Follicular Becker's nevi: A case series and review of literature.

The follicular variant of Becker's nevus is an under-reported entity. We present the rare occurrence of follicular Becker's nevus in 7 patients, confirmed through dermoscopy and histopathological examination. Dermoscopy shows perifollicular hypopigmentation surrounded by a well-defined net-like pigmentation corresponding clinically to the presence of folliculocentric macules. Histology shows prominent basal and suprabasal melanization surrounding the follicle, corresponding to well-defined net-like pigmentation seen on dermoscopy. However, the melanization does not extend along the entire length of the follicular epithelium leading to perifollicular hypopigmentation on dermoscopy. Though biopsy is confirmatory, it is not usually necessary.

Clinical and immunological predictors of post-rituximab paradoxical pemphigus flare: A prospective cohort study.

Background Paradoxical flare of pemphigus following rituximab infusion has been reported previously, however, its incidence or risk factors have not been studied in detail. Objectives To evaluate the clinical and immunological predictors associated with post-rituximab paradoxical pemphigus flare. Materials and Methods This was a prospective cohort study including adult patients with pemphigus vulgaris or foliaceus who were treated with rituximab. Patients were administered 1000 mg of intravenous rituximab on days 0 and 14 (Rheumatoid arthritis (RA) protocol), with or without oral prednisolone and/or conventional immunosuppressive agents. Baseline clinical and immunological predictors of post-rituximab pemphigus flares were assessed. Results Fifty patients (mean age 40.44 ± 12.36 years) with a mean pemphigus disease area index (PDAI) score of 27.8 ± 15.48 were administered rituximab. Post-rituximab flare occurred in 10 (20%) patients after a mean of 14.1 ± 4.33 days after the first rituximab infusion. The mean baseline PDAI score (36.4 ± 11.7 vs. 25.6 ± 15.7, P = 0.02) and serum anti-Dsg1 levels (1216.8 ± 850.1 vs. 592 ± 562.12 RU/mL, P = 0.03) were statistically significantly higher in patients experiencing a flare. Using ROC-curve analysis, a PDAI score of 328 (OR 8.3, 95% CI 1.5-44.7) was 80% sensitive and 67.5% specific in predicting post-rituximab flare, while serum anti-Dsg1 level of 31137.78 RU/ml had a sensitivity of 60% and specificity of 85%. There was no significant difference in terms of affected body surface area, type of pemphigus, starting prednisolone dose, oral immunosuppressive adjuvant, serum anti-Dsg3, serum anti-AchRM3, and peripheral CD19+ B cell population. Limitations Our study is limited by a relatively small sample size. Immunological factors were not evaluated at the time of pemphigus flare. Though these unexpected pemphigus flares are likely to be associated with rituximab infusion, the possibility of spontaneous disease exacerbation cannot be entirely excluded. Conclusions Patients with more severe pemphigus or high serum anti-Dsg1 are at risk of post-rituximab paradoxical flare, and may benefit from rituximab administration under close monitoring.

Diagnostic accuracy of International System for Reporting Serous Fluid Cytopathology: A systematic review and meta-analysis in malignancy diagnosis.

This study conducts the first meta-analysis to assess the aggregated risk of malignancy associated with each category of the International System for Reporting Serous Fluid Cytopathology (ISRSFC) for reporting serous effusion cytology, while also evaluating diagnostic accuracy. PubMed/MEDLINE and Embase were systematically searched using the keywords "(pleural, peritoneal, and pericardial effusions) AND (serous effusion cytology) OR (International System for Reporting Serous Fluid Cytopathology)". Articles underwent risk of bias assessment using the QUADAS-2 tool. After excluding inadequate samples, a meta-analysis determined sensitivity and specificity for different cutoff points, including "atypical considered positive," "suspicious of malignancy considered positive," and "malignant considered positive." Summary receiver operating characteristic curves assessed diagnostic accuracy, and the diagnostic odds ratio was pooled. Sixteen retrospective cross-sectional studies, totaling 19,128 cases, were included. Sensitivity and specificity for the "atypical and higher risk categories" considered positive were 77% (95% confidence interval [CI], 68%-84%) and 95% (95% CI, 93%-97%) respectively. For the "suspicious for malignancy and higher risk categories" considered positive, sensitivity and specificity were 57% (95% CI, 49%-65%) and 100% (95% CI, 99%-100%) respectively. Sensitivity and specificity for the "malignant" category considered positive for malignancy were 70% (95% CI, 60%-77%) and 99% (95% CI, 98%-99%), respectively. The pooled area under the curve ranged from 85% to 89.5% for each cutoff. This meta-analysis underscores the ISRSFC's accuracy in reporting serous fluid cytology. It emphasizes the diagnostic importance of the "suspicious" and "malignant" categories in identifying malignancy, and the role of the "benign" category in ruling out malignancy.

Comparison of patch test positivity after 24 and 48 hours of occlusion time in patients of allergic contact dermatitis: A prospective study.

BACKGROUND: Patch test is the gold standard for diagnosing allergic contact dermatitis. Conventionally, the patches are applied for 48 h, which in tropical weather conditions causes excessive sweating, leading to irritation, and sometimes the patches come off, making the test inconclusive. OBJECTIVE: To compare the patch test positivity after 24 and 48 h of occlusion time in patients of allergic contact dermatitis, using standard allergen concentration. MATERIALS AND METHODS: Clinically suspected patients of allergic contact dermatitis were enrolled and patch tested using the Indian Standard Series, parthenium acetone extracts (1:50, 1:100 and 1:200 dilutions) and patient material. Patches were applied in duplicate on either side of the back, using a random number table. One set of patches was removed after 24-h of occlusion, while the other set after 48-h. Readings were performed at 48- and 96-h by two independent dermatologists, blinded to the duration of occlusion. RESULTS: The study had 97 adult patients (58 males and 39 females; mean age: 48.12 ± 13.07 years). A total of 133 and 142 positive reactions were observed after 48 h occlusion at 48 and 96 h reading, respectively. Of these 117 (87.9%) and 132 (92.9%) patches were positive and concordant and noted at 24 h occlusion time. The Cohen's kappa coefficient were 0.94 for 48 h and 0.97 for 96 h reading, hence showing an almost complete agreement (ⱪ > 0.81) between patches occluded for 24 and 48 h. CONCLUSION: Though there is no significant difference in patch test positivity among ISS allergens after either occlusion time, 48 h occlusion performs significantly better compared with 24 h, when reactions of all allergens (ISS, patient material and parthenium acetone extract) are analysed together.

The shadow pandemic: rising syphilis rates in the wake of coronavirus (COVID-19).

The coronavirus disease 2019 (COVID-19) aftermath left an alarming surge in syphilis cases, contradicting the previously stable trajectory of the infection. US Centers for Disease Control and Prevention also reported a 38% increase in primary and secondary syphilis in 2021 compared to 2019 in the United States, prompting a retrospective analysis at our tertiary care centre in New Delhi, India. There was a persistent linear rise, surpassing pre-COVID levels. Male clinic attendees, exhibit a pronounced increase, likely due to the influence of MSM. Online sexual activity during lockdowns and redirected healthcare resources have possibly contributed to this trend. Urgent measures include strengthened surveillance data collection and public health response, awareness promotion, and early, free treatment. The syphilis surge may signify a broader, undiagnosed STI pandemic, necessitating comprehensive intervention and surveillance.

Systematic Review and Meta-Analysis of the Diagnostic Accuracy of the Sydney System for Reporting Lymph Node Fine-Needle Aspiration Biopsy in Diagnosing Malignancy.

INTRODUCTION: The aim of the study was to perform the first meta-analysis for assessment of the pooled risk of malignancy of each category of the Sydney system for reporting of lymph nodal aspirates along with the evaluation of diagnostic accuracy. METHODS: PubMed/MEDLINE and Embase were searched with the following keywords: "(Lymph node) AND (fine needle aspiration biopsy) OR (International system OR Sydney system)" in the timeframe 2020 to August 4, 2023. The selected articles were assessed for the risk of bias by the QUADAS-2 tool. The meta-analysis for sensitivity (SN) and specificity for each cut-off, that is, "atypical considered positive," "suspicious of malignancy considered positive," and "malignant considered positive" for the lesions, was carried out after excluding the inadequate samples in each study. To assess the diagnostic accuracy, summary receiver operating characteristic curves were constructed, and the diagnostic odds ratio was pooled in both scenarios. RESULTS: Nine studies, all of which were retrospective cross-sectional studies, were evaluated with a total of 13,205 cases. The SN and specificity for the "atypical and higher risk categories" considered positive for malignancy were 97% (95% CI, 95-99%) and 96% (95% CI, 91-98%), respectively. The SN and specificity for the "suspicious of malignancy and higher risk categories" considered positive for malignancy were 91% (95% CI, 85-95%) and 99% (95% CI, 97-100%), respectively. The SN and specificity for the "malignant" considered positive for malignancy were 75% (95% CI, 65-84%) and 100% (95% CI, 99-100%), respectively. The pooled area under the curve was 99-100% for each of the cut-offs. CONCLUSION: This meta-analysis highlights the accuracy of the Sydney system in reporting lymph node aspirates. It exhibits the significance of the "suspicious" and "malignant" categories in diagnosing malignancy and of the "benign" category in excluding malignancy.