Intralesional injection of vitamin D in verruca vulgaris increases cathelicidin (LL37) expression; therapeutic and immunohistochemical study.

INTRODUCTION: Despite the promising results of intralesional vitamin D in verruca treatment; its precise mechanism of action is not fully understood. AIM OF THE WORK: To investigate immunohistochemical expression of cathelicidin (LL 37) before and after injection of vitamin D in verruca vulgaris and to clarify its possible role in pathogenesis of verruca. PATIENTS AND METHODS: This study included 20 patients with multiple verrucae vulgaris. Vitamin D was intralesionally injected every 2 weeks for a maximum of 4 sessions or clearance of verrucae. Skin biopsies were taken from the patients before and at the end of the study and compared to skin samples from ten apparently healthy, age and sex matched individuals for histopathological and immunohistochemical assessment of LL37 expression. RESULTS: Eight (40%) verrucae showed complete response, seven (35%) showed partial response and five (25%) showed no response. Decreased epidermal thickness and reduced density of inflammatory cells in dermis were observed after injection. Significant increase in LL37 intensity of expression was observed after intralesional injection of vitamin D3 (p = .003) and in verrucae showing complete clinical response (p = .022). CONCLUSIONS: Intralesional injection of vitamin D is effective and safe treatment for verruca vulgaris and causes increase in LL37 expression.

Liposomal azelaic acid 20% cream vs hydroquinone 4% cream as adjuvant to oral tranexamic acid in melasma: a comparative study.

BACKGROUND: Melasma negatively impacts patient's quality of life (QoL). Although hydroquinone 4% is the most prescribed treatment, several side effects had been reported. The traditionally used azelaic acid 20% has poor tolerability and low skin absorption rate. AIM: To assess the efficacy and tolerability of the liposomal form of azelaic acid 20% as an adjuvant to oral tranexamic acid in the treatment of melasma. PATIENTS AND METHODS: Fifty females suffering from melasma were divided into two equal groups. The first group used a liposomal form of azelaic acid 20%, and the second group used hydroquinone 4%. Oral tranexamic acid 250 mg was taken by both groups as a single oral daily dose. Melasma severity and the patient's QoL were assessed. RESULTS: A significant improvement of melasma was detected in females who used the liposomal form of azelaic acid 20% than those who used hydroquinone 4%. This was associated with a significant positive effect on their QoL. Furthermore, the liposomal form of azelaic acid 20% was more significantly tolerable than hydroquinone 4%. CONCLUSION: The use of the liposomal form of azelaic acid provides an effective and well-tolerated addition to the treatment of melasma.

Does involucrin have a Role in Verruca Vulgaris? A Clinical and Immunohistochemical Study.

INTRODUCTION: Several modalities are used in the treatment of verrucae vulgaris; however, their side effects are common. Vitamin D3 has been recently used as a treatment in verruca vulgaris. AIM OF THE WORK: We aimed to assess the expression of involucrin in verrucae before and after intralesional injection of vitamin D3 and its correlation with clinical response. SUBJECTS AND METHODS: This study included 60 patients with verrucae vulgaris. These patients were subjected to intralesional injection of vitamin D3 at 3-week intervals for a maximum of five sessions. The pathological assessment was done by skin biopsies obtained from thirty patients before the first session and after the last session of injection and compared to skin biopsies from 30 healthy individuals. RESULTS: The injected verrucae showed complete response in 39 patients (65%), partial response in 15 patients (25%), and no response in 6 patients (10%). Nonsmoker patients had a better response than smokers. Vitamin D3 injections also resulted in increasing involucrin expression and changing its pattern of expression. CONCLUSIONS: Intralesional vitamin D3 is an effective treatment for verrucae vulgaris. Involucrin expression is modified in verrucae.

Effect of new oral direct acting antiviral therapy on sexual function in male patients with hepatitis C virus.

Hepatitis C virus (HCV) infection is a major health problem all over the world including Egypt. Chronic HCV infection is usually accompanied by decrease of libido and erectile dysfunction. This study aimed to evaluate the efficacy of new oral direct acting antiviral (DAA) therapy on sexual function of male patients with HCV. This study was conducted on 200 male participants divided into two groups, first group included 100 male patients with HCV and the second group included 100 healthy age matched males as a control. Patients received DAA for three months and virological free status was confirmed by polymerase chain reaction. All participants were subjected to full history taking, general examination and local genital examination, assessment of sexual function by a validated Arabic version of the international index of erectile function-5. Laboratory investigations included liver functions serum testosterone, free testosterone, sex hormone-binding globulin and bioavailable testosterone. Results of this study showed that patients with HCV suffer from sexual dysfunction than controls that significantly improved after DAA therapy, and this is accompanied by increasing of bioavailable testosterone. It could be concluded that beside its effectiveness in treatment of HCV infection, DAA therapy can improve sexual function in male patients with HCV.

Assessment of seminal YKL-40 in infertile men with varicocele.

Several studies attempted to explain the negative impact of varicocele on spermatogenesis and fertilisation processes. YKL-40 is a novel glycoprotein biomarker that had been associated with several diseases. This quasi-interventional study aimed to assess the seminal levels of YKL-40 in infertile men with varicocele before and after varicocelectomy. Overall, 50 men were included in this study divided into 20 healthy fertile men and 30 infertile oligoasthenoteratozoospermic (OAT) men with varicocele that underwent varicocelectomy. All participants were subjected to history taking, clinical examination and scrotal Doppler. Also, semen analysis and seminal YKL-40 assessment were carried out in the start and 6 months after varicocele surgical repair. The results showed a significant increase in the mean seminal YKL-40 level in infertile OAT men with varicocele compared with the healthy fertile men. Six months post-varicocelectomy, the mean seminal KYL-40 level exhibited significant decreases correlated with improved sperm parameters. Overall, seminal levels of YKL-40 showed significant negative correlations with sperm concentration, total sperm motility and sperm normal morphology. It could be concluded that seminal YKL-40 is elevated in infertile OAT men with varicocele where varicocelectomy induces decreased seminal YKL-40 levels correlated with improved semen parameters.

Soluble Fibrinogen-like protein 2 plays a role in varicocele induced male infertility.

Varicocele is the most common cause of male infertility. Several theories have been proposed to explain how varicocele induces infertility. The role of epididymis in male infertility is not fully well established. Fibrinogen-like protein 2 is one of serine proteases and is a potent coagulant in membranous form and immune-modulator in soluble form (sFGL-2) and expressed in the epididymis. There are no previous reports about its possible role in varicocele. This case-controlled study aimed to evaluate the seminal level of sFGL-2 in infertile men with varicocele and in men with idiopathic infertility. This study included 85 participants divided into three groups; 25 normal fertile men, 30 infertile men with varicocele and 30 infertile men of idiopathic cause. Clinical examination, Doppler ultrasound, semen analysis and measurement of seminal level of sFGL-2 were done to all participants. Seminal level of sFGL-2 was significantly elevated in infertile than normal fertile men. Seminal level of sFGL-2 showed negative correlations with sperm concentration, motility and normal morphology. Seminal level of sFGL-2 had a positive correlation with seminal liquefaction time. This study concluded that seminal level of sFGL-2 is increased in infertile men with idiopathic cause and with varicocele induced infertility and affects seminal liquefaction.

Expression of pigment epithelium-derived factor in psoriasis, verrucae, squamous cell carcinoma and normal skin: An immunohistochemical study.

BACKGROUND: Preservation of homeostasis status in the skin needs an equilibrium of keratinocyte proliferation, differentiation, necrosis and apoptosis. Disturbance of these regulatory mechanisms may lead to keratinocyte neoplastic and hyperproliferative diseases. Pigment epithelium-derived factor is a glycoprotein that is endogenously produced in different tissues and has a variety of biological effects in different diseases. OBJECTIVE: To evaluate the keratinocyte expression of pigment epithelium-derived factor in normal skin and three epidermal hyperproliferative diseases, namely, psoriasis, verrucae and squamous cell carcinoma. METHODS: This study included skin biopsy samples from 80 participants who were divided into four equal groups; each containing 20 samples. The first group included skin biopsies from normal skin, the second group from psoriatic lesions, the third group from verruca vulgaris and the fourth group from squamous cell carcinoma. All tissue samples were stained with hematoxylin and eosin stain and later immunohistochemically for pigment epithelium-derived factor expression. RESULTS: Scores of pigment epithelium-derived factor expression were lower in squamous cell carcinoma and verruca and psoriasis than normal skin with a significant difference (P = 0.04). In addition, the pattern of pigment epithelium-derived factor expression was mainly cytoplasmic in normal skin with a significant difference with that seen in psoriasis, squamous cell carcinoma and verruca vulgaris (P = 0.001). CONCLUSION: Pigment epithelium-derived factor may play a role in keratinocyte differentiation.

Association of Genetic Variants of the Interleukin-17F rs763780 and its Circulating Level in Psoriasis Patients in Egypt.

Psoriasis is a chronic autoimmune disease affecting the skin and joints, IL- 17 family has been shown to be the major effector cytokine in its pathogenesis. This study aimed to investigate genetic polymorphism of IL-17F (rs763780) and evaluate the impact of this polymorphism on circulating levels of IL-17F as a potential risk locus for psoriasis. 60 patients suffering from chronic plaque psoriasis and 60 healthy controls were genotyped for the IL-17F (rs763780) using an Amplification Refractory Mutation System -PCR (ARMS-PCR) method. Measurement of serum IL-17F was also done by ELISA. There was a significant difference in frequency between TT and TC genotypes (OR= 2.74, 95%CI=1.04 -7.4, P=0.04) and TT and CC genotypes (OR=10.9, 95%CI=1.3-91.3, P=0.007). Moreover, the TC and CC genotypes were associated with increased risk of psoriasis in comparison with the TT genotype. (OR= 3.8, 95% CI: 1.5- 9.4, P= 0.003). The mutant allele, C, was significantly associated with an increased risk of psoriasis compared to that with the wild T allele, T (OR= 4.1, 95% CI: 1.9- 9.1, P= 0.0002). Serum level of IL-17F was higher among psoriasis patients ( 25.7±3.8pg/ml) than healthy controls ((15.1±2.1 pg/ mL). In conclusion, IL17F polymorphism (rs763780) is associated with increased risk of psoriasis and may influence the level of production of IL-17F with subsequent effects on the pathogenesis of psoriasis.

Evaluation of serum level of omentin-1 in females with hirsutism.

BACKGROUND: Hirsutism is a common clinical condition encountered in day-to-day practice. The androgenic causes account for more than 80% of these patients and include polycystic ovary syndrome (PCOS), which affects about 70%-80% of hirsute women. The second most common cause is idiopathic hirsutism. Omentin-1 is an adipokine mainly produced by visceral adipose tissue. AIM: The current study aimed at evaluating omentin-1 levels in hirsute females with PCOS and in idiopathic hirsutism. PATIENTS AND METHODS: Eighty-five females were included in this study. They were classified into three groups: thirty hirsute patients with PCOS, thirty females with idiopathic hirsutism, and twenty-five healthy control females. The participants were subjected to history taking, physical and dermatological examination. A gynecological history and radiological examination of the ovary also were done. Serum testosterone and omentin-1 were measured by ELISA. RESULTS: Serum testosterone was statistically elevated in PCOS than other groups. Serum omentin-1 in females with idiopathic hirsutism was statistically significantly higher than control and PCOS. There was a significant inverse correlation between serum testosterone level and serum omentin-1 level. CONCLUSION: Omentin-1 may be involved in the pathogenic process of hirsutism.

Intralesional injection of bevacizumab versus triamcinolone acetonide in infantile hemangioma.

Background: Infantile hemangioma (IH) in most cases can be a self-limited condition; however, it may be ulcerated, infected, causing organ function disability and even death. Vascular endothelial growth factor (VEGF) has a role in IH. Bevacizumab is a monoclonal antibody against VEGF-A.Objectives: We aimed to evaluate and compare the efficacy of intralesional injection of bevacizumab versus triamcinolone acetonide (TAC) in IH.Methods: Thirty patients with IH were included in this study, divided into two equal groups, and treated with intralesional injection; the first group by bevacizumab and the second group by TAC. The injections in both groups were given every 4 weeks for six sessions. Assessment of the clinical response was done by the hemangioma activity score (HAS) and visual analog scale (VAS).Results: Both treatment modalities gave similar initial improvement after three sessions. However, with continuing injection sessions, bevacizumab reached a response's plateau and TAC gave better significant results after six injection sessions reading both HAS (p = .0017) and VAS (p ≤.001).Conclusion: Both intralesional injection of bevacizumab and TAC were safe and effective treatments in early proliferative IH after three sessions, however, TAC injection was significantly better than bevacizumab after six sessions.

Evaluation of serum levels of neurotrophin 4 and brain-derived nerve growth factor in uremic pruritus patients.

BACKGROUND: Pruritus is a common symptom in end-stage renal failure. Many patients suffer from this severe distressing symptom. Although several factors have been postulated to explain uremic pruritus, there is not any conclusive evidence for one of these factors. OBJECTIVES: We aimed to evaluate serum levels of brain-derived nerve growth factor (BDNF), neurotrophin-4 (NT-4), serum calcium, phosphors and parathyroid hormone in uremic patients with pruritus and without pruritus compared to control subjects. METHODS: One hundred twenty patients suffering from renal failure and 60 healthy subjects were included in the study. Serum BDNF and NT4 levels were determined by ELISA. The serum calcium, phosphorus, parathyroid hormone and hemoglobin were also evaluated. RESULTS: Serum BDNF was significantly higher in uremic patients with pruritus (P=0.0026) and uremic patients without pruritus (P=0.0294) than control subjects. In addition, NT-4 levels were significantly elevated in uremic patients with pruritus (P<0.0001) and uremic patients without pruritus than control subjects (P=0.0016). There was no significant difference of serum level of BDNF between uremic patients with pruritus and uremic patients without pruritus (P=0.1215). However, serum NT-4 was higher in uremic patients with pruritus vs nonpruritic uremic patients with a significant difference (P=0.0026). There was a positive significant correlation between serum level of NT-4 and severity of pruritus (P=0.024). CONCLUSION: The present study shows that NT-4 level is increased in the serum of uremic patients with pruritus and there was a significant correlation between NT-4 and severity of pruritus suggesting that NT-4 may have a role in uremic pruritus.

Assessment of seminal granulysin in infertile men with varicocele.

Varicocele has a common association with male infertility, but its exact role is still debated. Apoptosis has been suggested as one of the mechanisms of varicocele-associated infertility. Granulysin is a molecule that plays a role in apoptosis with no previous study about its role in male infertility. This case-controlled study aimed to assess seminal plasma granulysin level in infertile patients with varicocele. This study involved 90 men that were allocated into fertile normozoospermic men (n = 20), infertile men without varicocele (n = 30) and infertile men with varicocele (n = 40). These men were subjected to history taking, clinical examination, semen analysis and estimation of seminal granulysin. In general, seminal granulysin level was significantly elevated in infertile men compared with fertile men. Infertile men with varicocele showed significantly higher seminal granulysin compared with infertile men without varicocele, in bilateral varicocele cases and in grade III varicocele. Seminal granulysin level was negatively correlated with sperm concentration, sperm motility, sperm normal forms percentage and testicular volumes. It is concluded that increased seminal granulysin has a negative impact on spermatogenesis in infertile men in general and in infertile men associated with varicocele in particular.

Serum Interleukin-33 in Behcet's Disease: Its Relation to Disease Activity and Clinical Manifestations.

Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by a course of remissions and exacerbations of unpredictable frequency and duration . Pro- inflammatory cytokines seem to be responsible for the enhanced inflammatory response in BD. AIM OF THE WORK: This study aimed to investigate serum levels of IL-33 in patients with Behcet's disease (BD) and their relationship to disease activity and clinical manifestations. Thirty patients with BD were enrolled and subjected to assessment of disease activity according to Behcet's Disease Current Activity Form (BDCAF) score. Serum IL-33 levels were determined using Enzyme-Linked-Immunosorbent Assay (ELISA). Thirty age and sex matched rheumatoid arthritis patients and thirty healthy volunteers were included in this study as control groups. Serum IL-33 level was 132.5±19 pg\ml, 101.2±20.1 pg\ml and 31.5±10.5 pg\ml in RA, BD and healthy control groups respectively. IL-33 was significantly higher in BD patients (101.2±20.1pg/ml) as compared to healthy controls (31.5±10.5 pg/ml) but lower than rheumatoid arthritis patients (132.5±19.1 pg/ml). Levels of IL-33 were significantly increased in BD patients with skin lesions (Erythema nodosum & Acneiform lesions) and ocular lesions (retinal vasculitis) (P<0.05), and a positive correlation was found between BDCAF score and IL-33serum levels (r=0.9, P<0.001). In conclusions, serum IL-33 level is elevated in active BD patients with skin and ocular affection and correlates with disease activity.