RESUMEN
Acute phase reactants (APRs) are a heterogeneous group of plasma proteins whose concentration either increases or decreases by at least 25% during an inflammatory process. The conditions that commonly lead to acute phase response are infection, trauma, burns, tissue infarction, inflammatory conditions, and advanced malignancy. APRs are elevated in all infective conditions. In skin and soft tissue infection, the levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) help to predict the severity of infection. Procalcitonin can be used to differentiate between viral and bacterial infections. During active stages of systemic lupus erythematosus (SLE), ESR is elevated, but CRP either remains normal or shows only moderate elevation. In the case of superadded bacterial infection in SLE, CRP is elevated. In SLE, ferritin levels are elevated during the active stage of the disease. Serum amyloid antigen (SAA) and CRP levels are significantly higher in patients with early and late stages of diffuse systemic sclerosis. Elevated levels of serum ferritin are seen in rheumatoid arthritis and adult-onset Still's disease. CRP, SAA, and α2-macroglobulin (α 2M) are elevated in active psoriasis. In severe psoriasis, the ferritin-iron ratio is elevated. In drug-induced maculopapular rash, drug-induced hyperaemic vasculitis, and severe drug-induced cutaneous adverse reactions, CRP levels are elevated during the active stages. Neoplastic diseases in general are accompanied by increased serum ferritin. Further detailed studies are required to explore the clinical significance of APRs in dermatology and the scope of their possible application as a diagnostic tool.
RESUMEN
Background: Cardinal criteria proposed by the World Health Organisation (WHO) lack sensitivity to diagnose indeterminate leprosy. Aims: To estimate the frequency of hypopigmented skin lesions with doubtful/minimal sensory impairment showing histopathology features of indeterminate leprosy. To compare between the histopathology findings noted in specimens showing features suggestive of indeterminate leprosy and those showing a non-specific dermatitis pattern. Materials and Methods: Data on patients who attended our department with hypopigmented patches with doubtful/minimal sensory impairment from January 2018 to December 2019 and who underwent a skin biopsy were collected. A pathologist blinded to the clinical findings reviewed the histopathology specimens using a pre-set questionnaire. Results: We studied sixteen biopsy specimens from 14 patients. Eight specimens (50%) showed histopathology suggestive of indeterminate leprosy and the remaining eight showed a non-specific dermatitis pattern. A higher percentage of patients with indeterminate pattern showed mast cells (87.5% vs 25%) and fibrosis around nerve twig or sweat duct (75% vs 12.5%) when compared to those who showed a non-specific dermatitis pattern. Limitations: Small sample size and retrospective study design were the limitations. Conclusions: We found histopathology features of indeterminate leprosy in 50% of the skin biopsy specimens from hypopigmented lesions with doubtful/minimal sensory impairment. The present study highlights the need to improve the diagnostic definition of indeterminate leprosy.
RESUMEN
Context: Coronavirus disease 2019 (COVID-19) has shown the potential to affect the life of people all over the world either directly or indirectly. Aim: To assess the impact of lockdown measures on treatment of leprosy among patients who received treatment from a tertiary referral centre. Settings and Design: A retrospective study was conducted at the dermatology department of a tertiary referral centre. Materials and Methods: We did a retrospective analysis of case records of patients with leprosy who received treatment from our tertiary referral centre from 01 March 2020 to 31 May 2021. Results: During the 15-month period, 59 patients received multi-drug therapy (MDT) for leprosy from our centre. Thirty-two patients (54.2%) were already receiving MDT as on March 2020, and 27 others (45.8%) were diagnosed with leprosy and started on MDT during the period from March 2020 to May 2021. Two patients (3.4%) developed COVID-19 while on MDT. When lockdown measures were implemented, 12 patients (12/59, 20.3%) discontinued treatment, citing conveyance difficulties. Three patients (3/59, 5.1%) were lost to follow-up. Limitations: Small sample size and reliance on retrospective data from a single centre were the major limitations of the study. Conclusion: A conscious effort is needed from healthcare professionals and the government to ensure that implementation of national programmes is not adversely affected by the ongoing COVID-19 pandemic.