Epidemiology of Autoimmune Bullous Diseases and Therapeutic Modalities During a 10 Year Period in Iran

Autoimmune bullous diseases are systemic disorders with autoantibodies that result in blisters. Aim of this study was to indicate the spectrum and treatment modalities of five types of bullous disorders most prevalent in the south of Iran: pemphigus vulgaris (PV), pemphigus foliaceus (PF), epidermolysis bullousa aquisita (EBA), bullous pemphigoid (BP), and pemphigoid gestationis (PG). Patients with PV, PF, BP, EBA, and PG were included in this study. The data regarding the age, sex, and the treatment used for PV, PF, and BP were recorded and analyzed in our center, a tertiary referral center. T-test and Mann-Whitney test for independent samples were used for the analysis of parametric and nonparametric variables, respectively. Chi-square test was used for frequencies. Of the 441 patients included in this study, 82.9% had PV, 4.7% PF, 8.5% BP, 1.5% EBA, and 1.3% PG. 93.5% of patients with PV, 95.3% with PF, and 100% with patients with BP were treated and responded to first line therapies with one or two medications.The most frequent autoimmune bullous disease was PV, followed by PF. For PV and PF, combination of prednisolone and azathioprine was the most frequent first line medication. In the patients with BP, prednisolone monotherapy was the most frequent one. Only a minority of patients with PV and PF needed the third or fourth medications.</p

Identification and antifungal activity profile of Candida species isolated from patients with pemphigus vulgaris with oral lesions

Pemphigus vulgaris is an autoimmune disease that mostly affects the mucosa and oral cavity. Candida species can invade the mucosal lesions of these patients and cause diseases. The aim of this study was to identify the fungal agents isolated from mucosal lesions and evaluate antifungal activity profile against the isolates. A total of 25 patients with pemphigus vulgaris with active oral lesions and 25 healthy people serving as a control group were included in this study. Identification of the fungal isolates was performed based on conventional methods and DNA sequence analysis of the internal transcribed spacer (ITS) rDNA gene region. The sequence results were deposited in the NCBI database using the Basic Local Alignment Search Tool. Antifungal activity of fluconazole, itraconazole, ketoconazole, posaconazole, econazole, and amphotericin B against the isolates were evaluated based on the CLSI M-44 A protocol.  Oral candidiasis was detected in 20% of the patients. Candida species isolated from oral lesions of patients with pemphigus were identified as Candida albicans 22/25, Candida glabrata 2/25, and Candida dubliniensis 1/25. All of the isolates were sensitive to amphotericin and econazole, 96% to fluconazole and posaconazole, and 92% to ketoconazole and itraconazole. One patient showed a profile resistant to fluconazole, posaconazole, and ketoconazole, simultaneously. Ninety six percent of control group isolates were sensitive to six antifungals. Candida albicans was the most prevalent species isolated from oral lesions of patients with pemphigus vulgaris and the control group. Amphotericin B and econazole were the most effective antifungals against the isolates. </p

Flow of Scientific Publications in Iran during 2007 to 2011, Based on Triple Helix of University, Industry and Government

The aim of this study is to investigate the flow of scientific production in Iran during 2007 to 2011. The triple helix model was used to assess the relationship between universities, industries and the government on scientific production process. Iranian scientific products in the three ISI citation databases of Science Citation Index (SCI), Social Science Citation Index (SSCI) and Art and Humanities Citation Index (A&HCI) during the abovementioned period was collected as the research population and the authors addresses were reviewed carefully to be used in TH model. ISI.exe and SPSS software were used for this purpose. The Triple Helix collaboration of University, Industry and Government was measured by mutual information (transmission T) derived from the Shannon’s formulas. The T-value here represented the uncertainty when the probability distributions were combined. Findings indicated that the number of papers written by Iranian authors increased steadily from 8796 in 2007 to 19876 in 2011. Among the three sectors, university researchers had the most participation Researchers from the industry sector had the lowest participation. Two-dimensional and three-dimensional collaborations were calculated too. The results showed that University-Government collaboration was much higher than the University-Industry or Industry-Government collaborations indicating that the gap between Industry and the two other sectors in Iran was significantly big. Government–University interactions had a better condition. This can be explained due to the supports that research organizations receive from the government. Unfortunately the T value is not high for the three dimensional collaboration of University, Industry and Government researchers. But by adding the foreign collaboration as the forth factor into the study, the results change a little and the collaborations between different sectors and foreign researchers increase in comparison with internal collaborations. It is clear that an ideal point in relations to different sectors of Triple Helix of university, industry and government is not possible overnight but requires a long- term strategic planning

Dermatological manifestations of HIV/AIDS individuals in Shiraz, South of Iran

Introduction: HIV infection remains as a major challenge facing medical sciences in the world today. Mucocutaneous manifestation was first observed in patients with HIV/AIDS in the early 1980s. The aim of this study was to identify various skin manifestations based on making careful clinical observations and performing the necessary tests. Materials and Methods: A total of 240 patients whose disease was diagnosed using WB and ELISA tests, with dermatologic manifestations and were older than 18 years, participated in this study. These patients had referred to the voluntary counseling and testing center in Shiraz for routine examinations. Results: From the total of 240 participants, 158 were males (65.8%) and 82 were females (34.2%). The mean age was 40.87 ± 8.04 years. Dermatologic manifestations were of infectious origin in 79 (33%) of the participants. As the most common viral skin infections, herpes simplex was seen in 16 patients (6.7%), with herpes zoster ranking second with 15 patients (6.3%). No relationship was found between CD4 cell count and infectious or noninfectious dermatologic manifestations (P = 0.274). Conclusion: No association was found between CD4 cell counts and dermatologic manifestations. Many skin disorders may appear in HIV/AIDS patients with normal CD4 cell counts

Value of CD10 Expression in Differentiating Cutaneous Basal from Squamous Cell Carcinomas and Basal Cell Carcinoma from Trichoepithelioma

Background: In addition to the well-defined histological criteria for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC), immunohistochemical techniques can be used in difficult cases for their differentiation. As differential diagnosis between trichoepithelioma (TE) and BCC is sometimes difficult for the clinician and the pathologist, CD10 may be a useful marker for definite diagnosis. We aimed to evaluate the usefulness of this marker in the differentiation between SCC and BCC and also in the differentiation between BCC and TE.Methods: Fifty-five BCC cases, 50 SCC cases, and 20 cases of benign adnexal tumor with follicular differentiation were retrieved from the archives of the pathology departments of hospitals affiliated with Shiraz University of Medical Sciences. Immunohistochemistry for CD10 was performed on the sections obtained from formalin-fixed, paraffin-embedded blocks. CD10 immunoreactivity in the stroma and/or tumor cells was determined as follows: negative (0); 1+(10-50% positive cells); and 2+(>50% positive cells). Results: Comparison of CD10 expression between the BCC and SCC groups showed a significant difference (P<0.001) in each of the tumor and stromal cells. Comparison of CD10 expression between the BCC and TE groups demonstrated a significant difference in both the tumor and stromal cells (P<0.001). There was no significant difference in CD10 expression between the stromal and tumor cells of the BCC subtypes.Conclusion: CD10 is a useful adjunct marker in distinguishing TE from BCC. CD10 is suggested to be one of the useful immunohistochemical markers to differentiate BCC from SCC

Comparison of Fumaric Acid 5% Cream Versus Triamcinolone 0.1% Cream in the Treatment of Hand Eczema

Hand eczema is a common distressing skin problem. It is an immune reaction to haptens. Thus, substances that inhibit Immune system can be effective in the treatment of hand eczema. In this study, topical fumaric acid 5% cream is compared with topical steroid in the treatment of hand eczema. Patients with hand eczema were randomly divided into two groups. One group received fumaric acid 5% in a cream base, and the other received triamcinolone 0.1% in the same cream base. Both groups used creams twice daily for one month. Patients were checked for erythema, excoriation, population and lichenification, EASI score, and pruritus before and after treatment. In both groups, the mean of all signs of the disease and EASI score decreased after one month of treatment. There was no significant difference between the two treatments in decreasing erythema, but excoriation, population, lichenification, EASI score and itching were all decreased more in triamcinolone 0.1 % group. Although fumaric acid can inhibit the immune system; it was less effective for the treatment of all signs of hand eczema except erythema in comparison to triamcinolone. These results may be justified for two reasons: low penetration of topical fumaric acid through the skin or a low concentration used in this study

Analysis of Surgically Treated Cutaneous Malignancies in a Tertiary Dermatology Center During a Six-Year Period

Background: Cutaneous malignancies are common in dermatologic practice. Due to their relation to sun exposure the characteristics of these malignancies can differ in various geographic locations. This study intends to determine the characteristics of surgically treated cutaneous malignancies and various surgical modalities that have been applied. Methods: This was a retrospective study of patients with cutaneous malignancies who underwent surgery over a six-year period. Data regarding the general information, type of malignancy, location, surgical margin involvement and specific surgical modalities were recorded and analyzed. Results:A total of 432 patients were included. Basal cell carcinoma was the most common malignancy (82.8%) followed by squamous cell carcinoma (13.4%). Lentigo maligna, keratoacanthoma, basosquamous carcinoma, sebaceous carcinoma and Bowen’s disease accounted for the minority of cases. Patients' mean age was 65.7 years and the most common location was the nose and cheeks. The mean diameter was 2.97 cm. Excision was performed with safe margins. Incomplete excision was seen in 14% of basal cell and 15% of squamous cell carcinoma cases. The most common type of defect closure was a simple closure (43.9%). Conclusion: Basal cell carcinoma is the most common type of cutaneous malignancy. Surgery yields a satisfactory response as treatment for this cutaneous malignancy

Recurrence of scalp pyogenic granuloma with satellitosis in 4.5-Year-Old Boy

The patient was 4.5-year-old boy presented by an erythematous nodule in occiput that bleeds easily. He sought medical attention, and after each session of treatment, several nodules appear adjacent to the first lesion. Pyogenic granuloma (PG) recurrence at the site of treatment can occur, but satellitosis is a rare complication. PG satellitosis usually occurs in the site of pressure or trauma, but the patient did not mention any history of trauma