97%, 89.75% and 82.35%, respectively, and 58.54%, 54.55% and 57.99% in Group 2 (p < 0.05).These differences between two groups were statistically significant in favor of azithromycin and levamisole (Group 1) (p < 0.05). CONCLUSION: According to this study azithromycin plus levamisole may be more effective than azithromycin alone in decreasing of inflammatory acne lesions especially in nodulocystic form. So, regarding the low cost and side effect profile of levamisole, we suggest to consider combination of levamisole with azithromycin while facing acne patients at least with more inflammatory lesions especially when there is any contraindication for isotretinoin.

Utility of intraoperative pathology consultations of whipple resection specimens and their impact on final margin status.

The resection margin status is a significant surgical prognostic factor for the long-term outcomes of patients undergoing pancreaticoduodenectomy (Whipple procedure). As a result, surgeons frequently rely on intraoperative consults (IOCs) involving frozen sections to evaluate margin clearance during these resections. Nevertheless, the impact of this practice on final margin status and long-term outcomes remains a topic of debate. This study aimed to assess the impact of IOCs on the clearance rate of resection margins following Whipple procedure and distal pancreatectomy. A retrospective database review of all patients who underwent Whipple procedure or distal pancreatectomy at our institution between 2018 and 2020 was performed to evaluate the utility of IOCs by gastrointestinal surgeons and its correlation with final postoperative surgical margin status. A significant variation in the frequency of IOC requests for margins among surgeons was noted. However, the use of frozen section analysis for intraoperative margin assessment was not significantly associated with the clearance rate of final post-operative margins. More frequent use of IOC did not result in higher final margin clearance rate, an important prognostic factor following Whipple procedure.

Pitfalls in the diagnosis of lentigo maligna and lentigo maligna melanoma, facts and an opinion.

Lentigo maligna/lentigo maligna melanoma (LM/LMM) affects chronically sun-damaged skin of the head and neck with a slow radial growth phase. It is characterised by predominantly lentiginous proliferation of small, but atypical melanocytes with occasional upward scatter in an atrophic epidermis. It is not uncommon for pathologists to receive partial or scouting biopsies to assess for LM. This makes the interpretation of symmetry and circumscription of the lesions challenging. Therefore, both cytologic and architectural criteria should be taken into consideration to render an accurate diagnosis of melanoma. Moreover, pathologists should be vigilant to avoid missing invasion, as this can change the treatment plan and prognosis. Herein, we aim to discuss important pitfalls in the diagnosis of LMM and its invasive component. Some of these caveats are differentiating between true invasion versus adnexal involvement by the in situ component or an incidental intradermal nevus, detection of microinvasion and multifocal invasion, and recognition of desmoplastic/spindle cell melanoma component.

Olmsted syndrome in an Iranian family: report of two new cases.

Olmsted syndrome is a rare congenital entity characterized by combination of symmetrical, sharply-defined palmoplantar keratoderma with flexion deformities of the digits, periorificial keratosis, perianal involvement, onychodystrophy, and variable leukokeratosis. Herein, we report two new related male patients--the third familial cases of Olmsted syndrome--one with the full-blown spectrum of the syndrome, and the other with early signs and symptoms of the disorder.

Some epidemiological aspects of dermatophyte infections in Southwest Iran.

Distribution and prevalence of various species of dermatophytes are not the same in different areas of the world. The aim of the present study was epidemiologic evaluation of dermatophytic infections in our area. A retrospective epidemiologic study was carried out and all patients with dermatophyte positive smears identified at the Referral Center of Southwest Iran located in the city of Ahvaz between March 2005 and March 2007 were investigated. Body was divided into nine areas and information on age, sex, dermatophyte species and clinical presentation were recorded. The study included 428 patients, 233 (54.43%) men and 195 (45.56%) women, most of them aged 20-29 (29.8%). Regarding the body area involved, the groin, trunk and hands were the most prevalent areas. Tinea cruris and tinea corporis were the most common clinical presentation in both men and women. Epidermophyton floccosum was the most frequently isolated dermatophyte (39.25%), followed by Trichophyton verrucosum (27.33%) and Trichophyton rubrum (8.41%). Epidemiologic characteristics of dermatophytic infections in southwest Iran in comparison with other areas of the world and even Iran have changed significantly. As many factors such as area, weather conditions, occupation, and environmental factors are implicated in dermatophytic infections, it seems that dermatophytic infections change epidemiologically from time to time even in different areas of a country such as Iran. Accordingly, we think that the reason for this phenomenon in our area may change related to seeking healthy behaviors and hygiene in southwest Iran. We propose to do additional and larger epidemiologic studies regarding these variables.

Weekly vs. daily administration of oral methotrexate (MTX) for generalized plaque psoriasis: a randomized controlled clinical trial.

UNLABELLED: Methotrexate (MTX) treatment for psoriasis is most often administered weekly, because the drug has been considered more hepatotoxic when taken daily. However, some patients may tolerate smaller, more frequent doses better. OBJECTIVE: To study the efficacy and toxicity of daily vs. weekly MTX. PATIENTS AND METHODS: In a randomized controlled trial, 101 patients with generalized plaque psoriasis received oral MTX 2.5 mg daily for weeks, 4 weeks and monthly for a total of 4 months. Changes in PASI scores were classified into three categories: >75% improvement was considered significant; 25-75% moderate; and <25% poor. RESULTS: Sixty Group 1 patients and 81 Group 2 patients showed a significant response (P-value 0.001); 19 patients in Group 1 and 14 in Group 2 responded moderately; 22 patients in Group 1 and six patients from Group 2 responded poorly. Forty-five patients in Group 1 and 33 in Group 2 developed transient increases in liver enzymes (P-value 0.11). Nausea, headache, fatigue, and gastrointestinal upset were noted in four Group 1 patients and 30 Group 2 patients (P-value 0.0001). CONCLUSION: Nausea, vomiting, headache, and fatigue were significantly less common side effects in our patients who received MTX daily, but liver enzyme abnormalities were less common, and clinical efficacy was greater in the patients who received MTX weekly.