Treatment options for leishmaniasis

Leishmaniasis is broadly classified into three types: cutaneous, mucocutaneous and visceral. The visceral form is most dangerous and can result in death. Although leishmaniasis is an ancient disease, its treatment is still challenging. Several drugs, differing in their cost, toxicity, treatment duration and emergence of drug resistance, are used for different types of leishmaniasis. To overcome these limitations, the search for newer drugs and other treatments continues. In this article, we discuss conventional drugs, other treatments, including newer options such as immunotherapy and immunochemotherapy, and future prospects for leishmaniasis treatment.

Effects of metformin on autoimmune immunoglobins and interferon-γ in patients with early diagnosed pemphigus vulgaris: a prospective clinical trial

The management of pemphigus vulgaris (PV) is challenging. This study aimed to evaluate the immunomodulating effects of metformin on PV. The study was conducted in two phases: in the first phase, patients received routine first-line treatment (prednisolone plus azathioprine) for 2 months, then in the second phase, metformin was added to this regimen for another 2 months. After addition of metformin to the first-line medications, significant reductions were seen in serum IgG1 (reduced from 534.92 ± 134.83 mg/dL to 481.58 ± 130.46 mg/dL, P < 0.001), IgG4 (51.83 ± 27.26 mg/dL to 44.50 ± 26.05 mg/dL, P < 0.001) and interferon-γ (277.99 ± 108.71 pg/mL to 45.05 ± 17.080 pg/mL, P = 0.03) concentrations. The suppressant effect of metformin was greatest on IgG4 (coefficient of variation 1.28), the dominant subclass of IgG involved in PV. Metformin could have immunomodulating effects on PV with controlling effects on steroid complications.

[New botulinum toxins for aesthetic dermatology : A comprehensive review]

Facial rejuvenation is gaining immense popularity among patients and clinicians. Botulinum toxins derived from bacteria are well-tolerated options as minimally invasive interventions for facial rejuvenation or other aesthetic procedures. These products have revolutionized aesthetic treatments. Several types of botulinum toxins (BoNT) are available. Currently type A and B are clinically used and only BoNT‑A products are approved for use for cosmetic indications in the Germany and the United States. Each product is unique in terms of its composition. Understanding the various BoNT‑A products is essential in choosing the optimal treatment for our patients. In this article we discuss different BoNT‑A products used for aesthetic intervention.

Low-dose daily aspirin reduces topical minoxidil efficacy in androgenetic alopecia patients

Topical minoxidil is the only US FDA approved OTC drug for the treatment of androgenetic alopecia (AGA). Minoxidil is a pro-drug converted into its active form, minoxidil sulfate, by the sulfotransferase enzymes in the outer root sheath of hair follicles. Previously, we demonstrated that sulfotransferase activity in hair follicles predicts response to topical minoxidil in the treatment of AGA. In the human liver, sulfotransferase activity is significantly inhibited by salicylic acid. Low-dose OTC aspirin (75-81 mg), a derivative of salicylic acid, is used by millions of people daily for the prevention of coronary heart disease and cancer. It is not known whether oral aspirin inhibits sulfotransferase activity in hair follicles, potentially affecting minoxidil response in AGA patients. In the present study, we determined the follicular sulfotransferase enzymatic activity following 14 days of oral aspirin administration. In our cohort of 24 subjects, 50% were initially predicted to be responders to minoxidil. However, following 14 days of aspirin administration, only 27% of the subjects were predicted to respond to topical minoxidil. To the best of our knowledge, this is the first study to report the effect of low-dose daily aspirin use on the efficacy of topical minoxidil.

ABCD2 score and BNP level in patients with TIA and cerebral stroke

Scoring systems have been designed to help physicians in early prediction of cerebral stroke following Transitional Ischemic Attack (TIA). ABCD2 system is one of these scoring systems. Considering increase of brain natriuretic peptide following cerebral ischemic stroke, BNP level may be associated with incidence of ischemic stroke following TIA. The present study evaluates ABCD2 score, BNP level in patients with TIA and incidence of cerebral stroke. This cross sectional-analytical study evaluated 78 patients with TIA. ABCD2 score was calculated for all patients based on some criteria including age, blood pressure, clinical manifestations (speech/motor disorder), symptoms duration and diabetes. BNP level was measured at the reference laboratory when the patient referred to the treatment center. The patients were followed up for 6 months considering incidence of cerebral stroke and TIA. Mean age of the patients was 66.53 +/- 13.08 years and the sample was consisted of 62.8% male and 37.2% female patients. Mean BNP level and mean ABCD2 score was 611.31 +/- 125.61 and 4.61 +/- 10.99 in all patients, respectively. During follow-up period, TIA recurrence and cerebral stroke were, respectively seen in 11.5 and 3.8% of cases. Mortality was reported in 5.1% of the patients. BNP was significantly higher in cases with recursive TIA (p = 0.03). But, there was not any difference considering ABCD2 score (p = 0.38). BNP is capable of predicting TIA recurrence following first TIA and it can be used in this case.

Comparison of genu varum treating results using open and closed wedge high tibial osteotomy

High tibial osteotomy methods include open and closed wedge techniques. The study aims at comparing results of osteotomy methods in patients suffering from genu varum deformity. In a cohort study, 32 patients with genu varum deformity (42 knees) were evaluated. They were divided into two groups and matched according to age and gender. The patients were treated with open and closed wedge osteotomy. After surgery, they were followed up and compared for 6 months. Thirty two patients with genu varum deformity (10 cases of bilateral deformity (31.2%) including 25 women (87.2%) and 7 men (21.8%) were studied. Incidence of complications was the same after open and closed wedge osteotomy operation (12.5%). Patients overall satisfaction from open and closed wedge methods was 87.5 and 75%, respectively. There was statistically significant difference between two groups considering operation duration, weight bearing duration and return to routine activities (p < 0.001). There was no difference in other parameters including varus angle correction, Lysholm score Tegner activity as well as Insall Salvati index. This study demonstrated that there is no difference between two osteotomy methods considering patients' clinical outcomes and both methods are successful in final treatment results.

Studying the calcium serum level in patients suffering from psoriasis

The recent success of vitamin D and its analogues in the treatment of psoriasis has generated extensive research into the role of vitamin D and calcium in this hyperproliferative skin disease. This study aimed at studying the calcium serum level in patients suffering from psoriasis. In this case control studies, 98 hospitalized cases with psoriasis were compared with 100 patients who were hospitalized due to other diseases. Two groups were matched for age and gender. The type of psoriasis, age and sex of patients and serum calcium and albumin levels in two groups were documented in a especial questionnaire. Of all 98 patients with psoriasis, 37.2% were hypocalcemic and 63.7% had normal serum calcium. There was no hypercalcemia. In other group 9% were hypocalcemic, 89 and 2% were normocalcemic and hypercalcemic respectively. In 64.9% of hypocalcemic psoriatic patients, low serum albumin was noted. But all of control group had normal levels. Hypocalcemia is a risk factor of psoriasis. It is better to include dairy as calcium resource in daily diet of patients suffering from psoriasis.

Comparison of oral ivermectin vs. lindane lotion 1% for the treatment of scabies

BACKGROUND

Scabies is a common parasitic infestation that is an important public-health problem in many resource-poor regions. It is commonly treated with the insecticides ivermectin and permethrin.

AIM

To compare the efficacy and safety of oral ivermectin vs. lindane lotion 1% for the treatment of scabies.

METHODS

In total, 148 patients with scabies were enrolled, and were randomized into two groups: the first group received a single dose of oral ivermectin 200 μg/kg body weight, and the second group were treated with two applications of topical lindane lotion 1%, with a 1-week interval between applications. Treatment was evaluated at intervals of 2 and 4 weeks, and if there was treatment failure at the 2-week follow-up, treatment was repeated.

RESULTS

A single dose of ivermectin provided a cure rate of 60.8% at the 2-week follow-up, which increased to 89.1% at the 4-week follow-up. after crossing over to the lindane lotion 1% group. Treatment with two applications of lindane lotion 1%, with a 1-week interval between them, was effective in 47.2% of patients at the 2-week follow-up, which increased to 72.9% at the 4-week follow-up after this treatment was repeated.

CONCLUSIONS

A single dose of ivermectin was as effective as two applications of lindane lotion 1% at the 2-week follow-up. After repeat treatment, ivermectin was superior to lindane lotion 1% at the 4-week follow up. The delay in clinical response with ivermectin suggests that it may not be effective against all the stages in the life cycle of the parasite.

Lich-gregoir procedure in treatment of the vesicoureteral reflux

Vesicoureteral reflux is a major problem in childhood affecting 1% of all children. There are various surgical methods for vesicoureteral reflux treatment. Current study evaluates effectiveness and success rate of the Lich-gregoir procedure in treatment of the vesicoureteral reflux. In a descriptive-analytical study, 32 children with 47 reflux unit underwent Lich-gregoir anti-reflux procedure in Imam Reza and Amir-al-Momenin Hospitals, Tabriz between March 2008 and August 2011. Surgery outcome and success rate, sonographic findings and complications rate were recorded in follow-up. Patients mean age was 5.85 +/- 3.81 years. 28.1% were male and 71.9% were female. Reflux was unilateral in 53.1% and bilateral in 46.9%. Vesicoureteral reflux grade I to V was in one, 1, 13, 22 and ten patients, respectively. Voiding Cystourethrogram (VCUG) findings were abnormal in all cases before operation. Surgery success rate in first 6 months was 95.7% and was 100% in 8 months after operation. Hydronephrosis disappeared after operation in all cases. Complication occurred in 2 cases (6.25%) with bilateral reflux including urinary intention and lymphocele. Lich-gregoir anti-reflux procedure technique is accompanied with higher success rate, low complication and hydronephrosis improvement and is an appropriate treatment for vesicoureteral reflux in children.

Evaluation of surgical treatment of developmental dysplasia of hip for avascular necrosis of femoral head in children

Developmental Dysplasia of the Hip (DDH) is a common congenital malformation. Avascular necrosis of femoral head is the major complication of both close and open reduction of the dislocated joint. Aim of this study was to determine the incidence and influencing factors in different types of a vascular necrosis of femoral head, following surgical treatment of developmental dysplasia of hip in 1-7 years patients. In this study, 120 patients aged from 1 to 7 years old with DDH who had been undergone open surgery, entered to the study. All of these patients followed up for at least 1 year. Surgery procedures divided to 4 groups: open reduction, open reduction+salter osteotomy, open reduction+femur shortening and open reduction+salter osteotomy+femur shortening. The presence of Avascular Necrosis (AVN) had been appraised. 27.5% of surgeries performed on male and 72.5 on female patients. 35.0% of DDH cases were unilateral and remaining was bilateral. 36 patients (30%) shows radiologic findings of AVN, although all of them placed at group I of Bucholz-Ogden classification. 40% of group A patients, 25% of group B, 14.3% of group C and 36.4% of group D patients developed this findings. Open reduction of DDH in older children is effective in the management of DDH and if all of the contrivance considered in the surgery, the rate of AVN would be low and mild (at least in short term follow ups).

Vulvovaginitis candidiasis recurrence during pregnancy

Vulvovaginitis is the most common gynecologic condition seen by practitioners rendering primary care to women. Vulvovaginitis Candidiasis (VVC) is the most common type of vaginitis and this study aimed at specifying VVC recurrence during pregnancy. In this prospective study, 150 pregnant women suffering from vaginal excretion, morsus and itching were studied. Initially, the patients were treated using clotrimazole local cream (5 g) for 7 successive days. After initial treatment, the patients were freely visited once a month until delivery considering vaginitis symptoms and VVC recurrence was examined during pregnancy. Mean age of the understudy mothers was 27.26 +/- 3.76. Mean of recurrence number was 0.17 +/- 0.48 during the first trimester. Mean of recurrence number was 0.92 +/- 0.76 during the second trimester. Mean of recurrence number was 2.16 +/- 0.63 during the third trimester. Statistically significant difference was between recurrences during three trimesters of pregnancy (p < 0.001). There is statistically significant difference between mean number of recurrences during three trimesters of pregnancy.

Effects of Polygonum aviculare herbal extract on sperm parameters after EMF exposure in mouse

Electromagnetic fields with high energy same as ionizing radiation inserts their destructive effects via free radical production. Using antioxidants or herbal plants with antioxidants components could diminish hazardous effects of EMF. Polygonum aviculare has a high amount of phenolic and flavonoid and proved that has antioxidants effects. The aim of this study was to evaluate the effects of Polygonum aviculare herbal extract on sperm parameters after EMF exposure in mouse. Twenty four male mice, 8 weeks divided to 4 groups (one control and three experimental groups). Control group didn't receive EMF exposure. EMF group mice received 3 mT EMF during 2 months, 4 h daily and 5 days weekly. Polygonum aviculare group received 50 mg kg(-1) herbal extract during 2 months and poly -EMF group received 3 mT EMF during 2 months, 4 h daily and 5 days weekly and 50 mg kg(-1) herbal extract during 2 months. After 2 months the mice sacrificed with cervical dislocation and sperm obtained from tail of epididymis and motility and morphology of them were analyzed. Sperm analysis results showed that in group with Polygonum aviculare, morphology and motility of sperm developed (p < 0.05). Present results showed that EMF can reduce motility of sperm and treatment of Polygonum aviculare after EMF exposure developed sperm quality after EMF exposure.