Unilateral eyelid edema and mucosal involvement as the first presentations of Wegener granulomatosis

Background: Wegener granulomatosis or granulomatosis with polyangiitis is a pauci-immune small vessel vasculitis which is usually associated with anti-neutrophil cytoplasmic antibodies (ANCA) mainly in old men. This small vessel vasculitis is usually characterized by necrotizing granulomatous inflammation with multiorgan involvement. Kidneys could be involved as the main and life-threatening condition in Wegener granulomatosis.  Oral or ocular lesions may occur as the first and uncommon presentations before internal organ involvement in these patients and could be misdiagnosed with other diseases. Case presentation: We present a 24-year-old man with erosions and ulcerations on palatal mucosa and a strawberry-like gingival hypertrophy associated with nasal congestion and epistaxis which two stated months ago. Also he had an episode of unilateral blepharitis and upper eyelid edema five months ago. Mucosal biopsy showed perivascular infiltrations of mainly neutrophils, some eosinophils and rare giant cells. He had elevated level of proteinase 3–ANCA or C-ANCA with microscopic hematuria without significant kidney involvement in kidney biopsy. Mucosal lesions and hematuria improved after two months of treatment with oral prednisolone. Conclusion: Unilateral eyelid edema and mucosal erosions in a young man could be the uncommon presentations of Wegener granulomatosis

Antifungal properties of phenyl fatty hydroxamic acids and their copper complexes synthesized based on canola and palm kernel oils

Phenyl fatty hydroxamic acids (PFHAs) were synthesized by phenyl hydroxylaminolysis of canola or palm kernel oils using lipozyme TL IM as catalyst. Copper complexes of phenyl fatty hydroxamic acids (copper phenyl fatty hydroxamate (Cu-PFHs)) acids were prepared by stirring the phenyl fatty hydroxamic acids which were dissolved in hexane and copper(II) nitrate solution. The antifungal properties of phenyl fatty hydroxamic acids and its copper(II) complex Cu-PFHs based on canola and palm kernel oils were separately investigated against Candida parapsilosis, Candida albicans and Aspergillus fumigatus by the disc diffusion method using Mueller-Hinton agar. The results showed that antifungal activity of Cu-PFHs is higher than phenyl fatty hydroxamic acids do and also the activity of phenyl fatty hydroxamic acids and Cu-PFHs increase while their concentrations increase. The antifungal activity of phenyl fatty hydroxamic acids and Cu-PFHs are significantly higher than nystatin while use against the A. fumigatus, C. parapsilosis and C. albicans and also are significantly higher than ketoconazole while use against the A. fumigatus

Association between Immunofluorescence Pattern and Mucosal Involvement in Patients with Bullous Pemphigoid

Bullous pemphigoid is an acquired autoimmune subepidermal blistering disease which is associated with mucocutaneous lesions. The type and amount of autoantibody deposition may have a role in mucosal lesions. We studied the association between mucosal involvement and direct immunofluorescence pattern in cutaneous lesions of patients with bullous pemphigoid. In this retrospective analytical cross-sectional study, we studied the demographic data, clinical presentations, and immunopathological findings of 69 patients with bullous pemphigoid admitted to our hospital 2008-2016. Patients were allocated into two groups on the basis of the mucosal involvement, and direct immunofluorescence patterns were evaluated. The data were analyzed using SPSS version18. The mean age of patients was 70.9±14.97 (mean ± Standard Deviation) years old. In our study, 56.5% of patients were women. All patients showed deposition of IgG and C3 in the dermoepidermal junction, with different severity. Patients with mucosal involvement (40.6% of cases) had a more prominent deposition of IgG, IgA, and C3 at the dermoepidermal junction compared with patients without mucosal involvement, which represented a statistically significant difference (P&lt;0.05). Logistic regression analysis showed that lower age, IgA, and C3 deposition (P&lt;0.05) were associated with mucosal involvement. Deposition of IgA and C3 (in addition to IgG) at the dermoepidermal junction seems to be a marker of mucosal involvement in patients with bullous pemphigoid. Attention to direct immunofluorescence pattern in patients with bullous pemphigoid may be helpful in prediction of mucosal involvement in these patients. </p

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

The Effect of Virtual Reality Motor Games Interventions in Reducing the Symptoms of Attention Deficit and Impulsivity in Children with Attention Deficit Hyperactivity Disorder (ADHD)

Introduction: Virtual reality is one of the new areas of research. The application of this method in normal society has shown positive results. Aim: The purpose of this research was to investigate the role of virtual reality motor games interventions in reducing the symptoms of attention deficit and impulsivity in children with attention deficit hyperactivity disorder. Method: The present study is a semi-experimental study with a pre-test-post-test design and a control group. The statistical population included children aged 8-10 years in the 1st district of Mashhad in 2021, and 30 children with attention-deficit/hyperactivity disorder were selected. The SNAP-4 scale (2001), Hirschfeld's Children's Impulsivity Questionnaire (1965) and a virtual reality device were used to collect data. Subjects in the virtual reality group practiced for 30 minutes twice a week for 6 weeks. The data were analyzed using the composite analysis of variance test and SPSS version 20 software. Results: The results showed that the main effects of phases (η2=0.779, F=98.85), group (η2=43.48, 0.608) = F) and the interaction effect of group and phases (η2=0.827, F=133.80) were significant, that is, the virtual reality movement games had an impact on children's impulsivity. The results also showed that the main effect of phases (η2=0.691, F=62.73), group (η2=0.234, F=8.54 F) and the interaction effect of group-phases (η2=0.693, F=63.14) were significant and the virtual reality motor games had an effect on the reduction of attention deficit symptoms (P≤0.05). Conclusion: The research results show that virtual reality games can be used as a suitable educational tool for teaching behavioral skills to children with attention deficit hyperactivity disorder. Therefore, researchers and teachers are recommended to use virtual reality games for these childre

Triggering Role of Stressful Life Events in Patients with Alopecia Areata

SUMMARY Recent clinical studies examined the role of stress as a potential trigger for alopecia areata. However, it is still questioned whether and to what extent stress plays a role in its pathogenesis. We determined whether stressful life events are risk factors in the onset and course of alopecia areata among our population. The study included 61 consecutive patients with alopecia areata who were all outpatients at dermatology clinics of Semnan city. Sixty age-and sex-matched individuals selected among healthy subjects with respect to the diagnosis of alopecia areata served as controls. Stressful events were assessed using Traumatic Events Questionnaire (TEQ). No differences were found in the number as well as mean scores of physical and sexual stressful life time events across the two groups, while patients experienced a greater number of emotional stressing events with higher mean scores than the healthy group. Among different TEQ items, alopecia patients tended to have higher scores on the items indicating history of loss of a family member during childhood and a history of emotional neglect by relatives. In conclusion, loss of family members and emotional neglect by relatives might have major roles in triggering the onset and exacerbation of alopecia areata

Extramammary Paget's Disease Associated With Genital Wart and Lichen Sclerosus

Extramammary Paget’s disease is an uncommon intraepithelial adenocarcinoma in genital and perianal regions. Genital wart is the most common sexually transmitted disease caused by human papilloma viruses and vulval lichen sclerosus is chronic pruritic dermatitis in genital area which could be able to change to invasive squamous cell carcinoma. We report a patient who had simultaneous lichen sclerosus, genital wart and extramammary Paget’s disease of the vulva. We could not find any significant association between them in literature

Miliarial type pseudolymphoma mimicking as granulomatous rosacea

Miliarial type lymphocytoma cutis is a rare type of psuedolymphoma which is described by numerous semi-translucent papules on the sun exposed regions. Herein, we present a 25-year-old woman with numerous permanent translucent tiny papules on the face. Microscopic examination revealed dense infiltration of lymphocytes in the reticular dermis with lymphoid follicle formation and significant B-cell lymphocytes in immunohistochemistry study. She was diagnosed as miliarial type pseudolymphoma and treated with topical momethasone furoate ointment and oral hydroxychloroquine with a good response