Background: Dengue infections are public health concerns in India, where they occur in epidemics and have a high mortality in the advanced stages. Clinical features are nonspecific, and diagnosis is supported by lab features. One of these lab tests include total leucocyte count-easily available, simple and cost effective which is useful in small rural set ups for early diagnosis and prognosis of dengue. The aim of this study is to analyse the total leucocyte count patterns in dengue and assess its utility as early marker of dengue and prognosticator of severe dengue.Methods: A total of 132 serologically proven cases of dengue with total white cell counts (blood counts obtained by Automated hematology analyser) during November 2016 were analysed.Results: In our study, most cases were noted in the younger age group with a male predominance. The range of total leucocyte count was 1.1x109 /l to 14.3x109/l. Most (55%) had normal counts, leucopenia was noted in 36%, had an equal distribution in all ages and both sexes. 82% had mild leucopenia,52% of leucopenia cases were associated with severe thrombocytopenia. Almost half (47%) of leucopenia cases were NS1 positive while only 15% were antibody positive.59% of NS1 positive had leucopenia in contrast to 13% of antibody positive cases. While leucopenia was mostly (55%) associated with neutrophilia, lymphocytosis was seen in 74% of cases with a normal leucocyte count.Conclusions: Total leucocyte count is one of the simple, easily available, cost effective tests useful in small rural set ups for early diagnosis and prognosis in dengue and helps reduce the morbidity and mortality of dengue.
Familial hypercholesterolemia is a rare, monogenic, co-dominant, life-threatening disorder resulting from loss of function mutations in the genes responsible for synthesis of low-density lipoprotein receptors or apo-B genes or gain of function mutations in PCSK9 genes in the liver which affects 0.2% of the population. It is characterized by severe lifelong elevation of LDL cholesterol and by development of xanthelasma, xanthomas, premature coronary artery disease and peripheral artery occlusive disease. Most patients develop PCAD and aortic stenosis before the age of 20 years and die before 30 years of age. The diagnosis of FH is usually based on clinical presentation and commonly used criteria are the Dutch lipid clinic network criteria, Simon Broome criteria or the WHO criteria. We encountered four cases of familial hypercholesterolemia over last 10 years. All the four patients presented with effort angina and all were found to have obstructive coronary artery disease oncoronary angiogram and two of them had severe supravalvular aortic stenosis. All four patients were on dietary modifications, high intensity statin and cholesterol absorption inhibitor. Two patients underwent coronary artery bypass grafting with aortoplasty, one patient underwent coronary artery bypass grafting and one patient underwent percutaneous transluminal coronary angioplasty. Familial hypercholesterolemia leads to development of life-threatening manifestations early in the second and third decades of life. Early diagnosis, aggressive treatment and control of risk factors and cascade screening are important in management and will help to reduce the morbidity and mortality associated with this disease.
Background: The nail is our most versatile tool and serves a very important function of protecting the distal phalanx. The nail unit shows specific changes that are markers for a wide range of local and systemic conditions. Objectives: The objectives of the study are to identify the spectrum of histomorphological features in various nail lesions and to highlight the role of histopathology in diagnosis of nail diseases. Methods: This is a descriptive study done over a period of 18 months. The nail biopsy specimens were received in 10 % formalin, softened with 10% nitric acid, processed and stained with routine Hematoxylin & Eosin [H&E] stains. Periodic Acid stain[PAS] stain was done wherever necessary. Histopathological examination by light microscopy was done to arrive at a precise diagnosis. Brief patient history and clinical features were also noted. Results: A total of 50 nail punch biopsies were examined. Psoriasis was the most common accounting for 38%. The combined approach of H & E and PAS stain was helpful in diagnosis of onychomycosis in 24%. Pigmentary disorders (14%) , lichen planus (10%) and alopecia areata (6%) were the other conditions observed. In 8% of cases microscopic features were nonspecific. Conclusion: The nail unit has a complex morphology with many peculiarities. Though it is quite accessible, it remains understudied. Histomorphological evaluation of nail punch biopsy is useful in understanding the involvement of nail in various dermatoses and also aids in the accurate diagnosis. Keywords: Dermatoses, Histopathology, Nail biopsy
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