The effects of exposure to solar radiation on human health

This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.

Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, Update 2021

The Environmental Effects Assessment Panel of the Montreal Protocol under the United Nations Environment Programme evaluates effects on the environment and human health that arise from changes in the stratospheric ozone layer and concomitant variations in ultraviolet (UV) radiation at the Earth’s surface. The current update is based on scientific advances that have accumulated since our last assessment (Photochem and Photobiol Sci 20(1):1–67, 2021). We also discuss how climate change affects stratospheric ozone depletion and ultraviolet radiation, and how stratospheric ozone depletion affects climate change. The resulting interlinking effects of stratospheric ozone depletion, UV radiation, and climate change are assessed in terms of air quality, carbon sinks, ecosystems, human health, and natural and synthetic materials. We further highlight potential impacts on the biosphere from extreme climate events that are occurring with increasing frequency as a consequence of climate change. These and other interactive effects are examined with respect to the benefits that the Montreal Protocol and its Amendments are providing to life on Earth by controlling the production of various substances that contribute to both stratospheric ozone depletion and climate change.

In vitro toxicological assessment of flumethrin's effects on MCF-7 breast cancer cells

Pyrethroid pesticides are frequently used for household insect control of insects and in agriculture and livestock. Flumethrin is a pyrethroid that is used against ectoparasites in many animals. The goal of this study was to evaluate the cytotoxic, apoptotic, genotoxic, and estrogenic effects of flumethrin on the mammalian breast cancer cell line (MCF-7). Compared with control groups, a dose-dependent decrease was observed in cell viability at concentrations of 100 µM and higher. The cytotoxic and apoptotic effects detected by LDH assay and AO/EtBr staining increased significantly at a concentration of 1000 µM. The expression of BCL2, which is an anti-apoptotic gene, significantly decreased, whereas BAX, TP53, and P21 expression significantly increased. The results of a comet assay indicated that flumethrin significantly changed tail length, tail % DNA, tail moment, and Olive tail moment in concentrations above 1 and 10 µM. In addition, a 0.1 µM concentration of flumethrin affected ERα receptor mediated cell proliferation and increased transcription of estrogen-responsive pS2 (TFF1) and progesterone receptor (PGR) genes. As a result, flumethrin-induced apoptosis and cytotoxicity at a high concentration, while induced genotoxicity even at lower concentrations. Flumethrin is an endocrine disrupting insecticide with estrogenic effects at very low concentrations.

Large solitary scalp metastasis of renal cell carcinoma: A case report

Renal cell carcinoma (RCC) can metastasize to various organs of the body. The skin is an uncommon site for metastasis. However, if metastasis to skin occurs, scalp is a common area. We present a 77-year-old male patient, with a 12-year history of RCC. In the current presentation, he was hospitalized due to hematuria, fatigue, electrolyte imbalance, and deteriorating kidney functions. After the patient was stabilized, he was referred to the plastic surgery clinic due to an unusual, extremely large, hemorrhagic, ulcerative, and vegetative mass on his scalp. Total excision of the scalp mass was performed and, it was noted that the calvarium was intact and the defect was grafted. Histology report of the specimen confirmed to metastatic RCC. Clinicians need to keep in mind that large cutaneous lesion can be a metastasis from an internal malignancy.

Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, Update 2020

This assessment by the Environmental Effects Assessment Panel (EEAP) of the United Nations Environment Programme (UNEP) provides the latest scientific update since our most recent comprehensive assessment (Photochemical and Photobiological Sciences, 2019, 18, 595-828). The interactive effects between the stratospheric ozone layer, solar ultraviolet (UV) radiation, and climate change are presented within the framework of the Montreal Protocol and the United Nations Sustainable Development Goals. We address how these global environmental changes affect the atmosphere and air quality; human health; terrestrial and aquatic ecosystems; biogeochemical cycles; and materials used in outdoor construction, solar energy technologies, and fabrics. In many cases, there is a growing influence from changes in seasonality and extreme events due to climate change. Additionally, we assess the transmission and environmental effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the COVID-19 pandemic, in the context of linkages with solar UV radiation and the Montreal Protocol.

Environmental effects of stratospheric ozone depletion, UV radiation and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2019

This assessment, by the United Nations Environment Programme (UNEP) Environmental Effects Assessment Panel (EEAP), one of three Panels informing the Parties to the Montreal Protocol, provides an update, since our previous extensive assessment (Photochem. Photobiol. Sci., 2019, 18, 595-828), of recent findings of current and projected interactive environmental effects of ultraviolet (UV) radiation, stratospheric ozone, and climate change. These effects include those on human health, air quality, terrestrial and aquatic ecosystems, biogeochemical cycles, and materials used in construction and other services. The present update evaluates further evidence of the consequences of human activity on climate change that are altering the exposure of organisms and ecosystems to UV radiation. This in turn reveals the interactive effects of many climate change factors with UV radiation that have implications for the atmosphere, feedbacks, contaminant fate and transport, organismal responses, and many outdoor materials including plastics, wood, and fabrics. The universal ratification of the Montreal Protocol, signed by 197 countries, has led to the regulation and phase-out of chemicals that deplete the stratospheric ozone layer. Although this treaty has had unprecedented success in protecting the ozone layer, and hence all life on Earth from damaging UV radiation, it is also making a substantial contribution to reducing climate warming because many of the chemicals under this treaty are greenhouse gases.

Salvage local fasciocutaneous flap for T-junction tissue defect in inverted T-scar reduction mammoplasty

Macromastia can cause serious psychological problems in women as well as psychosocial problems due to esthetic appearances. For this reason, proper technique in breast reduction surgery yields a dramatic physical and psychological improvement for the patient. Inverted T-scar breast reduction using the inferior pedicle technique is the most commonly used breast reduction method. The most common complication in this technique regards wound healing at the T-junction area. There are no literature reports citing the use of local flaps for the repair of tissue defects in the T-junction area following reduction mammoplasty. In this study, we present a case of using a salvaged local, Limberg-like fasciocutaneous flap for tissue defect repair at the T-junction area after the inverted T-scar reduction mammoplasty using an inferior pedicle.

Idiopathic Pulmonary Hypertension After Liver Transplantation

Pulmonary hypertension is one of the problems that can be encountered before liver transplantation. It is not expected in cases with no additional disease in postoperative period. Herein, we report on a 43-year-old woman who developed idiopathic pulmonary hypertension in the early postoperative period. Further investigation both pathologically and clinically is needed in patients undergoing living donor liver transplantation that may help to solve the problems such as pulmonary arterial hypertension before it occurs and manage complex hemodynamic changes successfully in the future.

Human health in relation to exposure to solar ultraviolet radiation under changing stratospheric ozone and climate

The Montreal Protocol has limited increases in the UV-B (280-315 nm) radiation reaching the Earth's surface as a result of depletion of stratospheric ozone. Nevertheless, the incidence of skin cancers continues to increase in most light-skinned populations, probably due mainly to risky sun exposure behaviour. In locations with strong sun protection programs of long duration, incidence is now reducing in younger age groups. Changes in the epidemiology of UV-induced eye diseases are less clear, due to a lack of data. Exposure to UV radiation plays a role in the development of cataracts, pterygium and possibly age-related macular degeneration; these are major causes of visual impairment world-wide. Photodermatoses and phototoxic reactions to drugs are not uncommon; management of the latter includes recognition of the risks by the prescribing physician. Exposure to UV radiation has benefits for health through the production of vitamin D in the skin and modulation of immune function. The latter has benefits for skin diseases such as psoriasis and possibly for systemic autoimmune diseases such as multiple sclerosis. The health risks of sun exposure can be mitigated through appropriate sun protection, such as clothing with both good UV-blocking characteristics and adequate skin coverage, sunglasses, shade, and sunscreen. New sunscreen preparations provide protection against a broader spectrum of solar radiation, but it is not clear that this has benefits for health. Gaps in knowledge make it difficult to derive evidence-based sun protection advice that balances the risks and benefits of sun exposure.

Environmental effects of ozone depletion, UV radiation and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2017

The Environmental Effects Assessment Panel (EEAP) is one of three Panels of experts that inform the Parties to the Montreal Protocol. The EEAP focuses on the effects of UV radiation on human health, terrestrial and aquatic ecosystems, air quality, and materials, as well as on the interactive effects of UV radiation and global climate change. When considering the effects of climate change, it has become clear that processes resulting in changes in stratospheric ozone are more complex than previously held. Because of the Montreal Protocol, there are now indications of the beginnings of a recovery of stratospheric ozone, although the time required to reach levels like those before the 1960s is still uncertain, particularly as the effects of stratospheric ozone on climate change and vice versa, are not yet fully understood. Some regions will likely receive enhanced levels of UV radiation, while other areas will likely experience a reduction in UV radiation as ozone- and climate-driven changes affect the amounts of UV radiation reaching the Earth's surface. Like the other Panels, the EEAP produces detailed Quadrennial Reports every four years; the most recent was published as a series of seven papers in 2015 (Photochem. Photobiol. Sci., 2015, 14, 1-184). In the years in between, the EEAP produces less detailed and shorter Update Reports of recent and relevant scientific findings. The most recent of these was for 2016 (Photochem. Photobiol. Sci., 2017, 16, 107-145). The present 2017 Update Report assesses some of the highlights and new insights about the interactive nature of the direct and indirect effects of UV radiation, atmospheric processes, and climate change. A full 2018 Quadrennial Assessment, will be made available in 2018/2019.

Multiple prenatal ultrasound scans and ocular development: 20-year follow-up of a randomized controlled trial

OBJECTIVES

Through comprehensive ophthalmic examination of adult offspring we sought to determine the impact of multiple prenatal ultrasound scans on ocular development.

METHODS

2743 pregnant women recruited to the Western Australian Pregnancy (Raine) Cohort study during 1989-1991 were randomized to receive at King Edward Memorial Hospital, Western Australia either multiple prenatal ultrasound scans and Doppler flow studies (intensive group) or a single ultrasound scan at 18 weeks' gestation. Neonatal birth weight of the offspring and other physical measurements were collected prospectively. At age 20 years, participants underwent a comprehensive ophthalmic examination including measurement of ocular biometry and visual acuity.

RESULTS

Complete data were available for 1134 adult offspring participants. The mothers of 563 of these had been randomized to receive multiple prenatal ultrasound scans. The mean age of participants at follow-up was 20.0 years. There was no statistically significant difference between the two groups with regard to ocular biometric or visual outcomes, except for slightly higher intraocular pressure identified in individuals exposed to multiple ultrasound scans (P = 0.034). Although infants in the intensive-ultrasound arm were more likely to have birth weights in the lower quartiles, this was not reflected in adult eye development. Axial length, lens thickness, corneal curvature and thickness and optic cup to disc ratio (a risk factor for glaucomatous optic neuropathy) were not significantly influenced by the more frequent ultrasound protocol.

CONCLUSIONS

Prior to this study, there was a paucity of safety data for ultrasound with regard to eye development. We found that frequent in-utero exposure to ultrasound, including B-mode imaging and the use of spectral Doppler mode from 18 weeks' gestation, had no significant impact on visual outcomes or ocular biometry.

Magnesium, zinc and copper status in osteoporotic, osteopenic and normal post-menopausal women

Serum concentrations of magnesium, zinc and copper were measured in postmenopausal women with osteoporosis (n = 40), osteopenia (n = 40) or normal bone mineral density (n = 40) as classified on the basis of the T-score of the femur neck and dual energy X-ray absorptiometry results. Mean concentrations of magnesium and zinc were significantly lower in osteoporotic women than in both osteopenic women and normal women. In addition, magnesium and zinc concentrations in osteopenic women were significantly lower than in normal women. There were no statistically significant differences observed between the osteopenic, osteoporotic and control groups with respect to copper levels. The clinical significance of these changes needs further elucidation, but trace element supplementation, especially with magnesium and zinc and perhaps copper, may have beneficial effects on bone density.

Serum malondialdehyde levels in patients infected with Plasmodium vivax

Malondialdehyde, a lipid peroxide, may be used as an indicator of oxidative stress. This study investigated the oxidative stress hypothesis in patients infected with Plasmodium vivax. Serum malondialdehyde (MDA) concentration activity was measured in 87 patients. Scores were obtained for the patients and 60 seronegative healthy controls matched for age and gender. The difference between MDA levels of patients infected with Plasmodium vivax and the control group was statistically significant both for females (p < 0.001) and males (p < 0.001). In the patient and control group, no correlation was found between age and malondialdehyde levels (p > 0.05) in both females and males. In addition, no significant correlation could be found between MDA levels of both females and males for patients and control group (p > 0.05). MDA levels were increased in the patients infected with Plasmodium vivax.

A dynamic study of the thermal components in electrical injury mechanism for better understanding and management of electric trauma: an animal model

The thermal effects of acute electric trauma to living cells show some variation patterns and kinetics for different body components (muscle, bone, blood-vein and skin). Thermal energy transfer is random with no preferred directions, but electrical energy transfer is vectorial in the direction of the current. In the present study, a total 50 white male Wistar Albino rats, body weight 250-300 g, have been used to study electrical injury mechanism with subsequent change in muscle perfusion at different post-traumatic stages. The muscle temperature was found to increase with a sudden jump from 35.3+/-1.2 to 75.2+/-7.6 degrees C. The bone temperature increased from 35.2+/-1.4 to 45.8+/-1.2 degrees C and decayed slowly within 600+/-90 s. The venous blood curves show a similar pattern to that of muscle with a sudden jump of temperature from 36.4+/-.9 to 40.5+/-3.1 degrees C. The core temperature showed a flat pattern with a slight increase from 36.1+/-0.8 to 37.3+/-0.6 degrees C and the peak temperature was found after 70+/-10 s. From the scintigraphic study, muscle perfusion was found to be a minimum 72 h after electric shock. The right hind limbs of all the rats (ground) exhibited more intense histopathological damages (electric burns) than the left fore limb (source).

Identification of Borrelia burgdorferi sensu lato, Anaplasma and Ehrlichia species, and spotted fever group Rickettsiae in ticks from Southeastern Europe

Prevalence data for tick-borne pathogens are used to assess the risk for human health. In this study the presence and identity of Borrelia burgdorferi sensu lato, Ehrlichia, Anaplasma, and Rickettsia species in Bulgarian Ixodes ricinus ticks and in non- Ixodes ticks from Turkey and Albania was determined by polymerase chain reaction (PCR) and reverse line blot hybridization. In the adult Bulgarian ticks, the prevalence of Borrelia burgdorferi sensu lato infection was approximately 40%, while Borrelia afzelii was the predominant species, representing more than half of all Borrelia-positive ticks. Ehrlichia and Anaplasma species were detected in 35% of the adult Ixodes ricinus ticks and in 10% of the nymphs. Sequence analysis of PCR products reacting with the Anaplasma phagocytophila probe revealed a 16S rRNA gene identical to that of the Anaplasma phagocytophila prototype strain. Ehrlichia and Anaplasma species were found in approximately 7% of the non- Ixodes ticks. Sequence analysis of some of these samples revealed the presence of Anaplasma ovis, Ehrlichia canis, and a species closely resembling Ehrlichia chaffeensis. About half of all adult ticks examined and approximately 20% of all nymphs were infected with Rickettsia species. In Ixodes ricinus ticks, Rickettsia helvetica and a Rickettsia species designated as IRS3 were found in high prevalence. Rickettsia conorii was found in virtually all non- Ixodes tick species from Albania and Turkey. The results of this study show that many tick-borne diseases are most probably endemic in the Balkan area. Furthermore, the results suggest that there is a considerable chance for simultaneous transmission of tick-borne pathogens to human beings.

Elective free-tissue transfer in pediatric patients

Twenty-two elective free-tissue transfers for reconstruction of various defects were performed in 20 pediatric patients over a 7-year period. Patient ages ranged from 5 to 17 years (mean: 12.5 years). There were six open wounds, six unstable scars, five tumor resection defects, three facial gunshot wounds, one facial paralysis, and one penis agenesis. Ten free flaps were transferred to the head and neck region, seven to the lower extremity, four to the upper extremity, and one to the genital area. Ten fasciocutaneous flaps, seven muscle or myocutaneous flaps, and five vascularized bone grafts were transferred. All flaps survived, except for one in an electrical burn patient. The success rate was 95 percent. No vessel spasm was observed. Children tolerated long operation periods better than adults. The recovery time after surgery was considerably shorter than in adults. The mean operative time was 6 hr, and the average hospital stay was 12 days. The mean follow-up period was 27 months. Results of this study indicate that microvascular free-tissue transfer is a safe and reliable method for the reconstruction of various defects in children.

An experimental study of skin flap associated with muscle: is muscle nourishment possible through the musculocutaneous perforators?

An experimental study was planned to examine whether the blood supply of muscle would be maintained by reverse flow from the cutaneous arteriolar microcirculatory system via the musculocutaneous perforators. A flap model containing both muscle and skin based on the inferior superficial epigastric vessels was designed with the blood supplied directly from the cutaneous arteriolar microcirculatory system. A total of 154 male Wistar Albino rats were divided into three groups. Group I included the standard vertical rectus abdominis musculocutaneous flap based on the superior deep epigastric vessels (N = 48). Group II included the acute cutaneous muscle flap (N = 53). Group III contained the delayed cutaneous muscle flap (N = 53). Skin flap survival area, muscle scintigraphy with technetium-99m-methoxy-isobutyl-isonitrile, microangiography, and histopathological examination of the flaps were conducted. The mean percentage of surviving skin paddle area was 96.4 +/- 5.2%, 84.9 +/- 21.6%, and 91.0 +/- 16.8% in groups I, II, and III respectively. There was no significant difference between groups. Microangiography revealed the blood flow from skin to muscle through the musculocutaneous perforators. The radioisotope uptake of the muscle flap was expressed as A percentage of the intact contralateral muscle. Mean uptake in group I was 90.1 +/- 4.9% immediately after flap elevation, 62.5 +/- 13.5% on day 2, and 88.3 +/- 12.0% on day 7. These values were 53.7 +/- 7.1%, 63.6 +/- 14.1%, and 89.2 +/- 18.1% in group II, and 64 +/- 7.8%, 75.5 +/- 9.8%, and 92.8 +/- 40.1% in group III. Radioisotope uptake in group I was significantly higher than groups II and III immediately after flap elevation (p < 0.05, analysis of variance), whereas there was no significant difference on days 2 and 7. Histopathological examination revealed surviving muscle tissue without marked atrophy. There was no marked difference between groups histopathologically. These results indicate that muscle tissue may survive by reverse flow through the musculocutaneous perforators when elevated with an axial skin flap.

An unusual long-term complication of burn injury: malignant fibrous histiocytoma developed in chronic burn scar

Development of malignant tumors in chronic burn wounds is a well-known complication. These tumors are almost always squamous cell carcinomas, although other types of malignancies such as basal cell carcinoma, malignant melanoma and sarcomas can be seen rarely. There are only three previously reported cases of malignant fibrous histiocytoma developed in chronic burn scar in the literature. Two cases with malignant fibrous histiocytoma developed in chronic, badly treated burn wounds are presented. One of the tumors was multifocal and overexpression of the p53 gene was present. Both tumors were excised widely and skin grafted. Regional lymph node dissection was performed in one case. One of the patients died due to tumor recurrence and lymphatic metastases. These cases represent a very uncommon complication of burn injury and indicate the importance of the appropriate primary treatment of the burn wound.

Temporalis muscle flap for craniofacial reconstruction after tumor resection

Temporalis muscle flap provides a good solution for the reconstruction of craniofacial defects after tumor resection. Nine patients with complicated defects located at the upper two thirds of the face, anterior cranial base, or mastoid region are presented. Five patients had orbital exenteration, two with total maxillectomy and two with anterior craniofacial resection. Temporalis muscle flap provided profuse well-vascularized tissue for the obliteration of orbital exenteration and total maxillectomy cavities and coverage of surface defects. Cranial, oral, and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically easy flap can be preferred for the reconstruction of craniofacial defects after ablative tumor surgery, especially in older and debilitated patients.

Modulating the functions of neutrophils and lipid peroxidation by FK506 in a rat model of thermal injury

Neutrophils diffusely invade lung, liver, kidney, intestine, muscle and burned skin following burn injury. To ameliorate this invasion and minimize its effects, neutrophils can be modulated by giving neutrophil inhibitors and modulators. In this study, FK506 was used to decrease neutrophil infiltration and lipid peroxidation in remote organs (lung, liver, kidney and intestine) in a burned rat model. FK506 is a new major immunosuppressive agent that is known to modulate neutrophils during inflammation. Neutrophil infiltration was assessed indirectly by measuring myeloperoxidase (MPO) activity biochemically in remote organs following 30% full thickness burn injury. Malondialdehyde (MDA), the end product of lipid peroxidation, was measured biochemically in remote organs and plasma to determine if there is a relationship between neutrophil infiltration and lipid peroxidation after burn injury. FK506 was given intramuscularly at the dose of 0.5 and 1.0 mg/kg for three days before burn injury. Thermal trauma to the skin caused a statistically significant increase in MPO activity and MDA content in remote organs. FK506 was effective in reducing lipid peroxidation and neutrophil infiltration especially at 24 h postinjury in lung, liver and kidney. FK506 may have some benefit (prophylactic) in reducing systemic neutrophilic injury and related lipid peroxidation in burns.

A sero-epidemiological study of visceral leishmaniosis in Izmir District, Turkey

Visceral leishmaniosis caused by Leishmania infantum have been reported in Turkey. A total of 2055 blood samples collected in Izmir and six surrounding villages were tested for anti-Leishmania antibodies. Three established immunodiagnostic techniques, indirect fluorescence antibody (IFA), enzyme-linked immunosorbent assay (ELISA) and direct agglutination test (DAT), were employed using promastigotes and rK39 as antigens for the detection of anti-Leishmania antibodies. Five sero-positive cases (0.24%) were detected by the three tests used.

Comparison of the effects of intralesional interferon alfa-2a, 2b and the combination of 2a and 2b in the treatment of basal cell carcinoma

Interferons (IFN), especially alfa-2a and 2b, are potent inhibitors of normal and malignant cell growth and effective choices in the treatment of basal cell carcinoma (BCC). The aim of the study was to evaluate the effectiveness of the IFN alfa-2a and 2b, and whether this effect may be increased by their combination. A total of 45 patients with histopathologically confirmed BCC were divided into three groups, equally. Groups 1,2 and 3 were treated with intralesional IFN alfa-2a, 2b, and the combination of 2a and 2b, respectively. Lesions were injected three times weekly in Groups 1 and 2 (total ten injections). IFN alfa-2a and 2b were injected alternately in Group 3 (5 IFN alfa-2a and 5 IFN alfa-2b). Eight weeks after completion of therapy, cytologic specimens were taken, and all cases were evaluated clinically and cytologically. Ten (66.6%) patients had a complete response (CR) and 5 (33.3%) had a partial response (PR) in Group 1. Patients in Group 2 showed 10 (66.6%) CR, 4 (26.6%) PR, and 1 (6.6%) non response. In Group 3, 11 (73.3%) patients had CR and 4 (26.6%) had PR. Follow-up periods ranged from 6-24 months, and no recurrences have been observed. These results suggest that IFN alfa-2a, 2b, and the combination of 2a and 2b appear to be effective choices for the treatment of BCC; the effectiveness is not increased by their combination.

Efficacy of silver nitrate pencils in the treatment of common warts

Common warts are an important issue, especially in children and young adults. The methods proposed for common wart treatment are painful, destructive, and require special experience and devices. The chemical cauterization effect of silver nitrate on warts is noted in the classical pharmaceutical textbooks. In order to test this effect for this purpose, a placebo controlled clinical study was performed on 70 patients. On 35 randomly selected patients, a silver nitrate stick was used, and, on the other 35 patients, black ink was used. At the end of this study, of the patients treated with the silver nitrate stick, 15 (43%) were completely healed, 9 (26%) were partially healed, and 11 (31%) were not healed. Of the patients treated with black ink, 4 (11%) were completely healed, 5 (14%) were partially healed, and 26 (74%) patients were not affected. Thus the silver nitrate stick affected the warts of 24 (69%) patients. Therefore, this method appears to be an effective, economic, and easily applicable treatment for common warts.