Ilan Goldberg

Pemphigus vulgaris in Jewish patients is associated with HLA-A region genes: mapping by microsatellite markers

Pemphigus vulgaris (PV) is the most severe autoimmune blistering disorder of the skin that is mediated by circulating autoantibodies against desmoglein 3 (Dsg3). It has been reported that in Jews the associated haplotype in PV is human leukocyte antigen (HLA) B38, DRB1*0402, DQB1*0302. Significant associations with HLA were observed also in non-Jews. Dsg3-specific T-cell responses were detected in PV patients but also in healthy individuals who were either carriers of the PV-associated DRB1*0402 allele or alleles that share similar or identical peptide binding motifs to DRB1*0402. This suggests that genes other than the classical major histocompatibility complex (MHC) genes are associated with the development of the autoimmune response. We used 16 microsatellite probes that span the entire MHC region to screen DNA samples from 38 PV patients and 76 healthy controls. Results demonstrated that some markers were associated with class II region including a TAP associated marker. However, four probes, D6S265, C_527, D6S510, and MOGC, which are all mapped to the region of HLA-A, were highly associated with PV. These results suggest that a gene, or genes in the class I region are important in the initiation of the autoimmune cascade. Activation/suppression of these genes might act as the trigger mechanism that starts the autoimmune destructive process.

Long-term effects of peroxisome proliferator-activated receptor ligand bezafibrate on N-terminal pro-B type natriuretic peptide in patients with advanced functional capacity impairment

BackgroundThe effects of pan-peroxisome proliferator-activated receptor (PPAR) ligand bezafibrate on N-terminal pro-B type natriuretic peptide (ProBNP) level in patients with coronary artery disease (CAD) is unknown. The current study aimed to investigate the long-term effects of bezafibrate on ProBNP level in patients with pre-existing CAD and advanced functional capacity impairment.MethodsMetabolic and inflammatory parameters were analyzed from stored frozen serum samples obtained from 108 patients enrolled in the Bezafibrate Infarction Prevention (BIP) Study. They presented with New York Heart Association (NYHA) functional class III, comprising 58 patients in the bezafibrate group and 50 in the placebo groups, and completed a 2-year prospective, double-blind, placebo-controlled follow-up.ResultsDuring follow-up ProBNP level did not change significantly in the placebo group, whereas it increased slightly in the bezafibrate group, which was older and with lower baseline ProBNP values. No significant differences between the groups were found for ProBNP levels after 2 year of follow-up. Analysis-of-covariance (ANCOVA) -taking into account age and baseline ProBNP level- showed that bezafibrate was not associated with longitudinal ProBNP changes during the follow-up period (p = 0.3).ConclusionLong-term treatment by bezafibrate was not associated with longitudinal ProBNP changes in patients with pre-existing CAD and advanced functional capacity impairment.

Infrared fiber optic evanescent wave spectroscopy for the study of diffusion in the human skin

Fourier Transform Infrared (FTIR) spectroscopic systems make use of Attenuated Total Reflection (ATR) elements for the study of skin in dermatology. FTIR - ATR allows real time and reagent-less analysis of several components, simultaneously. The potential for skin studies is increased by the development of the flexible fiber optic sensor made from infrared transparent polycrystalline silver halide. Segments of fibers can replace the ATR sensing elements inside an FTIR system. Moreover a Fiberoptic Evanescent Wave Spectroscopy (FEWS) can also be used for real time in vivo measurement on skin, in situ. We used FEWS to study the diffusion of UV sunscreen lotions from the outer skin layer into the dermis and epidermis, and used the various absorption bands to differentiate between the behavior of the organic and the water molecules in the lotion. FEWS can be a powerful tool for studying the transport of drugs and cosmetic creams through the skin from the stratum corneum to the dermis and epidermis and for studying the lateral diffusion of various molecules into the skin, in vivo and in real time.

Tinea capitis outbreak among paediatric refugee population, an evolving healthcare challenge

Outbreaks of tinea capitis (TC) represent a major medical and economic burden. Population migrations have become a phenomenon of increasing relevance for medical conditions management. Given the recent massive arrival of immigrants, we sought to determine epidemiologic trends for TC among paediatric populations at the Tel Aviv Medical Center. We conducted a retrospective study of all TC cases diagnosed between 2010 and 2014 in a paediatric dermatology unit of a tertiary medical centre, serving as a referral centre for the paediatric refugee population from the great Tel Aviv area. Epidemiologic, clinical and treatment data including effectiveness and safety were reviewed. In all, 145 children met the inclusion criteria. Trend analyses showed increases in TC rates over the study period. Incidence rates were higher in boys than in girls. Children of African origin had the highest TC incidence rates as compared with other ethnic groups. Trichophyton violaceum and Microsporum audouinii were the predominant causative organisms. Treatment with griseofulvin was satisfactory in all cases. There was a significant increase in TC incidence rates in the Tel Aviv area over the study period. TV and MA were the predominant organisms. These trends may be a result of poor living conditions and crowded school premises.

Assessment of the effectiveness of topical propranolol 4% gel for infantile hemangiomas

Infantile hemangiomas (IHs) are the most common vascular tumors in children. Because of their benign character and natural involution, the vast majority of IHs do not require any treatment. In the past few years, topical beta blockers have been reported to be an effective treatment of superficial IHs.

Occupational mycosis fungoides – a case series

Mycosis fungoides (MF) is the most frequent type of cutaneous T‐cell lymphoma. MF has long been considered to develop as the result of a combination of genetic defects and exogenous triggers. Although no specific MF‐associated environmental trigger has been established to date, some studies have suggested that occupational exposures may occasionally trigger the onset of MF.

Topical pimecrolimus for paediatric cutaneous mastocytosis

Most cases of paediatric cutaneous mastocytosis (CM) occur before the age of 2 years, and regression occurs in only 67% of children. Given the absence of any specific therapy, CM is usually treated symptomatically. A few publications have reported the beneficial effect of calcineurin inhibitors for CM.