Lichen planus: a comprehensive evidence‐based analysis of medical treatment

Lichen planus (LP) is a chronic‐relapsing inflammatory skin disease. Although many drugs have been used for the management of LP, some of them lack the backup by strong therapeutic evidence, while others are not suitable for some patients due to safety profile issues. The aim of this study was to review the recent status of available medical therapies for LP to help physicians make better decisions upon best medical practice while facing patients with this condition. A review of published articles on management of LP was conducted with the MEDLINE and PubMed databases. The quality of the evidence was graded as high, moderate, low or very low. A total of 1366 articles were retrieved, and 219 (16%) were included in the final analysis. Twenty‐one different treatment modalities were analysed. The quality of evidence was high for topical steroid and calcineurin inhibitor, while it was moderate for oral steroids. All the other modalities reached low or very low quality of evidence. Topical steroids and calcineurin inhibitors are the current first‐line therapies, while for other therapies the strength of recommendation is not so evident. Unfortunately, larger randomized, controlled trials to support the efficacy, safety and tolerability of other therapies in LP are lacking, and many of them are recommended based on studies with small sample sizes, lack of standardized outcome measures or lack of controlled duration or even in anecdotal evidence. Thus, large‐scale randomized clinical trials are still warranted to establish the exact benefits of other topical treatments, phototherapy, immunosuppressant and new immunomodulators for an optimized treatment of LP.     

Speech evoked auditory brainstem response findings in children with epilepsy

Objectives

Children with epilepsy are at a considerable risk of cognitive impairment and school failure. Previous studies have typically documented abnormal responses in children with epilepsy at cortical level using speech stimuli. Recent studies reported that abnormal neural encoding of a speech syllable could be detected at the level of the brainstem using speech-evoked auditory brainstem response (ABR). The aim of this study is to investigate speech-evoked (ABR) results in children with epilepsy.

Methods

The study group consisted of 38 recently diagnosed epileptic children; none of them has received antiepileptic therapy. They were 22 males and 16 females with age 9.1 ± 3.1 years. The control group consisted of 38 healthy normal hearing children with matched age and gender distribution. All subjects underwent full history taking, basic audiologic evaluation including pure-tone, speech audiometry and immittance testing. Click ABR response was recorded monaurally from both ears at 90 dB nHL then speech ABR was recorded monaurally from each ear at 80 dB SPL.

Results

Though the study group disclosed normal click ABR compared to age matched normative values, speech-evoked ABR revealed a delayed waves V and A latencies in both ears. These findings reflect abnormal neural encoding of speech at the level of brainstem. The younger the age of epileptic child the more prolonged wave A latency and increased V/A inter-latency values.

Conclusions

Speech-evoked ABR results denote abnormal timing in the brainstem; such brainstem abnormality could be detected by speech evoked ABR rather than conventional click evoked ABR.     

Determinants of postoperative visual recovery in suprasellar meningiomas

Purpose  

Suprasellar meningiomas usually present with visual deterioration, including decreased visual acuity and/or visual field defects. Suprasellar meningiomas have a close relationship with the optic apparatus, arteries of the anterior circulation, pituitary stalk and hypothalamus, which makes safe surgical resection a challenge especially with dissection around an already compromised optic apparatus. In this report 21 patients operated on for a suprasellar meningioma over a 4-year period are reviewed. Postoperative outcome and visual recovery are evaluated, including analysis of its determinants.     

Rubella: Serosusceptibility among Egyptian females in late childhood and childbearing period

Our objective was to determine age-specific rubella susceptibility among Egyptian females. This was a cross-sectional survey in eight randomly selected communities, with the largest number of reported rubella cases in the 2007 Rubella surveillance. A sample of 5672 females between the ages of 6 and 45 years were interviewed. Of those 602 blood samples were obtained and tested for rubella IgG. The proportion of seronegative females was 9.7%. The highest proportion of susceptible females was in the ages between 6 and 25 years and the highest risk of susceptibility was among unmarried females [odds ratio (OR) = 7.2]. The knowledge of interviewed females about rubella, the vaccine and the effect rubella infection on pregnancy and on the fetus was very limited. In conclusion more vaccination coverage is needed, with simultaneous increase of public awareness to minimize the susceptible female population.     

Cosmeceuticals: peptides,proteins, and growth factors

Recent research advances in the molecular and biochemical processes involved in wound healing and skin aging have led to the development of innovative cosmeceuticals that rely on peptides, proteins, and growth factors to enhance skin health. Although the long‐term benefits of these products have not been fully tested and evaluated, evidence of the benefits derived from their use is steadily growing. This study describes the peptides, proteins, and growth factors that are most frequently used in cosmeceuticals and discusses their potential benefits and practical use in dermatology.     

Extragonadal primary yolk sac tumour of temporal bone

Yolk sac tumour, also known as endodermal sinus tumour (EST) is malignant germ cell tumours usually seen in children less than 3 years of age, involving the testis. We describe a rare case of extragonadal primary yolk sac tumour of the temporal bone in a 2.5 years old child presenting with a left sided post auricular mass and facial nerve palsy. Biopsy was consistent with yolk sac tumour showing expression of alpha fetoprotein. Patient was treated with chemotherapy including cisplatin, etoposide, and bleomycin. Post chemotherapy there was decrease in the swelling with improvement in facial nerve palsy.