INTRODUCTION: Verruca vulgaris, or common wart, is cause by the human papillomavirus (HPV). Cases may be recalcitrant, and may reflect deficient cell-mediated immunity, one cause of which could be low serum levels of zinc, which plays a crucial role in lymphocyte development and function. Here, we report a case of recalcitrant common warts in a zinc-deficient man responding to oral zinc supplementation.
CASE SUMMARY: A then 44-year-old man presented with hyperkeratotic verrucous papules on the left elbow, clinically and histopathologically diagnosed to be verucca vulgaris. Initial treatment with electrosurgery was followed by recurrence on the same site several weeks later. Further recurrences would be noted despite treatment with several sessions of electrosurgery and cryotherapy, with eventual involvement of both forearms and shins. Other treatment modalities tried by the patient included pulsed dye laser, imiquimod and a traditional topical medication containing salicylic acid. HPV typing showed HPV genotype 6. Primary immunodeficiency panel done on 2 separate occasions showed decreased CD4 count with reversed CD4:CD8 ratio, with decreased natural killer count. Whole blood and serum zinc levels were also found to be decreased on 2 separate occasions. The patient was then started on oral zinc picolinate 50mg (10mg elemental zinc) daily, eventually shifting to chelated zinc oxide 15mg (12mg elemental zinc) daily, without any other intervention. The only adverse effect reported was nausea. Follow-up at 1 year and 5 years after starting oral zinc supplementation has shown no recurrence of warts.
CONCLUSION: Recent years have seen a surge of interest in high-dose oral zinc as monotherapy for recalcitrant warts. Although there is still insufficient evidence to support this, the positive response demonstrated in this case corroborates the immunomodulatory role that zinc may play for this indication. In addition, this case may show that even low doses of zinc may be beneficial as either monotherapy or as adjunct in the treatment of recurrent common warts. It is recommended that randomized clinical trials with better quality, comparing different doses and formulations of oral zinc for common warts be done, while taking into account corresponding elemental zinc values.

Human ; Male ; Adult ; Aminoquinolines ; Cryotherapy ; Immunity, Cellular ; Lasers, Dye ; Lymphocytes ; Nausea ; Papillomaviridae ; Picolinic Acids ; Salicylic Acid ; Warts ; Zinc ; Zinc Oxide

BACKGROUND: Since metallo-beta-lactamase (MBL)-producing isolates can hydrolyze carbapenem and also easily transfer the resistance genes to other bacteria, a rapid and accurate detection of MBL has become very important. We evaluated the utility of Mueller Hinton agar (MHA) biplate containing dipicolinic acid (DPA) as a screening method to detect IMP-1 and VIM-2 type MBL-producing isolates. METHODS: Based on our preliminary tests using various concentrations of DPA, 200 and 300 microg/mL concentration of DPA were chosen for further study. Bacterial lawns were grown on MHA biplate, one half of which contained DPA while the other did not. The inhibition zone around the imipenem (IPM) disk on both sides of this plate was compared. The stability of DPA in the stored DPA-MHA biplate was also evaluated during three months using two MBL- and one non-MBL-producing isolates. RESULTS: When the criterion of a > or =7 mm increase of inhibition zone around the IPM disk on the MHA containing DPA compared to MHA without DPA was used, the sensitivities and specificities were 94.7% and 97.6% for 200 microg/mL DPA-MHA biplate, and 98.2% and 97.6% for 300 microg/mL DPA-MHA biplate, respectively. The activity of the DPA in this biplate was stable for three months. CONCLUSIONS: Assays using DPA 300-MHA biplate were highly sensitive and specific for the detection of IMP-1 and VIM-2 type MBL-producing bacteria. In addition, it is easy to perform; so, it may be useful to apply this method for detection of IMP-1 and VIM-2 type MBL in clinical laboratories.
Agar ; Anti-Bacterial Agents/*pharmacology ; Bacteriological Techniques ; Chelating Agents/chemistry/*pharmacology ; Drug Resistance, Bacterial ; Gram-Negative Bacteria/drug effects/enzymology/*isolation & purification ; Imipenem/*pharmacology ; Picolinic Acids/chemistry/*pharmacology ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; beta-Lactamases/*analysis/biosynthesis

BACKGROUND: The role of chromium in human nutrition was first reported in 1977 on a patient on total parenteral nutrition manifesting with neuropathy and impaired glucose tolerance attributed to chromium deficiency. After correction, nerve conduction and glucose tolerance tests normalized. Chromium is postulated to act as a cofactor for insulin action by enhancing insulin receptor phosphorylation and stimulating insulin receptor tyrosine kinase.
OBJECTIVE: To compare the effect of chromium picolinate versus placebo on glycated hemoglobin (HbA1C), fasting blood sugar (FBS), 2-hours postprandial blood sugar (2HPPBS), fasting insulin (FI) and lipid profile among T2DM patients.
METHODS: Literature search in Medicine, Cochrane and Herdin was made using terms such as chromium, chromium picolinate intake of >= 3 months among T2DM patients. Two reviewers independently screened abstracts and full articles. Results were plotted using Revman 4.2.
RESULTS: Thirty four trials were found and six trials were included in the meta-analysis. The pooled data for 467 patients with T2DM reported lowering of HbA1c -0.34% (CI -0.45, 0.24 p0.06); FBS -16.6 mg/dl (CI -18.9, -14.41 p 0.30); 2HPPBS -17.33 mg/dL (CI -20.21, -18..81 p <0.01) and FI -19.51 mg/dL (CI -20.21, -18.81 p<0.01). Chromium picolinate has no effect on lipids.
CONCLUSION: Chromium picolinate lowers HbA1c, FBS, 2HPPBS and FI moderately but it has no effect on lipids, However, the short duration of studies, variable quality and large heterogeneity across these data limits the strength of our conclusion, hence further studies are recommended.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Blood Glucose ; Chromium ; Glucose Intolerance ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated ; Insulin ; Lipids ; Phosphorylation ; Picolinic Acids ; Postprandial Period ; Protein-tyrosine Kinases ; Receptor, Insulin