Cardiovascular risk markers in premature canities.

BACKGROUND: An elevated cardiovascular risk has been demonstrated in middle-aged individuals with onset of hair greying before the age of 30 years. Increased serum levels of pro-inflammatory cytokines, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α), indicate an ongoing state of chronic inflammation that is correlated with cardiovascular risk but have not been studied earlier in patients with early onset of hair greying. AIM/OBJECTIVE: To study various cardiovascular risk markers including pro-inflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) in patients with premature canities. METHODS: This was a hospital-based case-control study of 40 patients with premature canities (age between 19 and 25 years; >5 grey hair) and an equal number of age and gender-matched healthy controls. The blood pressure, pulse rate and body mass index were recorded, and investigations including fasting blood sugar, serum insulin, fasting lipid profile, high sensitivity c-reactive protein (hs-CRP), IL-6 and TNF-α were performed. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for all the participants. RESULTS: The mean blood pressure, fasting blood sugar, serum insulin, hs-CRP and HOMA-IR were all significantly elevated in patients with premature canities and the serum HDL levels were significantly lower. A greater number of patients with premature canities had significantly elevated IL-6 as compared with the controls. LIMITATIONS: The sample size was small. A subjective scale was used for grading the severity of premature canities. Trichoscopic evaluation of severity of greying or modified phototrichogram could not be used in this study. CONCLUSION: Abnormalities in cardiovascular risk markers were found in patients with premature canities. Screening and counselling of patients with premature greying of hair is recommended in order to prevent future cardiovascular disease.

A study of serum vascular endothelial growth factor in infantile hemangiomas.

BACKGROUND: Though infantile hemangiomas are the most common benign tumor of infancy, their etiopathogenesis is not fully understood. Some studies report a diagnostic role for vascular endothelial growth factor (VEGF), but such studies are lacking from India. AIMS: To study the clinicoepidemiological profile of infantile hemangiomas, to estimate and compare the serum levels of VEGF in infantile hemangiomas and controls, and to determine correlations between serum levels of VEGF and growth characteristics of infantile hemangiomas. METHODS: A hospital-based, cross-sectional study was carried out on 30 clinically diagnosed cases of infantile hemangioma and 30 controls presenting with other disorders. VEGF levels were recorded for both cases and controls by the sandwich enzyme-linked immunosorbent assay (ELISA) technique. Results were analyzed using SPSS version 20.0, and their significance determined using appropriate tests. RESULTS: Mean serum VEGF level in the cases was 216.8 ± 49.2 pg/ml while in the control group it was 115.1 ± 43.1 pg/ml (P < 0.0001). There were no statistically significant correlations between serum VEGF levels and sex or size, phase of growth, morphological variants or ulceration of lesions. LIMITATIONS: Our sample was not large enough to draw clinically applicable conclusions. An adequate sample size could not be achieved because of low incidence of the disease, and resource and time constraints. CONCLUSIONS: The mean value of serum VEGF in the study group was significantly higher than that in the control group, suggesting that serum VEGF can serve as a diagnostic marker of infantile hemangiomas. Mean serum VEGF was higher in proliferative lesions than in involuting lesions, indicating that it may also be useful as a prognostic serological marker in cases of infantile hemangioma.

Fulminant hepatic failure in a 15 year old boy with borderline lepromatous leprosy and type 2 reaction.

The liver is the most frequently affected visceral organ in leprosy, particularly in the multibacillary group. Administration of hepatotoxic drugs may also affect liver function. We report the case of a male patient, diagnosed as borderline lepromatous leprosy with Type 2 reaction, who was managed with multibacillary multidrug therapy and steroids, and who then developed acute hepatitis and succumbed to sudden cardiac death. Although erythema nodosum leprosum has been described as a rare cause of death in the literature, such an occurrence in the present era when leprosy has been eliminated needs a special mention.

Molluscum contagiosum-like lesions in histoid leprosy in a 10-year-old Indian boy.

Histoid leprosy is extremely rare in children. Molluscum contagiosum-like lesions in the setting of histoid leprosy is a highly atypical presentation and may signify the process of "transepidermal elimination" in lesions with high bacillary load. A case of histoid leprosy with umbilicated papules and nodules mimicking molluscum contagiosum is reported in a 10-year-old Indian boy.

Perfil de citocinas séricas en la Lepra y su correlación con el perfil clínico-histopatológico / No disponible

Objetivos: Analizar las citocinas y sus niveles séricos en los pacientes de lepra para correlacionarlo con el perfil clínico-histopatológico y evaluar el efecto de la multiterapia estándar sobre el perfil citocínico sérico. Metodología: Se realizaron inmunoensayos (ELISA) séricos para determinar la TNF-α, IFN-γ, IL-1β e IL-10 en 61 nuevos casos de lepra antes de iniciar la terapia y durante los episodios reaccionales. De ellos, los ensayos para citocinas pudieroncompletarse en 17 casos al finalizar la multiterapia. Resultados: Los niveles de todas las citocinas analizadas estaban significativamente elevadas en los casos comparados con controles (P < 0·05). Los niveles de TNF-α e IFN-γ estaban significativamente elevados en los paucibacilares, mientras que todas las citocinas analizadas lo estaban en los casos multibacilares con los incrementos en IL- 1β e IL-10 siendo incluso estadísticamente significativos (P < 0·001). No se detectaron diferencias significativas entre los tipos TT y BT y los BB, BL y LL. Todas las citocinas estudiadas estaban incrementadas en las fases reaccionales en comparación con las no reaccionales. Al comparar la reacción Tipo 2 (T2R) y la reacción Tipo 1 (T1R), los niveles de IFN-γ, IL-1β e IL-10 eran más elevadas en casos T2R, pero solo en el caso de IL-10 era estadísticamente significativa (P = 0·05), mientras que la TNF-α era mayor en los casos T1R. Los niveles séricos post-tratamiento de las citocinas era significativamente menor (P < 0·05) que los niveles pretratamiento y resultó comparable a los valores de los controles. Entre los casos paucibacilares, todas las citocinas disminuyeron a los 6 meses de tratamiento con la multiterapia estándar. En los multibacilares, los niveles promedio de las citocinas disminuyeron al año de finalizar la multiterapia, excepto IFN-γ. Conclusión: el análisis de las citocinas séricas puede desempeñar un papel significativo en la clasificación de las distintas formas de lepra y puede utilizarse para controlar la multiterapia (AU)

Objectives: To analyse the serum levels of cytokines in leprosy patients, to correlate them with clinico-histopathological profile, and to study the effect of standard multidrug therapy on serum cytokine levels. Design: Serum immunoassays of TNF-α, IFN-γ, IL-1β and IL-10 were performed by ELISA in 61 newly diagnosed cases of leprosy before starting therapy and during reactional episodes. Of these, cytokine assays could be performed in 17 cases after completion of therapy. Results: Levels of all the studied cytokines were significantly raised in casescompared to controls (P < 0·05). Levels of TNF-α and IFN-γ were significantly raised in paucibacillary cases whereas all the studied cytokines were raised in multibacillary cases with rise in IL-1β and IL-10 being statistically significant (P < 0·001). No significant difference was however noted between TT and BT type; and BB, BL and LL types. All the studied cytokines were raised in reactional cases as compared to non-reactional cases. Comparing Type 2 reaction (T2R) and Type 1 reaction (T1R) cases, levels of IFN-γ, IL-1β and IL-10 were higher in T2R cases but only IL-10 was found to be statistically significant (P = 0·05) while TNF-α was higher in T1R cases. Post therapy serum levels of all the studied cytokines were significantly lower than pretherapy levels (P = 0·05) and were comparable to controls. Among the paucibacillary cases, levels of all the cytokines were seen to decrease after 6 months of standard multidrug therapy. In the multibacillary cases, mean levels of the cytokines were found to decrease after 1 year of therapy except IFN-γ. Conclusion: Serum cytokine estimation may have a significant role in classifying various forms of leprosy and can be used to monitor therapy (AU)

A nine-year clinico-epidemiological study of Histoid Hansen in India.

INTRODUCTION: Histoid Hansen is rare but a well-defined entity with specific clinical, histopathological, and bacteriological features. The incidence has been reported to vary from 1-2% amongst total leprosy patients. METHODOLOGY: We performed a retrospective analysis of the records of patients identified as histoid Hansen on the basis of clinico-histopathological criteria, who attended the Hansen clinic from 2000-2009. RESULTS: A total of 962 leprosy patients attended the Hansen clinic from 2000-2009, and of these, 11 (1.14%) were diagnosed as histoid Hansen. The youngest patient on record was 14 years of age. Nearly 70% of the patients were untreated and the rest were on multidrug therapy (MDT) before development of histoid lesions. Three patients showed Erythema nodusum leposum (ENL) reaction. CONCLUSION: India has achieved elimination of leprosy, but new cases of histoid are still recorded with the same incidence rate. Reactions are not uncommon in such forms, and may be a transition phase to manifest lepromatous leprosy. A thorough knowledge and early detection is needed for this uncommon variant of leprosy which can pose a threat to our elimination drive.

Serum cytokine profile in leprosy and its correlation with clinico-histopathological profile.

OBJECTIVES: To analyse the serum levels of cytokines in leprosy patients, to correlate them with clinico-histopathological profile, and to study the effect of standard multidrug therapy on serum cytokine levels. DESIGN: Serum immunoassays of TNF-alpha, IFN-gamma, IL-1 beta and IL-10 were performed by ELISA in 61 newly diagnosed cases of leprosy before starting therapy and during reactional episodes. Of these, cytokine assays could be performed in 17 cases after completion of therapy. RESULTS: Levels of all the studied cytokines were significantly raised in cases compared to controls (P < 0.05). Levels of TNF-alpha and IFN-gamma were significantly raised in paucibacillary cases whereas all the studied cytokines were raised in multibacillary cases with rise in IL-1 beta and IL-10 being statistically significant (P < 0.001). No significant difference was however noted between TT and BT type; and BB, BL and LL types. All the studied cytokines were raised in reactional cases as compared to non-reactional cases. Comparing Type 2 reaction (T2R) and Type 1 reaction (T1R) cases, levels of IFN-gamma, IL-1 beta and IL-10 were higher in T2R cases but only IL-10 was found to be statistically significant (P = 0.05) while TNF-alpha was higher in T1R cases. Post therapy serum levels of all the studied cytokines were significantly lower than pretherapy levels (P < 0.05) and were comparable to controls. Among the paucibacillary cases, levels of all the cytokines were seen to decrease after 6 months of standard multidrug therapy. In the multibacillary cases, mean levels of the cytokines were found to decrease after 1 year of therapy except IFN-gamma. CONCLUSION: Serum cytokine estimation may have a significant role in classifying various forms of leprosy and can be used to monitor therapy.

Mucocutaneous manifestations in children with human immunodeficiency virus infection.

Skin is one of the most frequently involved organs in human immunodeficiency virus (HIV) infection, and mucocutaneous manifestations may be one of the earliest markers of AIDS. The prevalence of cutaneous abnormalities in HIV approaches nearly 90%. Mucocutaneous manifestations may also act as a prognostic marker of HIV infection. Children are increasingly being affected by HIV infection and it is important to realize the presence of the infection early in the disease process as their immune status is not mature enough to handle the stress of various infections. Skin manifestations can serve as early markers and prognostic indicators of HIV infection. This review highlights the epidemiology, transmission, pathogenesis, and the mucocutaneous manifestations of HIV infection in children.