Pampa Ch Toi

Platelet activation in chronic urticaria and its correlation with disease severity

Abstract Chronic urticaria (CU) is characterized by the occurrence of wheals lasting for more than 6 weeks. The role of platelet activation in the pathophysiology of this condition has not been clearly studied. We undertook a cross-sectional study among 45 patients with CU and 45 age- and gender-matched healthy controls. The severity of the disease was assessed using the urticaria severity score. The autologous plasma skin test (APST) was done in all cases of CU. The platelet count and indices were estimated by an automated haematological laser optical analyzer. Platelet aggregation and soluble P-selectin levels were estimated in all study participants. It was observed that there was a significantly higher mean platelet volume (MPV) and platelet distribution width (PDW) in patients with CU when compared to controls. Platelet aggregation and soluble P-selectin levels were significantly higher in patients with CU, as compared to controls. Urticaria severity score correlated positively with platelet aggregability and soluble P-selectin levels. APST-positive patients had significantly higher platelet aggregation and higher soluble P-selectin levels, when compared to the APST-negative patients, indicating more platelet activation in the autoimmune group. There is significant platelet activation in patients with CU, especially in those with autoreactivity.

Platelet oxidative stress and systemic inflammation in chronic spontaneous urticaria.

Abstract Background: Recent studies implicate the role of immune-inflammatory responses in chronic spontaneous urticaria (CSU). Although it is well known that platelets release inflammatory mediators and reactive oxygen species upon activation, their role in CSU is poorly characterized. The present study was designed to evaluate platelet oxidative stress [platelet malondialdehyde (MDA), platelet superoxide dismutase (SOD), platelet glutathione peroxidase (GPx)] and systemic inflammatory markers [plasma Interleukin-6 (IL-6), high sensitivity C-reactive protein (hs-CRP)] in patients with CSU and their association with disease severity. Methods: Forty-five patients with CSU and 45 age- and gender-matched healthy controls were included in the study. Severity grading was completed according to the urticaria severity score (USS). Autologous plasma skin test (APST) was done in all patients with CSU. Platelet MDA, SOD and GPx and inflammatory markers plasma IL-6 and hs-CRP were assayed in all study participants. Results: In patients with CSU, platelet SOD and GPx were significantly lowered, while platelet MDA levels were significantly elevated in comparison to healthy controls. Both IL-6 and hs-CRP were significantly elevated in patients with CSU and correlated with platelet oxidative stress parameters (p<0.05). Platelet MDA, SOD and GPx and inflammatory markers (plasma IL-6 and hs-CRP) showed a significant correlation with USS in patients with CSU. Conclusions: Our results indicate significant systemic inflammation and platelet oxidative stress in patients with CSU.

Pulmonary Mucormycosis Presenting as Nonresolving Pneumonia in a Patient With Diabetes Mellitus

Zygomycosis refers to a group of disorders caused by filamentous fungi in the class Zygomycetes. This class is subdivided into 2 orders, Mucorales and Entomophthorales, both implicated in human disease. The majority of human infections are caused by fungi in the Mucorales order; hence, the terms

Fine-needle aspiration cytology of granular cell tumor: A report of two cases.

Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely on clinical examination. Being an effective first-line investigation, the fine-needle aspiration cytology (FNAC) plays a significant role in its pre-operative recognition. However, as the tumor is likely to mimic certain other lesions, a cytopathologist needs to be aware of its characteristic cytomorphology. We report two cases of GCT who presented with subcutaneous swellings in the left lower back and the right-sided anterior abdominal wall for 6 and 2 months, respectively. Both the patients had a clinical diagnosis of lipoma/neurofibroma. FNAC was done in both. In the first case a cytodiagnosis of xanthogranuloma was suggested and GCT in the second. Subsequent histologic examination of both showed features of GCT. FNAC would aid in presumptive diagnosis of GCT.

A comparative analysis of conventional and SurePath liquid-based cervicovaginal cytology: A study of 140 cases.

Background: The role of Papanicolaou (Pap) test in cervical cancer screening need not be overemphasized. While most Western countries have adopted the liquid-based cytology (LBC), which is considered superior, many developing countries are still using the conventional Pap smear (CPS) technique. Objective: To compare the staining and cytomorphological features on conventional versus liquid-based cervicovaginal smears. Materials and Methods: One hundred and forty cervicovaginal smears prepared by the standard conventional and LBC techniques were interpreted as per the Bethesda system of reporting cervicovaginal smears. Twelve parameters were studied, compared, and statistically analyzed. A P value <0.05 was considered to be statistically significant. Results: 129/140 (92%) of CPSs and 130/140 (93%) LBC smears were satisfactory. LBC had a significantly shorter screening time (2.0 ± 0.08 vs 4.0 ± 0.65) and better representative material than that of CPS (50% vs 42%). Neutrophils were significantly more in CPS than LBC (96% vs 92%) with a P value <0.05 while hemorrhagic background and red blood cells (RBCs) were more prominent in CPS. LBC showed significant artifactual changes in squamous epithelial cells. Epithelial abnormalities ranging from atypical squamous cells of undetermined significance (ASCUS) to high grade squamous intraepithelial lesion (HSIL) were seen in 3% (4) and 2% (2) of CPSs and LBCs, respectively. Organisms were better picked up in CPS (99% in CPS vs 73% LBC) with a value of P = 0.0001. Conclusion: Although a shorter screening time and cleaner background are the major advantages of LBC, CPS is not inferior to LBC. Considering the high cost, rather than the advantages associated with LBC, we feel that CPS is a better option for developing countries.

A comparative analysis of conventional cytopreparatory and liquid based cytological techniques (Sure Path) in evaluation of serous effusion fluids.

Clinically, detection of malignant cells in serous body fluids is critical, as their presence implies the upstaging of the disease. Cytology of body cavity fluids serves as an important tool when other diagnostic tests cannot be performed. In most laboratories, currently, the effusion fluid samples are analysed chiefly by the conventional cytopreparatory (CCP) technique. Although, there are several studies comparing the liquid‐based cytology (LBC), with CCP technique in the field of cervicovaginal cytology; the literature on such comparison with respect to serous body fluid examination is sparse.

Harlequin Infant Born to a Varicella Infected Mother: A Case Report.

Harlequin ichthyosis is a rare, severe form of congenital ichthyosis characterised by distinct physical appearance of the infant. It has occurrence of 1 in 1 million births and over 100 cases have been reported so far. It is caused by mutation in ABCA12 gene involved in lipid transport leading to profound thickening of stratum corneum. The mainstay of management relies on supportive care & administration of retinoid derivatives. Outcome is usually fatal and most of the babies die during neonatal period. In this article, we report a case of harlequin baby born of non-consanguineous marriage with history of chicken pox in the mother during first trimester of pregnancy.

Clinical, dermoscopic and histopathological features of a rare cutaneous neural tumour

A 56-year-old woman presented with a 15-year history of an asymptomatic, slow-growing mass over her right foot. Physical examination revealed a solitary, skin-coloured, nontender, lobulated exophytic growth, 50 9 40 mm in size, over the lateral aspect of the dorsum of the right foot. The surface of the lesion was studded with multiple grain-like protrusions (Fig. 1a). Under nonpolarized contact dermoscopy, the nodule was seen to have a diffuse grey to yellow background, grey to yellow cobblestone-like areas, and a pigmented network-like area. The grain-like protrusions had grey structureless areas within them, and hairpin, linear irregular and twisted vessels around them (Fig. 1b). Magnetic resonance imaging (MRI) of the growth showed a well-defined, lobulated, exophytic, soft-tissue lesion with multiple thin internal septa, confined to the cutaneous and subcutaneous plane without any infiltration of tendon, muscle or bone (Fig. 1c).

Pulmonary Langerhans cells histiocytosis with concomitant pleural effusion: A rare presentation in an adult

Pulmonary Langerhans cells histiocytosis (PLCH) is a rare disorder of unknown etiology. It usually presents as an isolated lung disease in adults; however, involvement of other organ systems can occur occasionally. In the presence of characteristic findings, high-resolution computed tomography scan may be sufficient for a confident diagnosis of PLCH in an adult smoker. Pneumothorax is the most commonly reported pleural complication of PLCH, and pleural effusion is extremely rare. Herein, we present a case of advanced PLCH in an adult smoker presenting with concomitant exudative pleural effusion.

Disseminated kaposi's sarcoma in an HIV-positive patient: A rare entity in an Indian patient

AIDS-associated disseminated Kaposi sarcoma (KS) is a rare entity, especially in India due to the low prevalence of human herpes virus-8 infections in Indian population. Due to its rapid and progressive nature, early diagnosis and institution of highly active antiretroviral therapy is crucial in AIDS-associated KS, with a view to achieving favorable prognosis. We report a case of disseminated KS in an HIV-1 positive patient, who presented with two months history of multiple violaceous patches and plaques over the trunk, bilateral upper limbs, lower limbs, and hard palate. The patient died of recurrent massive pleural effusion before starting antiretroviral therapy. This case is being reported due to the paucity of KS in the Indian literature, especially the disseminated type and to highlight its rapidly progressive course which can be fatal.