Background Several studies demonstrated the efficacy of intralesional purified protein derivative (PPD) immunotherapy in warts eradication. Nevertheless, the precise induced immune mechanisms are undetermined. Injected PPD is hypothesized to induce a delayed hypersensitivity reaction associated with cytokines release. Interleukin (IL)‐18 has a major role in defense against viral infection via inducing interferon‐γ release from T‐helper 1 and natural killer (NK) cells. Moreover, IL‐18 triggers Fas ligand expression on cytotoxic T cells and NK cells enhancing their cytotoxicity against virally infected cells. Aim The aim of this study was to assess the role of IL‐18 in the response to intralesional PPD injection in patients with warts. Methods The study included 25 patients with warts and 25 HCs. Patients underwent PPD skin test, and only patients with positive tests were included and received intralesional PPD injections starting 72 h after the test then every 2 weeks until wart clearance or a maximum of 3 sessions. Serum IL‐18 level was measured via enzyme‐linked immune‐sorbent assay in patients (pre‐treatment and 2 weeks after the last injection) and HCs. Results After 3 sessions of injection, six (24%) patients were designated responders, nine (36%) patients showed partial response, and 10 (40%) patients were designated non‐responders. Serum IL‐18 level, post‐treatment, was significantly higher than pre‐treatment level (p = 0.025) and level in HCs (p = 0.036). Furthermore, the post‐treatment level was significantly higher in responders than non‐responders (p = 0.025). Conclusion IL‐18 is probably implicated in the immune mechanisms induced by PPD injection that cause eradication of warts.

<abstract> <p>Background: Warts are viral cutaneous infections caused by human papilloma virus (HPV), presented by verrucous growth over the skin surface. The cell mediated immune response is considered to play a crucial role in HPV clearance. The viral load and number of lesions increase when there is an imbalance between the T-helper 1 and T-helper 2 immune responses. Interleukin (IL)-19 is a cytokine that belongs to interleukin 10 cytokines family and constitutes a sub-family with IL-20, IL-22 and IL-24. IL-19 is mainly produced by activated monocytes and to a lesser extent by B-cells, keratinocytes and fetal membranes. IL-19 was found to shift T-cell maturation away from the pro-inflammatory T-helper 1 cells toward the anti-inflammatory T-helper 2 cells. It induces IL-4 and IL-13 production in T cells and apoptosis in monocytes. Aim: This study aimed to measure serum level of IL-19 in patients with warts compared to healthy controls and to find out the correlation between this level and number, size and clinical types of warts. Methods: The study included 50 patients with warts and 50 control subjects. Serum concentration of IL-19 was measured by enzyme-linked immune sorbent assay. Results: Interleukin-19 serum level was significantly lower in patients with warts than in controls (P &lt; 0.003). Moreover, there was a significant positive correlation between IL-19 serum level and the number of warts (P = 0.027). Conclusion: Serum level of IL-19 was significantly lower in patients with warts, and this low level might be crucial for an effective cell mediated immunological response to HPV.</p> </abstract>

Background Ischemic stroke (IS) constitutes a relevant health concern recently in younger population causing permanent cognitive and function-limiting disability and ranks as the 3rd cause of death in Egypt after cardiac and hepatic diseases. Platelet activation has a crucial mechanism in arterial thrombogenesis, thus in pathophysiology of IS. Surface expression of P-selectin (CD62P) reflects platelet activation and measured by flowcytometry. The purpose of the study is to evaluate whether platelet activity and reactivity are considered risk factors for IS so more restrict antiplatelet protocols could be implemented for management and recurrence prevention. Results Study population was 60 IS patients and 60 apparently healthy age and gender-matched controls. Patients were subdivided into 37 patients without classical risk factors, aged 46.1 ± 8.2, and 23 patients with > 1 vascular risk factors, aged 52 ± 9.9. The percentage of platelets expressing CD62P reflecting ex vivo baseline activity was significantly higher in stroke patients to controls (p = 0.001), also platelet reactivity (CD62P expression after ADP provocation) was statistically significantly elevated in patients than in controls (p < 0.0001) and was significantly higher in IS patients with vascular risk factors compared to patients without risk factors (p = 0.02). Conclusion Both baseline platelet activity and reactivity were significantly higher in IS patients, and were also higher in IS patients with other vascular risk factors than in cryptogenic stroke and considered risk factors for IS.