BACKGROUND: Pemphigus vulgaris (PV) patients receiving immunosuppressive therapy may develop nail alterations resulting from infection, skin disorder, or drug regimen.

OBJECTIVE: This study aims to describe nail changes in PV female patients receiving immunosuppressive therapy and to report the frequency of associated fungal and bacterial growth in the patients' nails.

METHODS: Twenty-five female PV patients who had at least one acquired finger or toenail abnormality and had been administered at least one immunosuppressive drug were included in the study. Nail alterations were recorded. Nail scrapings were collected from abnormal nails for fungal and bacterial examination.

RESULTS: Positive fungal and bacterial cultures were detected in 20 (80%) of patients' nail samples. Five patients reported nail alterations coinciding with disease onset, whereas 13 reported nail changes after administration of immunosuppressive therapy.

LIMITATIONS: Lack of a control group (patients on similar immunosuppressive medications for conditions other than PV) which would have further supported the findings demonstrated in this observational study.

CONCLUSION: Nail abnormalities in severe PV patients are frequently associated with fungal and bacterial growth. Immunosuppressive therapy potentially initiates such changes.

Introduction: Nailfold capillaroscopy is a non-invasive technique to recognize peripheral microangiopathy, which is an important feature in SLE.

Development of potent vaccine for human respiratory syncytial virus (HRSV) that confers
better protection than natural infection remains a global challenge. Vaccination with naked DNA is considered
successful approach for the control of many viral diseases. In this study, the potential of DNA vaccination using
full-length attachment gene of HRSV type A Saudi strain cloned in pcDNA3.1+vector (pcDNA/GA) was evaluated in BALB/c mice. Te expression efciency of pcDNA/GA was frst confrmed in HEp-2 cells on RNA and
protein levels. Mice immunization with either pcDNA/GA or the positive control formalin-inactivated vaccine
(FI-RSV) has generated signifcant serum antibody concentration in ELISA (7.31±0.418 and 9.76±0.006 µg/ml,
respectively) with superior neutralizing activity. Similarly, both immunogens evoked robust HRSV-specifc CD8+
T-cell response in ELISPOT assay compared to mice immunized with pcDNA3.1+ vector or saline (negative
controls). Challenge of the immunized mice with the wild-type HRSV did not provoke clinical symptoms or
mortality in any mice group. On the 7th day post-challenge, mice were euthanized and lungs were extirpated for
evaluation of viral load, histopathological changes and cytokine profle. A signifcant diminish in the viral load
and histology score were concluded in lungs of pcDNA/GA immunized mice compared to those immunized
with FI-RSV and negative controls. Te pulmonary cytokine profle of pcDNA/GA immunized mice displayed
notable upregulation of T1-associated cytokines while that of FI-RSV immunized mice exhibited high levels
of T2-associated cytokines. In conclusion, the DNA vaccine candidate pcDNA/GA has proven prominent
efcacy and safety in mouse model, which encourages further evaluation in clinical trials.

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