Abstract: Background: The immune system plays an essential role in the clearance of warts, and thus recently there is a trend to use immunotherapy in wart treatment. Tuberculin-purified protein derivatives (PPDs) and zinc sulfate 2% were not previously compared regarding their efficacy in the treatment of warts. Objective: The aim of this study was to determine the efficacy and safety of intralesional (IL) immunotherapy with tuberculin PPD versus zinc sulfate 2% in multiple recalcitrant palmar and/or plantar warts. Patients and methods: Forty-five patients who presented with resistant palmar and/or plantar warts were divided randomly into two groups: the first group included 23 patients treated with IL tuberculin PPD, and the second group included 22 patients treated with IL zinc sulfate 2%. Results: The target wart in the tuberculin-PPD-treated group showed a statistically nonsignificant higher rate of complete clearance compared with the zinc sulfate 2%-treated group (87 vs. 72.7%, respectively). Partial response was seen in 13 versus 13.6% and no response was seen in 0 versus 13.6%. In untreated distant warts, the tuberculin-PPD-treated group showed statistically significant higher rates of complete response compared with the zinc sulfate 2%-treated group (73.9 vs. 40.9%, respectively); the partial response was 13 versus 36.4% and no response was 13 versus 22.7%, respectively. Conclusion: IL immunotherapy with tuberculin PPD was more effective than zinc sulfate 2% in the treatment of cutaneous warts. It is a simple, effective, safe procedure, with tolerable pain, and it may represent an alternative treatment for multiple resistant palmar and/or plantar warts. NULL

Abstract: Background: The immune system plays an essential role in the clearance of warts, and thus recently there is a trend to use immunotherapy in wart treatment. Tuberculin-purified protein derivatives (PPDs) and zinc sulfate 2% were not previously compared regarding their efficacy in the treatment of warts. Objective: The aim of this study was to determine the efficacy and safety of intralesional (IL) immunotherapy with tuberculin PPD versus zinc sulfate 2% in multiple recalcitrant palmar and/or plantar warts. Patients and methods: Forty-five patients who presented with resistant palmar and/or plantar warts were divided randomly into two groups: the first group included 23 patients treated with IL tuberculin PPD, and the second group included 22 patients treated with IL zinc sulfate 2%. Results: The target wart in the tuberculin-PPD-treated group showed a statistically nonsignificant higher rate of complete clearance compared with the zinc sulfate 2%-treated group (87 vs. 72.7%, respectively). Partial response was seen in 13 versus 13.6% and no response was seen in 0 versus 13.6%. In untreated distant warts, the tuberculin-PPD-treated group showed statistically significant higher rates of complete response compared with the zinc sulfate 2%-treated group (73.9 vs. 40.9%, respectively); the partial response was 13 versus 36.4% and no response was 13 versus 22.7%, respectively. Conclusion: IL immunotherapy with tuberculin PPD was more effective than zinc sulfate 2% in the treatment of cutaneous warts. It is a simple, effective, safe procedure, with tolerable pain, and it may represent an alternative treatment for multiple resistant palmar and/or plantar warts. NULL

Abstract BACKGROUND: Melasma is a common challenging pigmentary skin disorder especially in dark-skinned females urging them to seek medical help. Many modalities of treatment are available, but none is satisfactory. OBJECTIVE: To compare safety and efficacy of combined trichloroacetic acid (TCA) (20%-25%) and Jessner's solution versus TCA (20%-25%) alone in dark patients with melasma. MATERIALS AND METHODS: The study design was a split face, right-left, assessor-blinded, randomized controlled study. Twenty-four adult female patients (skin phototypes IV-V) with bilateral melasma were treated for 6 sessions at 2 weeks intervals. Clinical assessment of the 2 sides of the face with Melasma Area and Severity Index (MASI) score was performed, and photographs were taken before and after the peeling course. RESULTS: Both therapeutic modalities showed significant decrease in MASI score, which was significantly lower on the side treated with both Jessner solution and TCA. There were significant negative correlations between the percentage of improvement of MASI score and both age of the patients and duration of the melasma. CONCLUSION: Dark skin melasma can be treated with both regimens safely and effectively; however, combined Jessner solution and TCA is more effective.

Abstract BACKGROUND: Melasma is a common challenging pigmentary skin disorder especially in dark-skinned females urging them to seek medical help. Many modalities of treatment are available, but none is satisfactory. OBJECTIVE: To compare safety and efficacy of combined trichloroacetic acid (TCA) (20%-25%) and Jessner's solution versus TCA (20%-25%) alone in dark patients with melasma. MATERIALS AND METHODS: The study design was a split face, right-left, assessor-blinded, randomized controlled study. Twenty-four adult female patients (skin phototypes IV-V) with bilateral melasma were treated for 6 sessions at 2 weeks intervals. Clinical assessment of the 2 sides of the face with Melasma Area and Severity Index (MASI) score was performed, and photographs were taken before and after the peeling course. RESULTS: Both therapeutic modalities showed significant decrease in MASI score, which was significantly lower on the side treated with both Jessner solution and TCA. There were significant negative correlations between the percentage of improvement of MASI score and both age of the patients and duration of the melasma. CONCLUSION: Dark skin melasma can be treated with both regimens safely and effectively; however, combined Jessner solution and TCA is more effective.

Abstract BACKGROUND: Melasma is a common challenging pigmentary skin disorder especially in dark-skinned females urging them to seek medical help. Many modalities of treatment are available, but none is satisfactory. OBJECTIVE: To compare safety and efficacy of combined trichloroacetic acid (TCA) (20%-25%) and Jessner's solution versus TCA (20%-25%) alone in dark patients with melasma. MATERIALS AND METHODS: The study design was a split face, right-left, assessor-blinded, randomized controlled study. Twenty-four adult female patients (skin phototypes IV-V) with bilateral melasma were treated for 6 sessions at 2 weeks intervals. Clinical assessment of the 2 sides of the face with Melasma Area and Severity Index (MASI) score was performed, and photographs were taken before and after the peeling course. RESULTS: Both therapeutic modalities showed significant decrease in MASI score, which was significantly lower on the side treated with both Jessner solution and TCA. There were significant negative correlations between the percentage of improvement of MASI score and both age of the patients and duration of the melasma. CONCLUSION: Dark skin melasma can be treated with both regimens safely and effectively; however, combined Jessner solution and TCA is more effective.

Background and Objectives: Pre-kidney transplantation (pre-KT) duration of dialysis is the strongest modifiable risk factor for the KT outcome. Our aim is to trace the mode of changes of serum creatinine levels in early LDKT patients during the direct post-KT period. Patients and Methods: We prospectively followed the recipients of early LDKT; patients who received no dialysis (preemptive LDKT or group I) and those who received pre-KT dialysis ≤ 6 months (group II) in Misr Kidney Center and Giza Renal Center from June 2010 to June 2012. Means of serum creatinine levels were compared between the two groups at different time points through the direct post-KT period (days spent for reaching normal level, lowest level, abnormal rising attacks and level on discharge). Results: There were 30 patients in group I with a mean age of 43.7 years and 15 patients in group II with a mean age of 34.3 years. The means of days spent for reaching normal serum craetinine levels in group I (3.86 ± 5.20 days) and group II (3.36 ± 2.37 days) were similar (p=0.73). The mean of lowest serum creatinine levels were insignificantly lower in group I (0.93 ± 0.34 mg/dl) than in group II (1.05 ± 0.40 mg/dl) (p=0.28). The percentage of patients who exposed to attacks of abnormal serum creatinine level rising during the post-KT period was less in group I (10%) than in group II (33.4%), but was insignificant (p=0.054). Difference between means of serum creatinine levels on discharge in group I (1.07±0.63 mg/dl) and in group II (1.09±0.42 mg/dl) was insignificant (p=0.9). Conclusion: In the direct post-KT period, means of serum creatinine levels were insignificantly lower in PLDKT patients than in KT recipients after a period of pre-KT dialysis. They also, have less abnormal rising attacks.

Background and Objectives: Pre-kidney transplantation (pre-KT) duration of dialysis is the strongest modifiable risk factor for the KT outcome. Our aim is to trace the mode of changes of serum creatinine levels in early LDKT patients during the direct post-KT period. Patients and Methods: We prospectively followed the recipients of early LDKT; patients who received no dialysis (preemptive LDKT or group I) and those who received pre-KT dialysis ≤ 6 months (group II) in Misr Kidney Center and Giza Renal Center from June 2010 to June 2012. Means of serum creatinine levels were compared between the two groups at different time points through the direct post-KT period (days spent for reaching normal level, lowest level, abnormal rising attacks and level on discharge). Results: There were 30 patients in group I with a mean age of 43.7 years and 15 patients in group II with a mean age of 34.3 years. The means of days spent for reaching normal serum craetinine levels in group I (3.86 ± 5.20 days) and group II (3.36 ± 2.37 days) were similar (p=0.73). The mean of lowest serum creatinine levels were insignificantly lower in group I (0.93 ± 0.34 mg/dl) than in group II (1.05 ± 0.40 mg/dl) (p=0.28). The percentage of patients who exposed to attacks of abnormal serum creatinine level rising during the post-KT period was less in group I (10%) than in group II (33.4%), but was insignificant (p=0.054). Difference between means of serum creatinine levels on discharge in group I (1.07±0.63 mg/dl) and in group II (1.09±0.42 mg/dl) was insignificant (p=0.9). Conclusion: In the direct post-KT period, means of serum creatinine levels were insignificantly lower in PLDKT patients than in KT recipients after a period of pre-KT dialysis. They also, have less abnormal rising attacks.

Background and Objectives: Pre-kidney transplantation (pre-KT) duration of dialysis is the strongest modifiable risk factor for the KT outcome. Our aim is to trace the mode of changes of serum creatinine levels in early LDKT patients during the direct post-KT period. Patients and Methods: We prospectively followed the recipients of early LDKT; patients who received no dialysis (preemptive LDKT or group I) and those who received pre-KT dialysis ≤ 6 months (group II) in Misr Kidney Center and Giza Renal Center from June 2010 to June 2012. Means of serum creatinine levels were compared between the two groups at different time points through the direct post-KT period (days spent for reaching normal level, lowest level, abnormal rising attacks and level on discharge). Results: There were 30 patients in group I with a mean age of 43.7 years and 15 patients in group II with a mean age of 34.3 years. The means of days spent for reaching normal serum craetinine levels in group I (3.86 ± 5.20 days) and group II (3.36 ± 2.37 days) were similar (p=0.73). The mean of lowest serum creatinine levels were insignificantly lower in group I (0.93 ± 0.34 mg/dl) than in group II (1.05 ± 0.40 mg/dl) (p=0.28). The percentage of patients who exposed to attacks of abnormal serum creatinine level rising during the post-KT period was less in group I (10%) than in group II (33.4%), but was insignificant (p=0.054). Difference between means of serum creatinine levels on discharge in group I (1.07±0.63 mg/dl) and in group II (1.09±0.42 mg/dl) was insignificant (p=0.9). Conclusion: In the direct post-KT period, means of serum creatinine levels were insignificantly lower in PLDKT patients than in KT recipients after a period of pre-KT dialysis. They also, have less abnormal rising attacks.

Background and Objectives: Pre-kidney transplantation (pre-KT) duration of dialysis is the strongest modifiable risk factor for the KT outcome. Our aim is to trace the mode of changes of serum creatinine levels in early LDKT patients during the direct post-KT period. Patients and Methods: We prospectively followed the recipients of early LDKT; patients who received no dialysis (preemptive LDKT or group I) and those who received pre-KT dialysis ≤ 6 months (group II) in Misr Kidney Center and Giza Renal Center from June 2010 to June 2012. Means of serum creatinine levels were compared between the two groups at different time points through the direct post-KT period (days spent for reaching normal level, lowest level, abnormal rising attacks and level on discharge). Results: There were 30 patients in group I with a mean age of 43.7 years and 15 patients in group II with a mean age of 34.3 years. The means of days spent for reaching normal serum craetinine levels in group I (3.86 ± 5.20 days) and group II (3.36 ± 2.37 days) were similar (p=0.73). The mean of lowest serum creatinine levels were insignificantly lower in group I (0.93 ± 0.34 mg/dl) than in group II (1.05 ± 0.40 mg/dl) (p=0.28). The percentage of patients who exposed to attacks of abnormal serum creatinine level rising during the post-KT period was less in group I (10%) than in group II (33.4%), but was insignificant (p=0.054). Difference between means of serum creatinine levels on discharge in group I (1.07±0.63 mg/dl) and in group II (1.09±0.42 mg/dl) was insignificant (p=0.9). Conclusion: In the direct post-KT period, means of serum creatinine levels were insignificantly lower in PLDKT patients than in KT recipients after a period of pre-KT dialysis. They also, have less abnormal rising attacks.

Background and Objectives: Restoration of normal hemoglobin (Hb) level is an advantage of kidney transplantation (KT). Our aim is to study the magnitude of improvement in Hb levels during the first year of preemptive living donor kidney transplantation (PLDKT). Patients and Methods: We prospectively studied the Hb levels in two groups of KT patients in Misr Kidney Center and Giza Renal Center from June 2010 to June 2012. Group I included patients who received no pre-KT dialysis (PLDKT) and group II included patients who received pre-KT dialysis for ≤ 6 months. Hb levels were followed and compared directly before discharge and at 1, 3, 6, 9, and 12 months post-KT. Normal Hb level was defined as > 13 g/dl for males and > 12 g/dl for females. Results: Group I included 30 patients (20 males and 10 females) and group II included 15 patients (9 males and 6 females). On discharge means (± Standard Deviation) of Hb levels between group I (8.39 ± 1.04 g/dl) and group II (8.85 ± 1.52 g/dl) were similar (p=0.23). In group I and inspite of being below the normal values, means of Hb levels after 1, 3, 6, 9, and 12 months were 10.23±1.24 g/dl, 11.20±1.21 g/dl, 11.55±1.36 g/dl, 11.76±1.63 g/dl and 11.97±1.60 g/dl, respectively, with a significant improvement (p=0.00). In group II, means of Hb levels at the same time points were 10.13±1.85 g/dl, 11.55±1.11 g/dl, 12.43±1.33 g/dl, 12.63±1.44 g/dl and 13.07±1.40 g/dl, respectively, with a significant improvement (p=0.00) to reach the normal values after 6 months. The improvement in means of Hb levels were significantly better in group II after 6 months (p=0.048) and 12 months (p=0.048) than in group I. Conclusion: During the second half of the first post-KT year, the means of Hb levels improved significantly to normal values in group II and to near normal values in group I.