Intralesional injection of 2% zinc sulfate solution in the treatment of acute old world cutaneous leishmaniasis: a randomized, double-blind, controlled clinical trial

Several in vitro and in vivo studies have shown inhibitory effects of zinc sulfate (ZnSO4) on Leishmania parasites. The objective of this study was to compare the efficacy of intralesional injections of 2% ZnSO4 solution with meglumine antimonate (Glucantime) in the treatment of acute Old World cutaneous leishmaniasis (CL). Seventy-two patients with CL lesions less than 8 weeks were recruited in a randomized, double-blind, clinical trial in an area endemic for Leishmania major after giving written informed consent. They were treated with 6 weekly intralesional injections of either drug. Among 36 patients with 53 lesions treated with ZnSO4 and 36 patients with 53 lesions treated with Glucantime, 13 patients with 19 lesions and 22 patients with 31 lesions completed the trial, respectively. Inadequacy of treatment was the main reason for drop-out in 12 (33.3%) and 2 (5.5%) patients in ZnSO4 and Glucantime groups, respectively (P < .05). Complete re-epithelialization was observed in 2 (10.5%) and 19 (61.3%) lesions 1 week after the end of treatment in the ZnSO4 and Glucantime groups, respectively (P < .05). In conclusion a 6-week course of weekly intralesional injections of 2% ZnSO4 solution was less effective than Glucantime in the treatment of acute Old World CL.     

Value of pretransplantation cytokine profiles for predicting acute rejection in renal transplant recipients

Episodes of acute rejection may represent an important risk factor for the development of chronic allograft nephropathy. Various studies have shown that pretransplant cytokine profiles in recipient blood are associated with transplant outcome. Serum samples were collected 24 hours before transplantation from 57 patients (38 men and 19 women of age 36 +/- 5 years) receiving kidneys from unrelated living donors. Additional samples were collected at 1 and 2 weeks after transplantation, as well as during every rejection episode. The immunosuppression consisted of a cyclosporine, prednisolone, and mycophenolate mofetil. Among the transplanted patients, 19 (33.3%) individuals experienced an acute rejection episode based on an increased level of serum creatinine and blood urea nitrogen during the first 14 days after transplantation. TGF-beta, IL-2 and IFN-gamma serum levels were determined by an ELISA method using Bindermed system kits. The mean concentration of TGF-beta before transplantation tended to be lower among patients with acute rejection episodes compared to those with stable graft (75,265 versus 85,394 pg/mL; P = .34) and at 1 week after transplantation (77,558 versus 84,390 pg/mL), although the differences were not significant. Among patients with rejection the mean IL-2 concentration was significantly higher before, at 1 week, and at 2 weeks after transplantation (15.0 versus 6.8 pg/mL, P = .005; 19.0 versus 4.9 pg/mL, P = .001; and 21.1 versus 4.7 pg/mL, P = .0001). The mean concentration of IFN-gamma was significantly higher pre- and at 1 and 2 weeks posttransplantation in patients with acute rejection episodes (161.1 versus 65.2, 175.6 versus 66.5 and 173.7 versus 77.1 pg/mL, all P < .001). In conclusion, evaluation of Th1 cytokines before transplantation may represent valuable predictive marker for an acute rejection episode.     

Fertility and contraceptive issues after kidney transplantation in women

PURPOSE: Our purpose was to investigate reproductive performance among kidney transplant recipients. MATERIALS AND METHODS: We studied 126 kidney transplanted women 15 to 68 years of age including 33 who were single and 93 who were married. RESULTS: Infertility was seen in 10.4% of those who desired pregnancy, a rate similar to the general population. The most common method of contraception was coitus interruptus (56%), 22% of patients had tubal ligation, 6% had husbands who had vasectomies, 14% were using condoms, and only 2% used oral contraceptives. Among 33 pregnancies, 16 were unintended (48.5%). Most of the patients with unwanted pregnancy were using coitus interruptus (93.7%). In the group with unintended pregnancy, abortion was induced in three, spontaneous abortion or intrauterine fetal death occurred in six, and only seven pregnancies resulted in a live birth (43.7%). CONCLUSION: Kidney transplantation greatly improves fertility, so those who do not desire pregnancy should be protected by an effective method of contraception.     

Macular amyloidosis: an assessment of prevalence, sex, and age

Macular amyloidosis is a relatively common cutaneous disease in Asia and the Middle East. It is characterized by a reticulated or rippled pattern of pigmentation mostly in the upper back. This study was performed not only to determine the disease sex and age distribution, but also to evaluate its risk factors and the frequency among the dermatology clinic patients. Based on the clinical and random histopathologic findings, 100 macular amyloidosis patients were evaluated in a period of 3 years. Although the sex distribution (9 : 1, female : male ratio) differed dramatically from most of the previous reports, it was consistent with few other series. Eighty one percent of patients were between 21 and 50 years of age. The mean age of the female patients was higher than that of the males (difference of two means was 10.26 years and P = 0.027). Backscatching during bathing probably is not a common practice in Iran, therefore we could not consider this as a risk factor in our study. We found no evidence of any other associated risk factors.     

Precise intraoperative location of gastrointestinal bleeding with a hand-held counter. Work in progress

The nuclear medicine bleeding scan is frequently insufficient to locate sites of bleeding precisely, in spite of its great sensitivity. A small, hand-held Geiger-Müller counter, placed directly on exposed intestine in the operating room, enables precise location of the probable bleeding site. In three patients, the technique allowed a minimal amount of intestine to be resected, distinguished between large- and small-intestinal hemorrhage, and eliminated other foci as sites of bleeding.