Assessing the Effectiveness of Stabilized Cysteamine 5% Cream Compared to Hydroquinone 4%/Ascorbic Acid 3% Combination Cream in Treating Acne-induced Post-inflammatory Hyperpigmentation: A Randomized, Controlled Study

Objective

Postinflammatory hyperpigmentation (PIH) is a common sequela of acne vulgaris. Topical treatment with hydroquinone is the standard treatment, but may be associated with complications. Cysteamine is a relatively safe depigmenting agent with an observed depigmenting effect. We designed this study to assess the efficacy of a cysteamine 5% cream in treating acne-induced PIH.

Methods

Twenty-eight out of 32 participants finalized this investigator-blind, randomized, and controlled trial (registered in Iranian Registry of Clinical Trials [IRCTID: IRCT20140212016557N5]). We randomized the patients to apply either cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. Postacne hyperpigmentation index (PAHPI) and melanin index were the assessment measures after four months of treatment. We evaluated the quality of life by the Dermatology Life Quality Index (DLQI) questionnaire.

Results

Both cysteamine and HC cream significantly decreased the PAHPI score and melanin index of acne-induced PIH patients (p<0.05). The decrease in PAHPI score and melanin index were not significantly different in treatment groups after four months (p>0.05). Quality of life ameliorated significantly only with cysteamine treatment. However, no significant change in quality of life was observed between groups.

Limitations

Limitations of our study include the relatively small sample size and absence of follow-up.

Conclusion

Cysteamine cream is an effective treatment of post-acne PIH, with similar efficacy to the accepted treatment of PIH, i.e., hydroquinone cream.

Experimental demonstration of rainbow trapping of elastic waves in two-dimensional axisymmetric phononic crystal platesa)

Structures with specific graded geometries or properties can cause spatial separation and local field enhancement of wave energy. This phenomenon is called rainbow trapping, which manifests itself as stopping the propagation of waves at different locations according to their frequencies. In acoustics, most research on rainbow trapping has focused on wave propagation in one dimension. This research examined the elastic wave trapping performance of a two-dimensional (2D) axisymmetric grooved phononic crystal plate structure. The performance of the proposed structure is validated using numerical simulations based on finite element analysis and experimental measurements using a laser Doppler vibrometer. It is found that rainbow trapping within the frequency range of 165-205 kHz is achieved, where elastic waves are trapped at different radial distances in the plate. The results demonstrate that the proposed design is capable of effectively capturing elastic waves across a broad frequency range of interest. This concept could be useful in applications such as filtering and energy harvesting by concentrating wave energy at different locations in the structure.

Formaldehyde 5% in Flexible Collodion Compared to Cryotherapy for Treatment of Female Genital Warts: A Randomized Clinical Trial

Objectives

Genital wart is a sexually transmitted disease caused by human papillomavirus (HPV) and is responsible for discomfort, and decreased quality of life and productivity in victims with a high recurrence rate after treatments. This study aimed to compare the efficacy and safety of formaldehyde 5% with cryotherapy for the treatment of female genital warts.

Methods

Eighty women with at least two similar genital warts who visited the outpatient dermatology clinic of Shahid Faghihi hospital, Shiraz, Iran, were enrolled in this study. One lesion of each patient was self-treated with formaldehyde 5% in flexible collodion gel once daily for 28 days and the other matched lesion was treated by weekly repeated cryotherapy courses. The number of eradicated lesions and the mean days needed to treat, pain scores, complications and patient satisfaction were compared between the treatment methods.

Results

Complete clearance of lesions was observed in 58.7% of formaldehyde-treated lesions compared to 88.7% for cryotherapy (P value = 0.000). With formaldehyde-treated lesions, 51% complained of pain, 36.3% had pruritus, 86.3% had skin dryness, 88.8% complained of burning sensation and 93.7% showed erythema. In the cryotherapy group, 92.5% complained of pain, 15% had burning sensation, 75% showed erythema, 5% had atrophy, 80% developed post-inflammatory hyper or hypopigmentation (PIH) and 92.5% suffered from ulceration. Seventy-five (93%) found it easy to apply and (47) 58% were satisfied with their treatment results.

Conclusions

Self-administration of formaldehyde 5% resulted in a lower clearance rate but had better cosmetic outcomes with lower pain scores compared to cryotherapy.

[Recurrence of macular edema complicating central retinal vein occlusion: Consider follow-up fluorescein angiography]

PURPOSE

The goal of our study is to highlight, through a series of 4 cases, the importance of retinal fluorescein angiography in monitoring the retinal periphery in retinal vein occlusions, particularly in cases of recurrent macular edema.

OBSERVATIONS

This is a series of 4 patients aged between 50 and 90 years with ischemic central retinal vein occlusions in 2 cases and branch retinal venous occlusions in 2 cases. Fluorescein angiography was performed in two of our patients, and optical coherent tomography in all cases, showing cystoid macular edema with an average macular thickness of 439μm. All patients received a complete etiological assessment and intravitreal anti-VEGF injections with an initially favorable course in all cases. A recurrence with aggravation of the edema compared to the initial appearance was observed in all cases, with a delay varying between 9 and 16 months (mean 11.25 months). Fundus examination revealed an increased number of retinal hemorrhages in each case, with the appearance of cotton wool spots in one case, suggesting ischemic conversion. This was confirmed by performing fluorescein angiography, which revealed large areas of retinal ischemia. Retinal photocogulation of the ischemic areas was thus indicated, along with a second series of intravitreal injections.

CONCLUSION

Macular edema is the principal cause of visual acuity decline in retinal vein occlusions; its prognosis is similar to that of retinal venous occlusions in general, hampered by the possibility of ischemic conversion. The diagnosis of retinal vein occlusion is clinical and does not require angiography. This remains, however, a useful exam to better analyze the retinal periphery as well as for the detection of various modalities during spontaneous progression.

Amyloidosis cutis dyschromica: report of 3 cases

Amyloidosis cutis dyschromica (ACD) is a rare pigmentary disorder with about 50 cases having been reported in the English literature. Only one case of ACD has been reported from Iran. We present three patients who presented with generalized hyper- and hypopigmented patches, sparing face, hands, and feet in all three cases. The presence of amorphous eosinophilic deposits in the papillary dermis confirmed the diagnosis of ACD; the deposits were stained by crystal violet in the histopathological examination of the lesions. In all three cases, similar lesions were present in some of the family members. ACD should be considered in the differential diagnosis of diffuse hyperpigmentation studded with hypopigmentation, especially when beginning in childhood.

The Study of Ranitidine Interference With Morphine Detection Test by Thin-Layer Chromatography

Background: Drug abuse is a global and critical problem. One of the most frequent practices done in order to detect the drugs of abuse is Urine Drug Screen. However, for changing the drug test results, adulterants and urine substitutes are being designed. As the referring people’s background has shown, ranitidine is one of the interfering drugs in morphine detection test. Therefore, in the present study, the interference of ranitidine in morphine detection test will be studied. Methods: Ten healthy volunteers who had not used any kind of drug for 72 hours before the test were recruited into the study. First, 2 doses of ranitidine (150 and 300 mg) were administered to the subjects orally and 100-mL urine samples were collected from them before and after taking ranitidine. The second urine sample was collected at 6-8 am. Ten micrograms morphine was added to both urine samples of each individual. The urine samples were tested using thin-layer chromatography (TLC) technique. The experiment was repeated after 1 week using ranitidine 300 mg. Results: The TLC test was carried out on 40 urine samples. Twenty samples were tested before and, the rest, after ranitidine consumption. The TLC test results were positive before ranitidine consumption but negative for 18 samples and positive for two samples after taking ranitidine. Conclusion: Ranitidine may change the urine morphine screening test results via TLC method and induce a false negative result.

Association of PDCD1 gene markers with susceptibility to thyroid cancer

PURPOSE

PD-1 receptor is a co-signaling molecule with an important role in regulation of T-lymphocyte activity. Correlation between PD-1 gene (PDCD1) polymorphisms and some immune-related diseases has been reported before. In current study, we aimed to investigate the association of PD-1 polymorphisms at positions +7146 G/A (PD-1.3) and +7785 C/T (PD-1.5), as well as the emerged haplotypes with susceptibility to thyroid carcinoma.

METHODS

One hundred five patients with confirmed thyroid cancer and 160 healthy individuals as control group were enrolled. Genotypes were identified using PCR-RFLP and nested PCR-RFLP methods. Results were analyzed by Arlequin and SPSS software packages.

RESULTS

Analysis revealed a significant increase in the frequency of PD-1.5 mutant T allele and heterozygous CT genotype in patients with thyroid cancer in comparison with controls [79 (37.7%) vs. 71 (22.2%), and 51 (48.6%) vs. 51 (31.9%), p = 0.0001 and p = 0.009, receptively]. CC genotype at this position observed to be significantly higher among controls than the patients [99 (61.9%) vs. 40 (38.1%), p = 0.0002]. There were no significant differences in the frequencies of genotypes and alleles at locus PD-1.3 between patients and control group. Despite this, GT haplotype emerged from both positions (PD-1.3 G and PD-1.5 T) has also been observed with significant increased frequency between patients and controls [70 (36.8%) vs. 71 (22.2%), p = 0.0005].

CONCLUSION

As the first study to investigate two mentioned polymorphisms in thyroid cancer, current study confirmed the association of PD-1.5 C/T polymorphism and a haplotype resulted from both loci, PD-1.3 and PD-1.5, with susceptibility of Iranians to thyroid cancer.

The effect of l-arginine supplementation on body composition and performance in male athletes: a double-blinded randomized clinical trial

BACKGROUND/OBJECTIVE

Athletes used a lot of dietary supplements to achieve the more muscle mass and improve their athletic performance. The objective of this study was to investigate the effect of l-arginine supplementation on sport performance and body composition in male soccer players.

SUBJECTS/METHODS

This double-blinded, randomized and placebo-controlled trial was conducted on 56 male soccer players, with age range of 16-35, who referred to sport clubs in Isfahan, Iran. Subjects were randomly assigned to either l-arginine or placebo groups. Athletes received daily either 2 g per day l-arginine supplement or the same amount of placebo (maltodextrin) for 45 days. Sport performance and also body mass index (BMI), body fat mass (BFM) and lean body mass (LBM) were measured at the beginning and end of the study. Also, 3-day dietary records were collected at three different time points (before, in the middle of, and at the end of the study).

RESULTS

The mean age of subjects was 20.85±4.29 years. Sport performance (VO₂ max) significantly increased in l-arginine supplementation group (4.12±6.07) compared with placebo group (1.23±3.36) (P=0.03). This increase remained significant even after adjustment of baseline values, physical activity and usual dietary intake of subjects throughout the study. No significant effect of l-arginine supplementation was found on weight, BMI, BFM and LBM.

CONCLUSIONS

l-arginine supplementation (2 g per day) could increase the sport performance in male athletes, but had no effect on anthropometric measurements, including BMI, BFM and LBM. So, further studies are needed to shed light our findings.

Green synthesis of silver nanoparticles using Salvadora persica L. and its antibacterial activity

The silver nanoparticles (AgNPs) shows special physicochemical properties, therefore they use many applications such as catalysis, health, electronic and optical. In this study, AgNPs was synthesized using aqueous extract of Salvadora persica bark. The synthesized AgNPs were characterized by UV-Vis spectroscopy, Powder X-ray diffraction (PXRD) and Transmission electron microscopy (TEM) methods. The optimal synthesis condition to prepare nanoparticles was determined as silver nitrate 3 mM, 5 ml of aqueous extract in the room temperature for 1 h. The TEM image of AgNPs showed the formation of spherical, non-uniform nanoparticles of mean size of 50 nm. The antibacterial activity of synthesized AgNPs was evaluated using disk diffusion, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) methods on Escherichia coli and Staphylococcus aureus bacteria. The MIC values of AgNPs were 100 and 400 µg/mL on E. coli and S. aureus, respectively. Also the MBC of AgNPs was 200 µg/mL for E. coli and there was no result observed for S. aureus bacteria. The results showed that synthesized nanoparticles have favorable antibacterial properties.

Mutagenic, antimutagenic, antioxidant, anti-lipoxygenase and antimicrobial activities of Scandix pecten-veneris L

Scandix pecten-veneris L. or Shepherd's-needle is a weed species used in some countries for medicinal purposes. In this study S. pecten-veneris leaves were shade dried, powdered and extracted with methanol. The purpose of this study was to assay the in vitro mutagenic, antimutagenic, antioxidant, antilipoxygenase and antimicrobial activities of S. pecten-veneris leaf extract. The methanolic extract indicated no mutagenicity when tested with Salmonella typhimurium strains TA98 and TA100. Antimutagenic activity was reported with inhibition of mutagenicity in a concentration dependent fashion. The methanolic extract demonstrated antioxidant activity in the DPPH radical-scavenging test (IC50 = 4.57 mg/mL), comparable to ascorbic acid and BHT. Moreover, the extract presented a remarkable and potent inhibition against soybean lipoxygenase (IC50 = 641.57 µg/mL). The methanolic extract was examined for its antimicrobial powers against four different bacteria with MIC values >100. Our results introduced this plant as a useful factor for the treatment of cancer, inflammatory and infectious diseases.

Guaiasistanol: A new guaiane sesquiterpenoid from Teucrium persicum Boiss

In this study, a new guaiane type skeleton sesquiterpenoid named guaiasistanol (6α, 10α-epoxy-4α-hydroxyguaiane) was isolated from chloroform part of the Teucrium persicum extract, also chrysothol. Spectroscopic means explained the structures. This compound was evaluated for inhibitory activity against acetylcholinesterase and it showed a moderate activity with 28% inhibition.

[Secondary opacification of hydrophilic acrylic intraocular lenses: report of two cases]

PURPOSE

To describe two cases of secondary opacification of hydrophilic acrylic IOLs after vitreoretinal surgery.

METHODS

Analysis of IOL deposits with anterior segment optical coherence tomography (OCT Visante(®)) and high-frequency ultrasound biomicroscopy (CineScan HF, Quantel Medical(®)) was carried out preoperatively. The explanted IOLs were analyzed with optical and electron microscopy, and energy dispersive spectrometry (EDS).

RESULTS

In both patients, the deposits were located on the surface and within the implant and were composed of calcium phosphate crystals. Vitreoretinal surgery performed a few months prior to the secondary opacification was identified as a risk factor.

CONCLUSION

When a patient presents with a secondary opacification of the IOL involving the visual axis, explantation is sometimes necessary, fortunately with typically good functional recovery in the postoperative period. While this complication is rare and the exact pathophysiology poorly understood, it must be considered in a pseudophakic patient with an unexplained decrease in visual acuity who has undergone more than one intraocular procedure.

Rapid suture management of post-keratoplasty astigmatism

AIM

Post-keratoplasty astigmatism is managed by topography-guided suture removal. This can take several weeks until satisfactory reduction in astigmatism is achieved. This study aimed to assess whether topography performed 30-40 min after the removal of the first pair of sutures would predict the next set of sutures requiring removal.

METHODS

A prospective study of 20 consecutive penetrating keratoplasty patients was carried out. Topography guided suture removal in the steep meridian was carried out. Topography was repeated after 30-40 min and 4-6 weeks later. The tight sutures requiring removal were identified for each occasion and compared. The difference was considered insignificant if the axes of sutures requiring removal was <22.5 degrees. Paired t-test and chi (2) were performed for statistical analysis.

RESULTS

In 85% of individuals, the 30-40 min topography gave an accurate indication of the next pair of sutures requiring removal. The difference in mean astigmatism at 30-40 min post suture removal (4.37+/-2.08 D) and at 4-6 weeks (4.24+1.97 D) was not significant (P=0.150). However, the difference between vector-corrected change of topographic astigmatism at 30-40 min after suture removal and at 4-6 weeks (1.72 D) was significant (P<0.001). Improved best-corrected visual acuity was seen in 50% of patients.

CONCLUSION

This study showed that corneal topography performed 30-40 min after suture removal can identify the next set of sutures requiring removal. This can be used as a guide to remove more sutures at the same visit, thereby expediting post-keratoplasty visual rehabilitation and reducing the number of follow-up visits.

False aneurysm of the radial artery: Unusual complication of both-bone forearm fracture in children: A case report

False aneurysm or pseudo aneurysm of an artery in close proximity to fractured bone is a well-recognized entity, and fewer various cases, involving different sites have been reported in the literature. We report new case of a Moroccan's patient who had 10-year-old boy presented with a right non displaced both-bone forearm fracture; the patient was placed in a long arm splint. After, six weeks, the cast was removed. And a pulsatile mass on the volar-radial aspect of the forearm was decouvred. The mass was non-tender and the patient had radial and ulnar pulse. An Ultrasound and brachial angiography showed a false aneurysm of distal radial and the radial artery was ligated.In conclusion, pseudoaneurysm of the radial artery can be associated with any bone fracture despite non displacing fractures related to the elasticity of the bone in this age and orthopedic surgeons should be aware of this potential complication.

[Muscular tuberculosis: an unusual focus of Koch bacillus]

We report an exceptional case of tuberculosis in an 8-year-old girl. The focus of infection was situated in the anterior muscle compartment of the left thigh. Diagnosis was established on the basis of histological findings. A 12-month antituberculosis regimen was given. Outcome was good with no general or functional sequelae. Based on this case and data reported in the literature, we discuss the routes of dissemination of the Koch bacillus explaining this unusual sporadic localization.

[Centro-somatic staged tuberculous vertebral osteitis: a case report]

Centro-somatic tuberculous vertebral osteitis is defined as tuberculous infection of the vertebral body with preserved integrity of the adjacent intervertabral disk. Other types of vertebral tuberculosis include Pott's spondylodiscitis and exceptional lesions of the posterior arch. We report a case of centro-somatic tuberculous vertebral osteitis in a 14-year-old boy who developed staged lesions of the L2 to S1 bodies, associated with a posterior epidural collection but without any deterioration of the intervertebral disk on plain x-rays and computed tomography. This atypical aspect of the lesions required a surgical biopsy which yielded a yellow-whitish fibro-oleagenous, friable product more suggestive of neoplasm than infection, but histology rectified the diagnosis, showing typical caseo-follicular tuberculosis. A 6-month anti-tuberculosis regimen was rapidly followed by symptom improvement. We emphasize the importance of modern imaging techniques for the diagnosis of vertebral lesions and for guided biopsy or drainage.

[An unusual localization of solitary bone cyst in a child: the lumbar spine]

Solitary bone cysts involving the spine in children are extremely rare. We report such a lesion in a 7-year-old girl who presented with an expansible, bubbly cystic lesion of the third lumbar vertebra. The intraoperative findings and histologic examination indicated the diagnosis of a solitary bone cyst. She was treated successfully with curettage and bone grafting.

[Scoliosis and diastematomyelia: four cases and a review of the literature]

We report four cases of scoliosis associated with diatematomyelia observed between 1984 and 1998. The patients were four girls aged 10 to 12 years. Skin lesions were found on the midline in 3 cases and 2 had a neurological disorder. A myeloscan was performed in two cases, tomomyelography in one and MRI in one. Three patients were operated on with good outcome. The fourth child is under orthopedic treatment. We reviewed the literature on scoliosis with diastematomyelia.

[Fibrocartilaginous mesenchymoma of bone. A case report]

Fibrocartilaginous mesenchymoma of bone is a tumoral entity which is somewhat controversial. It has been delineated in 1984 by Dahlin and al. Fifteen cases have been reported in the literature. We report a new case which involves proximal humerus. X-ray data, microscopic findings and local recurrence indicate a low grade malignancy. Metastasis have never been reported. The main differential diagnosis are desmoplastic fibroma, fibrous dysplasia and fibrosarcoma with low grade malignancy. Treatment is surgical.

Craniocervical junction tuberculosis in children

A case of tuberculosis of the craniocervical junction in an eight-year-old is reported. Presenting symptoms were painful torticollis, dysphagia, and tetraparesis. Computed tomography and magnetic resonance imaging findings strongly suggested the diagnosis, which was confirmed by peroral aspiration of a retropharyngeal collection. Management was by immobilization and antituberculous agents. Surgery was not performed. After one year, the outcome was highly satisfactory.

Hydatid cyst of the sacrum. Report of a case

An unusual case of hydatid cyst of the sacrum revealed by low back pain and sciatica in a 16-year-old is reported. Computed tomography and a surgical biopsy provided the diagnosis. The outcome was favorable one year after mebendazole therapy initiation.

Metabolic events with spontaneous malignant hyperthermia crisis in an anaesthetized pig

PURPOSE

To analyze metabolic changes associated with a fulminant malignant hyperthermia (MH) crisis developed spontaneously in an MH susceptible pig which was part of 12 pigs undergoing metabolic investigation (six MH susceptible and six controls) and had been anaesthetized with a non-triggering agent (pentobarbitone).

METHODS

The pig was placed in a cradle and then inserted into a 4.7 T magnet bore. The semi-membranous muscle was submitted to three repetitive stimulation-recovery sessions. 31-P magnetic resonance spectra and mechanical data were recorded.

RESULTS

The pig developed a non-rigid MH crisis during recovery from the second set of experiments. Although no mechanical work was performed, dramatic metabolic changes were noted. Twitch tension decreased progressively reaching zero while mouth temperature continuously increased to 44.5 degrees C. Phosphocreatine (PCr) consumption was coupled to Pi accumulation. Also, a marked intracellular acidosis and a large accumulation of phosphomonoesters (PME) were observed, probably as a result of massive glycolysis activation. Interestingly, ATP level remained constant.

CONCLUSION

These irreversible mechanisms may constitute a metabolic dead-end coupling calcium pumping ATP-consuming processes and ATP synthesis through PCr breakdown and anaerobic glycolysis. They do not differ from metabolic changes previously reported in rigid forms of MH crisis.

Glutamine synthetase induction by glucocorticoids is preserved in skeletal muscle of aged rats

Glutamine synthetase (GS) is a glucocorticoid-inducible enzyme that has a key role for glutamine synthesis in muscle. We hypothesized that the glucocorticoid induction of GS could be altered in aged rats, because alterations in the responsiveness of some genes to glucocorticoids were reported in aging. We compared the glucocorticoid-induced GS in fast-twitch and slow-twitch skeletal muscles (tibialis anterior and soleus, respectively) and heart from adult (age 6-8 mo) and aged (age 22 mo) female rats. All animals received dexamethasone (Dex) in their drinking water (0.77 +/- 0.10 and 0.80 +/- 0.08 mg/day per adult and aged rat, respectively) for 5 days. Dex caused an increase in both GS activity and GS mRNA in fast-twitch and slow-twitch skeletal muscles from adult and aged rats. In contrast, Dex increased GS activity in heart of adult rats, without any concomitant change in GS mRNA levels. Furthermore, Dex did not affect GS activity in aged heart. Thus the responsiveness of GS to an excess of glucocorticoids is preserved in skeletal muscle but not in heart from aged animals.