Hair restoration approaches for early onset male androgenetic alopecia

Society places great emphasis on the presence of hair. Some degree of hair loss is accepted as a normal part of the aging process, in line with the observation that more than 50% of men will develop androgenetic alopecia by the age of 50 years. However, it is possible to understand the psychosocial isolation and distress felt by men with a strong familial predisposition to androgenetic alopecia, who tend to display hair loss in their late teens or twenties. There are currently two drugs which have been licensed for the treatment of male androgenetic alopecia: oral finasteride and topical minoxidil solution which are effective to some extent. Furthermore, upon discontinuing treatment, any gain that has been achieved is quickly lost. Added to which there is an entire market of unproven over the counter products: advertised in the electronic media, local hair salons, and various departmental stores. In this review, we highlight the important advances in the management of male androgenetic alopecia with emphasis on approaches that can lead to more successful and long‐term hair restoration for young adults. In particular, we discuss the evidence supporting the use of the follicular unit grafting technique in conjunction with medical treatment before and after the procedure. Moreover, some other alterations of this most popular state of the art hair restoration technique have been mentioned briefly. As a result, patients and physicians seem equally satisfied from this procedure for its naturally looking results which are cosmetically more acceptable and esthetically pleasing for longer period of time.     

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369μm, ±0.233, 0.133± 0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm ±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P<0.01) and total spherical aberration (P<0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P=0.05). Mesopic pupil size in the myopic group was larger (P≤0.05). CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.     

Prevalence and risk indicators of gingivitis and periodontitis in a Multi-Centre study in North Jordan: a cross sectional study

Background  

There are limited data about the epidemiology and risk factors/indicators of gingivitis, aggressive periodontitis (AgP) and chronic periodontitis (CP) in Jordan. The aim of this study was to assess the prevalence and risk indicators of gingivitis, AgP and CP.     

Involvement of platelet-activating factor in ultraviolet B-induced hyperalgesia

Ultraviolet B (UVB) radiation causes cutaneous inflammation. One important clinical consequence of UVB-induced inflammation is increased pain or hyperalgesia, which is likely mediated by enhanced sensitivity of cutaneous sensory neurons. Previous studies have demonstrated that UVB radiation generates the lipid mediator, platelet-activating factor (PAF), as well as oxidized phospholipids that act as PAF-mimetics. These substances exert effects through the PAF receptor (PAF-R). This study was designed to assess whether PAF-R is involved in UVB-induced hyperalgesia. Intradermal injection of carbamoyl PAF (CPAF; 1-hexadecyl-2-N-methylcarbamoyl glycerophosphocholine) resulted in an enhanced response to mechanical stimuli in wild-type mice but not in PAF-R knockout (KO) mice. There was no significant change in paw withdrawal to noxious thermal stimuli in either genotype after intradermal injection of CPAF. Exposure of the hind paw to 1,500 J m(-2) UVB radiation caused an increased sensitivity to both mechanical and thermal stimulation in wild-type mice but not in PAF-R KO mice. The thermal hyperalgesia caused by UVB irradiation was inhibited in mice that lacked PAF-R in bone marrow-derived cells. These data demonstrate that the PAF-R is important for UVB-induced hyperalgesia. Further investigation of the role of PAF-R signaling in UVB-induced hyperalgesia could provide better understanding of the pathological processes initiated by UVB-induced skin damage.     

Global gene expression analysis of keloid fibroblasts in response to electron beam irradiation reveals the involvement of interleukin-6 pathway

Keloid is a dermal fibroproliferative lesion of unknown etiology that commonly recurs after surgical excision. Post-operative adjuvant electron beam (EB) irradiation has been successfully used to reduce keloid recurrences. To provide new insights into the molecular mechanism behind the effect of EB irradiation, we used a cDNA microarray screening of more than 5000 genes to assess early changes in gene expression between EB-irradiated and non-irradiated keloid and non-lesional dermal fibroblasts. Primary fibroblast cultures from keloid and associated non-lesional dermis obtained from five patients were exposed to 15 Gy EB irradiation and analyzed after 15 min incubation. Early response to EB irradiation showed that 96 (1.8%) genes were modulated 2-fold or more in keloid fibroblasts. Upregulated genes accounted for 29.2% (28 genes), whereas downregulated genes comprised 70.8% (68 genes), indicating a silencing of many genes in keloid fibroblasts after EB irradiation. Many of the downregulated genes play roles in the enhancement of cell proliferation and extracellular matrix production, whereas several of the upregulated genes involves in the promotion of apoptosis and extracellular matrix (ECM) degradation. Using emerging bioinformatic tools and further corroboration, the interleukin 6 (IL-6) signaling pathway was found to be mainly involved in EB irradiation response. We also showed co-expression of IL-6 and its specific receptor (IL-6Ralpha) in keloid fibroblasts that points to the existence of an IL-6 autocrine loop in these cells. These results suggested that at the molecular level, EB irradiation might hinder keloid formation by regularizing disturbances in the homeostatic equilibrium between inducer and inhibitor activities in the matrix system most likely through the IL-6 pathway. Our study provides clues for the molecular mechanism(s) behind the beneficial effect of EB irradiation in reducing keloid recurrences and may help develop alternative strategies for the therapy and prophylaxis of this lesion.     

Intravitreal bevacizumab (Avastin) injection for neovascular glaucoma

Neovascular glaucoma is a secondary glaucoma with grave prognosis which follows ischemic retinal disorders in the majority of cases. Mediators that induce new vessel formation such as the vascular endothelial growth factor-A seem to play a key role in the pathophysiology of this condition. Herein, we report 2 cases with neovascular glaucoma secondary to ischemic central retinal vein occlusion who received treatment with intravitreal bevacizumab (Avastin) a nonselective antibody against vascular endothelial growth factor-A. Both patients demonstrated dramatic short-term response in terms of intraocular pressure reduction and regression of neovascularization.     

Inner retinal abnormalities in X-linked retinitis pigmentosa with RPGR mutations

PURPOSE: To investigate in vivo the retinal microstructure in X-linked retinitis pigmentosa (XLRP) caused by RPGR mutations as a prelude to treatment initiatives for this common form of RP. METHODS: Patients with RPGR-XLRP (n = 12; age range, 10-56 years) were studied by optical coherence tomography (OCT) in a wide region of central retina. Overall retinal thickness and outer nuclear layer (ONL) and inner retinal parameters across horizontal and vertical meridians were analyzed and compared. RESULTS: Retinal architecture of all patients with RPGR mutations was abnormal. At the fovea in younger patients, the ONL could be normal; but, at increasing eccentricities, there was a loss of photoreceptor laminar structure, even at the youngest ages studied. At later ages and advanced disease stages, the ONL was thin and reduced in extent. Inner retinal thickness, in contrast, was normal or hyperthick. Inner retinal thickening was detectable at all ages studied and was strongly associated with ONL loss. CONCLUSIONS: Inner retinal laminar abnormalities in RPGR-XLRP are likely to reflect a neuronal-glial retinal remodeling response to photoreceptor loss and are detectable relatively early in the disease course. These results should be factored into emerging therapeutic strategies for this form of RP.     

Lens opacities in adults in Pakistan: prevalence and risk factors

PURPOSE: To investigate the prevalence and risk factors for lens opacity (LO) amongst a nationally representative sample of the adult population of Pakistan. METHODS: This national study of blindness and visual impairment (adults > or =30 years) used multistage, stratified, cluster random sampling. Grading of LO was conducted using the Mehra/Minassian classification system. LO, partly or wholly obscuring the red reflex, or previous cataract surgery were indicators of opacity. RESULTS: 16,402 (94.7%) adults were included in this analysis (study conducted 2002-2003). A total of 4,096 (standardized prevalence 20.9%, 95%CI: 20.3, 21.5%) adults were found to have LO. The highest prevalence of LO was found in Punjab province (22.2%), the lowest in Balochistan Province (18.0%). Significant positive associations were increasing age (multivariable odds ratio (OR) 3.2: 95%CI: 3.1, 3.4), hypertension (OR 1.2, 95%CI: 1.1, 1.3), history of diabetes (OR 2.6: 95%CI 2.0, 3.2) and smoking (OR 1.3: 95%CI: 1.1, 1.5). Higher body mass index (BMI) (OR 0.8: 95%CI 0.7, 0.9, heavy vs. normal BMI) and attendance to school (OR 0.6: 95%CI: 0.5, 0.8) were associated with lower risk of LO. Individuals in districts classified as hot were at significantly increased risk (OR 1.3: 95%CI: 1.1, 1.5), and those in wet districts (> 600 mm annual rainfall) had lower odds than individuals living in dry districts (OR 0.7: 95%CI: 0.6, 0.8). CONCLUSIONS: Almost a fifth of the adult population had LO. Significant positive associations were age, smoking status, hypertension, diabetes, and increased deprivation level. Protective factors included high BMI and educational achievement. The climatic associations offer novel hypothesis for further research into cataractogenesis.     

Treatment of axillary hyperhidrosis with botulinum-A toxin

BACKGROUND: Severe axillary hyperhidrosis is a source of great embarrassment and considerable emotional stress to individuals afflicted with this condition. Existing topical and surgical therapies are either ineffective or associated with unacceptable morbidity. We attempt to determine the effect of botulinum-A toxin (Dysport) in the treatment of axillary hyperhidrosis. PATIENTS AND METHODS: After visualization of hyperhidrosis using the iodine-starch test, 10 patients with axillary hyperhidrosis underwent intradermal injection with 125 units of Dysport on each axilla. Patients were observed for 7 months after treatment. RESULTS: The treatment was well tolerated without side-effects. All patients experienced relatively complete anhidrosis of the axillary skin after about 1 week for periods ranging from 4 to 7 months. CONCLUSIONS: Botulinum-A toxin may offer a fast, safe, and highly effective therapeutic option for severe hyperhidrosis.