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Introduction: To investigate the efficacy of double carbapenem therapy (ertapenem + meropenem combination) in an experimental sepsis model in rats with Klebsiella pneumoniae (K. pneumoniae), which is carbapenem-resistant and colistin susceptible, and compare it with colistin and meropenem monotherapy. Materials and Methods: K. pneumoniae isolate that is known to carry the blaOXA-48 and blaNDM carbapenemase genes was used, and 1-2×108 colony forming unit/ml was inoculated intraperitoneally to 40 rats (20 males/20 females), and a sepsis model was created. The rats were divided into four equal groups: control, colistin, meropenem, and meropenem + ertapenem combination. The rats were followed for 24 h for signs of sepsis and mortality. Euthanasia was then performed, and blood cultures were taken. Results: After 24 h, none of the rats in the control or treatment groups died. K. pneumoniae growth was observed in all rats in the control, five in the colistin, seven in the meropenem, and five in the meropenem + ertapenem combination groups. A statistically significant difference was found between the control group and the colistin and meropenem + ertapenem combination groups (p=0.033 and p=0.033, respectively). No statistically significant difference was found between the control group and the meropenem monotherapy group (p=0.215). The numbers of non-growth blood cultures were comparable between the colistin group and the meropenem + ertapenem combination group, and no statistically significant difference was found between the two groups (p=1). The mean time of growth signals (minutes) were compared between the treatment groups: colistin, 642.6 ± 116.4; meropenem, 582.6 ± 107.7; and meropenem + ertapenem combination, 701.2 ± 70.4 min. Conclusion: Meropenem + ertapenem combination treatment was comparable to colistin monotherapy, and the mean time of growth signals of blood cultures were longer than those in the colistin and meropenem monotherapy groups.

Brucellosis is a systemic zoonotic infection transmitted to humans by contact with the body fluids of infected animals or consumption of infected animal products. Although nearly eradicated in many developed countries, the disease is still endemic in Middle and South America, Central Asia, the Arabian Peninsula, Middle East, and Mediterranean regions. Any organ or system of the body may be involved. Skeletal system, spleen, liver, and bone marrow are the most frequently affected sites. Ocular involvement is reported relatively rarely, in 3.4%-26% of brucellosis cases, usually as a complication of chronic phases of the disease. Although ocular complications have been known since the early 20th century, decades after recognition of the disease, there is no convincing data about its true incidence, as most citations in the literature refer to case reports. Ocular brucellosis has severe complications and may result in total loss of vision in a quarter of patients despite appropriate treatment. A literature search conducted in PubMed on 10 September 2018 using the keywords "ocular-brucellosis" and "uveitis-brucellosis" and limiting to only human studies in the English literature published after 1950 yielded 27 and 29 articles, respectively. Of these, 14 were case reports or case series and included a total of 131 cases. We also found five case reports by searching for "oküler-brusella" and "göz-brusella", two in the Turkish Medline database (www.turkmedline.net) and four in Google search, with a total of six cases. Herein, we describe a case of ocular involvement of chronic brucellosis presenting with chorioretinitis that led to severe visual loss, and present a systematic review of previous cases reports and series in the literature. We believe that in an endemic area such as our country, routine ophthalmologic evaluation of all patients diagnosed with brucellosis and immediate initiation of therapy are necessary to prevent disease progression and severe sequelae.

Giriş: Türkiye, visceral leishmaniasis (VL) için endemik ülkeler arasında bulunur. Burada tanı süreci uzun ve zor olan erişkin bir VL hastası sunulmaktadır. Olgu: Kırk iki yaşında, 8 yıldır akciğerde nodül nedeniyle takip edilen, başka bilinen kronik hastalık öyküsü olmayan erkek hasta, Nisan 2023'te 1 haftadır geceleri daha fazla olan terleme ve öksürük şikayetleriyle başvurmuştu. Fizik muayenesinde patoloji saptanmamıştı. Yapılan tetkiklerde beyaz küre: 5040/mm3 hemoglobin: 12,4 g/dl PLT: 144000/mm3 CRP: 112 mg/l sedimentasyon 60 dk: 56 mm/saat AST: 45 IU/l ALT: 44 IU/l saptanmıştı. Hastaya çeşitli ampirik antibiyotikler verilmişti. Yakınmaları devam eden hasta Haziran 2023'te tekrar başvurmuştu. Tetkiklerinde lökopeni geliştiği, anemi ve trombositopeninin derinleştiği, KCFT ve CRP'nin yükseldiği görülmüş, hiperferritinemi saptanmıştı. Batın ultrasonografisinde; karaciğer boyutu artmış (175 mm), dalak büyük (145 mm) bulunmuştu. Pansitopeni ve splenomegali nedeniyle hasta hematoloji kliniğine yönlendirilmişti. Değerlendirme sonucu hastaya vitamin B12 tedavisi verilmiş, 1 ay sonra kontrol önerilmişti. 1 ay sonraki kontrolde üşüme-titreme ataklarının ve kilo kaybının devam ettiği öğrenilmişti. Pansitopeninin derinleştiği görülmüştü. Hastaya kemik iliği aspirasyon ve biyopsisi yapılmıştı. Hasta Eylül 2023'te kemik iliği biyopsisi patoloji sonucu ile başvurmuştu. Patoloji; plazma hücre diskrazisi olarak raporlanmıştı. Hastadan serum ve idrar protein elektroforezi ile immünfiksasyon elektroforezi istenmişti. Elektroforez sonuçları multipl miyelom ile uyumlu bulunmamıştı. Bunun üzerine hastanın patoloji preparatları dış merkeze revizyona gönderilmişti. Sonuç; çok sayıda Leishmania amastigotları içeren histiosit/makrofaj enfiltrasyonu ve hemofagositoz şeklinde sonuçlanmıştı (Şekil 1). Polikliniğimize yönlendirilen hastadan Leishmania serolojisi gönderildi. Leishmania IgG ve IgM pozitif saptandı. Hasta VL nedeniyle yatırıldı. Lipozomal amfoterisin B 3 mg/kg IV/gün başlandı ve 1-5 gün, 14. ve 21. günlerde verildi. Tedavi bitiminde hastanın yakınmaları ve pansitopenisi tamamen düzeldi. KCFT ve CRP geriledi. USG'de KC ve dalak normal boyutta saptandı. Taburculuktan 2 hafta sonra yapılan kemik iliği aspirasyon ve biyopsisinde Leishmania amastigotu görülmedi. Tedavi bitiminden 3 ay sonraki kontrolünde hemogram ve biyokimya değerleri normal saptandı. Hasta takibimizde kontrollerine devam etmektedir. Sonuç: VL, erişkinlerde çocuklara göre daha nadirdir, genellikle immün yetmezlikli olgularda görülmektedir. Kuluçka döneminin uzun olması, başlangıç bulgularının özgül olmaması nedeniyle tanı koymak güçtür. Çeşitli hematolojik bozuklukları taklit edebilir veya bunlara yol açabilir. Ateş, terleme, kilo kaybı yakınmalarıyla başvuran hastalarda akılda bulundurulmalıdır. Bu hastalarda anemi, lökopeni, trombositopeni, hepatosplenomegali gelişmeden önce serolojik testlerle VL saptanabilir, böylelikle invaziv işlemlere gerek kalmayacaktır. [ABSTRACT FROM AUTHOR]

BackgroundBreast cancer (BC) is the most common cancer in women globally. The North Africa and Middle East (NAME) region is coping hard with the burden of BC. We aimed to present the latest epidemiology of BC and its risk factors in this region.MethodsWe retrieved the data on BC burden and risk factors from the Global Burden of Disease Study 2019 to describe BC status in the 21 countries of the NAME region from 1990 to 2019. We explored BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to seven risk factors of female BC, namely, alcohol use, diet high in red meat, low physical activity, smoking, secondhand smoke, high body mass index, and high fasting plasma glucose. Decomposition analysis on BC incidence trend was done to find out the contributing factors to this cancer’s growth.ResultsIn 2019, there were 835,576 (95% uncertainty interval: 741,968 to 944,851) female and 10,938 (9,030 to 13,256) male prevalent cases of BC in the NAME region. This number leads to 35,405 (30,676 to 40,571) deaths among female patients and 809 (654 to 1,002) deaths in male patients this year. BC was responsible for 1,222,835 (1,053,073 to 1,411,009) DALYs among female patients in 2019, with a greater proportion (94.9%) of burden in years of life lost (YLLs). The major contributor to female BC incidence increase in the past three decades was found to be increase in age-specific incidence rates of BC (227.5%), compared to population growth (73.8%) and aging (81.8%). The behavioral risk factors were responsible for majority of attributable female BC burden (DALYs: 106,026 [66,614 to 144,247]). High fasting plasma glucose was found to be the risk factor with the largest effect (DALYs: 84,912 [17,377 to 192,838]) on female BC burden.ConclusionThe increasing incidence and burden of BC in the NAME region is remarkable, especially when considering limited resources in the developing countries of this region. Proper policies like expanding screening programs and careful resource management are needed to effectively manage BC burden.

Metronidazole is a common antibiotic agent for hepatic abscesses, which require both gram-negative and anaerobic coverage. Rarely, this antibiotic has been found to induce encephalopathy. Here, we describe a 65-year-old male who was treated with metronidazole for his hepatic abscess, who presented with syncope and questionable seizure and was found to have magnetic resonance imaging (MRI) brain findings consistent with metronidazole toxicity. Our patient demonstrated striking brain MRI findings which can be used to further understand the process behind this medication-induced toxicity. Hypotheses of this mechanism include swelling of axons secondary to increased water or vasospasm leading to reversible ischemia that is localized in the brain. In terms of MRI findings, brain lesions tend to populate bilaterally with focus at the dorsal pons, midbrain, cerebellar dentate nuclei (as with our patient), dorsal medulla, or splenium of corpus callosum. Additional research is warranted regarding this rare manifestation and timely removal of the offending agent is crucial for reversal of symptoms.

BackgroundThyroid cancer is the leading cause of mortality and morbidity among cancers of the endocrine system. We aimed to describe the trends of thyroid cancer burden in North Africa and Middle East for 1990–2019.MethodsData on burden of thyroid cancer in North Africa and Middle East from 1990 to 2019 were obtained from the Global Burden of Disease (GBD) Study 2019. Decomposition analysis was used to estimate the effects of population growth, aging, and change in incident numbers on overall change of thyroid cancer incidence. Also, we used the comparative risk assessment framework of GBD to determine the burden of thyroid cancer attributable to a high body mass index (BMI).ResultsIn 2019, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of thyroid cancer were 3.5 (2.9–4) and 0.5 (0.5–0.7) per 100,000, respectively. The highest age-standardized incidence, deaths, and disability-adjusted life year (DALY) rate were in Lebanon, Afghanistan, and United Arab Emirates, respectively. The ASIR of thyroid cancer in region was about 2.5 times higher among women, which had a positive association with increasing age. In 2019, the age-standardized deaths attributable to a high BMI was 16.7% of all deaths due to thyroid cancer. In 1990–2019, the overall change in thyroid cancer incident cases was a 396% increase which was mostly driven by the increase in disease-specific incidence rate (256.8%).ConclusionsWomen, the elderly above about 60 years old, and countries with a higher sociodemographic index showed higher incidence rates of thyroid cancer. Regarding our findings, it is recommended to establish preventive plans by modification in life style like weight reduction programs.

BackgroundProstate cancer (PCa) is the second most prevalent cancer among men worldwide. This study presents estimates of PCa prevalence, incidence, death, years-of-life-lost (YLLs), years-lived-with-disability (YLDs), disability-adjusted-life-years (DALYs), and the burden attributable to smoking during 1990-2019 in North Africa and Middle East using data of Global Burden of Diseases (GBD) Study 2019.MethodsThis study is a part of GBD 2019. Using vital registration and cancer registry data, the estimates on PCa burden were modeled. Risk factor analysis was performed through the six-step conceptual framework of Comparative Risk Assessment.ResultsThe age-standardized rates (95% UI) of PCa incidence, prevalence, and death in 2019 were 23.7 (18.5-27.9), 161.1 (126.6-187.6), and 11.7 (9.4-13.9) per 100,000 population. While PCa incidence and prevalence increased by 77% and 144% during 1990-2019, respectively, the death rate stagnated. Of the 397% increase in PCa new cases, 234% was due to a rise in the age-specific incidence rate, 79% due to population growth, and 84% due to population aging. The YLLs, YLDs, and DALYs of PCa increased by 2% (-11.8-23.1), 108% (75.5-155.1), and 6% (-8.9-28.1). The death rate and DALYs rate attributable to smoking have decreased 12% and 10%, respectively. The DALYs rate attributable to smoking was 37.4 (15.9-67.8) in Lebanon and 5.9 (2.5-10.6) in Saudi Arabia, which were the highest and lowest in the region, respectively.ConclusionsThe PCa incidence and prevalence rates increased during 1990-2019; however, the death rate stagnated. The increase in the incidence was mostly due to the rise in the age-specific incidence rate, rather than population growth or aging. The burden of PCa attributable to smoking has decreased in the past 30 years.

Abstract Background Combination of gemcitabine and nab-paclitaxel has superior clinical efficacy than gemcitabine alone. Nevertheless, health-related quality of life. (QoL) associated with this combination therapy when administered at first-line in advanced pancreatic adenocarcinoma is unknown. Methods A total of 125 patients were randomized to combination therapy (1000 mg/m2 gemcitabine + 125 mg/m2 nab-paclitaxel) and single-agent gemcitabine (1000 mg/m2) arms to take treatment weekly for 7 of 8 weeks, and following 3 of 4 weeks, until progression or severe toxicity. Primary endpoints were three-months of definitive deterioration free percent of patients, and QoL. Results Overall QoL analyses showed that 34 and 58.3% of cases in gemcitabine and gemcitabine+nab-P arms had no deterioration in 3rd month QoL scores (p = 0.018). These proportions were 27.3 and 36.6% in 6th month assessments, respectively (p = 0.357). Median overall survivals in combination and single-agent arms were 9.92 months and 5.95 months, respectively (HR: 0.64, 95% CI: 0.42–0.86, p = 0.038). Median progression free survivals in these treatment arms were 6.28 and 3.22 months, respectively (HR: 0.58, 95% CI: 0.39–0.87, p = 0.008). Median time-to-deterioration were 5.36 vs 3.68 months, and objective response rates were 37.1% vs 23.7% (p = 0.009), respectively in combination and single-agent arms. Conclusions Combination therapy with gemcitabine + nab-paclitaxel had better overall and progression-free survival than gemcitabine alone. Also, combination therapy showed increased response rate without toxicity or deteriorated QoL. Combination treatment with gemcitabine and nab-paclitaxel may provide significant benefit for advanced pancreatic cancer. Trial registration This study has been registered in ClinicalTrials.gov as NCT03807999 on January 8, 2019 (retrospectively registered).

Objective: This study tests the effects of work-family conflict, in both directions, on partners' agreement on fertility preferences among dual-earner couples, as well as whether this relationship varies by women's employment status. Background: Few studies have examined the relationship between work-family conflict and fertility preferences. Given the high percentages of women working part-time in Germany, it is important to investigate the role working women’s employment status plays to further understand this relationship. Method: Using data from 716 dual-earner couples in Wave 10 of the German Family Panel (pairfam), we use dyadic data analysis to test whether work-family conflict impacts one’s own ("actor effects") and/or one’s partner’s ("partner effects") reports of agreement on fertility preferences. We also run multi-group analyses to compare whether these effects vary in "full-time dual-earner" versus "modernized male breadwinner" couples. Results: There are significant actor effects for family-to-work conflict in both types of couples, and for work-to-family conflict in modernized male breadwinner couples only. Partner effects for family-to-work conflict exist only among modernized male breadwinner couples. While there are no gender differences in actor or partner effects, results suggest differences in the partner effect (for family-to-work conflict only) between these two couple types. Conclusion: These findings indicate that work-family conflict is associated with greater partner disagreement on fertility preferences and highlight the differential impact incompatible work and family responsibilities have on fertility decisions when women work full-time versus part-time.

Abstract Background The aim of this study was to evaluate the prevalence of some gynecological cancer risk factors in a population of female relatives of cancer patients in Hacettepe University Oncology Hospital. Additionally, what are the levels of the women’s awareness /behavior toward available screening tools? Methods An individual cancer risk assessment questionnaire has been developed in the Department of Preventive Oncology, which questions the medical history, health behaviors and cancer awareness, as well as their behavior toward available cancer screening tools. Results The mean age of the study population was 45.7 ± 12.2 years. Median age at menarche was 13 years (IQR, 12–14), 6.9% of the women reported their menarche was before age of 12. About 11.1% of the women had intercourse before age of 18. The median age at first delivery was 22 years. Median BMI was 24.9, with 18.3% of population having obesity. Of the women 65% were current/past smokers. Sixty-two percent of the women had never used condom. About 8% of the women were unaware about mammography and 17.7% about the Pap test. Conclusions This study has documented high tobacco use, low protective condom use and low rates of physical activity. Percentage of some risk factors like early menarche was lower than what was suggested for general Turkish population. Awareness and behavior of the women were better about mammography when compared to the Pap test. Considering our results, some measures should be put in place to increase people’s awareness, and to modify their behavior toward cancer prevention.

In Turkey today, one of the most frequently mentioned issues in the media is the influx of refugees, mostly from Syria. While most refugees are attempting to reach Europe by crossing through Turkey illegally, some consider Turkey an asylum center. This study used a phenomenological approach and qualitative experiment to determine how the phenomenon of refugeehood discussed in the media in Turkey affects children’s views on the issue. The sample was determined using the convenience sampling method, and 31 seventh-grade students (18 girls and 13 boys, all aged 14 years old) were selected. “Having previously met refugees” was used as a basic criterion in the selection of students, while classroom activities, letters, and semi-structured interviews were used to collect data. Descriptive and content analyses revealed that there were both positive and negative changes in students’ views regarding refugees, depending on the content of the news in the media, which was an important factor in influencing these changes.

Bone marrow stem cells (BMSCs) are frequently used in nerve tissue engineering studies due to ease of their isolation and high potential for differentiation into nerve cells. A bilayer fiber-foam construct containing nanofibrous elements to house and guide BMSCs was designed as a model to study the regeneration of damaged peripheral nerve tissue and eventually serve as a nerve guide. The construct consisted of a) a macroporous bottom layer to serve as the backing and support, and for nutrient transport, and b) an electrospun, fibrous upper layer for cell attachment and guidance. Porosity and pore sizes of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) bottom layer were 85% and 5-200 μm, respectively, suitable for cell attachment and growth. Alignment of the cells is essential for cell-to-cell contact and the degree of alignment of electrospun PHBV/Collagen fibers was 11° when a frame type collector was used, while it was much higher (53°) for random fibers produced on an ordinary aluminum sheet collector. When the fibers were electrospun directly onto a PHBV foam attached on the frame type collector to create the bilayer, the degree of alignment of fibers decreased, alignment angle increased from 11° to 44°. This value did not change when the fibers were electrospun directly on the foams on the aluminum collector (53° vs 55°). A new media was designed to achieve comparable differentiation with the commercial media. It was found that the commercial Mesenchymal Stem Cell Neurogenic Differentiation Medium (PromoCell, Germany) was the better in terms of the expressions of neuronal markers nestin and β-III tubulin and the medium made in the lab with known constituents led to neuronal marker expressions very close to that with the commercial medium. Attachment and proliferation of the rBMSCs were higher on the random fiber mats, while alignment of cells was higher on the aligned fibers. In conclusion, the bilayer construct with aligned PHBV-collagen fibers on a PHBV foam was found to be more appropriate for peripheral nerve repair when used as a nerve guide

Three-dimensional (3D) and Four-dimensional (4D) printing emerged as the next generation of fabrication techniques, spanning across various research areas, such as engineering, chemistry, biology, computer science, and materials science. Three-dimensional printing enables the fabrication of complex forms with high precision, through a layer-by-layer addition of different materials. Use of intelligent materials which change shape or color, produce an electrical current, become bioactive, or perform an intended function in response to an external stimulus, paves the way for the production of dynamic 3D structures, which is now called 4D printing. 3D and 4D printing techniques have great potential in the production of scaffolds to be applied in tissue engineering, especially in constructing patient specific scaffolds. Furthermore, physical and chemical guidance cues can be printed with these methods to improve the extent and rate of targeted tissue regeneration. This review presents a comprehensive survey of 3D and 4D printing methods, and the advantage of their use in tissue regeneration over other scaffold production approaches.

Atopic dermatitis (AD) is a heterogeneous disease with regard to clinical phenotype and natural history. We investigated T cell subtypes and cytokine responses in peripheral blood and skin lesions of AD patients with various sensitivities. Immunological studies were performed in 27 subjects: 9 house dust mite (HDM)-sensitized; 6 subjects with sensitizations other than HDM; 7 non-allergic AD patients and 5 healthy controls. Among those, skin biopsy samples of 13 subjects were evaluated for immunohistochemical analyses, as well. The mean age was 8.93±5.17 years. HDM-allergic AD emerged as a distinct immunologic phenotype, with higher production of interleukin (IL)-4, -5, -2 both at rest and when stimulated by Der p1 or SEB along with higher Th17. As for TH17 cell percentage, it was increased in all AD groups compared to healthy controls, while HDM-allergic group was distinguished with a significantly lower production of IL-17. Patients with sensitizations other than HDM were mostly similar to non-allergic AD, with increased Th17 and CD4+CD69+interferon-gamma (IFN-γ)+ T cells percentage. The biopsy of lesional skin showed that HDM-allergic AD had lower IFN-γ and IFN-γ co-expressing CD8+ T cells compared to patients with other sensitizations (p=0.03 and p=0.04, respectively). Among the HDM allergic patients, pairwise comparison of lesional versus non-lesional skin revealed higher CD4+ T cells numbers, expression of forkhead box P3 (Foxp3) and T-cell-specific transcription factor (T-bet) (p=0.018, p=0.018, p=0.018, respectively). HDM-allergic AD is a distinct subtype with a predominant skewing in Th2 and higher Th17 cell percentage along with a blunted Th1 response in the skin, all of which may have therapeutic implications.

We report a 63-year-old man with a history of chronic lymphocytic leukemia (CLL) who presented with asymmetrical Raynaud’s phenomenon of sudden onset which progressed to acral gangrene rapidly in a week. These symptoms began approximately one week after the fourth cycle of fludarabine and cyclophosphamide chemotherapy and were accompanied by pain, numbness, and cyanosis in the fingers of his right hand except the first finger. Fludarabine may play a role in acral vascular syndrome. The treatment with fludarabine in patients with evolving digital ischemia should be carried out with caution.

Scientific BACKGROUND: Neurofibromatosis is an autosomal dominant genetic disease which affects skin, nervous system and eyes. Neurofibromatosis has two frequently seen subtypes which are called Type 1 (Von Recklinghausen disease: periferal neurofibromatosis) and Type 2. Type 1 is characterized with cafe au lait spots, periferal neurofibroms, Lisch nodules and axillar freckles. Type 2 is central neurofibromatosis which appears with bilateral acoustic neurinoms with slightly cutaneous changes around twenty years old. Convulsive disorders are seen in about 5% of patients. OBJECTIVE: We emphasized the importance of early diagnosis and genetic counseiling on epilepsy. CASE: We examined two cases that belong to the same family with definitively clinical diagnosis on neurofibromatosis type 1. The mother had amnesia, dermal invasion, forgetfulness, Lisch nodules and no family history. Her daughter had learning disability, dermal invasion, and refractory epilepsy. CONCLUSION: We considered genetic transmission which was possible mutational transmission for mother and autosomal dominant transmission for daughter. We emphasized that there may be different clinical features in the same family

Background: Autoimmune bullous disorders (AIBDs) are a heterogeneous group of diseases which are rarely seen in children. Studies concerning the immunobullous diseases in pediatric patients are scarce. Aims and Objectives: In this study, we aimed to investigate the clinical features and treatment outcomes of AIBDs in children. Materials and Methods: The electronic records of the patients in our AIBDs outpatient clinic were retrospectively reviewed. All cases diagnosed before the age of 16 years were included in the analysis of clinical features, treatment outcomes, and follow-up data. Results: Of the 196 patients with immunobullous diseases, 9 (4.6%) were diagnosed before the age of 16 years. Mean age of the patients at the time of diagnosis was 7.72 ± 5.66 years. Among nine patients, linear immunoglobulin A disease (LAD), pemphigus vulgaris (PV), and bullous pemphigoid (BP) were seen in 5, 2, and 2 children, respectively. All patients were treated with at least two systemic agents (including methylprednisolone, dapsone, methotrexate, salazopyrine, intravenous Ig [IVIg], and rituximab) leading to clinical remission in all of them after a mean period of 31.77 ± 27.99 months. Conclusion: In line with earlier studies, LAD was the most common immunobullous disease and in general, associated with a favorable response to dapsone. This study was noteworthy in that the patients with PV and BP demonstrated a relatively more recalcitrant course, requiring rituximab and IVIg for remission, respectively. Overall, patients had a good prognosis.