Dermatology Venereology Leprology

Cosmetic dermatology: An integral part of current dermatology curriculum Jasleen Kaur Sandhu Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):1-2

Methods to overcome poor responses and challenges of laser hair removal in dark skin Shehnaz Zulfikar Arsiwala, Imran M Majid Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):3-9 Conventional and advance technologies are available for laser hair removal. Complete and permanent hair reduction is not yet possible by treatment with lasers. Ideal patient for any conventional laser hair removal treatment is one who has thick, dark terminal hair, light skin and normal hormonal status. Factors that contribute to variable outcomes in laser hair removal can be broadly divided into patient related ones and the technology related ones. Skin type, hair color, thickness and density, degree of tan, hormonal dysfunction etc., constitute the patient related factors. The wavelength, fluence, spot size and pulse duration of the laser system are the technology related factors. There are some patients who respond variably, unpredictably or poorly to laser hair removal despite ensuring that indication for treatment is appropriate with adequate parameters of the laser system. This article reviews various patient related and technology related factors which lead to variable-to-poor outcomes in laser hair removal; and various challenges and limitations of laser hair removal technology in patients with dark skin types.

Optimizing Q-switched lasers for melasma and acquired dermal melanoses Sanjeev Jayanth Aurangabadkar Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):10-17 The Q-switched Nd:YAG laser is an established modality of treatment for epidermal and dermal pigmented lesions. The dual wavelengths of 1064nm and 532nm are suited for the darker skin tones encountered in India. Though this laser has become the one of choice for conditions such as nevus of Ota, Hori's nevus and tattoos, its role in the management of melasma and other acquired dermal melanoses is not clear. Despite several studies having been done on the Q-switched Nd:YAG laser in melasma, there is no consensus on the protocol or number of sessions required. Acquired dermal melanoses are heterogenous entities with the common features of pigment incontinence and dermal melanophages resulting in greyish macular hyperpigmentation. This article reviews the current literature on laser toning in melasma and the role of the Q-switched Nd:YAG laser in stubborn pigmentary disorders such as lichen planus pigmentosus. As the pathology is primarily dermal or mixed epidermal-dermal in these conditions, the longer wavelength of 1064nm is preferred due to its deeper penetration. Generally multiple sessions are needed for successful outcomes. Low fluence Q-switched Nd:YAG laser at 1064nm utilizing the multi-pass technique with a large spot size has been suggested as a modality to treat melasma. Varying degrees of success have been reported but recurrences are common on discontinuing laser therapy. Adverse effects such as mottled hypopigmentation have been reported following laser toning; these can be minimized by using larger spot sizes of 8 to 10mm with longer intervals (2 weeks) between sessions.

Isotretinoin and dermatosurgical procedures Venkataram Mysore, HM Omprakash, Gayatri Nagindas Khatri Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):18-23 Several early reports suggested that performance of dermatosurgical procedures in patients on oral isotretinoin is associated with abnormal skin healing, keloid or hypertrophic scar formation. However, this association has been recently questioned in some studies. This review examines this issue, analyzes the studies published and concludes that the recommendation made earlier about the need to avoid dermatosurgical procedures in patients on isotretinoin is based on inadequate and insufficient evidence and hence needs revision. The review also suggests that recent studies on the subject establish that performing such procedures is safe.

Complications of laser and light-based devices therapy in patients with skin of color BS Chandrashekar, Chaithra Shenoy, C Madura Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):24-31 Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.

Autologous noncultured melanocyte-keratinocyte transplantation in stable vitiligo: A randomized comparative study of recipient site preparation by two techniques Sumit Gupta, Vineet Relhan, Vijay Kumar Garg, Bijaylaxmi Sahoo Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):32-38 Background: Accurate preparation of recipient area is a critical step in melanocyte-keratinocyte transplantation procedure for vitiligo. It is an important potential step for adaptation in the quest to achieve better results and ablative lasers potentially offer excellent precision over margin and depth control in achieving that. Objective: To compare between the two techniques used for recipient site preparation: Er:YAG laser ablation and mechanical dermabrasion for melanocyte-keratinocyte transplantation procedure in terms of re-pigmentation achieved and adverse effects seen. Methods: A randomized comparative trial was performed among 32 patients of stable vitiligo undergoing melanocyte-keratinocyte transplantation procedure. In Group A (n = 15), recipient site preparation was done with Er:YAG laser, and in Group B (n = 17), it was done with a motorized dermabrader. Patients of both groups were objectively assessed for re-pigmentation at 1, 3 and 6 months. Results: A total of 253.696 cm2 of depigmented surface was operated upon and re-pigmentation of 125.359 cm2 (49.4%) was achieved. On comparison between two groups, no statistical difference was found with respect to total re-pigmentation achieved (Group A: 54.67% vs Group B: 48.841%, P = 0.663) and grades of re-pigmentation achieved (P = 0.796). Occurrence of adverse events was also statistically similar in both the groups. Conclusion: This study did not reveal any statistically different outcome (in terms of re-pigmentation and adverse effects) between the two methods of recipient site preparation – motorized dermabrasion and Er:YAG ablation. Limitations: This study is small and larger studies are needed to ascertain the benefit of Er:YAG for recipient site preparation. Future studies may also ascertain variables such as time taken to prepare the recipient area, nature of bleeding, postoperative healing, difficulties in specific area, cost of the procedure, patient comfort and ease of the surgeon, rather than comparing the re-pigmentation alone.

A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma Vinod K Khurana, Rachita R Misri, Swati Agarwal, Akhilesh V Thole, Sachin Kumar, Tanu Anand Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):39-43 Background: Melasma poses a great challenge as its treatment modalities are unsatisfactory. Treatment using tranexamic acid is a novel concept. Aim: This study aimed to compare the therapeutic efficacy and safety of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Methods: This is a prospective, randomized, open-label study with a sample size of 64, 32 in each treatment arm. Thirty-two patients were administered localized microinjections (4 mg/ml) of tranexamic acid monthly in 1 arm, while in the other arm, 32 were given oral tranexamic acid 250 mg twice a day. Patients were followed up for 3 consecutive months. Clinical photographs were taken at each visit, and a modified melasma area and severity index scoring was performed at the beginning and end of treatment. Results: Improvement in melasma area and severity index score in the oral group was 57.5% as compared to 43.5% in the intralesional group. All 32 patients in the oral group (100%) showed >50% improvement, out of which 8 showed >75% improvement. In the intralesional group, 17 (53%) patients had >50% improvement, of which 3 had >75% improvement. The remaining 15 patients in this group had <50% improvement. Thus, the oral group showed a more significant response as compared to the intralesional group. No major adverse effects were observed in both the groups. At 6-month follow-up, two patients (6.2%) in the oral group had recurrence as compared to three patients (9.4%) in the intralesional group. Limitations: A small sample size was one of the limitations in this study. The dose of tranexamic acid in microinjections and the frequency of injections could have been increased. Conclusion: Tranexamic acid provides rapid and sustained improvement in the treatment of melasma. It is easily available and affordable. Oral route is undoubtedly efficacious, but the results of microinjections, while encouraging, can probably be enhanced by either increasing the frequency of injections or increasing the concentration of the preparation.

Safety and efficacy of autologous noncultured dermal cell suspension transplantation in the treatment of localized facial volume loss: A pilot study Alok Kumar Sahoo, Savita Yadav, Vinod K Sharma, Anita Singh Parihar, Surabhi Vyas, Somesh Gupta Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):44-50 Background: Available options for correction of facial volume loss, such as synthetic fillers, autologous fat and cultured fibroblasts, have limitations viz. temporary effect and high cost. Aim: To assess the use of a novel technique, autologous non-cultured dermal cell suspension transplantation, for correction of localized facial volume loss due to inflammatory pathologies. Methods: It was a pilot study conducted in the Dermatology Outpatient Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Autologous non-cultured dermal cell suspension was transplanted in a total of 10 patients, out of which 5 had predominantly dermal loss and the rest had predominantly lipoatrophy. The donor tissue from the gluteal region was digested into a single cell suspension using collagenase-1 and injected into the recipient area. The outcome was assessed subjectively by patients and investigators and objectively using ultrasonography. Cell count, viability testing and measurement of mesenchymal stem cells were also done. Results: On assessment of patients, the median improvement in the predominantly dermal atrophy group at 3 and 6 months was 70% (range: 10–90%) and 80% (range: 0–90%), respectively, and in the predominantly lipoatrophy group, 0% (range: 0–40) and 0% (range: 0–50), respectively. Mean thickness of dermis + subcutis at the baseline was 1.835 mm (range: 0.89–6.04 mm), which increased to 2.912 mm (range: 0.88–7.07 mm, P = 0.03) at 6 months. Limitations: Our pilot study has some limitations such as small sample size and heterogeneity of the recruited patients. Conclusions: Autologous non-cultured dermal cell suspension transplantation appears to be safe and effective in localized facial dermal defects because of inflammatory pathologies, but not effective in deeper defects.

Toenail concentrations of zinc, selenium and nickel in patients with chronic recurrent warts: A pilot two-group comparative study Mohamed El-Komy, Vanessa Hafez, Rania Abdel Hay, Dina Mehaney, Iman Hafez Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):51-55 Background: Normal immune functioning requires sufficient levels of trace elements including zinc and selenium, while elements such as nickel can be immunotoxic. Aim: To assess long-term abnormalities in zinc, selenium and nickel levels in patients with chronic recurrent warts. Methods: Toenail samples were taken from 28 patients with chronic recurrent warts and 30 apparently healthy matching controls were analysed. Toenail concentrations of zinc, selenium and nickel were measured using inductively-coupled plasma-optical emission spectroscopy. Results: Selenium levels were significantly higher in patients than in controls (P = 0.03). Levels of trace elements did not correlate with the number or duration of warts. Toenail nickel levels in all subjects were higher than globally reported values. Limitations: A small sample size and the absence of regional reference ranges for concentrations of trace elements in toenails. Conclusion: Zinc does not seem to be involved in the chronicity of warts, and it is unclear if selenium has a protective role against warts. Our finding of high concentrations of nickel in both patients and controls raises concerns about environmental exposure.

Successful treatment of metastatic extramammary Paget's disease with pemetrexed monotherapy systemically and 5-fluorouracil topically Kexu Chen, Hanlin Liang, Jiewen Peng, Yanfang Zheng Indian Journal of Dermatology, Venereology, and Leprology 2019 85(1):56-59 Advanced extramammary Paget's disease does not have a standardized treatment guideline as its incidence is low and has been rarely reported in literature. Here we describe a case of metastatic extramammary Paget's disease successfully treated with topical 5-fluorouracil (5-FU) and systemic pemetrexed. The therapy was safe without any appreciable adverse effects like diarrhea, rash, neutropenia or fatigue; maintaining remission for more than 6 months. Thus, we propose 5-FU and pemetrexed as the first-line therapy for advanced extramammary Paget's disease, especially for aged patients with unresectable skin lesions.

Medical Research

'Infectobesity' in egyptian adolescent women and its relations to carotid intima–media thickness Sahar A El-Masry, Hanan A El Gamal, Muhammad Al-Tohamy, Ayman Nada, Amany H Abdelrahman, Mohamed Kh. Metkees, Amany Ebrahim, Walaa Saad Journal of The Arab Society for Medical Research 2018 13(2):79-88 Background ‘Infectobesity’ is a new term to describe obesity of infectious origin, such as infection by human adenovirus-36 (Adv36). It appears to be a new concept, evolved over the past 20 years. Visceral obesity is associated with a higher risk of cardiovascular disease. Increased carotid intima–media thickness (CIMT), a marker of early-onset atherosclerosis, has been observed in obese children and adolescents. The present study aims to investigate the relationship between visceral obesity, CIMT, and Adv36 in female Egyptian adolescents. Patients and methods The present study included 90 women aged 12–15 years. It was conducted at the Medical Excellence Research Center of the National Research Centre, Cairo, Egypt, during the period between September 2016 and November 2017. Anthropometric assessment was done. Fasting blood samples were withdrawn for the measurement of Qualitative Human Adv36 antibody using a sandwich enzyme-linked immunosorbent assay. Fasting plasma glucose was determined calorimetrically, by the glucose oxidase method and insulin level using the solid-phase enzyme-linked immunosorbent assay and lipid profile. Visceral obesity was measured by an abdominal ultrasound. CIMT for both carotid arteries were measured by high-resolution echo Doppler. Results Girls with visceral obesity (n=26) had higher frequency of increased CIMT at left (96.2 vs. 75%), right carotid artery (84.6 vs. 73.4%) and Adv36 sero-positive antibody (69.2 vs. 56.2%) than among those without visceral obesity (n=64). Among the total samples, visceral obesity had significant positive correlations with BMI, waist and hip circumference, while it had insignificant correlations with age, blood pressure (BP), CIMT at right and left carotid arteries, adenovirus and laboratory findings. CIMT had a significant positive correlation with each other, insulin resistance and total cholesterol, and significant negative correlations with high-density lipoprotein and waist circumference. Adv36 had significant negative correlations with BP (both systolic and diastolic) and significant positive correlation with insulin level. Adv36 and CIMT had insignificant correlations with each other and with the anthropometric measurements, BP, visceral obesity, triglycerides, and low density lipoprotein. Conclusion The frequency of Adv36 and increased CIMT at left carotid artery were higher among girls with visceral obesity than among those without visceral obesity. However, visceral obesity, CIMT at both right and left carotid arteries, and Adv36 had insignificant correlations with each other.

Inhibitory effect of bee venom against potassium bromate causing genetic toxicity and biochemical alterations in mice Abeer H Abd El-Rahim, Omaima M Abd-El-Moneim, Heba A.M. Abd El-Kader, Amira Abd El Raouf Journal of The Arab Society for Medical Research 2018 13(2):89-98 Background/aim Bee venom (BV) therapy is a highly effective treatment, capable of improving one’s health. The present study attempts to assess the effect of BV on the toxicity of oral administration of potassium bromate (KBrO3) which has been widely used in food and cosmetic industries. Materials and methods Sixty adult male mice were gavaged with KBrO3 at two doses (100 and 200 mg/kg body weight) for 10 days. Afterwards, BV at a dose of 120 μg/kg body weight was injected subcutaneously three times per week for two successive weeks. The genetic study was performed using chromosomal aberration and micronucleus formation in the bone marrow, DNA fragmentation in liver cells and by sperm analysis. In addition, serum biochemical markers such as catalase and malondialdehyde, kidney, and liver functions were assessed. Results The results have shown that KBrO3 caused DNA damage that represented the increase in the frequencies of chromosome abnormalities, micronuclei formation, percentage of DNA fragmentation, and sperm morphological abnormalities. Meanwhile, the results showed that KBrO3 exhibited severe toxicity for antioxidant activities for liver and kidney functions. Conversely, BV significantly decreased the frequencies of DNA damage in all aforementioned parameters induced by KBrO3. In addition, it improved the antioxidant activities and the function of the liver and kidneys. Conclusion BV has a potent ameliorating effect against the KBrO3 hazard impacts in animal tissues especially at higher doses. This observation indicated that BV could be a potential therapeutic agent in the treatment of KBrO3 risk.

Impact of nano-TiO2 particles on water sorption and solubility in different denture base materials Wessam M Dehis, Sherihan M Eissa, Ayman F Elawady, Menatallah M Elhotaby Journal of The Arab Society for Medical Research 2018 13(2):99-105 Background/aim Denture base materials with all their diversities and the curing method have a massive impact on their physical, mechanical, and biological traits. This contemplate is aimed to both assess and relate water sorption and solubility of heat-cured and microwave-cured acrylic resin denture base materials with and without the addition of titanium oxide nanoparticles (TiO2 NPs). Materials and methods A total number of 80 circular specimens were fabricated for the two tested groups (n=40). Group I was divided into two subgroups: group IA and group IB (20 each) fabricated from heat-cured and microwave-cured acrylic resin, respectively. Another group (group II) was divided into two subgroups: group IIA and group IIB (20 each) as in group I with the addition of TiO2 NPs. Then, the degree of water sorption and water solubility was calibrated by using an electronic balance for all specimens and determined by the aid of a specific formula. Results The present results indicated that there is a significant difference between all groups using one-way analysis of variance test as the P value was less than 0.05. Moreover, Tukey’s post-hoc test was performed and revealed that there was a significant difference between all subgroups except (group IIA and group IIB) in which there was an insignificant difference regarding water sorption and water solubility. Conclusion Within the limitation of this consideration, microwave-cured acrylic resin is superior to the heat-cured one regarding both water sorption and solubility. Moreover, the addition of TiO2 NPs revealed the best outcome.

Clinical efficacy of nicotine replacement therapy in the treatment of minor recurrent aphthous stomatitis Mai Zakaria, Aliaa El-Meshad Journal of The Arab Society for Medical Research 2018 13(2):106-112 Background/aim Recurrent aphthous stomatitis (RAS) is a common and widely recognized disease involving the oral mucous membrane. Nicotine replacement therapy (NRT) is a dose-dependent safe method for encountering useful effects of nicotine. This study aimed to evaluate the clinical efficacy of NRT in the treatment of minor RAS. Materials and methods A total of 50 patients from Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, with active minor RAS lasting for less than 48 h were randomly allocated into two groups (25 each): placebo and nicotine groups. They were treated with placebo and 2-mg nicotine chewing gum, correspondingly, twice daily for 2 weeks. All participants were assessed for pain, erythema, and ulcer size sores at 4 and 6 days from baseline. Frequency of recurrence was evaluated at 1-month, 2-month, and 3-month intervals. Results Regarding pain and erythema scores, the nicotine group showed lower mean with significant difference after 6 days in comparison with the placebo group. A lower mean of ulcer size was recorded in the nicotine group, with a significant difference after 4 and 6 days. A lower mean of recurrence score was recorded in nicotine group, with nonsignificant difference compared with the placebo group. Conclusion Low-dosage NRT in the form of chewing gum may be considered as an innovative and safe alternate treatment modality for minor RAS.

Androgen receptor expression in hormone-negative breast cancers and its prognostic significance Dalia M Abouelfadl, Hebat Allah A Amin, Noha N Yassen, Marwa E Shabana, Amir M.H. Salem Journal of The Arab Society for Medical Research 2018 13(2):113-118 Background/aim Breast carcinoma is a common, yet heterogeneous aggressive disease affecting relatively young patients. The androgen receptor (AR) is expressed in majority of breast cancers and across the main breast cancer subtypes. The aim of this study was to evaluate AR expression in hormone-negative breast cancer subtypes. Materials and methods Sixty cases of breast cancer were involved in this study; the samples were received in the Department of Pathology of Kasr El-Aini Hospital, Cairo University, Egypt. The expression of AR and human epidermal growth factor receptor-2 receptors were studied by immunohistochemistry in 60 formalin-fixed paraffin-embedded selected hormone-negative breast cancer surgical specimens. The immunohistochemistry expression of the marker was correlated with the clinicopathological variables. Results Of the hormone-negative cases, 61.6% show positive AR expression, 89% of which are invasive duct carcinoma, 68.3% are associated with ductal carcinoma in situ, and 55% are human epidermal growth factor receptor-2-enriched subtype. A significant correlation was found between the AR expression and tumor type. There is no evident significant correlation with tumor grade, multicentricity or lymphovascular invasion. Conclusion The AR has recently emerged as a useful marker for the further refinement of breast cancer subtype classification. Antiandrogens are thought to markedly enhance treatments and to be the first targeted therapy in hormone-negative breast cancer cases.

Morphometric analysis and immunohistochemical expression of cytochrome C oxidase in colonic adenomas and adenocarcinomas Noha N Yassen, Dalia M Abouelfadl, Amina A Gamal elDin Journal of The Arab Society for Medical Research 2018 13(2):119-128 Background/aim Colorectal cancer is the seventh most common cancer in Egypt, constituting 3.47% of male cancers and 3% of female cancers. The aim of the current study is to evaluate the immunohistochemical expression of cytochrome C oxidase (CcO) as well as the nuclear morphometric measurements in colonic adenomas and adenocarcinomas. Materials and methods Sixty cases of colonic biopsies/specimens were involved in this study. The samples were received in the Department of Pathology of Kasr El-Aini Hospital, Cairo University, Egypt, and they were divided into three groups: 20 cases of normal control, 20 cases of colonic adenoma, and 20 cases of colonic adenocarcinoma. The expression of CcO was studied by immunohistochemistry in 60 formalin-fixed paraffin blocks. Nuclear morphometric parameters were evaluated using an image analysis system. The area percentage of the marker expression was correlated with nuclear morphometric parameters. Results Immunohistochemical study showed that 65% of control biopsies showed a significant difference with colonic adenocarcinoma cases in contrast and adenoma cases showed a nonsignificant difference with normal control biopsies. Mean areas percentages of CcO expression were significantly different between all three studied groups. The means of nuclear area, length, and perimeter showed a significant difference while means nuclear width and roundness showed a nonsignificant difference between all three studied groups. There was significant correlation between mean area percentage of CcO expression with mean nuclear area and perimeter in control, adenoma, and adenocarcinoma cases. Conclusion CcO protein is significantly expressed in the cytoplasm of normal colonic mucosa. It was significantly deficient in colonic adenocarcinoma. Nuclear morphometry can be introduced as a useful morphologic feature of patients with variable colonic lesions specially in combination with CcO.

The antifibrotic effect of Zilla spinosa extracts targeting apoptosis in CCl4-induced liver damage in rats Enayat A Omara, Sayed A El-Toumy, Marwa E Shabana, Abdel-Razik H Farrag, Somaia A Nada, Nermeen Shafee Journal of The Arab Society for Medical Research 2018 13(2):129-143 Background/aim Liver fibrosis and its end-stage cirrhosis are the main reasons of morbidity and mortality all over the world. The current study aimed to evaluate the efficacy of Zilla spinosa (Z. spinosa) on CCl4-induced liver fibrosis, apoptosis, and oxidative stresses in rats. Materials and methods Extract of aerial part of Z. spinosa was used in this study. Thirty male Sprague‑Dawley rats were enrolled in this study and divided into five groups (six each): group 1 served as control and groups 2–5 were treated with CCl4 (1 ml/kg intraperitoneal twice a week for 8 weeks), where group 2 served as a control positive, group 3 received silymarin (50 mg/kg) daily, and groups 4 and 5 were administrated with Z. spinosa (100 and 200 mg/kg, respectively) daily for 8 weeks. At the end of each experiment, liver function tests were analyzed in serum, whereas malondialdehyde (MDA), Nitric oxide (NO), Glutathione (GSH), and hydroxyproline (HA) were analyzed in liver tissues. Liver fibrosis was confirmed histopathologically, and collagen content, caspase-3, and α-smooth muscle actin (α-SMA) were assayed immunhistochemically. Results Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, MDA, NO, and HA levels were increased (P<0.05), whereas total protein and GSH were decreased (P<0.05) in CCl4-administrated rats. Histopathological results showed loss of lobular structure, fibrosis with expansion of portal tract by fibrous tissue together with inflammatory changes confined to portal tract and central vein, and intense centrilobular necrosis and remarkable fatty hydropic degeneration. In addition, extensive accumulation of connective tissue, marked depletion of glycogen, strong expression of α-SMA, and increased of caspase-3 were found in CCl4-administrated rats. Oral administration of Z. spinosa at 100 or 200 mg/kg restored the normal levels of liver function parameters, MDA, NO and GSH; decreased HA; and reduced collagen, glycogen content, caspase-3, and α-SMA in liver tissue of rats. The high dose of 200 mg/kg showed more potent effect than low dose of 100 mg/kg when compared with silymarin treatment group. Conclusion The present study clarified that Z. spinosa extract has antioxidant and antiapoptotic properties in CCl4-induced liver fibrosis in rats, and may be able to exert a therapeutic effect on developing hepatic fibrosis; moreover, high dose of 200 mg/kg appeared to be more potent than low dose (100 mg/kg).

Image analysis and Ki-67 expression in urothelial dysplasia and carcinoma Manal A Badawi, Sonia L El-Sharkawy, Naglaa F Abbas, Wafaa E Abdel-Aal Journal of The Arab Society for Medical Research 2018 13(2):144-150 Background/aim Cancer of the urinary bladder is a worldwide disease in which transitional cell carcinoma is the most common histologic type. The diagnosis of dysplasia is particularly important, as it is the precursor of invasive carcinoma. The present study aimed to investigate the role of image analysis together with Ki-67 immunostaining in bladder dysplasia and invasive urothelial carcinoma. Materials and methods This study was carried out in 80 urinary bladder paraffin blocks that were selected from the Department of Pathology of Kasr El-Aini Hospital, Cairo University, Egypt. The studied cases were divided into four groups: six cases of normal bladder mucosa, 12 cases of chronic cystitis, 18 cases of epithelial dysplasia, and 44 cases with transitional cell carcinoma. Morphometric analysis and Ki-67 expression were studied in all cases using an image analysis system. Results All morphometric parameters, DNA index, and proliferating cells’ percent and Ki-67 index were increasing from normal, chronic cystitis, dysplasia to carcinoma cases. However, nuclear area, length, size, and epithelial stromal ratio showed significant differences between dysplasia and carcinoma cases (P<0.05). High-grade carcinoma showed significant enlargement of nuclear area and size, as compared with low-grade carcinoma. DNA index and proliferating cells’ % showed a significant difference between dysplasia and carcinoma cases. Both parameters were significantly higher in high-grade carcinoma. Normal bladder and chronic cystitis cases exhibited negative stain for Ki-67. However, all cases of dysplasia and carcinoma exhibited a positive stain for Ki-67. The carcinoma cases showed a significantly higher Ki-67 index (68%) than the dysplastic cases (34%). Conclusion The present study revealed the usefulness of image analysis together with Ki-67 expression in discriminating cases of bladder dysplasia and carcinoma.

Combination therapy versus monotherapy in the treatment of recalcitrant warts: A clinical and immunological study

Summary

Background

Treatment of recalcitrant warts represents a continuing therapeutic challenge. Combination therapies can help improve treatment response, decrease adverse effects, and reduce recurrence.

Objective

To compare the efficacy, safety and immunological effects of a combined acitretin‐intralesional Candida antigen against acitretin alone and Candida antigen alone for intractable warts.

Methods

Sixty adult patients with intractable warts were included in this study. Patients were subdivided into three groups, each containing 20 patients. Acitretin alone was taken by patients of group I, Candida antigen alone was injected in patients of group II, and group III received a combination of intralesional Candida antigen and acitretin. Serum cytokine levels of IL‐10 and IFN‐γ were measured before and after therapy in the studied groups.

Results

Total resolution of warts was achieved in 8 patients (40%) of the acitretin alone group, 9 patients (45%) of the Candida antigen alone group and 15 patients (75%) of the combination therapy group. The therapeutic response was statistically higher in the combined acitretin‐Candida antigen group as compared with either agent alone. Adverse effects were non‐significant in the three groups. There were no statistically significant differences in the serum levels of IFN‐γ and IL‐10 between responders and non‐responders after therapy in the three studied groups.

Conclusion

The combination therapy of acitretin + Candida antigen is superior to either agent alone. Serum cytokine levels of IL‐10 and IFN‐γ were not associated with clearance or persistence of warts in any of the studied groups.

http://bit.ly/2EZ08wH

Sterol‐standardized phytopharmaceutical from ground cherry: Corticoid‐like properties on human keratinocytes and fibroblasts and its effects in a randomized double‐blind placebo‐controlled clinical trial

Summary

Background

Topical corticosteroids have been the most commonly prescribed drugs to treat skin inflammation, but their uses can lead to several adverse effects. Nowadays, new pharmacological strategies have been evaluated to improve dermatologic efficacy and reduce adverse effects, including natural products.

Objectives

The aim of this study was to evaluate and compare the effects of a plant sterol standardized supercritical CO₂ phytopharmaceutical of Physalis angulata L. with hydrocortisone on the immune and inflammatory mediators, and skin repair components production. Moreover, we studied effects of both products on the skin microcirculation and temperature in a double‐blind placebo‐controlled clinical trial.

Methods

Both products were evaluated on the immune (IL‐6, IL‐10, INF‐γ, TNF‐α, and IL‐1α), inflammatory (COX‐2, LOX, PLA₂, PGE₂, LTB₄, histamine, and NF‐κB), and repair components (TGF‐β, GM‐CSF, collagen, and GAG) production on human keratinocytes and fibroblast in non‐stimulated and LPS‐stimulated conditions. Indeed, in a randomized double‐blind placebo‐controlled clinical trial, we evaluated the effects of the both creams on the skin microcirculation and temperature using laser Doppler and infrared thermometer, respectively.

Results

Physalis angulata acted on the skin, modulating immune status and inflammatory response producing corticoid‐like effects, but different of hydrocortisone, increased skin repair factors. The effects of phytopharmaceutical cream in the clinical trial promoted a better reduction in skin microcirculation and temperature than hydrocortisone.

Conclusions

Taken together, the results indicate that sterol standardized CO₂ supercritical preparation of P angulata is a new and innovative phytopharmaceutical with multiple pharmacological effects potentially useful as human skin protective product, particularly against cutaneous inflammatory disorders.

http://bit.ly/2EYuHBH

1927‐nm fiber‐optic diode laser: A novel therapeutic option for facial steatocystoma multiplex

Summary

Steatocystoma multiplex (SM) is a cutaneous disorder that presents with multiple yellowish intradermal cysts originating from the pilosebaceous ducts. Although various treatments have been attempted to improve cosmetic outcomes, no optimal treatment strategy has been established to date. A 41‐year‐old man presented with a 10‐year history of multiple skin‐colored papulonodules over his entire body. He was diagnosed with SM, and we treated his facial SM with a 1927‐nm diode laser. Two treatment sessions at a 5‐week interval led to cosmetically excellent outcomes. There was no recurrence at the 8‐month follow‐up. Herein, we present a case of SM that was successfully treated with a 1927‐nm fiber‐optic diode laser.

http://bit.ly/2EYIf1c

Primary cutaneous embryonal rhabdomyosarcoma with desmoplastic growth pattern and anaplastic lymphoma kinase overexpression. Report of a case with special emphasis on the differential diagnosis

http://bit.ly/2Qe3oW0

Giant cutaneous pleomorphic fibroma: an unusual presentation

http://bit.ly/2Vgag9c

Scholar : Molecular and Clinical Oncology - Volume:10 Number:2

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TABLE OF CONTENTS February-2019 Volume 10 Issue 2

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Androgen receptor and soy isoflavones in prostate cancer (Review) Monika Kmetová Sivoňová, Peter Kaplán, Zuzana Tatarková, Lucia Lichardusová, Róbert Dušenka, Jana Jurečeková View Abstract ❯
Prognostic and therapeutic role of HER2 expression in micropapillary carcinoma of the bladder (Review) Francesca Sanguedolce, Davide Russo, Vito Mancini, Oscar Selvaggio, Beppe Calo, Giuseppe Carrieri, Luigi Cormio View Abstract ❯
Clinical significance of Stathmin1 expression and epithelial‑mesenchymal transition in curatively resected gastric cancer Bin Ke, Xiao‑Fan Guo, Ning Li, Liang‑Liang Wu, Bin Li, Ru‑Peng Zhang, Han Liang View Abstract ❯
Inflammatory breast cancer in 210 patients: A retrospective study on epidemiological, anatomo‑clinical features and therapeutic results Maroua Manai, Pascal Finetti, Nesrine Mejri, Salma Athimni, Daniel Birnbaum, François Bertucci, Khaled Rahal, Amor Gamoudi, Max Chaffanet, Mohamed Manai, Hamouda Boussen View Abstract ❯
Metastasis of pulmonary adenocarcinoma to the palatine tonsil Lena Zaubitzer, Nicole Rotter, Christoph Aderhold, Timo Gaiser, Frederic Jungbauer, Benedikt Kramer, Beatrice Kuhlin, Carsten Thorn, Anne Lammert View Abstract ❯
Intestinal obstruction caused by primary adenosquamous cell carcinoma of the small intestine: A case report and review of the literature Naotake Funamizu, Yukio Nakabayashi, Katsushi Dairaku, Kenta Tomori, Yuki Hiramoto, Kazunao Kurihara View Abstract ❯
Vessel wall magnetic resonance imaging findings and surgical treatment in nilotinib‑associated cerebrovascular disease: A case report Kohei Suzuki, Junkoh Yamamoto, Shingo Kakeda, Seishiro Takamatsu, Ryo Miyaoka, Takehiro Kitagawa, Takeshi Saito, Yoshiteru Nakano, Shigeru Nishizawa View Abstract ❯
Histological complete response with nivolumab for renal cell carcinoma with multiple metastases: A case report Suguru Shirotake, Go Kaneko, Koji Nagata, Masafumi Oyama, Koshiro Nishimoto View Abstract ❯
Poorly differentiated pulmonary synovial sarcoma with SYT gene amplification: A case report Xiaoyan Li, Dan Wu, Yuhui Zheng, Huanxing Yang, Yinghong Yang View Abstract ❯
Core needle biopsy promotes lung metastasis of breast cancer: An experimental study Yongqiang Fu, Fangming Guo, Haohao Chen, Yiping Lin, Xiaoyan Fu, Hui Zhang, Mingxing Ding View Abstract ❯
Protective effects of genistein and melatonin on mouse liver injury induced by whole‑body ionising radiation Gonca Hanedan Uslu, Emine Canyilmaz, Lasif Serdar, Şafak Ersöz View Abstract ❯
Pembrolizumab-induced autoimmune encephalitis in a patient with advanced non-small cell lung cancer: A case report Maiko Niki, Aya Nakaya, Takayasu Kurata, Kahori Nakahama, Hiroshige Yoshioka, Toshihiko Kaneda, Kayoko Kibata, Makoto Ogata, Shosaku Nomura View Abstract ❯
Complete remission of peritoneal dissemination of colon cancer by alternate‑day S‑1 and oxaliplatin plus bevacizumab treatment and maintenance chemotherapy comprising alternate‑day S‑1 plus bevacizumab: A case report Nobuhiro Nitori, Ayu Kato, Tomoaki Deguchi, Jumpei Nakadai, Ayako Tada, Makoto Takahashi, Rumiko Umeda, Naoteru Miyata, Mikinori Kataoka, Tomohisa Kadomura, Hajime Higuchi, Hirotoshi Ebinuma, Atsushi Kato, Takashi Hatori, Yoshifumi Ikeda, Masaru Miyazaki View Abstract ❯
Improved prognosis of low baseline neutrophil‑to‑lymphocyte ratio is significantly exclusive in breast cancer patients with high absolute counts of lymphocytes Yukie Fujimoto, Hiromi Ozawa, Tomoko Higuchi, Yoshimasa Miyagawa, Ayako Bun, Michiko Imamura, Yasuo Miyoshi View Abstract ❯
Impact of the occurrence of new lesions on the survival of patients who undergo chemotherapy for metastatic colorectal cancer Masatsune Shibutani, Kiyoshi Maeda, Hisashi Nagahara, Tatsunari Fukuoka, Shinji Matsutani, Shinichiro Kashiwagi, Kosei Hirakawa, Masaichi Ohira View Abstract ❯
Tolerability and safety of real‑world use of pomalidomide in patients with relapsed/refractory multiple myeloma Eiseki Usami, Michio Kimura, Shoya Takenaka, Mina Iwai, Hitomi Teramachi, Tomoaki Yoshimura View Abstract ❯
Pulmonary cement embolism following balloon kyphoplasty: The impact of a procedural complication in a new era for lung cancer management Daniela Marta Rodrigues, Daniela Patrícia Cunha Machado, Sérgio André Campainha Fernandes, Ana Maria Paixão Barroso View Abstract ❯
Isolated adrenocorticotropic hormone deficiency potentially induced by nivolumab following pseudo‑progression in clear cell renal cell carcinoma: A case report Nobuki Furubayashi, Takahito Negishi, Tomoharu Uozumi, Dai Takamatsu, Koichi Shiraishi, Daisuke Hirose, Motonobu Nakamura View Abstract ❯
Elevated IL‑6/IL‑1Ra ratio as a prognostic biomarker of poor chemotherapy efficacy in Chinese patients with metastatic NSCLC, validated in a Caucasian patient cohort Fang Liu, Benoît Sansas, Xavier Préville, Romain Gineste, Jialei Wang, Hui Yu, Xia Meng, Romain Micol, Luc Barraud View Abstract ❯
Human immunodeficiency virus‑negative multicentric Castleman's disease coexistent with Kaposi's sarcoma on 18F‑FDG PET/CT: A case report Jae Pil Hwang, Jiyoon Kim, Jung Mi Park View Abstract ❯

20-22 September, 2018, Metropolitan Hotel, Athens, Greece 23nd World Congress on Advances in Oncology & 22th International Symposium on Molecular Medicine 18-19 September 2018, Pre-Congress Workshop: 'MicroRNA Analysis'

28-30 March, 2019, Tawana Hotel, Bangkok, Thailand 23 rd International Symposium on Molecular Medicine

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BCG Therapy for Type 1 Diabetes: Restoration of Balanced Immunity and Metabolism

Publication date: Available online 29 December 2018

Source: Trends in Endocrinology & Metabolism

Author(s): Willem M. Kühtreiber, Denise L. Faustman

The bacillus Calmette–Guerin (BCG) vaccine is a microorganism developed as a vaccine for tuberculosis 100 years ago and used as therapy for bladder cancer 40 years ago. More recently, BCG has shown therapeutic promise for type 1 diabetes (T1D) and several other autoimmune diseases. In T1D, BCG restored blood sugars to near normal, even in patients with advanced disease of >20 years duration. This clinically important effect may be driven by resetting of the immune system and the shifting of glucose metabolism from overactive oxidative phosphorylation, a state of minimal sugar utilization, to aerobic glycolysis, a state of high glucose utilization, for energy production. The mechanistic findings support the Hygiene Hypothesis and reveal the immune and metabolic synergy of mycobacterial reintroduction in modern humans.

http://bit.ly/2AnnCaN

Diffusion kurtosis imaging of endometrial carcinoma: Correlation with histopathological findings

Publication date: Available online 30 December 2018

Source: Magnetic Resonance Imaging

Author(s): Ichiro Yamada, Junichiro Sakamoto, Daisuke Kobayashi, Naoyuki Miyasaka, Kimio Wakana, Noriko Oshima, Akira Wakabayashi, Yukihisa Saida, Ukihide Tateishi, Yoshinobu Eishi

Abstract

Purpose

In this study, we aimed to determine the usefulness of diffusion kurtosis imaging (DKI) as a noninvasive method for the evaluation of tumor invasion depth, histological grade, and lymph node metastasis in patients with endometrial carcinoma (EMC).

Materials and methods

Our institutional review board approved this retrospective study and waived informed consent. In total, 24 patients suspected of having EMC were examined by a 1.5-T magnetic resonance imaging. DKI data were obtained using a single-shot echo-planar imaging sequence with four b values (0, 500, 1000, and 2000 s/mm²). Kurtosis (K), diffusivity (D), and apparent diffusion coefficient (ADC) maps were generated and compared with histopathological findings.

Results

K maps from all patients identified the junctional zone as a distinct high-K zone (1.443 ± 0.362). This zone was significantly different from the zone of endometrium and outer myometrium (0.678 ± 0.179 and 0.694 ± 0.113, respectively; P < 0.001). K and D values of all EMCs were significantly different from those of all normal uterine wall layers. K and D values were significantly correlated with histological grades of endometrioid adenocarcinomas (r = 0.799, P < 0.001 and r = −0.799, P < 0.001, respectively), while ADC values were not (r = −0.243, P = 0.382). Metastatic and nonmetastatic lymph nodes showed significantly different K (P = 0.001) and D (P = 0.001) values, but not ADC values (P = 0.827).

Conclusions

DKI may be clinically useful for the noninvasive evaluation of depth of tumor invasion, histological grade, and lymph node metastasis in patients with EMC.

http://bit.ly/2VjM4ms

The Co-occurrence of Pitch and Rhythm Disorders in Congenital Amusia

Publication date: Available online 30 December 2018

Source: Cortex

Author(s): Marie-Élaine Lagrois, Isabelle Peretz

Abstract

The most studied form of congenital amusia is characterized by a difficulty with detecting pitch anomalies in melodies, also referred to as pitch deafness. Here, we tested for the presence of associated deficits in rhythm processing, beat in particular, in pitch deafness. In Experiment 1, participants performed beat perception and production tasks with musical excerpts of various genres. The results show a beat finding disorder in six of the ten assessed pitch-deaf participants. In order to remove a putative interference of pitch variations with beat extraction, the same participants were tested with percussive rhythms in Experiment 2 and showed a similar impairment. Furthermore, musical pitch and beat processing abilities were correlated. These new results highlight the tight connection between melody and rhythm in music processing that can nevertheless dissociate in some individuals.

http://bit.ly/2QZ6tOW

Human Reproductive Sciences

http://www.jhrsonline.org/currentissue.asp?sabs=n

From the editors desk Madhuri Patil Journal of Human Reproductive Sciences 2018 11(4):303-305

Preimplantation genetic testing: Its evolution, where are we today? Firuza Rajesh Parikh, Arundhati Sitaram Athalye, Nandkishor Jagannath Naik, Dattatray Jayaram Naik, Rupesh Ramesh Sanap, Prochi Fali Madon Journal of Human Reproductive Sciences 2018 11(4):306-314 Preimplantation genetic testing (PGT) is an early form of prenatal genetic diagnosis where abnormal embryos are identified, thereby allowing transfer of genetically normal embryos. This technology has become an integral part of Assisted Reproductive Technology (ART) procedures. Initial experiments with animals as early as 1890 and those in the mid and later part of the last century paved the forward path of ART and PGT. This review article covers the evolution of PGT and is a pointer toward current and fast-evolving technology, allowing scientists and doctors to better comprehend human reproduction, and ensure healthy pregnancy outcomes.

Psychosocial aspects of therapeutic donor insemination Ansha Patel, P. S. V. N. Sharma, Pratap Kumar Journal of Human Reproductive Sciences 2018 11(4):315-319 The experience of delays in conception or possibility of remaining childless has the potential to create considerable psychological discomfort. In couples with severe male factor infertility, therapeutic intrauterine insemination using donor sperms (TDI) is offered as a treatment, second to in vitro fertilization using donor sperms. TDI is lucrative, less invasive, and a hopeful treatment. However, there are intricacies associated with it. Its immediate outcomes involve limited success rates, nonresponse, and chances of implantation failures, miscarriages, and multifetal pregnancies. Due to this, couples experience distress when they are advised to undergo three to six cycles of TDI in order to meet the expectations of having a baby. TDI has long-term issues on the triad comprising the “recipients,” the “donors,” and the “the children born out of TDI.” Nevertheless, managing psychosocial needs for couples undergoing TDI and other treatments in Indian clinics are grey areas of the conventional treatment pathway. The present review expands on the psychological issues and needs in couples opting for TDI.

"In cycles of dreams, despair, and desperation:" Research perspectives on infertility specific distress in patients undergoing fertility treatments Ansha Patel, P. S. V. N. Sharma, Pratap Kumar Journal of Human Reproductive Sciences 2018 11(4):320-328 “Emotional distress in infertility” is a broad expression that loosely denotes anxiety, depression, grief, crisis, depleting psychological well-being, and all forms of affective and interpersonal disturbances faced by individuals with infertility. The distress is usually associated with involuntary childlessness as it is an unwelcoming event. The developmental crisis associated with childlessness poses a threat to one's sense of self at all levels (individual, family and social). Distress may begin before or during treatments as a person experiences the loss of control over attaining parenthood, anxiety or dejection after the diagnosis, treatments, its complications particularly its limited success rates. This paper reviews the basic concepts, theoretical models related to infertility specific distress (ISD). It elaborates on the effects of individual and treatment-specific variables on ISD with special highlights gathered from the national and international research.

Examination of Y-chromosomal microdeletions and partial microdeletions in idiopathic infertility in East Hungarian patients Attila Mokánszki, Anikó Ujfalusi, Éva Gombos, István Balogh Journal of Human Reproductive Sciences 2018 11(4):329-336 Purpose: The aim of this study was to establish the Y chromosome microdeletion and partial AZFc microdeletion/duplication frequency firstly in East Hungarian population and to gain information about the molecular mechanism of the heterogeneous phenotype identified in males bearing partial AZFc deletions and duplications. Materials and Methods: Exactly determined sequences of azoospermia factor (AZF) region were amplified. Lack of amplification was detected for deletion. To determine the copy number of DAZ and CDY1 genes, we performed a quantitative analysis. The primers flank an insertion/deletion difference, which permitted the polymerase chain reaction products to be separated by polyacrylamide gel electrophoresis. Statistical Analysis Used: Mann–Whitney/Wilcoxon two-sample test, Kruskal–Wallis test, and two-sample t-probe were used for statistical analysis. Results: AZFbc deletion was detected only in the azoospermic cases; AZFc deletion occurred significantly more frequently among azoospermic patients, than among oligozoospermic males. The frequency of gr/gr deletions was significantly higher in the oligozoospermic patients than in the normospermic group. The b2/b3 deletion and partial duplications were not different among our groups, while b1/b3 deletion was found only in the azoospermic group. In infertile males and in normozoospermic controls, similar Y haplogroup distribution was detected with the highest frequency of haplogroup P. The gr/gr deletion with P haplogroup was more frequent in the oligozoospermic group than in the normozoospermic males. The b2/b3 deletion with E haplogroup was the most frequent, found only in the normozoospermic group. Conclusions: Y microdeletion screening has prognostic value and can affect the clinical therapy. In case of Y chromosome molecular genetic aberrations, genetic counseling makes sense also for other males in the family because these types of aberrations are transmittable (from father to son 100% transmission).

A study on balanced chromosomal translocations in couples with recurrent pregnancy loss Pritti K Priya, Vineet V Mishra, Priyankur Roy, Hetvi Patel Journal of Human Reproductive Sciences 2018 11(4):337-342 Background: Recurrent pregnancy loss (RPL) is an obstetric complication that affects couples in their reproductive age. Chromosomal abnormalities, mainly balanced rearrangements, could commonly be present in couples with RPL. Aim: The purpose of this study is to evaluate the contribution of chromosomal abnormalities and balanced reciprocal translocations, in particular occurring in either of the partners, resulting in RPL. Materials and Methods: A retrospective cytogenetic study was carried out on 152 individuals (76 couples) having a history of RPL. The cases were analyzed using G-banding and fluorescence in situ hybridization, wherever necessary. Results: Chromosomal abnormalities were observed in 3.2% of the total RPL cases, of which balanced translocations were observed in 4 (80%) individuals and marker chromosome was detected in 1 (20%) individual. All balanced translocations comprised reciprocal translocations, and no cases of Robertsonian translocations were detected in our study. Among reciprocal translocation carriers, three were male and one was female. Polymorphic variants were noted in 8 (5.3%) individuals. Conclusions: Chromosomal analysis is an important etiological investigation in couples with RPL. Balanced translocations are the most commonly detected chromosomal abnormalities in such couples. Thus, these couples are the best candidates for offering prenatal genetic diagnosis, thereby ensuring a better reproductive outcome.

Circulating levels of vitamin D3 and leptin in lean infertile women with polycystic ovary syndrome Ayman Shehata Dawood, Adel Elgergawy, Ahmed Elhalwagy Journal of Human Reproductive Sciences 2018 11(4):343-347 Objective: The objective of this study is to measure levels of Vitamin D3 and leptin and assess their relation of each to the pathogenesis of polycystic ovary syndrome (PCOS). Design: This was a cohort observational study. Settings: This study was conducted at the Department of Obstetrics and Gynecology, Tanta University. Materials and Methods: Ninety lean women were enrolled in this study and were allocated into two groups with 45 patients in each group: the first group (study group) who are lean women with PCOS and the second group (control group) who are the lean infertile patients without PCOS. Blood samples were collected and tested for study parameters. Results: There were no significant differences regarding demographic characteristics between both groups. The differences were in ovarian volume and hormonal profiles. Serum leptin was found to be significantly increased in lean PCOS than in control groups. Vitamin D3 levels were found to be lower in the lean PCOS group than in control group. Conclusion: Lean PCOS women are a unique group with specific hormonal profiles different from the typical PCOS profiles. Leptin and Vitamin D3 may have a role in the pathogenesis of lean PCOS, but large studies are still required regarding this unique group.

Effect of insulin sensitizers on raised serum anti-mullerian hormone levels in infertile women with polycystic ovarian syndrome Neeti Chhabra, Sonia Malik Journal of Human Reproductive Sciences 2018 11(4):348-352 Context: Increased circulating insulin levels contribute to hyperandrogenism in polycystic ovarian syndrome (PCOS) which causes a derangement in folliculogenesis, thus contributing to polycystic morphogenesis of the ovaries and a higher than normal anti-Mullerian hormone (AMH). A high AMH is an indicator of either stubborn anovulation or a predictor of ovarian hyperstimulation syndrome. Hence, it is postulated that the use of insulin sensitizers will reduce insulin resistance, hyperandrogenism, and subsequently serum AMH levels and will convert anovulatory cycles to ovulatory. Aim: To study the effect of insulin sensitizers on raised serum AMH levels in infertile women with PCOS. Settings and Design: This was a prospective interventional randomized single tertiary center study. Methodology: The study was conducted from August 2015 to April 2016. Infertile patients with PCOS as defined by the Rotterdam criteria with raised AMH (>5 ng/ml) levels were enrolled in the study under strict inclusion and exclusion criteria. The sample size was 105 patients. Cycle regularity, day 2–antral follicle count (AFC), luteinizing hormone, AMH levels, modified Ferriman–Gallwey score (mFGS), and acne score were recorded before starting the intervention. Patients were randomized into three equal groups of 35 each. Group A received metformin alone, Group B metformin plus myoinositol, and Group C only myoinositol. After completion of 3 months of pretreatment, the same parameters were rechecked. Statistical Analysis Used: Univariate analysis and Chi-square test were used for statistical analysis. Results: Of 105 patients, 95 completed treatment and the rest 10 dropped out. There was a reduction in AMH in all groups of insulin sensitizers with significant fall in the metformin only group. Cycle regularity, reduction in AFC, mFGS, and grade of acne were also obtained. Conclusions: Therapy with insulin sensitizers in PCOS women with raised AMH reduces the AMH levels, converts irregular menstrual cycles to regular, and reduces clinical hyperandrogenism.

Window of implantation is significantly displaced in patients with adenomyosis with previous implantation failure as determined by endometrial receptivity assay Nalini Mahajan, Simrandeep Kaur, Maria Ruiz Alonso Journal of Human Reproductive Sciences 2018 11(4):353-358 Background: Adenomyosis is associated with implantation failure and poor reproductive performance in IVF/ICSI cycles. Aims: To compare if window of implantation (WOI) is displaced in patients having adenomyosis compared to controls using endometrial receptivity array (ERA) test. Settings and Design: Retrospective Case control study. 374 patients with previous one or more IVF failures who underwent ERA test between 2013-2016 at our centre were enrolled. Patients were divided into two groups; Group A-36 patients with adenomyosis (study group) and Group B- 338 patients without adenomyosis (controls). Statistical Analysis: Normality assumptions for continuous variables were tested using Kolmogorov Smirnov test. Mean values of two groups were compared using Student's t-independent test. Frequency data by categories were compared using Chi-square/Fisher's exact test. Risk ratio and 95% confidence limits were calculated. P < 0.05 was considered for statistical significance. Results: WOI was displaced (Non Receptive ERA) significantly in adenomyosis 47.2% (17/36) compared to controls 21.6% (73/338) (P < 0.001, CI-8.7%-42.5%) making risk ratio of displaced WOI in adenomyosis versus controls to be 2:1. The incidence of RIF was 66.6% in adenomyosis compared to 34.9% in controls (P < 0.001, CI- 15.5%-47.9%). Pregnancy rate after personalized embryo transfer in adenomyosis group was 62.5%, signifying displaced WOI as a cause of implantation failure in adenomyosis patients with previous implantation failure. Conclusions: Our study suggests it is prudent to evaluate Endometrial receptivity before embryo transfer in patients with adenomyosis to avoid wastage of good embryos.

Knowledge about age-related decline in fertility and oocyte cryopreservation: A national survey Karissa C Hammer, Alyssa N Kahan, Louis F Fogg, Mark A Walker, Jennifer E Hirshfeld-Cytron Journal of Human Reproductive Sciences 2018 11(4):359-364 Context: Women worldwide are delaying childbearing, but are they aware of the age-related decline in fertility? Aims: The aim of this study is to investigate awareness of age-related decline in fertility and oocyte cryopreservation. Settings and Design: A primary analysis of a cross-sectional electronic survey with a nationally representative sample of nulliparous women aged 25–45 years. Subjects and Methods: A national online survey performed March 4–March 9, 2016. Statistical Analysis Used: A linear regression model and ANOVA tests were performed. Results: A total of 1213 women completed the survey. A significant difference was discovered in fecundity knowledge between women who identified as in a partnership compared to those who did not. Partnered women were more likely to respond “know a lot” about the age-related decline in fertility, whereas unpartnered women were more likely to respond “never heard of it” (P < 0.01). Partnered women are also more likely to respond that they would have made different life choices had they been more knowledgeable about fertility at a younger age (P = 0.01). The majority of the survey population had heard of oocyte cryopreservation but did not know much about it. Conclusions: Slightly over half of participants had an understanding of the natural age-related decline in fertility. Having a partner significantly increased the likelihood that a woman reported more knowledge about fertility. More effort is necessary to educate all women on assisted reproductive technologies and the natural age-related decline in fertility, specifically single women of childbearing age.