Sara Mahmoud

Enhanced efficacy of pegylated interferon alpha-2a over pegylated interferon and ribavirin in chronic hepatitis C genotype 4A randomized trial and quality of life analysis

Aim: The therapy of chronic hepatitis C genotype 4 (HCV‐4) has not been optimized yet. This randomized, prospective, parallel‐group clinical trial compared the efficacy and safety of pegylated interferon α‐2a (PEG‐IFN α‐2a) plus ribavirin and PEG‐IFN α‐2b plus ribavirin and assessed the health‐related quality of life (HRQOL) in patients with chronic HCV‐4.

Host and Viral Determinants of the Outcome of Exposure to HCV Infection Genotype 4: A Large Longitudinal Study

OBJECTIVES:The objective of this study was to characterize the factors that influence the outcome of exposure to hepatitis C virus (HCV) genotype 4 (HCV-G4) and the course of recent infection.METHODS:In this longitudinal study, we prospectively assessed the clinical, genetic, virological, and immunological parameters and retrospectively determined single-nucleotide polymorphisms at interleukin-28B (IL-28B) rs12979860 in a well-characterized large cohort recently exposed to HCV-G4.RESULTS:A total of 136 subjects with acute HCV (new viremia, seroconversion, and HCV-specific T-cell responses) were identified. Forty-eight subjects (35%) had spontaneous viral clearance and 88 subjects developed chronic HCV of which 42 subjects were treated with pegylated interferon monotherapy, with a sustained virologic response (SVR) rate of 88%. Twenty-six subjects developed HCV-specific T-cell immune responses without detectable viremia or seroconversion. IL-28B-CC (odds ratio (OR) 14.22; P<0.0001), multispecific T-cell responses (OR=11.66; P<0.0001), >300 IU/l alanine aminotransferase (ALT) decline within 4 weeks (OR=6.83; P<0.0001), jaundice (OR=3.54; P=0.001), female gender (OR=2.39; P=0.007), and >2.5 log10 HCV-RNA drop within 8 weeks (OR=2.48; P=0.016) were independently associated with spontaneous clearance. ALT normalization and undetectable HCV-RNA predicted SVR. Exposed apparently uninfected participants had a higher frequency of IL-28B-CC than patients with unresolved acute HCV (P<0.001). IL-28B-CC was associated with multispecific T-cell response (r2=0.0.835; P<0.001).CONCLUSIONS:IL-28B-CC genotype, multispecific HCV T-cell responses, rapid decline in ALT, and viral load predict spontaneous clearance and response to acute HCV-G 4 therapy. IL-28B-CC genotype correlates with developing early multispecific T-cell responses. These findings have important implications for predicting the outcome of HCV exposure and acute infection and identifying patients likely to benefit from therapy.

Study of mast cell count in skin tags

Background: Skin tags or acrochordons are common tumors of middle-aged and elderly subjects. They consist of loose fibrous tissue and occur mainly on the neck and major flexures as small, soft, pedunculated protrusions. Objectives: The aim was to compare the mast cells count in skin tags to adjacent normal skin in diabetic and nondiabetic participants in an attempt to elucidate the possible role of mast cells in the pathogenesis of skin tags. Participants and Methods: Thirty participants with skin tags were divided into group I (15 nondiabetic participants) and group II (15 diabetic participants). Three biopsies were obtained from each participant: a large skin tag, a small skin tag and adjacent normal skin. Mast cell count from all the obtained sections was carried out, and the mast cell density was expressed as the average mast cell count/high power field (HPF). Results: A statistically significant increase in mast cells count in skin tags in comparison to normal skin was detected in group I and group II. There was no statistically significant difference between mast cell counts in skin tags of both the groups. Conclusion: Both the mast cell mediators and hyperinsulinemia are capable of inducing fibroblast proliferation and epidermal hyperplasia that are the main pathologic abnormalities seen in all types of skin tags. However, the presence of mast cells in all examined skin tags regardless of diabetes and obesity may point to the possible crucial role of mast cells in the etiogenesis of skin tags through its interaction with fibroblasts and keratinocytes.

Assessment of vitamin D receptors in alopecia areata and androgenetic alopecia.

Alopecia areata (AA) is a frequent autoimmune disease, the pathogenesis of which is still unknown. Androgenetic alopecia (AGA) is a noncicatricial type of patterned hair loss. Expression of vitamin D receptors (VDRs) on keratinocytes is essential for maintenance of normal hair cycle, especially anagen initiation.

Prevalence of photosensitivity in chronic hepatitis C virus patients and its relation to serum and urinary porphyrins.

HCV is a major cause of chronic liver disease in Egypt. The aim was to study the prevalence of photosensitivity among asymptomatic HCV‐infected patients and its possible relation to porphyrins levels and whether it can be considered an alarm for early diagnosis of the disease, which is the most important goal in the management.

Assessment of tissue levels of dickkopf-1 in androgenetic alopecia and alopecia areata

Androgenetic alopecia (AGA) is the commonest form of hair loss in men. Alopecia areata (AA) is an organ‐specific autoimmune disease. Studies revealed that Dickkopf 1 (DKK‐1), a powerful suppressor of the Wnt/β‐catenin signaling pathway, induced anagen‐to‐catagen transition in mice. Moreover, in vitro studies suggested that DKK‐1 played a role in dihydrotestosterone (DHT)‐induced balding.

Assessment of gene expression levels of proopiomelanocortin (POMC) and melanocortin-1 receptor (MC1R) in vitiligo.

Proopiomelanocortin (POMC) and melanocortin 1 receptor (MC1R) are regulators of melanogenesis and pigmentation. Our objective was to estimate their levels, searching for a possible role of the melanocortin system in vitiligo. This study included 40 vitiligo patients and 40 controls. Skin biopsies were taken from lesional and non‐lesional skin of patients and from the non‐sun exposed skin of controls to detect the expression of POMC and MC1R using quantitative real‐time polymerase chain reaction. Both factors were significantly lower in lesional than non‐lesional skin and controls, while they were significantly higher in non‐lesional skin than in controls. There was a statistically significant positive correlation between lesional levels of POMC and MC1R, as well as between non‐lesional levels of POMC and MC1R in the patients. On the other hand, we found a statistically significant negative correlation between the lesional and non‐lesional levels of POMC, as well as between the lesional and non‐lesional levels of MC1R in the patients. As a conclusion, the melanocortin system could play a role in the pathogenesis of vitiligo or could be affected as the end result of the disease.

Assessment of serum levels of cathelicidin and vitamin D in acne vulgaris

BackgroundAntimicrobial peptides, including cathelicidin, play a dual role in acne vulgaris: a protective role by acting against Propionibacterium acnes, or a proinflammatory role by acting as signaling molecules. Vitamin D is an important regulator of cathelicidin expression. ObjectiveTo evaluate serum levels of cathelicidin and vitamin D in a group of Egyptian patients with acne vulgaris in comparison with controls, to explore the complex relationship between them and shed more light on their possible role in the pathogenesis of acne vulgaris. Patients and methodsThis study included 60 patients with acne vulgaris and 60 healthy controls. Blood samples were obtained from all participants for the estimation of serum levels of cathelicidin and vitamin D using enzyme-linked immunosorbent assay. ResultsThe study revealed a significantly higher serum cathelicidin levels in acne patients compared with controls. Serum vitamin D levels were lower in acne patients compared with controls, with no significant difference. There was a statistically significant negative correlation between serum vitamin D and serum cathelicidin in both groups. ConclusionSignificantly higher serum cathelicidin levels were detected in acne patients compared with controls, suggesting that cathelicidin may play a role in the pathogenesis of acne vulgaris and may provide a possible therapeutic target for future treatment. In addition, lower (although nonsignificant) serum vitamin D levels were detected in patients, suggesting a possible role for vitamin D supplementation in acne treatment.

Human β-defensin-2 expression in the scales of pityriasis versicolor and psoriasis

BackgroundHuman &bgr;-defensin-2 (hBD-2) is a cysteine-rich, cationic, low-molecular-weight antimicrobial peptide, first extracted from psoriatic scales. Pityriasis versicolor (PV) is a common superficial fungal infection, in which the causative organisms are limited to the stratum corneum. ObjectiveTo compare the degree of expression of hBD-2 in the skin of both PV and psoriasis to clarify the specificity of hBD-2 in infective and noninfective dermatoses. Patients and methodsThis study included 17 patients with PV, 15 patients with psoriasis, and 10 healthy controls. Skin scrapings were obtained from all participants for estimation of hBD-2 levels in the scales using enzyme-linked immunosorbent assay. ResultsThe study revealed significantly higher hBD-2 levels in the scales of PV, as well as of psoriasis, in comparison with controls. ConclusionhBD-2 is a nonspecific antimicrobial peptide that is overexpressed equally in both infective (PV) and noninfective (psoriasis) cutaneous disorders, encouraging further investigations on its role in immune regulation and antimicrobial defense.