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Diabetic nephropathy (DN) is a major cause of end-stage renal disease (ESRD). Agomelatine, a melatonin receptor agonist, has a potent anti-inflammatory activity. The current study aimed to determine the ameliorative anti-inflammatory effect of agomelatine against DN.We used 10 % fructose with streptozotocin (STZ) to induce DN in male Wistar rats. Diabetic rats were treated with agomelatine in presence or absence of melatonin receptor antagonist (luzindole) or Sirtuin1 (SIRT1) inhibitor (EX527). SIRT1 expression was measured by qRT-PCR and immunohistochemical analysis. The expression of nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), 5'adenosine monophosphate-activated protein kinase (AMPK), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1), and monocyte chemoattractant protein-1 (MCP-1) were measured using ELISA. Histological assessment was performed using hematoxylin and eosin-stained renal sections.Fructose and STZ treatment induced diabetes, insulin resistance, and renal damage accompanied by reduced SIRT1 expression, increased NFκB activation, and decreased AMPK phosphorylation in the kidney. Agomelatine treatment improved kidney histology and function and upregulated SIRT1 expression (2-fold). Inhibition of melatonin receptors and SIRT1 activity increased NFκB phosphorylation (2.13 and 1.98-folds, respectively), reduced AMPK activation (0.51 and 0.53-folds, respectively), increased inflammatory markers ICAM-1 (2.16 and 2.23-folds, respectively), VCAM-1 (2.19 and 2.26-folds, respectively), and MCP-1(2.84 and 3.12-folds, respectively), and inhibited the ameliorative effect of agomelatine on kidney structure and function.Our findings reveal the ameliorative anti-inflammatory activity of agomelatine against STZ-induced DN and this effect is SIRT1- and melatonin receptor-dependent. Therefore, agomelatine may be beneficial to prevent the development of ESRD from diabetes mellitus.

Background: Alopecia areata (AA) is a non-scaring alopecia which can affect any body hairy area. Excimer light 308 nm is a UVB irradiation with immunosuppressive effects. Low level light therapy (LLLT) emits low energy visible and infrared irradiation to modulate biological processes in cell. This study aimed to evaluate efficacy and safety of excimer light 308 nm versus LLLT in treatment of AA. Methods: Thirty patients with multilocular AA of the scalp were collected after excluding those with alopecia totalis, universalis, AA in other body sites than scalp, those with other systemic or dermatological diseases, those received topical therapy in the last 2 weeks or systemic therapy for AA in the last three months, pregnant and lactating females. Patients were distributed into two equal groups; group A was treated by excimer lamp and group B was treated by LLLT. Sessions were repeated twice weekly for 3 months and patients were followed for 3 months. Treatment efficacy was evaluated by severity of alopecia tool score (SALT score) and Dermoscopy; at baseline, at end of sessions and at follow up. Results: A statistically significant improvement was detected in treated patches of both groups than control patches at end of sessions and only in group A at follow up. There was no statistically significant difference between both groups according to short vellus hair and regrowing hair at end of sessions and at follow up in dermoscopy. Side effects reported were minimal and transient in both groups. Conclusion: Both excimer light and LLLT are safe and effective in treatment of AA. Apart from its relatively higher cost, Excimer light induced better and more sustained improvement than LLLT.

Many modalities are used for treatment of facial wrinkles, such as microneedling that enhances collagen production, and platelet-rich plasma (PRP) which contains concentrated levels of growth factors. The human amniotic membrane isolated from the placentae of donors (during elective cesarean sections) has high levels of growth factors that help in rejuvenation by improving the migration and proliferation of keratinocytes, fibroblasts and increased collagen synthesis. Was to confirm the efficacy of irradiated amniotic collagen matrix (IACM) versus platelet rich plasma (PRP) delivered via microneedling in facial rejuvenation. The present study included 20 patients with facial wrinkles divided into two groups using split face technique: Group A subjected to microneedling with topical IACM on the right side of the face. Group B subjected to microneedling with topical PRP on the left side of the face. Patients received six sessions 2 weeks apart. Photos by Antera camera and skin biopsies were taken to assess the clinical results. There were a statistically significant improvement in both sides after than before treatment; with better improvement in patients treated with IACM more than patients treated with PRP using microneedling in both sides as proved clinically (assessed by WSRS and GAIS scale), pathologically (Orcein and Masson trichrome stain) and by Antera camera (texture and pigmentation). Microneedling using IACM is a new, safe and effective method for facial rejuvenation, more effective when compared to microneedling using PRP; in need for further studies to evaluate the correct dose and number of sessions to get the best outcome.

Background Androgenetic alopecia (AGA) is a common hair loss disorder. Objectives To evaluate the therapeutic effects of platelet-rich plasma (PRP) in androgenetic alopecia. Methods This study was done on 126 AGA patients, 42 patients survived as control group who received medical treatment, only other 84 patients were subdivided into two groups, and they received PRP sessions as co-adjuvant therapy using different methods administration. Patients were evaluated clinically, by dermoscopy and by digital dermoscopy to measure hair density and diameters before and after treatment. Results PRP-treated patients showed statistically significant increase in hair density and diameter measurements than control group. These results increased by using microneedling as a method of PRP administration. Conclusion In AGA, the addition of "PRP with microneedling" to the combined medical treatment increases its efficacy and shortens the time needed for optimum improvement. Study design Single-blinded randomized controlled study.

Background Warts are common viral infection of the skin. Treating warts are still an ongoing challenge and no general agreement is reached, on the best treatment, despite different therapeutic approaches. Intralesional (IL) immunotherapy has recently been shown to be effective in treating various wart forms. Aims To assess the efficacy and safety of IL tuberculin, IL MMR vaccine, and intradermal (ID) BCG vaccination in treating viral warts. Patients and methods Sixty patients with single or multiple warts were divided equally into three groups. Group A received IL MMR vaccine, and group B received IL tuberculin every 3 weeks (maximum 3 times). Group C received ID BCG vaccination in the arm with one month interval (maximum 3 times). Recurrence was followed up for 6 months. Results In group A, complete response occurred in 30%, partial response in 5%, and no response in 65%. In group B, complete response occurred in 45%, partial response in 20%, minimal response in 10% and no response in 25%. In group C, complete response occurred in 70%, partial response in 5%, minimal response in 5%, and no response in 20%. No recurrence was observed in group A and B but occurred in one patient in group C with the same lesion. Conclusions Immunotherapy by IL tuberculin and ID BCG vaccination are safe, effective, and inexpensive techniques in treating all types of warts even if recalcitrant or multiple but immunotherapy by IL MMR vaccine has shown less effectiveness and less safety technique.

Dermatochalasis is frequently associated with tissue ageing and leads to multiple functional and cosmetic issues. There are several possible medical and surgical treatments available, such as blepharoplasty and laser therapy.The aim of this work was to evaluate plasma exeresis as a new technique for nonsurgical treatment of dermatochalasis of the upper eyelid.This clinical trial included 40 female patients with dermatochalasis. Each patient received 3 sessions of treatment with the technology of plasma exeresis with one-month interval. Final evaluation was performed three months after the last session by 2 blinded dermatologists and 2 ophthalmologists, lid laxity according to facial laxity rating scale (FLRS), marginal crease distance (MCD) before and after treatment and patient satisfaction score.There was a significant decrease in eye lid laxity (FLRS) after treatment wherePlasma exeresis seems to improve appearance of the upper eyelid, without any serious adverse events and could be a valid solution for dermatochalasis especially in mild and moderate cases.

While the etiology of rosacea is multifactorial, it is not surprising that treatment has been controversial. Pulsed dye laser (PDL) has been successfully used to treat vascular components of rosacea. Ivermectin 1% cream is an emerging treatment of rosacea.To provide a comprehensive clinical and dermatoscopic comparative study between the efficacy and safety of pulsed dye laser alone versus its combination with topical ivermectin 1% in the treatment of rosacea.Thirty Patients were randomly divided into two groups. Group A (At the 3-month follow-up, group B induced better clinical improvement than group A. However, this difference was not significant. No serious adverse events were observed in either treatment group.This study supports the efficacy of PDL treatment for patients with rosacea. PDL could be more effective when combined with ivermectin 1% cream.

Background: Sebaceous hyperplasias are benign skin lesions mostly seen on the face. These lesions are a common cosmetic concern but are difficult to be treated, as the entire sebaceous gland needs to be destroyed. Multiple treatment modalities have been employed for the management of seba-ceous hyperplasia but some therapies are associated with side effects and recurrence rates. The pulsed dye laser may be an effective and safe alternative treatment option.Aim of Study: To evaluate the efficacy of pulsed dye laser in treating sebaceous hyperplasia.Patients and Methods: Twenty patients with a total of 72 sebaceous hyperplasia lesions were treated by 1-3 sessions of pulsed dye laser, two weeks apart (with parameters of hand piece 7, fluence 9-12J/cm2, pulse width 1.5ms, rate 1HZ and air cooling). The patients were assessed clinically to evaluate the efficacy and safety of PDL.Results: 83.3% of lesions responded to treatment, with complete reduction in 46 lesions (63.9%) and partial reduction in 14 lesions (19.4%). Treatment was well tolerated with no side effects and high patient satisfaction.Conclusion: Pulsed dye laser is effective and safe as a monotherapy for treating sebaceous hyperplasia.

In this study, we investigated the effect of acute administration of gold nanorods (AuNRs) on testicular function, sexual hormones, and oxidative stress parameters in male albino rats. Forty mature male albino rats were divided into two equal groups (n = 20/each). The first group received 1 ml saline solution intraperitoneally (i.p.). The second group received single i.p. injection of 75 μg 50 nm AuNRs/kg/bwt. Five rats from each group were sacrificed on days 1, 3, 7, and 14 post treatment and blood samples were collected for hormonal and biochemical analysis. Testes were collected from each group at each time point for histopathology, morphometric, and transmission electron microscope analyses of testis and epididymis. Results indicated that i.p. injection of AuNRs did not produce any histopathological changes. Morphometric analysis of testicular samples revealed that the height of lining epithelium was significantly (P

Background: Melasma is one of the most common causes of facial hyperpigmentation which causes cosmetic disfigure-ment and leads to psychological proplems, although various treatments are available for melasma, it remains a difficult condition to treat.Aim of Study: To evaluate and compare the efficacy of topical flutamide 1% alone and in-combination with Carbox-ytherapy in treatment of patients with melasma.Patients and Methods: The study included 30 female patients with different types and patterns of melasma. They were divided into two groups, each group included 15 patients: Group A, patients were treated with 1% flutamide topical gel on the face and group B, patients were treated with 1% flutamide topical gel on the face and carboxytherapy injection was done in both sides of the face every four weeks for three sessions.Results: Both groups showed highly significant decrease in mMASI score after the treatment in which group B showed better results with (p-value=0.048*) than group A with (p-value=0. 007*).Conclusion: As new treatment for melasma topical fluta-mide was effective and safe therapeutic modalities. Carboxy-therapy could be effective and safe new treatment modality for melasma as adjuvant treatment with topical flutamide.

BackgroundMelasma is a common cause of cosmetic disfigurement in the face. This facial hyperpigmentation leads to many psychological problems. It is difficult to be treated and has a high rate of recurrence.ObjectiveThe aim of this study was to evaluate and compare the efficacy of topical tranexamic

In this study, we investigated the effect of acute administration of gold nanorods (AuNRs) on testicular function, sexual hormones, and oxidative stress parameters in male albino rats. Forty mature male albino rats were divided into two equal groups (n = 20/each). The first group received 1 ml saline solution intraperitoneally (i.p.). The second group received single i.p. injection of 75 μg 50 nm AuNRs/kg/bwt. Five rats from each group were sacrificed on days 1, 3, 7, and 14 post treatment and blood samples were collected for hormonal and biochemical analysis. Testes were collected from each group at each time point for histopathology, morphometric, and transmission electron microscope analyses of testis and epididymis. Results indicated that i.p. injection of AuNRs did not produce any histopathological changes. Morphometric analysis of testicular samples revealed that the height of lining epithelium was significantly (P 0.05) higher in AuNR group on days 3 and 14 post treatment, and the minor axis of seminiferous tubules was higher (P 0.05) in AuNR-injected rats than in control group. For the epididymis, the number of spermatozoa was significantly (P 0.05) higher on days 7 and 14 after AuNR injection when compared with control rats. AuNRs were not detected by TEM at all time points of the experiment. Serum analysis demonstrated that total and free testosterone values significantly (P 0.05) increased on days 1, 3, 7, and 14 post AuNR injection. LH was higher (P 0.05) in AuNRs-injected rats on days 3, 7, and 14 post injection, while FSH values were higher (P 0.05) in AuNR group on days 3 and 14. Malondialdehyde significantly (P 0.05) decreased on days 3, 7, and 14 in AuNR group, while catalase, glutathione peroxidase, and superoxide dismutase values were significantly (P 0.05) elevated on days 3, 7, and 14 in AuNRs-injected rats compared with control group. In conclusion, intraperitoneal injection of 50 nm AuNRs is safe on the reproductive function and has an antioxidant action.

Recent reports suggest that melasma may have a vascular component. Vascular targeting lasers and light treatment can be a therapeutic option that will provide benefits to the patients.To compare the efficacy and tolerability of pulsed dye laser (PDL) and intense pulsed light in treatment of melasma.Twenty-eight Egyptian female patients with melasma were treated with PDL on the right hemiface (Group A) and with the intense pulsed light on the left hemiface (Group B). Clinical assessment was performed according to the hemifacial modified Melasma Area and Severity Index score (mMASI). Tissue biopsies were taken from patients for immunohistochemical staining with vascular endothelial growth factor (VEGF) antibody.The hemifacial mMASI score was significantly reduced after treatment in studied groups with no statistically significant difference. Intense pulsed light (IPL) group showed higher efficacy of treatment than PDL group in the epidermal melasma and in melasma lesions which had a vascular component. The expression level and intensity score of VEGF were significantly reduced after treatment in both groups.Both PDL and IPL were effective and safe treatment modalities for lightening of melasma. VEGF can be proved as a possible mechanism underlying the action of both PDL and IPL on melasma.

Juvenile systemic lupus erythematosus (jSLE) is a multisystem autoimmune disease of unpredicted course and prognosis. Rates of organ involvement in SLE are higher in children, and overt lupus nephropathy is more often a presenting manifestation of SLE in children than adults. Inflammatory soluble chemokine CXC motif-ligand 16 (sCXCL16) is an important pathogenic mediator in inflammatory diseases as SLE. Herein, we aimed to evaluate serum level of sCXCL16 in jSLE patients in comparison to healthy controls and to correlate it with disease activity and extent of cutaneous and renal affection, to detect its possible role in disease pathogenesis. Serum level of sCXCL16 was determined by ELISA in 27 patients with jSLE (mean age 12.35 years ± 2.26 SD) in addition to 30 age- and sex-matched healthy controls and correlated with clinical and laboratory parameters in lupus group. Serum sCXCL16 was significantly higher in jSLE patients than controls (P ≤ 0.001), and it correlated positively with SLE disease activity, severity of lupus nephritis, 24-h urinary protein, anti-dsDNA titre, blood pressure, and ESR, while it correlated negatively with serum C3 levels. Serum sCXCL16 was higher in jSLE patients with alopecia and malar erythema. Serum sCXCL16 might play a role in inflammatory pathogenesis of jSLE particularly in periods of disease activity. It might serve as a future useful laboratory test for detection of jSLE activity, renal insult, and its severity which might limit the need for invasive renal biopsies in such a delicate patient population.

Periorbital dark circles (PODC) are a common worldwide cosmetic problem. It is difficult to treat due to complications in its pathogenesis and aetiology. Available lines of treatment for PODC include whitening creams, topical retinoid acid, chemical peeling, laser therapy, carboxytherapy, autologous fat transplantation, injectable fillers and surgery (blepharoplasty).The aim of this study isto evaluate and compare the efficacy of chemical peels using trichloroacetic acid (3.75%) and lactic acid (15%) in a gel formula with that of carboxytherapy, in the treatment of periorbital hyperpigmentation.Two groups of patients with PODC were included in the study, named Group A and B in which each group consisted of 15 patients. Group A was assigned for patients who received treatment with chemical peeling with a combination of trichloroacetic acid (3.75%) and lactic acid (15%) in a gel formula, once a week for four weeks. Group B was assigned for patients who received carboxytherapy that was performed by subcutaneous and intradermal injection of CO2 once a week for four weeks. All patients were assessed by digital photographs, before and after treatment, by observing the improvement in the grade of PODC. Reports of patient satisfaction and global tolerance were evaluated by three medical observers. There was a significant improvement in the grade of PODC in both groups. The degree of improvement of PODC in group A was excellent, with good grade in 93.4% of the treated patients while fair grade in 6.6% of them. There was a statistically significant improvement in the pigmented type. The degree of improvement of PODC in group B was excellent, with good grade in 86.7% of the treated patients while fair grade in 13.3% of them. However, no statistically significant difference between the two groups was observed. Minimal and transient side effects were noticed; however, it did not require further treatment. In conclusion, the two methods of treatment were effective in the treatment of PODC, with the improvement of PODC observed from the first treatment session with both chemical peeling and carboxytherapy.

Corruption remains one of the greatest stumbling blocks to good governance, human rights, and development in the Middle East and throughout the rest of the world. It is a symptom of fundamental economic and political problems that can become systemic when economic opportunities for it prevail and political will to combat it is lacking. When it is systemic—whereby a complex web of graft permeates the political, economic, and social spheres, impeding the basic provision of services to citizens—it can create conditions of social unrest and frustration, which may in turn lead to people seeking an outlet in factional and sectarian groups to provide for their basic needs. Corruption also creates an overall climate of impunity.2 Civil liberties groups, including Amnesty International, Human Rights Watch, and the Center for Victims of Torture, link corruption to repression and human rights violations, as it impedes government accountability, and can motivate officials and security forces to commit abuses for financial gain.3

Skin tags (ST) are the most common fibro-epithelial skin tumors. They are tumors of the middle-aged and elderly people. However, in women, the age of 50 is suggested to be the turning point of life at which the development of skin tags comes to a stop. A major event that occurs around this period of life is menopause/andropause, after menopause, estrogen receptors amounts decrease significantly. Estrogen receptors (ER) and androgen receptors (AR) are members of the steroid receptor gene superfamily. Estrogen receptors positivity has been demonstrated in most skin tumors by both histochemical and biochemical assays.This study aimed to assess the role of estrogen and androgen receptors in the development of skin tags by assessment of their immunohistochemical expression. Twenty five patients were included in this study. Snip excision of skin tags was done for each patient, punch biopsy from adjacent sites from skin tags have been taken as perilesional skin biopsy only for twelve patients. Histopathology was performed to confirm the diagnosis. Immunohistochemical staining was done to detect ER and AR for skin tags, perilesional skin, and control normal skin.Immunohistochemical staining for ER was positive in 64% of skin tag cases and AR were positive in 60% of them. There was a statistically significant difference in ER and AR staining pattern between skin tags, perilesional skin and normal skin. It could be concluded that ST correlated positively with ER and AR immunohistochemical staining which may implicate a role for them in the pathogenesis of skin tags.

Background Nevus depigmentosus is a congenital, non-progressive, hypopigmented macule or patch that is stable in its relative size and distribution throughout life. The lesions are often single but may be multiple, circumscribed and either isolated, dermatomal or in whorls. The lesions are uniformly hypomelanoic but not amelanotic. The aetiopathogenesis of nevus depigmentosus is not yet fully understood. A defect in the transfer of melanosomes from melanocytes to keratinocytes has been reported. Objective This work aimed at evaluation of the clinical and ultrastructural characteristics of nevus depigmentosus in a trial to understand its pathogenesis. Patients and methods This study included 15 patients having nevus depigmentosus. Ultrastructural study was performed for 5 patients. 2 punch biopsies were taken from each patient, one from the center of the lesion and another from the nearby apparently normal skin as a control. Results The lesions were mostly present before 3 years of age, mostly on the trunk. Six patients (40%) had the isolated type and 9 (60%) had the segmental type. Under Wood's lamp, the lesions exhibited an off-white accentuation without fluorescence. Ultrastructural study showed apparent reduction in melanosomal content of lesional melanocytes and keratinocytes. Immature and aggregated melanosomes were more present in lesional keratinocytes. Electron microscopic DOPA oxidase reaction was decreased in lesional skin compared to control indicating a reduced tyrosinase activity. Conclusion The results of this study support the hypothesis that nevus depigmentosus is caused by functional defect of melanocytes and morphologic abnormalities of melanosomes.