Chronic Kidney Disease in Patients with Psoriasis -A Hospital Based Cross Sectional Study.

BACKGROUND: Psoriasis is a multi-system inflammatory disease where skin and joints are the primary targets. Recently, some studies had shown the association of psoriasis with kidney disease. AIMS: To study the association of psoriasis with chronic kidney disease (CKD) in a tertiary health care center. METHODOLOGY: The study was conducted in the Department of Dermatology in a tertiary care center in Kerala. The study was a descriptive cross-sectional study for 6 months from August 2017 to January 2018. A total of 104 patients with psoriasis were studied. Clinical data was collected. Glomerular filtration rate (GFR) and albumin creatinine ratio (ACR) were found out to know the presence of CKD. Descriptive and inferential statistical analysis has been carried out in the present study. OBSERVATIONS: Of the 104 patients, 14 were diagnosed as having CKD. Of the 14 CKD patients, 12 had severe psoriasis, 2 had moderate psoriasis, and none had mild psoriasis. The risk factors for CKD (presence of diabetes mellitus/hypertension or intake of drugs-non-steroidal anti-inflammatory drugs [NSAIDs]/cyclosporine) were present in 9 out of 14 CKD patients. The duration of psoriasis was more than 10 years in 10 CKD patients. CONCLUSION: Our study demonstrated that psoriatic patients have an increased risk of developing CKD and this risk is found to increase with the severity and duration of psoriasis. Our results require confirmation in large-patient populations in prospective studies or case-control studies.

Monocyte clearance of apoptotic neutrophils is unhindered in the presence of NETosis, but proteins of NET trigger ETosis in monocytes.

Resolution of inflammation needs effective and timely removal of dead cells and other toxic products of neutrophils, monocytes, and macrophages. In this study, we evaluated the role of monocytes in the clearance of neutrophil extracellular trap (NET) and apoptotic neutrophils in the inflammation site. For this, monocytes were observed microscopically after exposing them with NETs and/or apoptotic bodies. A subset of monocytes exposed to NETs ejected extracellular traps and this was shown to be mediated by proteins like elastase and citrullinated histones present in NET supernatant. Monocytes showed a preference for the internalisation of the apoptotic body when both NET and apoptotic bodies were present in the medium. The study provides new insight into the role of monocytes in the clearance of NET and apoptotic neutrophils and this information may open up a way in formulating therapeutic strategies for accelerating resolution of inflammation.

Atypical Manifestations of Leprosy - A Case Series.

Atypical manifestations are not rare in leprosy and they may present diagnostic challenges. We report a series of five cases having atypical presentations. First case presented with an asymptomatic buccal lesion and later developed skin lesions. Second patient had secondary Anti-phosphospholipidsyndrome (APS) due to leprosy. We also report another interesting case of annular vesiculobullous lesions and erythema nodosumleprosum (ENL) following intake of antibiotics for pneumonia. Other two had exacerbation reactions (ER). Two of these patients were had irregular/incompleteanti-leprosy treatment earlier., These profiles will be of interest to clinicians who may encounter cases with such manifestations.