Doxycycline In Pityriasis Rosea: Placebo- Controlled Clinical Trial

Background: Pityriasis rosea is an acute, self-limiting skin disease, probably of infective origin. Doxycycline is a broad-spectrum antibiotic, and most probably has an immunomodulator and an anti-inflammatory effect. Objective: To assess the efficacy of doxycycline in the treatment of pityriasis rosea in patients evaluated between January 2001 and May 2002. Patients and methods: This was a placebo-controlled clinical trial. One hundred and twenty patients with pityriasis rosea were included in the study; all of them were above 12 years of age. They had been divided into 2 groups, the treatment group consisted of 60 patients and received doxycycline capsule. 100,mg orally for 14 days and the placebo group consisted of 60 patients and received glucose capsules for 14 days, all the patients were followed up clinically for 4 weeks after treatment, the responses were categorized into excellent, partial and no response. Results: forty-six patients from the treatment group completed the study. Excellent response was achieved in 30 patients (65%), partial response in 15 patients (33.5%) and no response in I patient (1.5%). Forty patients from the placebo group completed the study. Excellent response was achieved in 4 patients (10%), partial response in 20 (50%) and no response in 16 patients (40%). The results were statistically significant. Conclusions: we concluded that doxycycline was effective in the treatment of pityriasis rosea, with very few adverse effects

The Role Of IL-4 And IL-8 In The Itiology Of Tinea Versicolor In Group Of Iraqi Patients

Background: Tinea versicolor is a common dermatological problem ,world wide distribution , caused by a dimorphic fungus called Malassezia furfur ,it live normally on skin as a commensal . Many factors play a role in the etiology of TV among these could be the disturbed immune system which may be related to the ability of TV alter the immune system by a process called Immunomodulation leading to subsequent infection. Immuno-inflammatory activity mediated by different cytokines could have a role in the etiology of TV. Objective: To evaluate the serum level of the inflammatory cytokines ,IL-4andIL-8,in patients with TV as compared to immunocompramized patients and healthy groups. Patients and methods: This study enrolled 50 total patients, 15 of them were as patients control group who were immunocompramized with evident skin lesion ,to be compared serologically with 15 patients who had TV and normal immunity, the control group composed of20 healthy volunteers. Using ELISA test technique the following tests were done :detection of IL-4 and IL-8 in the sera of all groups. Results and discussion: The statistical differences in the rate of detectable IL-4 level between TV and healthy control p< 0.001,while the difference was a highly significant between the healthy control and immunocompramized patients with TV,P<0.00338.The difference between two diseased groups was(p< 0.219)which is non significant , when p<0. 05 was considered significant. IL-8 the results of our study showed a significant difference between the healthy control and the patients with tinea versicolor, p-value was( 0.05). In this study there was a nice findings by which the difference between the healthy control and the immunocompramized patients was highly significant as ,p<0.005.  Conclusion :The genus Malassezia is an immunological paradox. In some circumstances, it acts as an adjuvant, activates the complement cascade, and elicits both cellular and humoral immune responses in healthy individuals, among which IL8 and IL-4 were notably increased . In contrast, it also seems to have the ability not only to evade the immune system but actually to suppress the response directed agains

Chronic ulcerative Cutaneous Vasculitis of the legs Clinical and histopathological study

Background: Cutaneous small vessel vasculitis characterized by necrosis and inflammation of upper dermal blood vessels. It presents with ulcers and systemic manifestations after extensive acute onset. Many patients have a form of cutaneous vasculitis that presents with chronic painful ulcerations & purpuras involving the ankles without systemic manifestations, with some similarity in clinical presentation to livedoid vasculopathy. Patients and Methods: Thirteen patients were seen in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, for a period extending from January 2004 to March 2005. They were evaluated clinically, histopathologically and other laboratory studies. In addition, evaluation of the clinical response to prednisolone 0.5mg/kg/day and azathioprine150mg/day was done. Results: Thirteen patients were included in this study; eight females and five males, with male to female ratio of 1:1.6. Their ages ranged between 26-66 years with a mean ±SD of 42 ± 13.8 years. The duration of the disease ranged from 0.5 – 18 years with a mean ±SD of 38 ± 59.2 months.The clinical examination revealed multiple oval punched out ulcers, with an indurated base, and surrounded by a zone of erythema; affecting mainly the ankles and dorsa of feet. Histopathological evaluation showed upper dermal vessels' wall necrosis, fibrinoid deposition, obliteration of the lumen, extravasation of red blood cells, endothelial cells swelling with perivascular and vascular wall infiltration mainly by mononuclear cells.The treatment was started with prednisolone & azathioprine. The ulcers healed completely with residual hyperpigmentation - hypopigmentation, atrophy and scars within 10-15 weeks  Conclusions: Chronic ulcerative cutaneous vasculitis is often a neglected and misdiagnosed variant of vasulitis. Histologically it has vascuiltic features, and clinically looks like livedoid vasculopathy

Microbial-host co-metabolites are prodromal markers predicting phenotypic heterogeneity in behavior, obesity, and impaired glucose tolerance

The influence of the gut microbiome on metabolic and behavioral traits is widely accepted, though the microbiome-derived metabolites involved remain unclear. We carried out untargeted urine 1 H-NMR spectroscopy-based metabolic phenotyping in an isogenic C57BL/6J mouse population (n = 50) and show that microbial-host co-metabolites are prodromal (i.e., early) markers predicting future divergence in metabolic (obesity and glucose homeostasis) and behavioral (anxiety and activity) outcomes with 94%– 100% accuracy. Some of these metabolites also modulate disease phenotypes, best illustrated by trimethylamine-N-oxide (TMAO), a product of microbial-host co-metabolism predicting future obesity, impaired glucose tolerance (IGT), and behavior while reducing endoplasmic reticulum stress and lipogenesis in 3T3-L1 adipocytes. Chronic in vivo TMAO treatment limits IGT in HFD-fed mice and isolated pancreatic islets by increasing insulin secretion. We highlight the prodromal potential of microbial metabolites to predict disease outcomes and their potential in shaping mammalian phenotypic heterogeneity

Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars

The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies

Gut Flora Metabolism of Phosphatidylcholine Promotes Cardiovascular Disease

Metabolomics studies hold promise for the discovery of pathways linked to disease processes. Cardiovascular disease (CVD) represents the leading cause of death and morbidity worldwide. Here we used a metabolomics approach to generate unbiased small-molecule metabolic profiles in plasma that predict risk for CVD. Three metabolites of the dietary lipid phosphatidylcholine—choline, trimethylamine N-oxide (TMAO) and betaine—were identified and then shown to predict risk for CVD in an independent large clinical cohort. Dietary supplementation of mice with choline, TMAO or betaine promoted upregulation of multiple macrophage scavenger receptors linked to atherosclerosis, and supplementation with choline or TMAO promoted atherosclerosis. Studies using germ-free mice confirmed a critical role for dietary choline and gut flora in TMAO production, augmented macrophage cholesterol accumulation and foam cell formation. Suppression of intestinal microflora in atherosclerosis-prone mice inhibited dietary-choline-enhanced atherosclerosis. Genetic variations controlling expression of flavin monooxygenases, an enzymatic source of TMAO, segregated with atherosclerosis in hyperlipidaemic mice. Discovery of a relationship between gut-flora-dependent metabolism of dietary phosphatidylcholine and CVD pathogenesis provides opportunities for the development of new diagnostic tests and therapeutic approaches for atherosclerotic heart disease

The gut microbiome: scourge, sentinel or spectator?

The gut microbiota consists of trillions of prokaryotes that reside in the intestinal mucosa. This long-established commensalism indicates that these microbes are an integral part of the eukaryotic host. Recent research findings have implicated the dynamics of microbial function in setting thresholds for many physiological parameters. Conversely, it has been convincingly argued that dysbiosis, representing microbial imbalance, may be an important underlying factor that contributes to a variety of diseases, inside and outside the gut. This review discusses the latest findings, including enterotype classification, changes brought on by dysbiosis, gut inflammation, and metabolic mediators in an attempt to underscore the importance of the gut microbiota for human health. A cautiously optimistic idea is taking hold, invoking the gut microbiota as a medium to track, target and treat a plethora of diseases

A Genome-Wide Metabolic QTL Analysis in Europeans Implicates Two Loci Shaped by Recent Positive Selection

We have performed a metabolite quantitative trait locus (mQTL) study of the 1H nuclear magnetic resonance spectroscopy (1H NMR) metabolome in humans, building on recent targeted knowledge of genetic drivers of metabolic regulation. Urine and plasma samples were collected from two cohorts of individuals of European descent, with one cohort comprised of female twins donating samples longitudinally. Sample metabolite concentrations were quantified by 1H NMR and tested for association with genome-wide single-nucleotide polymorphisms (SNPs). Four metabolites' concentrations exhibited significant, replicable association with SNP variation (8.6×10−11<p<2.8×10−23). Three of these—trimethylamine, 3-amino-isobutyrate, and an N-acetylated compound—were measured in urine. The other—dimethylamine—was measured in plasma. Trimethylamine and dimethylamine mapped to a single genetic region (hence we report a total of three implicated genomic regions). Two of the three hit regions lie within haplotype blocks (at 2p13.1 and 10q24.2) that carry the genetic signature of strong, recent, positive selection in European populations. Genes NAT8 and PYROXD2, both with relatively uncharacterized functional roles, are good candidates for mediating the corresponding mQTL associations. The study's longitudinal twin design allowed detailed variance-components analysis of the sources of population variation in metabolite levels. The mQTLs explained 40%–64% of biological population variation in the corresponding metabolites' concentrations. These effect sizes are stronger than those reported in a recent, targeted mQTL study of metabolites in serum using the targeted-metabolomics Biocrates platform. By re-analysing our plasma samples using the Biocrates platform, we replicated the mQTL findings of the previous study and discovered a previously uncharacterized yet substantial familial component of variation in metabolite levels in addition to the heritability contribution from the corresponding mQTL effects