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Shalaby SM, Bosseila M, Fawzy MM, Abdel Halim DM, Sayed SS, Allam RS. Fractional carbon dioxide laser versus low-dose UVA-1 phototherapy for treatment of localized scleroderma: a clinical and immunohistochemical randomized controlled study. Lasers Med Sci. 2016;31(8):1707-15. Abstract

Morphea is a rare fibrosing skin disorder that occurs as a result of abnormal homogenized collagen synthesis. Fractional ablative laser resurfacing has been used effectively in scar treatment via abnormal collagen degradation and induction of healthy collagen synthesis. Therefore, fractional ablative laser can provide an effective modality in treatment of morphea. The study aimed at evaluating the efficacy of fractional carbon dioxide laser as a new modality for the treatment of localized scleroderma and to compare its results with the well-established method of UVA-1 phototherapy. Seventeen patients with plaque and linear morphea were included in this parallel intra-individual comparative randomized controlled clinical trial. Each with two comparable morphea lesions that were randomly assigned to either 30 sessions of low-dose (30 J/cm(2)) UVA-1 phototherapy (340-400 nm) or 3 sessions of fractional CO2 laser (10,600 nm-power 25 W). The response to therapy was then evaluated clinically and histopathologically via validated scoring systems. Immunohistochemical analysis of TGF-ß1 and MMP1 was done. Patient satisfaction was also assessed. Wilcoxon signed rank test for paired (matched) samples and Spearman rank correlation equation were used as indicated. Comparing the two groups, there was an obvious improvement with fractional CO2 laser that was superior to that of low-dose UVA-1 phototherapy. Statistically, there was a significant difference in the clinical scores (p = 0.001), collagen homogenization scores (p = 0.012), and patient satisfaction scores (p = 0.001). In conclusion, fractional carbon dioxide laser is a promising treatment modality for cases of localized morphea, with proved efficacy of this treatment on clinical and histopathological levels.

Hoshy KE, Bosseila M, Sharkawy DE, Sobhi R. Can Basal Cell Carcinoma Lateral Border be Determined by Fluorescence Diagnosis? Photodiagnosis and Photodynamic Therapy. 2016. AbstractWebsite

The preferential accumulation of 5-aminolaevulinic acid (ALA)- induced protoporphyrin IX (PpIX) in neoplastic cells supports its potential use in the photodetection of epithelial tumours through porphyrin fluorescence.

To assess the validity of fluorescence diagnosis (FD) as an efficient pre-surgical in vivo imaging tool for defining the lateral boundaries of various types of basal cell carcinomas (BCCs).

The BCC tumour area was determined for 27 patients using FD digitalized imaging system, where the accumulation of PpIX in tumour tissue in relation to normal tissue was measured. Subsequently, BCCs were excised according to the complete area defined by FD using Mohs micrographic surgery (MMS).

Of the 27 BCCs, the FD margin of the lesion coincided with the histopathological picture in 12 BCCs (44.44%). The mean value of accumulation factor (AF) was 2.7. Although 17 pigmented BCCs showed attenuated or absent fluorescence in the center, fluorescence at their periphery was used as a guide for excision, and statistically, the pigmentation of the BCCs showed no effect on the results of the FD efficacy (p = 1.0).

Fluorescence diagnosis of BCC may be beneficial as a guide to the safety margin needed before MMS. The safety margin is decided according to the FD tumour diameter in relation to the clinical tumour diameter.

Bosseila M, ElSayed K, El-Din SS, Monaem NA. Evaluation of Angiogenesis in Early Mycosis Fungoides Patients: Dermoscopic and Immunohistochemical Study. Dermatology. 2015;31(1):82-6. Abstractangiogenesis_proofs-dermatology_journal2015.pdfWebsite

Angiogenesis is the production of new blood vessels from an existing vascular network; it plays a critical role in solid tumor development and metastasis.
To assess angiogenesis in early cases of mycosis fungoides (MF) and to determine vascular patterns in MF dermoscopically.
25 patients with MF and 20 healthy controls were included. The MF lesions were assessed dermoscopically. CD34 immunohistochemistry was performed to count dermal microvessel density (MVD).
The total dermal MVD was significantly higher in MF patients (19.77 ± 5.81) than in controls (4.44 ± 3.16; p = 0.013). Among them, there were 10.8 ± 4.1 sprouts of endothelial buds (clusters of cells per field) in patients and 2.4 ± 2 in controls (p = 0.000). The dotted pattern of blood vessels was the most frequently encountered pattern in the MF lesions by dermoscopy.
Our findings support that neoangiogenesis is significantly increased in early MF lesions and that the main dermoscopic feature of MF is dotted blood vessels.

Hafez VG, Bosseila M, Abdel Halim MR, Shaker OG, Kamal M, Kareem HS. Clinical effects of “pioglitazone”, an insulin sensitizing drug, on psoriasis vulgaris and its co-morbidities, a double blinded randomized controlled trialx1. Journal of Dermatological Treatment. 2014:1-7. AbstractWebsite

To evaluate the therapeutic efficacy of pioglitazone on psoriasis vulgaris and its comorbidities.
Forty-eight patients with moderate-to-severe psoriasis vulgaris were enrolled in this randomized double blinded placebo-controlled trial. Active treatment included: oral pioglitazone 30 mg daily for 10 weeks. Primary outcome (treatment success) was PASI-75. Secondary outcomes included changes in metabolic syndrome, insulin resistance and cardiovascular risk.
Treatment success was achieved in 5/24 (21%) in the pioglitazone group compared to 1/24 (4%) in the placebo group; however, this difference was not significant (p = 0.081). Compared to placebo, no significant difference existed as regards high-sensitive C reactive protein. Metabolic syndrome and insulin resistance were not affected.
This short term (10 weeks duration) study revealed no effect of pioglitazone 30 mg daily neither on the clinical response of moderate-to-severe psoriasis nor on metabolic syndrome and insulin resistance. Cardio-protective role appears to be more related to improvement of psoriasis.
Short duration of treatment and small number of subgroups.

Bosseila M, Mahgoub D, El-Sayed A, Salama D, El-Moneim MA, Al-Helf F. Does fluorescence diagnosis have a role in follow up of response to therapy in mycosis fungoides? Photodiagnosis and photodynamic therapy. 2014;11:595-602. AbstractWebsite

Monitoring of tumor burden during mycosis fungoides (MF) treatment, is crucial to adjust therapy accordingly. This is usually achieved through combined by clinical assessment with histopathological and immunohistochemical evaluation.
To assess the validity of fluorescence diagnosis (FD) in the measurement of response to therapy in early MF, using in comparison flow cytometric technique of skin biopsies for CD4+/CD7- malignant T-cell count before and after therapy.
Twenty-two patients of histologically proven early MF (stages Ia, Ib, IIa) were subjected to fluorescence diagnosis of their most affected skin lesion before and after 12 weeks of phototherapy with or without combination therapy. In comparison flow cytometric assessment of skin biopsies for CD4+/CD7- malignant T-cell count was evaluated before and after therapy from skin biopsy of the same lesion.
All tested MF lesions showed varying degrees of fluorescence by FD at week zero, with a mean accumulation factor (AF), which is the fluorescence ratio between the tumor tissue and normal skin, of 2.2. After 12 weeks of therapy, the mean AF showed significant reduction to 1.94 (p=0.009). The percent of CD4+/CD7- cells dropped significantly after treatment (p=0.029). No correlation between CD4+/CD7- cell counts and the mean AF could be deduced.
In cases of mycosis fungoides, fluorescence diagnosis can represent an effective tool for evaluating the response to therapy. Changes in accumulation factor values can be used for follow-up of therapy in the same patient, but it should not be used as an absolute value.

ElMofty M, Bosseila M, Mashaly HM, Gawdat H, Makaly H. Broadband ultraviolet A vs. psoralen ultraviolet A in the treatment of vitiligo: a randomized controlled trial. Clinical and experimental dermatology. 2013;38:830-5. AbstractWebsite


Bosseila M, Tawfic SO, Ezzat MA, Shaker OG. Tissue liver X-receptor-$\alpha$ (LXR$\alpha$) level in acne vulgaris. Journal of the Egyptian Women’s Dermatologic Society. 2013;10:101-5. AbstractWebsite


El-Mofty M, Mostafa W, Esmat S, Youssef R, Bosseila M, HEGAZY RA. Phototherapy in vitiligo: a comparative evaluation of various therapeutic modalities. Journal of the Egyptian Women’s Dermatologic Society. 2012;9:123-35. Abstract
Bosseila M, Elkholy A, Hussein H. Infective endocarditis in children with atopic dermatitis. In: JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY. Vol 64. MOSBY-ELSEVIER 360 PARK AVENUE SOUTH, NEW YORK, NY 10010-1710 USA; 2011. p. AB56. Abstract
Mostafa WZ, Mahfouz SM, Bosseila M, Sobhi RM, El-Nabarawy E. An immunohistochemical study of laminin in basal cell carcinoma. Journal of cutaneous pathology. 2010;37:68-74. Abstract
ElMofty M, Mostafa W, Bosseila M, Youssef R, Essmat S, El Ramly A, et al. A large scale analytical study on efficacy of different photo (chemo) therapeutic modalities in the treatment of psoriasis. In: JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY AND VENEREOLOGY. Vol 24. WILEY-BLACKWELL PUBLISHING, INC COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA; 2010. p. 46. Abstract
El-Mofty M, Mostafa WZ, Bosseila M, Youssef R, Esmat S, Ramly EA, et al. A large scale analytical study on efficacy of different photo (chemo) therapeutic modalities in the treatment of psoriasis, vitiligo and mycosis fungoides. Dermatologic therapy. 2010;23:428-34. Abstract
El-Batawy MM, Bosseila MA, Mashaly HM, Hafez VS. Topical calcineurin inhibitors in atopic dermatitis: a systematic review and meta-analysis. Journal of dermatological science. 2009;54:76-87. Abstract
Mostafa WZ, Mahfouz SM, Bosseila M, Sobhi RM, Zaki NS. An Immunohistochemical study of laminin in cutaneous and mucosal squamous cell carcinomas. J Egypt Women Dermatol Soc. 2007;4:24-33. Abstract
El-Darouti MA, Marzouk SA, Bosseila M, abu Zeid O, El-Safouri O, Zayed A, et al. Microscopic study of normal skin in cases of mycosis fungoides. International journal of dermatology. 2006;45:1043-6. Abstract