Therapeutic Options for Hidradenitis Suppurativa: An Update

Hidradenitis suppurativa (HS) is chronic deteriorating skin condition characterized by severe, deep inflammatory lesions, often referred to as acne inversa. Intertriginous regions, such as the axillae, groins (genital, anal, and perianal areas), infra- and intermammary skin, buttocks, and upper thighs, are usually affected although there can also be other areas, such as the neck and the stomach. Patients with severe conditions are affected by several painful nodules and draining sinuses, which exude fluid that often smells, and the fear that those new lesions can erupt at any time, requiring incision and drainage, corticosteroid, or surgical injection. Topical clindamycin lotion or resorcinol cream can be effective long-term treatment in mild disease, while tetracycline is mostly systemic first-line choice. Although antibiotics can help to reduce inflamed lesions, but recurrence is significant after discontinuation. If patients do not respond well to these common medical procedures, the next step is to use biologics such as adalimumab or infliximab. Several anti-inflammatory medications such as fumarate, dapsone, and cyclosporine have been also recommended for the treatment of HS. Surgical procedures, particularly when sinuses or scares are present, are often important for healing. The HS clinical interpretation and patients’ expectations should be used as a basis for each patient therapy.

Umbilical Myiasis in a Healthy Newborn: A Case Report

Myiasis is an infestation of living tissue with larvae of dipteran flies that commonly inhabit tropical and subtropical regions. The infection principally affects animals but human cases have been also reported. The larvae commonly invade the contaminated cutaneous structures such as wounds or furuncles, but sometimes can invade inner deeper structures. Many cases of myiasis affecting the newborn infants are globally reported with the highest incidence in rural communities with poor hygienic conditions. In this piece of research, we report a case of umbilical myiasis of an 11-day-old infant from Al-Mikhwah city, South Western Saudi Arabia. Parasitologic examination identified the infestation with tumbu fly (Cordylobia anthropophaga) larvae. The clinical presentation and epidemiology were discussed.

MicroRNA-30e and MicroRNA-223 Expression for Early Diagnosis of Hepatocellular Carcinoma Associated with Hepatitis C Virus

Background. The goals of this study were to elucidate the use of the expression of microRNA-30e (miR-30e) and microRNA-223 (miR-223) as diagnostic biomarkers for early diagnosis of hepatocellular carcinoma (HCC) associated with hepatitis C virus (HCV) infection. Methods. The study included three groups, the first group included thirty patients with HCC associated with HCV, the second group included thirty patients with cirrhosis with HCV and the third group included thirty healthy control subjects. Blood samples were obtained for determination of serum expression of miR-30e and miR-223 by real time polymerase chain reaction. Results. There was significant decrease of miR-30e of expression in patients with HCC (0.16 ± 0.1) compared to both patients with cirrhosis (0.4 ± 0.2, P<0.01) and healthy control subjects (1.2 ± 0.4, P<0.001). There was also significant reduction of miR-223 expression levels in patients with HCC (0.2 ± 0.1) compared to patients with cirrhosis (0.5 ± 0.2, P<0.01) and healthy control subjects (1.0 ± 0.1, P<0.001). There was also significant decrease of miR-30e expression in late stage versus early stage of HCC (0.1 ± 0.0 vs. 0.22 ± 0.1, P<0.001), while there was no significant difference of alpha-fetoprotein (AFP) between patients with late and early HCC. Also, values of miR-223 had significantly reduced levels in late HCC compared to its expression values in early HCC (0.1± 0.0 vs. 0.23 ± 0.2, P<001). Conclusion. There was significant reduction of expression of miR-30e and miR-223 in serum of HCC patients compared to either patients with cirrhosis or healthy subjects. These results show that the combined use of both biomarkers had better sensitivity in the diagnosis of HCC compared to AFP.

The Pathogenic Role of Vascular Endothelial Growth Factor (VEGF) in Skin Diseases

Vascular endothelial growth factor (VEGF), first isolated in 1989, is now considered the key mediator for the process of angiogenesis involved in many developmental, physiological, and pathological conditions. Studies have shown that VEGF family consists of 5 isoforms with similar biological activity but differ in their target receptor activity; the most important of them being the VEGF-A. Studies have also defined the presence of 3 types of VEGF receptors predominantly located on vascular endothelial, stromal, and hematopoietic cells. Recent research has shed light on VEGF as a key mediator of angiogenesis in many pathological conditions such as tumor growth and metastasis. Likewise, there have been intensive efforts to clarify the pathogenic role of VEGF/VEGFRs in skin diseases. VEGF and its receptors are also investigated as pivotal players in many skin diseases such as psoriasis, atopic dermatitis, chronic inflammatory skin diseases, phototoxicity, and dysregulated differentiation/proliferation of dermal and epidermal cells. Therefore, in this review, we will discuss the implication of VEGF as a pathogenic biomarker for skin disorders by discussing the available experimental and clinical evidences for the potential role of VEGF in some dermatologic disorders.

Early versus Late Oral Feeding on the Recovery of Normal Bowel Functions After Caesarean Section: A Randomized Controlled Study

Background. To compare early oral feeding (EF) versus late oral feeding (LF) on the return of normal bowel functions in spinally anesthetized women after having lower segment Caesarean section (LSCS). Secondary outcomes such as maternal satisfaction and gastrointestinal complications were also evaluated. Methods. Three-hundred and sixty-two singleton pregnant women undergoing elective LSCS with spinal anesthesia were assigned to receive either EF (n= 183) or LF (n= 179) after surgery. Participants began to take normal diet between immediately and 6 hours, or began sipping water after 12 hours and soft diet after 24 hours then normal diet after 48 hours of surgery. Results. The ages of participants ranged from 19 to 47, with a mean age of 35±12 years. There was no-loss follow up and no significant difference in patient characteristics. Participants given EF were more likely to experience bowel sound the next morning after surgery than patients given LF (EF 93% vs. LF 71%, P<0.05). However, there was no difference in time to passing flatus and time to passing stool. Maternal satisfaction, rated on a 5-point scale was significantly higher in the EF group. However, there was no significant difference in gastrointestinal complications between both groups. Conclusion. The findings of this trial support the recommendation of EF for women who undergo uncomplicated LSCS under spinal anesthesia.

Cutaneous Leishmaniasis: Treatment Options and Possibilities for Drug Repurposing

Leishmaniasis is a tropical disease caused by aprotozoan which is obligate intracellular parasite belongs to the genus Leishmania. There are 3 forms of the disease: visceral leishmaniasis, cutaneous leishmaniasis which is the most common, and mucocutaneous leishmaniasis. The most important compounds used to treat leishmaniasis were meglumine antimoniate (e.g. glucantime), sodium stibogluconate (e.g. pentostam) and pentavalent antimonials. There are other drugs that may be used such as pentamidine and amphotericin B. Until now, the pentavalent antimonial compounds remain the corner stone in the treatment of cutaneous leishmaniasis although this group possesses high degree of toxicity. Other treatment options include the pentamidines and liposomal amphotericin B (AmBisome). Combination therapies using AmBisome and miltefosine are another effective alternative to antimonial compounds. Other latest therapeutic options include photodynamic therapy, tamoxifen and imiquimod. The proper choice of antileishmanial therapy depends on the geographic location, host immune status, availability of the drug, and expertise of the treating physician. The present review summarizes the current treatment options available for cutaneous leishmaniasis as well as some drugs on the horizon that show promising results in the treatment of cutaneous leishmaniasis.

Association of Vitamin D Receptor Gene Polymorphism with Metabolic Syndrome and Type 2 Diabetes Mellitus in a Sample of Egyptian Patients

Background. There are insufficient data on the association of vitamin D receptor (VDR) genes polymorphism and type 2 diabetes mellitus (type 2 DM), and various components of metabolic syndrome among Egyptian patients. The aim of the present study was to study the association of different SNPs of VDR genes BsmI, ApaI, TaqI and FokI and components of metabolic syndrome and type 2 DM among cohort of Egyptian patients. Methods. The study is a case-control study. Patients included in the study were divided into three groups. Group 1 included 78 patients with type 2 DM; group 2 included 72 patients with metabolic syndrome and one hundred age-matched healthy subjects were served as control group. Full biochemical study and serum 25 hydroxy vitamin D (25(OH)D) were done. Purified DNA was subjected to study with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) for genotyping of SNPs of VDR gene. Data were presented as mean and standard deviation, and were analysed as appropriate by using the one-way ANOVA or paired t-test. Pearson correlation coefficient was used to correlate between variables. Results. Study of VDR genetic polymorphism had shown significant increase in the prevalence of Ff genotypes among diabetic patients and patients with manifestations of metabolic syndrome. There was significant negative correlation between 25(OH)D and total cholesterol, triglyceride, fasting and post-prandial blood glucose levels, waist circumference and diastolic blood pressure. Conclusion. The genetic polymorphism of VDR might play a role in the pathophysiology of type 2 DM and metabolic syndrome., however, more longitudinal studies are still required to support these finding.

Reduction of Hepato-Metabolic Changes in Rat Model of Metabolic Syndrome by Metformin and Atorvastatin Combination

Metabolic syndrome (MetS) and the commonly associated nonalcoholic fatty liver disease (NAFLD) is an increasing health concern and hot topic in medical research. Together with lifestyle modification, metformin (MET) and statins are among drugs with potential therapeutic beneft. The aim of this study is to investigate the potential of synergistic combination of MET and atorvastatin (ATR) in rat model of MetS. Methods. Rats were fed on high-carbohydrate, highfat (HCHF) diet for 16 weeks and either of MET, ATR, or their combination were administered from the beginning of the 9th week to the end of the study. Body weight, insulin resistance, plasma lipids, serum transaminases, TNF-α, leptin and adiponectin as well as liver histopathology were assessed. Results. Both MET and ATR worked synergistically to reverse the biochemical and histological abnormalities of MetS and ameliorated steatohepatitis more than their individual effects. Conclusion. The present study clearly demonstrates a synergistic effect of MET an ATR combination to reverse hepato-metabolic abnormalities of MetS/NAFLD in rat model and calls for pursuing subsequent clinical studies to consolidate data at hand

Assessment of Global Methylation in Paraffin Embedded Prostatic Tissues and Cell Lines Using Flow Cytometry

Background. The aim of this study is to measure global 5-methylcystosine (5MeC) methylation in paraffin embedded prostatic tissues and cell lines using flow cytometry. Methods. Cell/nuclei suspension from 10 cases of benign prostatic hyperplasia (BPH), 10 cases of prostatic adenocarcinoma, and two prostatic cell lines (PNT1A and LNCaP) were prepared using modified heat pretreatment technique. 5MeC global methylation was assessed by flow cytometry of cell/nuclei suspension and immunostaining of tissue sections. Results. Higher percentage of positively stained cells (PPSC) and mean channel fluorescence (MCF) were detected in PNT1A cell line and BPH cell/nuclei suspensions as compared to LNCaP cell lines and adenocarcinoma cell/nuclei suspensions. Lower scores of 5MeC immunostaining were observed in all prostate adenocarcinoma tissue sections as compared to BPH sections indicating global hypomethylation in prostate adenocarcinoma. Two distinctive populations of cells were detected in histograms generated from most of the BPH cell/nuclei suspensions. Conclusion. The study developed a novel technique that could measure 5MeC global methylation in paraffin embedded prostatic tissues. This represents a rapid and objective assessment of methylation and when combined with tissue micro-dissection and cell sorting, this technique could be applied to larger tissue samples such as post radical prostatectomy and transurethral resected specimens.

Curcumin Enhances Chemosensitivity and Apoptosis in T24 Bladder Cancer Cells through Inhibition of the Ras/ MAPK Signaling Pathway

Background. Curcumin (CUR), a natural phenolic compound, has been recently reported to exert antitumor actions in variety of cancers; however, the exact mechanism(s) is not clear. In this study we investigated whether CUR could inhibit Ras/MAPK pathway and enhance mitomycin C (MMC) cytotoxicity in T24 bladder cancer cells. Methods. T24 cells were cultured with different concentrations of CUR (5, 10, 20 μM) alone or combined with 10 μg/ml MMC. At the end of 72 h culture, cell viability was assessed by MTT assay; apoptosis by flow cytometry; total Ras and ERK1/2 by immunohistochemistry and western blotting. Results. In comparison to cells exposed to MMC alone, cells treated with combined MMC and either 10 or 20 μM CUR showed reduced cell proliferation, disrupted morphological appearance, and increased subG0/G1 apoptotic events. This inhibition was associated with marked reduction of Ras and ERK1/2 expression. Likewise, cells treated with 10 or 20 μM CUR alone showed significant inhibition, while the effect of 5 μM was less obvious. Conclusion. Resistance of T24 cells to cytotoxic effect of MMC is dependent, at least partially, on Ras/ERK activation. CUR at concentrations of 10 and 20 μM in combination with low dose MMC induced toxic synergism in T24 cells. Clinical translation of this experimental study may be reasonable in light of wide safety margin and availability of CUR.