Does Indoxyl Sulfate Have a Role in Uremic Pruritus? A Laboratory and Interventional Study.

BACKGROUND: Pruritus is a common complaint in patients with end-stage renal disease. Indoxyl sulfate (IS) is a tryptophan end metabolite extremely renal excreted. Activated charcoal can interfere with IS intestinal absorption. OBJECTIVES: To evaluate the serum level of IS and the effect of activated charcoal on uremic pruritus. MATERIALS AND METHODS: In all, 135 participants were divided into 2 main groups. In total, 45 normal and healthy individuals as a control group and 90 patients on regular hemodialysis; 45 of these patients had uremic pruritus and the other 45 were not complaining of uremic pruritus. Serum IS was measured. Activated charcoal was used by patients with uremic pruritus. The severity of pruritus and Dermatology Life Quality Index (DLQI) were assessed. RESULTS: The serum IS was significantly elevated in uremic patients than in control subjects (P < .001) and significantly elevated in uremic patients without pruritus (P < .001). Furthermore, there were positive significant correlations between the serum IS and both severity of pruritus (P < .001) and DLQI (P < .001). After activated charcoal usage, there was a significant decrease in IS level with the improvement of pruritus and quality of life of patients. CONCLUSIONS: IS may play a role in uremic pruritus. Activated charcoal could be considered a treatment for uremic pruritus.

Assessment of seminal cystatin C levels in infertile men with varicocele: A preliminary study.

Varicocele has been raised as a contributor to male infertility supported by the improvement of sperm parameters after varicocelectomy. Cystatin C (Cys C) has been linked to several cellular changes that are common in male infertility cases associated with varicocele such as apoptosis and autophagy. This preliminary study aimed to assess the seminal levels of Cys C in infertile oligoasthenoteratozoospermic (OAT) men associated with varicocele that have been shown to have spermatic vein vasodilation and active death pathway. Overall, 60 men were investigated being divided into two equivalent groups-infertile OAT men with varicocele who underwent varicocelectomy and healthy fertile men as a control group. These men were subjected to history taking, clinical examination, semen analysis and assessment of seminal Cys C pre and 6 months post-varicocelectomy. The results showed a significant increase of seminal Cys C in infertile OAT men with varicocele than the fertile control (55.57 ± 25.6 ng/ml versus 10.78 ± 1.88 ng/ml, p = .001). Seminal Cys C was a significantly decreased post-operative than its pre-operative level (34.69 ± 14.02 versus 55.57 ± 25.6 ng/ml, p = .01). These results show a potential role of Cys C in varicocele-induced infertility.

Serum level of serum amyloid A1 protein in patients with acne vulgaris.

INTRODUCTION: The serum amyloid A1 (SAA1) protein is involved in many pathological diseases. The increased secretion of SAA1 can maintain inflammatory conditions. Acne vulgaris (AV) is a chronic inflammatory disease of pilosebaceous glands and may be associated with systemic manifestations. AIM OF THE WORK: This study aimed to evaluate the serum level of SAA1 in patients with AV. SUBJECTS AND METHODS: 120 participants were included in this study: 60 patients with AV and 60 apparently healthy volunteers as a control group. These participants were subjected to dermatological examination and assessments of lipid profile, fasting blood glucose (FBG), and serum SAA1. RESULTS: Both serum SAA1 and FBG are significantly elevated in patients with AV than control (p < 0.0001 and p < 0.001, respectively). Furthermore, there are positive correlations between AV severity and SAA1 and FBG (p < 0.001 and p < 0.0001, respectively). CONCLUSIONS: Serum amyloid A1 is increased in AV, and this elevation may play a role in the inflammatory milieu of AV.

Angiopoietin-like protein 2 in psoriasis: a new linkage with metabolic syndrome.

INTRODUCTION: Psoriasis is a chronic disease of inflammatory nature which can be considered as a systemic disorder. Metabolic syndrome is prevalent in psoriatic patients, with a negative impact on disease severity. Angiopoietin-like protein 2 (ANGPTL2) role has been investigated in several chronic inflammatory conditions, but not in psoriasis. AIM: To evaluate the serum level of ANGPTL2 and its possible role in the occurrence of metabolic syndrome in psoriatic patients. MATERIAL AND METHODS: This study enrolled 180 participants divided into two groups: psoriatic group (120 patients with chronic plaque psoriasis) and control group (60 normal subjects). Psoriasis severity was determined by the psoriasis area severity index. Anthropometric measurements, lipid profile, fasting blood sugar and ANGPTL2 have been evaluated in both groups. RESULTS: Psoriatic patients had a higher body mass index (p = 0.014), waist circumference (p < 0.001), and blood pressure than controls (p L 0.001). Fasting blood sugar and the serum level of ANGPTL2 were also higher in psoriatic patients than in controls (p < 0.001, 0.025, respectively). In addition, the serum level of ANGPTL2 was significantly correlated with both disease severity (p < 0.001) and occurrence of metabolic syndrome (p < 0.001). CONCLUSIONS: Serum ANGPTL2 is elevated in psoriasis patients compared to normal subjects. Serum ANGPTL2 elevation may have a role in chronic inflammatory status in psoriasis and occurrence of metabolic syndrome.

Intralesional pentoxifylline injection in localized alopecia areata.

BACKGROUND: Alopecia areata (AA) is a common non-scarring autoimmune disease that affects hair-bearing areas. A variety of therapeutic options has been used for treating this disease such as corticosteroids, minoxidil, methotrexate, cyclosporine, and azathioprine. Intralesional triamcinolone acetonide (TRA) injection is considered the first-line treatment in localized alopecia areata involving <50% of the scalp; however, intralesional steroid injections are associated with a variety of side effects. OBJECTIVE: The aim of this study was to evaluate the efficacy of pentoxifylline (PTX) vs triamcinolone acetonide intralesional in localized AA. PATIENTS AND METHODS: The sample included 75 patients (47 males and 28 females) aged 18-55 years, diagnosed as localized alopecia areata. The patients were treated by intralesional injection every three weeks up to five sessions. The patients were classified into three groups according to the used therapeutic modality. Group A: 25 patients treated by intralesional injection of TRA. Group B: 25 patients treated by combined intralesional injection of TRA and PTX injection. Group C: 25 patients treated by intralesional PTX injection. RESULTS: Both PTX and TRA intralesional injections were effective in the treatment of AA, but there was a statistically significant difference regarding the response to treatment between the three study groups (P value = 0.01). The highest response was reported in combined drug usage (TRA & PTX) followed by PTX alone and then TRA alone (72.0%, 60.0%, and 32.0%, respectively). CONCLUSION: Pentoxifylline intralesional injection is effective, easy to perform with little side effects for the treatment of localized alopecia areata.

Serum markers for asymptomatic atherosclerosis in Egyptian psoriatic patients: study controlled by Doppler estimation of carotid intima-media thickness.

BACKGROUND: The aim of the study was to measure serum levels of endocan, myeloperoxidase (MPO), pentraxin 3 (PTX3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in psoriatic patients and to study their correlations with carotid intima-media thickness (CIMT) in trial to evaluate predictability of these parameters in diagnosing asymptomatic atherosclerosis (AAS). PATIENTS AND METHODS: Seventy-five psoriasis patients and 75 control subjects underwent complete clinical examination and Doppler estimation of CIMT using thickness of 0.9 mm as cutoff point for diagnosis of AAS. Blood samples were collected for determination of fasting blood glucose, lipid profile and serum C-reactive protein (CRP), endocan, MPO, PTX3 and 1,25(OH)2D3. RESULTS: Estimated blood low-density lipoprotein cholesterol (LDL-c) and serum CRP, PTX3, MPO and endocan levels were significantly higher, while blood high-density lipoprotein cholesterol (HDL-c) and serum 1,25(OH)2D3 levels were significantly lower in patients than in controls. CIMT showed significant positive correlation with disease severity and duration; patients' age; and endocan, MPO, LDL-c, PTX3 and CRP levels, and significant negative correlation with HDL-c and 1,25(OH)2D3 levels. Regression analysis defined high serum endocan and MPO, low serum 1,25(OH)2D3 and increased disease severity as significant predictors of high CIMT. CONCLUSION: Elevated serum levels of endocan and MPO and low 1,25(OH)2D3 levels may underlie the development of psoriasis-related cardiac manifestations. Elevated serum endocan and low 1,25(OH)2D3 levels could be used as early predictors of increased CIMT, which is a pathognomonic feature of AAS.