Systems immunology of transcriptional responses to viral infection identifies conserved antiviral pathways across macaques and humans

Viral pandemics and epidemics pose a significant global threat. While macaque models of viral disease are routinely used, it remains unclear how conserved antiviral responses are between macaques and humans. Therefore, we conducted a cross-species analysis of transcriptomic data from over 6,088 blood samples from macaques and humans infected with one of 31 viruses. Our findings demonstrate that irrespective of primate or viral species, there are conserved antiviral responses that are consistent across infection phase (acute, chronic, or latent) and viral genome type (DNA or RNA viruses). Leveraging longitudinal data from experimental challenges, we identify virus-specific response kinetics such as host responses to Coronaviridae and Orthomyxoviridae infections peaking 1-3 days earlier than responses to Filoviridae and Arenaviridae viral infections. Our results underscore macaque studies as a powerful tool for understanding viral pathogenesis and immune responses that translate to humans, with implications for viral therapeutic development and pandemic preparedness.

Global and cell type-specific immunological hallmarks of severe dengue progression identified via a systems immunology approach

Severe dengue (SD) is a major cause of morbidity and mortality. To define dengue virus (DENV) target cells and immunological hallmarks of SD progression in children's blood, we integrated two single-cell approaches capturing cellular and viral elements: virus-inclusive single-cell RNA sequencing (viscRNA-Seq 2) and targeted proteomics with secretome analysis and functional assays. Beyond myeloid cells, in natural infection, B cells harbor replicating DENV capable of infecting permissive cells. Alterations in cell type abundance, gene and protein expression and secretion as well as cell-cell communications point towards increased immune cell migration and inflammation in SD progressors. Concurrently, antigen-presenting cells from SD progressors demonstrate intact uptake yet impaired interferon response and antigen processing and presentation signatures, which are partly modulated by DENV. Increased activation, regulation and exhaustion of effector responses and expansion of HLA-DR-expressing adaptive-like NK cells also characterize SD progressors. These findings reveal DENV target cells in human blood and provide insight into SD pathogenesis beyond antibody-mediated enhancement.

Single B cell transcriptomics identifies multiple isotypes of broadly neutralizing antibodies against flaviviruses

Sequential dengue virus (DENV) infections often generate neutralizing antibodies against all four DENV serotypes and sometimes, Zika virus. Characterizing cross-flavivirus broadly neutralizing antibody (bnAb) responses can inform countermeasures that avoid enhancement of infection associated with non-neutralizing antibodies. Here, we used single cell transcriptomics to mine the bnAb repertoire following repeated DENV infections. We identified several new bnAbs with comparable or superior breadth and potency to known bnAbs, and with distinct recognition determinants. Unlike all known flavivirus bnAbs, which are IgG1, one newly identified cross-flavivirus bnAb (F25.S02) was derived from IgA1. Both IgG1 and IgA1 versions of F25.S02 and known bnAbs displayed neutralizing activity, but only IgG1 enhanced infection in monocytes expressing IgG and IgA Fc receptors. Moreover, IgG-mediated enhancement of infection was inhibited by IgA1 versions of bnAbs. We demonstrate a role for IgA in flavivirus infection and immunity with implications for vaccine and therapeutic strategies.

Single B cell transcriptomics identifies multiple isotypes of broadly neutralizing antibodies against flaviviruses

Sequential dengue virus (DENV) infections often generate neutralizing antibodies against all four DENV serotypes and sometimes, Zika virus. Characterizing cross-flavivirus broadly neutralizing antibody (bnAb) responses can inform countermeasure strategies that avoid infection enhancement associated with non-neutralizing antibodies. Here, we used single cell transcriptomics to mine the bnAb repertoire following secondary DENV infection. We identified several new bnAbs with comparable or superior breadth and potency to known bnAbs, and with distinct recognition determinants. Unlike all known flavivirus bnAbs, which are IgG1, one newly identified cross-flavivirus bnAb (F25.S02) was derived from IgA1. Both IgG1 and IgA1 versions of F25.S02 and known bnAbs displayed neutralizing activity, but only IgG1 enhanced infection in monocytes expressing IgG and IgA Fc receptors. Moreover, IgG-mediated enhancement of infection was inhibited by IgA1 versions of bnAbs. We demonstrate a role for IgA in flavivirus infection and immunity with implications for vaccine and therapeutic strategies.

Magnitude and kinetics of the human immune cell response associated with severe dengue progression by single-cell proteomics

Approximately 5 million dengue virus-infected patients progress to a potentially life-threatening severe dengue (SD) infection annually. To identify the immune features and temporal dynamics underlying SD progression, we performed deep immune profiling by mass cytometry of PBMCs collected longitudinally from SD progressors (SDp) and uncomplicated dengue (D) patients. While D is characterized by early activation of innate immune responses, in SDp there is rapid expansion and activation of IgG-secreting plasma cells and memory and regulatory T cells. Concurrently, SDp, particularly children, demonstrate increased proinflammatory NK cells, inadequate expansion of CD16⁺ monocytes, and high expression of the FcγR CD64 on myeloid cells, yet a signature of diminished antigen presentation. Syndrome-specific determinants include suppressed dendritic cell abundance in shock/hemorrhage versus enriched plasma cell expansion in organ impairment. This study reveals uncoordinated immune responses in SDp and provides insights into SD pathogenesis in humans with potential implications for prediction and treatment.

In vitro characterization and clinical evaluation of skin hydration by two formulations mimicking the skin's natural components

BACKGROUND

We have developed innovative base formulations that were designed to mimic the skin with respect to its components and galenic structure. Components include water, proteins, lipids, sugars and minerals.

OBJECTIVES

We characterized formulations and their skin penetration using in vitro methods and evaluated their impact on skin hydration in a clinical trial.

METHODS

Scanning electron microscopy (SEM) imaging and X-ray diffraction were used to analyse formulations as well as formulation impact on the stratum corneum (SC) structure. Mass spectrometry imaging (MSI) was used to compare formulation ingredients with SC components and to detect their distribution in the skin. Clinical studies were performed to confirm effects on skin hydration and investigate potential adverse skin effects (irritation and sensitization).

RESULTS

SEM and X-ray diffraction of the formulations showed that lipids were organized in sheets similar to SC lipids. MSI demonstrated similarities between formulation components and skin constituents, as well as a good penetration into the skin. The formulations did not modify the lamellar organization of the SC lipids, but they increased the relative proportion of the crystallized lipids and some of the amorphous lipids. In in vivo studies, a high level of hydration was maintained over 24 h after application with an intense and 'very good hydration'. Both formulations were shown to be non-(photo)sensitizers with excellent tolerance. Sensorial evaluation indicated the formulations were not oily or sticky and maintained the skin's suppleness over time. Formulations had a 'nude skin' touch and created a natural protective film.

CONCLUSIONS

The two formulations were well-tolerated and increased skin hydration in clinical subjects, an effect that could contribute to the alleviation of sensitive skin. The formulations were shown to resemble the lipid organization of the stratum corneum, as well as penetrate the skin without disrupting the lipid lamella organization.

Human monocyte-derived macrophages inhibit HCMV spread independent of classical antiviral cytokines

Infection of healthy individuals with human cytomegalovirus (HCMV) is usually unnoticed and results in life-long latency, whereas HCMV reactivation as well as infection of newborns or immunocompromised patients can cause life-threatening disease. To better understand HCMV pathogenesis we studied mechanisms that restrict HCMV spread. We discovered that HCMV-infected cells can directly trigger plasmacytoid dendritic cells (pDC) to mount antiviral type I interferon (IFN-I) responses, even in the absence of cell-free virus. In contrast, monocyte-derived cells only expressed IFN-I when stimulated by cell-free HCMV, or upon encounter of HCMV-infected cells that already produced cell-free virus. Nevertheless, also in the absence of cell-free virus, i.e., upon co-culture of infected epithelial/endothelial cells and monocyte-derived macrophages (moMΦ) or dendritic cells (moDC), antiviral responses were induced that limited HCMV spread. The induction of this antiviral effect was dependent on cell-cell contact, whereas cell-free supernatants from co-culture experiments also inhibited virus spread, implying that soluble factors were critically needed. Interestingly, the antiviral effect was independent of IFN-γ, TNF-α, and IFN-I as indicated by cytokine inhibition experiments using neutralizing antibodies or the vaccinia virus-derived soluble IFN-I binding protein B18R, which traps human IFN-α and IFN-β. In conclusion, our results indicate that human macrophages and dendritic cells can limit HCMV spread by IFN-I dependent as well as independent mechanisms, whereas the latter ones might be particularly relevant for the restriction of HCMV transmission via cell-to-cell spread.

Context-sensitive recovery of neuromuscular function from vecuronium in dogs: Effects of dose and dosing protocol

Recovery of neuromuscular function is a gradual phenomenon whereby function progresses from absent to normal. The speed of spontaneous recovery can be used to predict the time when neuromuscular function is expected to be restored. However, the speed of recovery might be affected by the dose of the neuromuscular blocker administered, and by the dosing regimen of that dose. The effects of both factors on the speed of spontaneous recovery from vecuronium were evaluated. Seven dogs were anesthetized three times and the train-of-four (TOF) ratio was measured with acceleromyography. Vecuronium was administered at 0.1 mg/kg, 0.2 mg/kg, or 0.1 mg/kg followed by two doses of 0.05 mg/kg was administered each time. In the divided-dose treatment group, aliquots were administered on return of the first twitch (T1) of the TOF from the previous dose. The duration of surgical block, from injection to return of T1, was longest for the divided-dose protocol, intermediate for 0.2 mg/kg single bolus, and shortest for 0.1 mg/kg (P <  0.0001). The recovery period, from return of T1 to a TOF ratio ≥0.9, was longer for 0.2 mg/kg administered as a single bolus than for the other two groups (P = 0.007). Doubling the dose of a single bolus of vecuronium extended the time of surgical block and prolonged the duration of the recovery period. However, dividing that dose into smaller aliquots extended the period of surgical block while shortening the recovery period. Hence, the spontaneous reappearance of T1 should not be used in isolation to predict the time to complete recovery of neuromuscular function.

Type I IFN and not TNF, is Essential for Cyclic Di-nucleotide-elicited CTL by a Cytosolic Cross-presentation Pathway

Cyclic di-nucleotides (CDN) are potent stimulators of innate and adaptive immune responses. Cyclic di-AMP (CDA) is a promising adjuvant that generates humoral and cellular immunity. The strong STING-dependent stimulation of type I IFN represents a key feature of CDA. However, recent studies suggested that this is dispensable for adjuvanticity. Here we demonstrate that stimulation of IFN-γ-secreting CD8⁺ cytotoxic T lymphocytes (CTL) is significantly decreased after vaccination in the absence of type I IFN signaling. The biological significance of this CTL response was confirmed by the stimulation of MHC class I-restricted protection against influenza virus challenge. We show here that type I IFN (and not TNF-α) is essential for CDA-mediated cross-presentation by a cathepsin independent, TAP and proteosome dependent cytosolic antigen processing pathway, which promotes effective cross-priming and further CTL induction. Our data clearly demonstrate that type I IFN signaling is critical for CDN-mediated cross-presentation.

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Cyclic di-AMP is a potent adjuvant with a proven capacity to promote cellular and humoral immunity.

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It was postulated that type I IFN is irrelevant for CDA-generated immunity.

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We show that CDA-mediated IFN-α/β signaling is essential for cytosolic cross-presentation, generating CTL by cross-priming.

Antigen cross-presentation generates cross-priming of CD8 cytotoxic T cells (CTL), which kill intracellular pathogens and cancer cells. The generation of CTL is the main feature of cyclic di- nucleotide adjuvants (CDN). The production of type I IFN has been shown to be essential for the generation of CTL by other adjuvants, but not for cyclic di-AMP, a paramount CDN. Surprisingly, it was recently claimed that type I IFN is dispensable for the immunogenicity of CDN. We show here that type I IFN (and not TNF) is necessary for the cytosolic cross-presentation pathway activated by CDN, which results in CTL generation. This finding and the knowledge of the mechanism are of crucial importance for the safe development of CDN-adjuvanted vaccines.

Persistent hepatic venous plexus in a patient with Sturge-Weber syndrome

A patient with extensive facial and intracranial features of Sturge-Weber syndrome was found to have a persistent primitive hepatic venous plexus, characterized by three additional vessels arising from the inferior vena cava, circulating between liver segments, which formed a common trunk in the supra-hepatic region that flowed into the right atrium. To the best of our knowledge, this hepatic finding has not been previously described in association with Sturge-Weber syndrome.

Sesquiterpene lactone mix patch testing supplemented with dandelion extract in patients with allergic contact dermatitis, atopic dermatitis and non-allergic chronic inflammatory skin diseases

We investigated the value of patch testing with dandelion (Compositae) extract in addition to sesquiterpene lactone (SL) mix in selected patients. After we detected a case of contact erythema multiforme after patch testing with dandelion and common chickweed (Caryophyllaceae), additional testing with common chickweed extract was performed. A total of 235 adults with a mean age of 52.3 years were tested. There were 66 men and 169 women: 53 consecutive patients with allergic contact dermatitis (ACD); 43 with atopic dermatitis (AD); 90 non-atopics suffering from non-allergic chronic inflammatory skin diseases; 49 healthy volunteers. All were tested with SL mix 0.1% petrolatum (pet.) and diethyl ether extracts from Taraxacum officinale (dandelion) 0.1 and 3.0% pet. and from Stellaria media (common chickweed) 0.1 and 3% pet. A total of 14 individuals (5.9%) showed allergic reaction (AR) to at least 1 of the plant allergens, 4 (28.6%) to common chickweed extract, and 11 (78.6%) to Compositae allergens. These 11 persons made the overall prevalence of 4.7%: 8 (3.4%) were SL-positive and 3 (1.3%) reacted to dandelion extract. 5 persons (45.5%) had AD, 2 had ACD, 2 had psoriasis and 2 were healthy controls. The Compositae allergy was relevant in 8 cases (72.7%). The highest frequency of SL mix sensitivity (9.3%) was among those with AD. Half the SL mix-sensitive individuals had AD. ARs to dandelion extract were obtained only among patients with eczema. A total of 9 irritant reactions (IRs) in 9 individuals (3.8%) were recorded, 8 to SL mix and 1 to common chickweed extract 3.0% pet. No IR was recorded to dandelion extract (P = 0.007). Among those with relevant Compositae allergy, 50.0% had AR to fragrance mix and balsam of Peru (Myroxylon pereirae resin) and colophonium. SLs were detected in dandelion but not in common chickweed. Our study confirmed the importance of 1 positive reaction for emerging, not fully established, Compositae allergy. In conclusion, the overall prevalence of 4.7% in our study represents a basal SL mix detection rate of 3.4% reinforced and safely supplemented by testing with the dandelion extract.

Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers

The aim of this study was to determine the therapeutic efficacy of marigold (Calendula officinalis) extract on the epithelialization of lower leg venous ulcers. The experiment was carried out in 34 patients with venous leg ulcers. The patients were divided into two groups. In the first (experimental) group, patients were treated with an ointment containing marigold extract, which was prepared in an apparatus devised by Soxleth and was incorporated into a neutral base. Twenty-one patients with 33 venous ulcers were treated. Therapy was applied twice a day for 3 weeks. The second group was a control group that consisted of 13 patients with 22 venous ulcers. In the control group, saline solution dressings were applied to ulcers for 3 weeks. In the experimental group the total surface of all the ulcers at the beginning of the therapy was 67,544 mm2. After the third week the total surface of all the ulcers was 39,373 mm2 (a decrease of 41.71%). In seven patients, complete epithelialization was achieved. In the control group the total surface of all the ulcers at the beginning of the therapy was 69,722 mm2. After the third week the total surface of all the ulcers was 58,743 mm2 (a decrease of 14.52%). In four patients, complete epithelialization was achieved. There was a statistically significant acceleration of wound healing in the experimental group (p < 0.05). The results obtained are preliminary, but they suggest the positive effects of the ointment with marigold extract on venous ulcer epithelialization.

[Chronic venous insufficiency and compression therapy]

INTRODUCTION

Disorders of venous circulation are among most frequent diseases in the human population. During recent years there has been increased interest in physiopathology of chronic venous insufficiency (CVI), due to development of more accurate diagnostic methods and new therapeutic techniques. Considering patophysiology of CVI and its consequences the crucial points are stasis and reflux of blood flow, with increase of intravascular pressure.

CLASSIFICATION AND THERAPY OF CVI

Empirical experience and theoretical models suggest that progression of the disease can be stopped or reverted by correction of stasis. Today, this is the main direction in all therapeutic approaches. Compression therapy represents the most successful conservative technique. In this article we are presenting basic principles of the compression therapy of CVI. Evidence for the physiologic effect of compression therapy are decrease of edema, softening of lipodermatosclerosis, acceleration of venous flow, decrease in venous volume, blood shift into central compartments, reduction of venous refluxes, influence on arterial flow and improvement of microcirculation and lymph drainage. There are several types of compression devices: elastic stockings, elastic bandages, inelastic bandages, intermittent pneumatic compression devices. Other advantages of compression therapy are decrease of hospital treatment and better quality of life for patients with CVI.

[Microcirculatory changes in chronic venous insufficiency]

INTRODUCTION

The venous system of lower leg can be topographically divided into two subsystems: superficial (extrafascial) and profound (subfascial). Functionally, we can divide circulation in to macrocirculation (arteries and veins) and microcirculation (arterioles, capillaries, and venules). Blood flow towards heart can be disturbed by different pathological conditions, and than chronic venous insufficiency (CVI) develops. First alterations occurs in macrocirculation, and after some period changes in microcirculation also appear. Those changes are leading to the ultimate stage in CVI--venous ulcer.

RESULTS AND DISCUSSION

Previous conceptions that alterations in microcirculation in CVI are consequences of venous stasis, high pressure in capillaries and anoxic tissue are still actual. Observations that partial pressure of oxygen is higher in venous blood of lower limbs with ulceration than in limbs without ulceration lead to hypothesis that blood is passing directly from arterioles to venules over arterio-venous temperature-regulating shunts in dermis. Histological and electron-microscopic examinations certain alterations in the structure of capillaries. Raised pressure in these altered capillaries leads to exudation of plasma and fibrinogen in the interstitial space. Soluble fibrinogen is transformed to insoluble fibrin and forms fibrin cuffs. These cuffs are a barrier for normal diffusion of oxygen. Recently, it was observed that blood cells can adhere to the endothelial cells--Leukocyte trapping hypothesis. It can be explained by slower blood flow velocity and also by expression of certain endothelial and leukocyte adhesion molecules intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1). This causes congestion of white blood cells which leads to tissue damage due to secretion of inflammatory mediators.

Access to emergency contraception

OBJECTIVE

To evaluate access to emergency contraception among women seeking help from clinicians who registered to be listed on the Emergency Contraception Hotline (1-888-NOT-2-LATE, ie, 1-888-668-2528) and the Emergency Contraception Website (not-2-late.com).

METHODS

Two college-educated investigators posing as women who had a condom break the previous night called 200 providers to seek help.

RESULTS

Only 76% of attempts resulted in an appointment or telephone prescription from a hotline provider within 72 hours, 14% were failures, and 11% resulted in referrals to other providers not listed on the hotline or website.

CONCLUSION

Even under ideal conditions, access to emergency contraception is currently constrained. Although emergency contraception could reduce significantly the incidence of unintended pregnancy and the consequent need for abortion, its potential will not be realized unless women have better access to clinicians who can prescribe emergency contraceptive pills.

The "boom and bust phenomenon": the hopes, dreams, and broken promises of the contraceptive revolution

The "boom and bust phenomenon" is a pattern that has emerged in the development, introduction, and delivery of a number of significant new contraceptive products in the United States. When a new contraceptive product is introduced with great promise and publicity, it usually experiences a "boom" during which sales, demand, and expectations are high. This boom is often followed by a "bust" phase during which a product does not live up to expectations, initial excitement falls off, and a drop in sales and use ensues. The boom and bust phenomenon goes to the heart of what some have referred to as the failed promise of the contraception revolution by creating obstacles to significant expansion of contraceptive choice in the United States. Case studies of oral contraceptives, intrauterine devices, and Norplant(R) are used to illustrate the boom and bust phenomenon and the effect it has had in shaping the direction of advances in contraceptive technology.

[The Koebner phenomenon, a prognostic sign of PUVA therapy effectiveness in patients with psoriasis vulgaris--yes or no?]

INTRODUCTION

Former investigations of Koebner phenomenon had demonstrated its higher incidence in patients with severe generalized and/or unstable forms of psoriasis which expressed increased resistance to various treatment modalities. The aim of this study was to establish the correlation between the presence of Koebner phenomenon and the PUVA therapy effects, total number of PUVA treatments, total dose of UVA radiation and the duration of remission after PUVA therapy discontinuation.

MATERIAL AND METHODS

Sixty patients with severe clinical picture of psoriasis vulgaris, treated with PUVA therapy, were included in this research. According to the presence of Koebner phenomenon they were divided into two groups, 20 patients with positive and 40 patients with negative Koebner reaction, who were the control group at the same time.

RESULTS AND DISCUSSION

95% of patients treated with PUVA, were cleared of psoriatic changes in the Koebner positive, as well as in the Koebner negative group. There were also no differences between the Koebner positive and Koebner negative group in the mean number of PUVA treatments, mean total dose and the last dose of UVA radiation, which led up to the clinical remission of psoriasis. Our results of investigation have demonstrated increased relapse of psoriasis, during the first 6 months after cessation of PUVA therapy, in the Koebner positive group, with a high statistical significance (p < 0.001), comparing with Koebner negative group in the same period. Furthermore, the tendency of relapse of Koebner positive and Koebner negative psoriatic patients was higher in Koebner positive group even in the first 3 months after PUVA therapy.

CONCLUSIONS

PUVA therapy effects, total number of PUVA treatments, total dose of UVA radiation didn't depend on presence of Koebner phenomenon. However, Koebner phenomenon was a mark of high relapsing tendency of psoriasis in the first 6 months after PUVA therapy cessation.

[Persistent dyschromic erythema]

INTRODUCTION

Erythema dyschromicum perstans (ashy dermatosis) is a very rare skin disease included in the group of acquired, idiopathic hypermelanosis, with development of blue-gray macules. This disease appears more frequently in dark coloured persons, especially women in the first and second life decade.

CASE REPORT

A male patient, 42 years of age, was admitted to Clinic of Dermatovenereology in Novi Sad due to appearance of slightly pruriginous, brown-reddish macules on the trunk, upper and lower extremities, without affecting the skin of the face, scalp, palm soles and visible mucous membranes. Later, the color of the macules changed into blue-gray and new lesions appeared in axilla and flexor side of the big joints, with active, erythematous and thin raised borders. Laboratory findings showed no abnormalities; antinuclear antibodies were negative. Histopathological examination of the skin specimens (which were taken from two different places) showed vacuolar degeneration of the basal cell layer, numerous pigmentophages in papillary dermis and presence of lymphohistiocytic infiltrate in dermis. No history of drug intake or exposure to UV light was established.

DISCUSSION

Ashy dermatosis is included in the group of hypermelanosis of unknown origin. As possible etiological factors we can mention ingestion of ammonium nitrate, environmental pollution, hypersensitivity to cobalt chloride and postinflammatory pigmentation. Clinical characteristics: occurrence of blue-gray and gray macules on the trunk, face, neck and extremities (absence on the palms, soles, visible mucous membranes, scalp and nails). In the active phase of the disease, these macules are surrounded by erythematous and thin, raised borders. The lesions are mostly permanent. Due to clinical, histopathological, immunofluorescent and electron microscopy established similarities with lichen planus, it is considered that ashy dermatosis is a variant of lichen planus. Absence of previous drug intake, exposure to UV light, absence of the antinuclear antibodies, clinical picture and histological findings confirm the diagnosis of erythema dyschromicum perstans.

CONCLUSION

This case of ashy dermatosis shows that there is a need for differential diagnosis of acquired skin pigmentations, because this dermatosis must also be taken into consideration.

[Case report of Klippel-Trenaunay-Weber syndrome]

This is a case report on a very rare and interesting clinical form of a generalized nevus flammeus as a part of Klippel-Trenaunay-Weber syndrome. Authors point to necessity of cooperation among dermatologists and other specialists in treatment and follow-up of such diseases.

[Modern psychosomatic aspects of dermatology]

Concerning their origin most diseases are multifactorial and that goes for skin diseases too. Emphasizing just one must not exclude further research and other aspects of etiopathogenetic mechanisms. It has been known for along time that psychological factors have a certain influence on the start, aggravation and maintenance on skin changes and that cosmetic defects of this kind disturb the psychological peace of the sick person and his capacity of establishing satisfactory social relations. Psychosomatic approach in dermatology cannot be reduced to investigation of specific etiology in the field of psyche without physical or social spheres. It unites all of them and in that way the old question what cause and what the consequence is has no importance, because there is no time or distance limit among them. They act simultaneously, holistically.

[Epidemiological characteristic of basocellular skin epitheliomas treated at the Department of Dermatovenereal Diseases in Novi Sad]

The authors review some of the epidemiological characteristics of epithelioma basocellulare (EB) of the skin, showing the incidence of 2.39% of the cases treated for EB of the skin from 1984 to 1990, derived from the total of 61,384 initial examinations carried out in this period at the Department of Dermatovenereal Diseases in Novi Sad. The mean age of the patients was 64.42, the male-female ratio was slightly in favor of the females, 1:1.25. As for localization, EB of the skin were most frequently found on the face, head and neck (87.16%). Regarding occupation of the patients on the top were retired people (47.17%) and agricultural workers (33.02%) and regarding the place of living, most were found in the rural population (68.07). The mean time the treated patients came for a check-up was 1.26 year after the onset of the tumor. Relapses were found in 18 cases (1.23%). The mean time of their occurrence after the rtg therapy was 1.9 year. Familial predisposition for skin tumors was detected in 232 cases (15.79%).

[Skin and laboratory tests: comparison of the epicutaneous patch test with the TTL and LIF tests in the diagnosis of medicamentous allergic contact dermatitis]

We investigated 158 patients from 15 to 82 years of age with clinically evident contact dermatitis, diagnosed at the Department for Allergic Diseases Investigations-Clinic for Dermatovenerological Diseases, Medical Faculty in Novi Sad, during the period of 1 year. We performed patch-epicutaneous test, lymphocyte transformation test (TTL) and leukocyte migration inhibition test (LIF). Among the 130 (82.2%) patients suffering from contact dermatitis, with the positive patch tests to commercial or standard battery epicutaneous allergens, 26 (20%) had at least one positive patch test to the medicament. In these cases contact allergic medicamentous dermatitis (SAMD) was proved by positive clinical and allergic investigations. In only one case, patch test was negative, with booth the TTL and LIF test positive. Among the medicaments TTL and LIF tested, antibiotics were the most frequent in 9 (34.61%) cases, analgetics were found in 6 (23.08%). Professional contact allergy to medicaments has been estimated in 5 patients (19.23%). According to the obtained results and statistic findings, relationships between the two variables-TTL and patch test, and LIF and patch test, were estimated due to the contact allergy to medicaments. Both of them were low and negative without statistic significance. Patch test remains to be the irreplaceable test with regard to CAMD.

[Impetigo herpetiformis-Hebra and pregnancy]

A patient is presented who developed impetigo herpetiformis-Hebra for the first time in her 19th year, one month before a normal delivery. The child is alive and in good health. The second time the disease appeared after three years, in the 20th gestational week of the woman's new pregnancy when because of her bad general condition, pronounced skin changes, and a very high temperature (up to 41 degrees C) the artificial interruption of pregnancy was carried out by using Prostin 15M-Upjohn. She was given a total of 6 ml Prostin in two doses, and the abortion period lasted 17 hours. After abortion, the acrocyanosis of the feet and wrists appeared (after the application of Methergin). A general and symptomatic therapy was applied and the patient recovered in 24 hours. Skin and her general condition improved, and after 10 days she was discharged, and since that time (April 1984) she has had no symptoms of the disease.