Journal of Advances in Medicine and Medical Research
Background: Tristetraprolin (TTP) is RNA-binding protein encoded by Zfp36 gene which regulates th... more Background: Tristetraprolin (TTP) is RNA-binding protein encoded by Zfp36 gene which regulates the mRNA stability of several important cytokines. Due to its critical role in control of inflammation, TTP deficiency leads to the spontaneous development of a complex inflammatory syndrome. So far, this phenotype has been largely attributed to dysregulated production of TNF and IL23 by myeloid cells, such as macrophages or DCs. The expression of TTP was studied in keratinocytes and explored its role in the imiquimod-induced psoriasis model. Objective: To study the possible role of Tristetraprolin in the pathogenesis of psoriasis. Methods: The study included 32 patients who were randomly assigned to two groups, group 1 included 22 patients with psoriasis and group 2 included 10 apparently healthy individual as a control group. Skin specimens were obtained by punch biopsy (3mm) from the skin lesion of the patients and normal skin of controls. Skin tissue from each case was homogenized in p...
Photodermatology, Photoimmunology & Photomedicine
BackgroundCaveolin‐1 (Cav‐1) is a significant structural and regulatory constituent of cell membr... more BackgroundCaveolin‐1 (Cav‐1) is a significant structural and regulatory constituent of cell membranes that has been implicated in cell kinetics and inflammation.ObjectiveTo assess Cav‐1 expression in psoriasis before and after phototherapy.Patients and methodsThirty psoriasis cases and 30 healthy controls were recruited. Cases were managed with narrow band‐ultraviolet B (NB‐UVB) phototherapy at frequency three times per week for 12 weeks. From every case, two biopsy specimens were gained from psoriatic lesions (pre and post phototherapy), in addition to one from apparently normal skin of psoriasis cases. Regarding the control group, one biopsy was taken from a matched site. All were studied for Cav‐1 antibody immuno‐expression.ResultsThere was a significant decrease in Cav‐1 expression in psoriatic lesions compared to both the apparently normal skin of psoriasis patients and standard control skin of healthy individuals. After NB‐UVB phototherapy, significant upregulation of Cav‐1 im...
BackgroundManagement of multiple recalcitrant common warts represents a therapeutic challenge. Bo... more BackgroundManagement of multiple recalcitrant common warts represents a therapeutic challenge. Both oral isotretinoin and acitretin have shown a promising efficacy in the treatment of various types of warts. However, a comparative study of the two medicines in wart treatment has not yet been conducted.ObjectiveThe aim of this study was to assess the efficacy and adverse effects of oral isotretinoin versus acitretin in the treatment of multiple recalcitrant common warts.MethodsThis study was conducted on 75 adult male patients with recalcitrant multiple common warts. The patients were randomly assigned to three groups: group 1 (30 patients) received oral isotretinoin, group 2 (30 patients) received acitretin, and group 3 received oral placebo (15 patients). The treatment was given daily until complete clearance or for a maximum of 3 months.ResultsComplete clearance of the treated lesions was observed in 18 patients (60%) of the isotretinoin group, in 22 patients (73.3%) of the acitre...
INTRODUCTION Phthiriasis palpebrarum is an ectoparasitosis of the eyelashes due to infestation wi... more INTRODUCTION Phthiriasis palpebrarum is an ectoparasitosis of the eyelashes due to infestation with Phthirus pubis, also known as crab louse. It may affect children or adults and present with different clinical symptoms such as eyelid itching, pain, or gritty sensation. Adult lice and nits can be detected by a careful clinical examination and confirmed by dermoscopy. The treatment of phthiriasis palpebrarum may be in the form of topical application of ovidicidal formulations or physical agents, which may be combined with systemic ivermectin. Herein, we present a rare case of unilateral phthiriasis palpebrarum affecting an 8-year-old child with an excellent response to oral ivermectin.
Ceramic membranes, operating in membrane distillation mode, are deemed to withstand relatively hi... more Ceramic membranes, operating in membrane distillation mode, are deemed to withstand relatively high operating temperatures when compared to polymeric membranes, since high temperatures promote higher transmembrane fluxes. Hydrophobic membrane contactors are typically proposed for mass transfer operations in which vapor-liquid interfaces are necessary to perform absorption and/or stripping processes or others, avoiding the dispersion of one phase into the other.
International Journal of Sports Science and Arts, 2021
Movement competence is a critical component for a young child. It may be an important prerequisit... more Movement competence is a critical component for a young child. It may be an important prerequisite for engagement in physical activity (PA) later in life. Objective: This study was carried out to determine whether movement competence of children differed according to their geographical regions? Methods: 35 children (19 boys, 16 girls) from urban (Cairo) region schools, and 25 children (13 boys, 12 girls) from rural (Al Minia) region schools were included in the study. Movement competence was evaluated using the Test of Gross Motor Development-2 (TGMD-2) instrument (Ulrich, 2000). Results: A significant relationship was revealed between urban and rural Egyptian children aged 6-7 years in movement competence and Boys found to be better on movement competence when compared with girls in rural region while girls were better than boys in urban region. Conclusion: The movement competence of the Egyptian child is affected by the different geographical region in which he lives.
Newcastle disease (ND), infectious bronchitis (IB) and avian influenza (AI) are highly contagious... more Newcastle disease (ND), infectious bronchitis (IB) and avian influenza (AI) are highly contagious and are responsible for huge economic losses in poultry production. Thirteen chicken flocks showed upper respiratory tract manifestation from Ismailia, Sharkia and Dumyat provinces during 2011 and 2012 winter seasons. SPF embryonated chicken eggs were used for virus isolation. Results of HI and PCR indicated that, 13 isolates were positive to IBV and negative for AIV. In addition, 6 isolates were positive to NDV. Six chicken flocks had mixed infection with IBV and NDV, while seven flocks were infected with IBV only. The PCR of IBV targeted ORF1a gene of IBV while targeting the F gene of NDV.
APA Citation Fawzy, M. (2017).Effectiveness of self healing in repair of strategic concrete struc... more APA Citation Fawzy, M. (2017).Effectiveness of self healing in repair of strategic concrete structures "a simplified model" [Master’s thesis, the American University in Cairo]. AUC Knowledge Fountain. https://fount.aucegypt.edu/etds/394 MLA Citation Fawzy, Mohamed Hussein. Effectiveness of self healing in repair of strategic concrete structures "a simplified model". 2017. American University in Cairo, Master's thesis. AUC Knowledge Fountain. https://fount.aucegypt.edu/etds/394
Objectives: Drug addiction has its effects on different behavioral and personality traits includi... more Objectives: Drug addiction has its effects on different behavioral and personality traits including impulsivity and pattern of decision-making. The frontal lobe was the focus of many of these studies regarding its important role in decision-making and other higher cognitive processes. We aimed to detect the pattern of decision-making styles and impulsivity among people with tramadol addiction, and also to find out if tramadol addiction has effects on the volume of different regions of the frontal lobe. Materials and Methods: Two groups were included: group A included 12 patients with tramadol addiction and group B included 23 healthy cross-matching controls. Both groups were subjected to urine drug screening, Iowa gambling task (IGT), UPPS scales (negative urgency, lack of perseverance, lack of premeditation, and sensation seeking), and structural magnetic resonance imaging brain study. Results: The patients’ group has shown a significantly lower volume of the brain white matter, gray matter, and cortical thickness (P<0.001). This group has also shown a significantly higher scores of IGT-A and IGT-B (P<0.001 and P=0.02, respectively) and has shown a higher score of all subscales of UPPS. Conclusions: Tramadol addiction is associated with a reduced volume of the brain white matter, gray matter, and cortical thickness. All regions of the frontal lobe have shown significant volume reduction in the tramadol group. Tramadol addiction and its duration are associated with risky decision-making style and with higher impulsivity than nonaddicts.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2021
ZusammenfassungHintergrund und ZielsetzungenBei Patienten mit ausgedehnter Vitiligo wurden versch... more ZusammenfassungHintergrund und ZielsetzungenBei Patienten mit ausgedehnter Vitiligo wurden verschiedene Methoden zur Entfernung der Restpigmentierung im Gesicht angewendet. Es gibt jedoch nach wie vor kein ideales Depigmentierungsmittel. Kürzlich wurde über die Verwendung von Trichloressigsäure (TCA) zur Depigmentierung bei universeller Vitiligo berichtet. Unser Ziel ist die Prüfung der Wirksamkeit und Sicherheit von 100 % TCA zur Depigmentierung bei therapieresistenter Gesichtspigmentierung bei Patienten mit universeller Vitiligo in Ägypten.Patienten und MethodenDie Studie umfasste 50 Patienten mit universeller Vitiligo und Restpigmentierung im Gesicht, die psychische Belastungen verursachte. Trichloressigsäure wurde in einer Konzentration von 100 % fokal auf die pigmentierten Stellen aufgetragen. Die Behandlung wurde alle zwei Wochen bis zur vollständigen Depigmentierung oder in maximal fünf Behandlungssitzungen wiederholt.ErgebnisseBei 80 % der untersuchten Fälle war das Ansprech...
Background Intralesional immunotherapy using different types of antigens is considered an effecti... more Background Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. Objective To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. Methods The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Results Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied g...
Herpes zoster ophthalmicus in COVID-19 patients Dear Editor, Herpes zoster ophthalmicus (HZO) is ... more Herpes zoster ophthalmicus in COVID-19 patients Dear Editor, Herpes zoster ophthalmicus (HZO) is an uncommon variant of herpes zoster (HZ) that affects the ophthalmic division of the trigeminal nerve. It presents with crops of vesicles on an erythematous base and dermatomal pain distribution, in addition to ocular manifestations such as conjunctivitis, uveitis, episcleritis, keratitis, and retinitis. Risk factors for reactivation of varicella zoster virus (VZV) include old age, immunocompromised conditions such as autoimmune diseases, and chronic diseases such as diabetes mellitus. Several skin manifestations have been reported in COVID19 patients, including HZ. To the best of our knowledge, HZO has not been previously reported in COVID-19 patients. Herein, we present four cases of HZO in two children and two young adults infected with this pandemic disease. The age of our patients ranged from 7 to 42 years with a mean of 21.5 years. All the patients reported a previous episode of chickenpox at a younger age. At the onset of HZO presentation, the patients were immunocompetent and had mild to moderate COVID-19 disease manifestations, including fever, malaise, bone aches, sore throat, dry cough, diarrhea, and loss of taste. The disease was confirmed using a nasopharyngeal smear test, and a complete blood count revealed mild/moderate lymphopenia with a mean of 0.904 9 10/ul (normal value: 1.5– 4 9 10/ul for adults, 1.5– 9 10/ul for children). The patients received supportive and symptomatic treatment for COVID-19 and did not require hospitalization. The mean time between the onset of COVID-19 disease and HZO diagnosis was 4.5 days (Table 1). Herpes zoster ophthalmicus is rarely reported in childhood, particularly in immunocompetent children. Most of the reported cases are related to varicella infection acquired during the first year of life or intrauterine and children with immunosuppression. Therefore, it was quite interesting to diagnose HZO at this young age (7 and 9 years) (Figure 1a). Given the absence of any of the previously mentioned predisposing factors for reactivation of VZV, it seems that COVID19 infection, as an acute illness with its associated physical and emotional stress, might represent the triggering factor for the development of HZO in our patients. Another possible explanation of VZV reactivation with COVID-19 may be related to the decrease in the total lymphocytic count in these patients. Lymphopenia occurs as a result of direct infection of lymphocytes with SARS-CoV-2, the activation-induced cell death, and the impairment to antiviral responses. Our patients showed mild/moderate lymphopenia that is usually associated with rapid recovery. Ocular complications that may result in visual loss are considered the most serious complications of HZO. Although all of the presented patients showed positive Hutchinson sign and had variable degrees of eye affection, no impairment of visual acuity was observed in any of them. Timely diagnosis and prompt antiviral treatment are critical in reducing visual
Dear Editor, We read with interest the article entitled “Low dose isotretinoin as an adjuvant the... more Dear Editor, We read with interest the article entitled “Low dose isotretinoin as an adjuvant therapy for treatment of different clinical variants of warts: A case series” by Dave and Abdelmaksoud. We would like to share our experience on the use of isotretinoin in the treatment of multiple plane warts. Very recently, we have used low-dose isotretinoin (0.3 mg/kg/day) for 3 months in the treatment of multiple plane warts and the complete clearance was observed in 16 out of 36 studied patients (44.4%). This success rate was much lower than that reported by Dave and Abdelmaksoud who have shown 100% complete clearance of warts in their 14 patients after addition of a low dose of isotretinoin (0.1-0.2 mg/kg/every other day) to conventional therapeutic modalities. This was quite surprising to us because the dose of isotretinoin in our study was higher than that of Dave and Abdelmaksoud, both in the quantity and in the frequency of administration (daily vs every other day, respectively), and the nature of warts was non-recalcitrant in our study, while it was recalcitrant in their study. Differences in the study population (Egyptian vs Indian patients, respectively), in the number of the studied patients (36 vs 14, respectively), in the type of warts (plane vs almost common, respectively), and in the isolated vs combined treatment, respectively, may partly explain the lower success rate in our study as compared with that of Dave and Abdelmaksoud. Going with our concept, literature review revealed that all the reported studies demonstrated high clearance rates of warts after a high dose of oral isotretinoin ranging from 0.5 mg/kg/day as is the case with Hamamy et al (73%), Olguín-García et al (87.5%), and Kaur et al (69%) to 1 mg/kg/day as shown in isolated case reports by Pasmatzi et al and Monastirli et al. These studies indicate that isotretinoin at high doses is associated with much better results than low doses such as 0.3 mg/kg/day as was the case in our study. We have also observed a high partial response rate in 44.4% of our patients; therefore, we proposed that increasing the dose of isotretinoin to 0.5 mg/kg/day, and the duration to 4 months might be associated with much better results in this subset of patients. In this respect, other authors have also recommended increasing the dose and duration of isotretinoin to achieve better cure rates and less recurrence potential. Finally, we agree with Dave and Abdelmaksoud that oral isotretinoin, alone or in combination, should be tried first for the treatment of multiple recalcitrant warts before starting any physical intervention. However, we do not agree with their firm conclusion about the efficacy of “low-dose” isotretinoin in the treatment of recalcitrant warts. This is particularly true given the combined use of isotretinoin with conventional therapeutic modalities, not as a single therapy and the absence of similar studies. Furthermore, larger comparative studies using isotretinoin alone at different doses are a must before giving a definite conclusion about the efficacy of the low dose in the treatment of warts.
Journal of Advances in Medicine and Medical Research
Background: Tristetraprolin (TTP) is RNA-binding protein encoded by Zfp36 gene which regulates th... more Background: Tristetraprolin (TTP) is RNA-binding protein encoded by Zfp36 gene which regulates the mRNA stability of several important cytokines. Due to its critical role in control of inflammation, TTP deficiency leads to the spontaneous development of a complex inflammatory syndrome. So far, this phenotype has been largely attributed to dysregulated production of TNF and IL23 by myeloid cells, such as macrophages or DCs. The expression of TTP was studied in keratinocytes and explored its role in the imiquimod-induced psoriasis model. Objective: To study the possible role of Tristetraprolin in the pathogenesis of psoriasis. Methods: The study included 32 patients who were randomly assigned to two groups, group 1 included 22 patients with psoriasis and group 2 included 10 apparently healthy individual as a control group. Skin specimens were obtained by punch biopsy (3mm) from the skin lesion of the patients and normal skin of controls. Skin tissue from each case was homogenized in p...
Photodermatology, Photoimmunology & Photomedicine
BackgroundCaveolin‐1 (Cav‐1) is a significant structural and regulatory constituent of cell membr... more BackgroundCaveolin‐1 (Cav‐1) is a significant structural and regulatory constituent of cell membranes that has been implicated in cell kinetics and inflammation.ObjectiveTo assess Cav‐1 expression in psoriasis before and after phototherapy.Patients and methodsThirty psoriasis cases and 30 healthy controls were recruited. Cases were managed with narrow band‐ultraviolet B (NB‐UVB) phototherapy at frequency three times per week for 12 weeks. From every case, two biopsy specimens were gained from psoriatic lesions (pre and post phototherapy), in addition to one from apparently normal skin of psoriasis cases. Regarding the control group, one biopsy was taken from a matched site. All were studied for Cav‐1 antibody immuno‐expression.ResultsThere was a significant decrease in Cav‐1 expression in psoriatic lesions compared to both the apparently normal skin of psoriasis patients and standard control skin of healthy individuals. After NB‐UVB phototherapy, significant upregulation of Cav‐1 im...
BackgroundManagement of multiple recalcitrant common warts represents a therapeutic challenge. Bo... more BackgroundManagement of multiple recalcitrant common warts represents a therapeutic challenge. Both oral isotretinoin and acitretin have shown a promising efficacy in the treatment of various types of warts. However, a comparative study of the two medicines in wart treatment has not yet been conducted.ObjectiveThe aim of this study was to assess the efficacy and adverse effects of oral isotretinoin versus acitretin in the treatment of multiple recalcitrant common warts.MethodsThis study was conducted on 75 adult male patients with recalcitrant multiple common warts. The patients were randomly assigned to three groups: group 1 (30 patients) received oral isotretinoin, group 2 (30 patients) received acitretin, and group 3 received oral placebo (15 patients). The treatment was given daily until complete clearance or for a maximum of 3 months.ResultsComplete clearance of the treated lesions was observed in 18 patients (60%) of the isotretinoin group, in 22 patients (73.3%) of the acitre...
INTRODUCTION Phthiriasis palpebrarum is an ectoparasitosis of the eyelashes due to infestation wi... more INTRODUCTION Phthiriasis palpebrarum is an ectoparasitosis of the eyelashes due to infestation with Phthirus pubis, also known as crab louse. It may affect children or adults and present with different clinical symptoms such as eyelid itching, pain, or gritty sensation. Adult lice and nits can be detected by a careful clinical examination and confirmed by dermoscopy. The treatment of phthiriasis palpebrarum may be in the form of topical application of ovidicidal formulations or physical agents, which may be combined with systemic ivermectin. Herein, we present a rare case of unilateral phthiriasis palpebrarum affecting an 8-year-old child with an excellent response to oral ivermectin.
Ceramic membranes, operating in membrane distillation mode, are deemed to withstand relatively hi... more Ceramic membranes, operating in membrane distillation mode, are deemed to withstand relatively high operating temperatures when compared to polymeric membranes, since high temperatures promote higher transmembrane fluxes. Hydrophobic membrane contactors are typically proposed for mass transfer operations in which vapor-liquid interfaces are necessary to perform absorption and/or stripping processes or others, avoiding the dispersion of one phase into the other.
International Journal of Sports Science and Arts, 2021
Movement competence is a critical component for a young child. It may be an important prerequisit... more Movement competence is a critical component for a young child. It may be an important prerequisite for engagement in physical activity (PA) later in life. Objective: This study was carried out to determine whether movement competence of children differed according to their geographical regions? Methods: 35 children (19 boys, 16 girls) from urban (Cairo) region schools, and 25 children (13 boys, 12 girls) from rural (Al Minia) region schools were included in the study. Movement competence was evaluated using the Test of Gross Motor Development-2 (TGMD-2) instrument (Ulrich, 2000). Results: A significant relationship was revealed between urban and rural Egyptian children aged 6-7 years in movement competence and Boys found to be better on movement competence when compared with girls in rural region while girls were better than boys in urban region. Conclusion: The movement competence of the Egyptian child is affected by the different geographical region in which he lives.
Newcastle disease (ND), infectious bronchitis (IB) and avian influenza (AI) are highly contagious... more Newcastle disease (ND), infectious bronchitis (IB) and avian influenza (AI) are highly contagious and are responsible for huge economic losses in poultry production. Thirteen chicken flocks showed upper respiratory tract manifestation from Ismailia, Sharkia and Dumyat provinces during 2011 and 2012 winter seasons. SPF embryonated chicken eggs were used for virus isolation. Results of HI and PCR indicated that, 13 isolates were positive to IBV and negative for AIV. In addition, 6 isolates were positive to NDV. Six chicken flocks had mixed infection with IBV and NDV, while seven flocks were infected with IBV only. The PCR of IBV targeted ORF1a gene of IBV while targeting the F gene of NDV.
APA Citation Fawzy, M. (2017).Effectiveness of self healing in repair of strategic concrete struc... more APA Citation Fawzy, M. (2017).Effectiveness of self healing in repair of strategic concrete structures "a simplified model" [Master’s thesis, the American University in Cairo]. AUC Knowledge Fountain. https://fount.aucegypt.edu/etds/394 MLA Citation Fawzy, Mohamed Hussein. Effectiveness of self healing in repair of strategic concrete structures "a simplified model". 2017. American University in Cairo, Master's thesis. AUC Knowledge Fountain. https://fount.aucegypt.edu/etds/394
Objectives: Drug addiction has its effects on different behavioral and personality traits includi... more Objectives: Drug addiction has its effects on different behavioral and personality traits including impulsivity and pattern of decision-making. The frontal lobe was the focus of many of these studies regarding its important role in decision-making and other higher cognitive processes. We aimed to detect the pattern of decision-making styles and impulsivity among people with tramadol addiction, and also to find out if tramadol addiction has effects on the volume of different regions of the frontal lobe. Materials and Methods: Two groups were included: group A included 12 patients with tramadol addiction and group B included 23 healthy cross-matching controls. Both groups were subjected to urine drug screening, Iowa gambling task (IGT), UPPS scales (negative urgency, lack of perseverance, lack of premeditation, and sensation seeking), and structural magnetic resonance imaging brain study. Results: The patients’ group has shown a significantly lower volume of the brain white matter, gray matter, and cortical thickness (P<0.001). This group has also shown a significantly higher scores of IGT-A and IGT-B (P<0.001 and P=0.02, respectively) and has shown a higher score of all subscales of UPPS. Conclusions: Tramadol addiction is associated with a reduced volume of the brain white matter, gray matter, and cortical thickness. All regions of the frontal lobe have shown significant volume reduction in the tramadol group. Tramadol addiction and its duration are associated with risky decision-making style and with higher impulsivity than nonaddicts.
JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 2021
ZusammenfassungHintergrund und ZielsetzungenBei Patienten mit ausgedehnter Vitiligo wurden versch... more ZusammenfassungHintergrund und ZielsetzungenBei Patienten mit ausgedehnter Vitiligo wurden verschiedene Methoden zur Entfernung der Restpigmentierung im Gesicht angewendet. Es gibt jedoch nach wie vor kein ideales Depigmentierungsmittel. Kürzlich wurde über die Verwendung von Trichloressigsäure (TCA) zur Depigmentierung bei universeller Vitiligo berichtet. Unser Ziel ist die Prüfung der Wirksamkeit und Sicherheit von 100 % TCA zur Depigmentierung bei therapieresistenter Gesichtspigmentierung bei Patienten mit universeller Vitiligo in Ägypten.Patienten und MethodenDie Studie umfasste 50 Patienten mit universeller Vitiligo und Restpigmentierung im Gesicht, die psychische Belastungen verursachte. Trichloressigsäure wurde in einer Konzentration von 100 % fokal auf die pigmentierten Stellen aufgetragen. Die Behandlung wurde alle zwei Wochen bis zur vollständigen Depigmentierung oder in maximal fünf Behandlungssitzungen wiederholt.ErgebnisseBei 80 % der untersuchten Fälle war das Ansprech...
Background Intralesional immunotherapy using different types of antigens is considered an effecti... more Background Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. Objective To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. Methods The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Results Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied g...
Herpes zoster ophthalmicus in COVID-19 patients Dear Editor, Herpes zoster ophthalmicus (HZO) is ... more Herpes zoster ophthalmicus in COVID-19 patients Dear Editor, Herpes zoster ophthalmicus (HZO) is an uncommon variant of herpes zoster (HZ) that affects the ophthalmic division of the trigeminal nerve. It presents with crops of vesicles on an erythematous base and dermatomal pain distribution, in addition to ocular manifestations such as conjunctivitis, uveitis, episcleritis, keratitis, and retinitis. Risk factors for reactivation of varicella zoster virus (VZV) include old age, immunocompromised conditions such as autoimmune diseases, and chronic diseases such as diabetes mellitus. Several skin manifestations have been reported in COVID19 patients, including HZ. To the best of our knowledge, HZO has not been previously reported in COVID-19 patients. Herein, we present four cases of HZO in two children and two young adults infected with this pandemic disease. The age of our patients ranged from 7 to 42 years with a mean of 21.5 years. All the patients reported a previous episode of chickenpox at a younger age. At the onset of HZO presentation, the patients were immunocompetent and had mild to moderate COVID-19 disease manifestations, including fever, malaise, bone aches, sore throat, dry cough, diarrhea, and loss of taste. The disease was confirmed using a nasopharyngeal smear test, and a complete blood count revealed mild/moderate lymphopenia with a mean of 0.904 9 10/ul (normal value: 1.5– 4 9 10/ul for adults, 1.5– 9 10/ul for children). The patients received supportive and symptomatic treatment for COVID-19 and did not require hospitalization. The mean time between the onset of COVID-19 disease and HZO diagnosis was 4.5 days (Table 1). Herpes zoster ophthalmicus is rarely reported in childhood, particularly in immunocompetent children. Most of the reported cases are related to varicella infection acquired during the first year of life or intrauterine and children with immunosuppression. Therefore, it was quite interesting to diagnose HZO at this young age (7 and 9 years) (Figure 1a). Given the absence of any of the previously mentioned predisposing factors for reactivation of VZV, it seems that COVID19 infection, as an acute illness with its associated physical and emotional stress, might represent the triggering factor for the development of HZO in our patients. Another possible explanation of VZV reactivation with COVID-19 may be related to the decrease in the total lymphocytic count in these patients. Lymphopenia occurs as a result of direct infection of lymphocytes with SARS-CoV-2, the activation-induced cell death, and the impairment to antiviral responses. Our patients showed mild/moderate lymphopenia that is usually associated with rapid recovery. Ocular complications that may result in visual loss are considered the most serious complications of HZO. Although all of the presented patients showed positive Hutchinson sign and had variable degrees of eye affection, no impairment of visual acuity was observed in any of them. Timely diagnosis and prompt antiviral treatment are critical in reducing visual
Dear Editor, We read with interest the article entitled “Low dose isotretinoin as an adjuvant the... more Dear Editor, We read with interest the article entitled “Low dose isotretinoin as an adjuvant therapy for treatment of different clinical variants of warts: A case series” by Dave and Abdelmaksoud. We would like to share our experience on the use of isotretinoin in the treatment of multiple plane warts. Very recently, we have used low-dose isotretinoin (0.3 mg/kg/day) for 3 months in the treatment of multiple plane warts and the complete clearance was observed in 16 out of 36 studied patients (44.4%). This success rate was much lower than that reported by Dave and Abdelmaksoud who have shown 100% complete clearance of warts in their 14 patients after addition of a low dose of isotretinoin (0.1-0.2 mg/kg/every other day) to conventional therapeutic modalities. This was quite surprising to us because the dose of isotretinoin in our study was higher than that of Dave and Abdelmaksoud, both in the quantity and in the frequency of administration (daily vs every other day, respectively), and the nature of warts was non-recalcitrant in our study, while it was recalcitrant in their study. Differences in the study population (Egyptian vs Indian patients, respectively), in the number of the studied patients (36 vs 14, respectively), in the type of warts (plane vs almost common, respectively), and in the isolated vs combined treatment, respectively, may partly explain the lower success rate in our study as compared with that of Dave and Abdelmaksoud. Going with our concept, literature review revealed that all the reported studies demonstrated high clearance rates of warts after a high dose of oral isotretinoin ranging from 0.5 mg/kg/day as is the case with Hamamy et al (73%), Olguín-García et al (87.5%), and Kaur et al (69%) to 1 mg/kg/day as shown in isolated case reports by Pasmatzi et al and Monastirli et al. These studies indicate that isotretinoin at high doses is associated with much better results than low doses such as 0.3 mg/kg/day as was the case in our study. We have also observed a high partial response rate in 44.4% of our patients; therefore, we proposed that increasing the dose of isotretinoin to 0.5 mg/kg/day, and the duration to 4 months might be associated with much better results in this subset of patients. In this respect, other authors have also recommended increasing the dose and duration of isotretinoin to achieve better cure rates and less recurrence potential. Finally, we agree with Dave and Abdelmaksoud that oral isotretinoin, alone or in combination, should be tried first for the treatment of multiple recalcitrant warts before starting any physical intervention. However, we do not agree with their firm conclusion about the efficacy of “low-dose” isotretinoin in the treatment of recalcitrant warts. This is particularly true given the combined use of isotretinoin with conventional therapeutic modalities, not as a single therapy and the absence of similar studies. Furthermore, larger comparative studies using isotretinoin alone at different doses are a must before giving a definite conclusion about the efficacy of the low dose in the treatment of warts.
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Papers by Mohamed Fawzy