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Objective: Popular urticaria [PU] is considered to be an allergic reaction of the human skin to the insult of a large number of haematogeous arthropods. However, the immuno-pathogenesis is still unsettled. The aim of this work was to clarify the pathogenesis of PU. The studied subjects: Thirty six patients with PU and 10 normal control subjects of comparable age were included in this study. Setting: Dermatological Outpatient Clinic, Menoufyia University Hospitals
Intervention: Skin biopsies front lesions, beside normal skin biopsies front normal subjects were obtained; Haemtoxylin and eosin-stained sections were subjected to pathological examination. Four unstained sections, from each biopsy, were prepared on poly-L-lysine coated slides and subjected to immuno-staining by CD3, CD20, CD68 and HLA class II
Results: Histopathologically, all the studied cases had perivascular chronic inflammatory infiltrate, formed of lymphocytes, macrophages and eosinophils. Marked density of inflammatory infiltrate was evident in 16/36 cases; moderate density was detected in 14/36 cases, while mild density was found among the last six cases. Prominent nerve proliferation in the superficial dermis was prominent among 88.9% of the studied cases. After immunostaining by CD3 and CD68 monoclonal antibodies, all cases showed CD3+ and CD68+ cells, the intensity of which was correlated to the intensity of inflammatory cell infiltrate. On the other hand immunostaining by CD20 monoclonal antibody showed absence of CD20+ cells in all cases. Seventy percent of the studied cases showed HLA class II [DP, DQ and DR] positivity in the inflammatory cells and overlying keratinocytes
Conclusions: The interpretation of the results of the immunohistochemical staining will be discussed
RESUMO
Objectives: Fixed drug eruption is a common distinct variant of druginduced dermatoses. Although effector and regulatory T cells play roles in the progression and resolution of FDE, respectively, little in- vivo data exist regarding the T cell dynamics in the pathogenesis of FDE. The aim of this study was to through some light on the pathogenesis of FDE through in-situ study of the immunostaining with CD4, CD8 and HLA-DR. Design: Thirty patients with FDE, [16 females and 14 males], their ages ranged between 6 and 54 years with mean 19.6 years old, were included in this study, in addition to 10 normal, age and sex matched, control subjects Settings: Dermatology and Pathology Departments, Menoufiya Faculty of Medicine
Intervention: skin biopsies were taken from 16 active and 14 healed lesions of FDE besides 20 control biopsies [10 biopsies from lesionalnearby, skill and 10 normal skin]. H and E stained sections were subjected to ordinary pathological examination. Three unstained sections from each biopsy were prepared on poly-L lysine coated slides and subjected to immunostaining withCD4, CD8 and HLA-DR. Serum Ca, total and ionized, was measured
Results: In acute FDE lesions, H and E sections revealed prominent dermal inflammatory cells infiltrating the epidermis in 100% of cases, hydropic degeneration, spongiosis and dyskeratosis besides melanin in- continence; In healed lesions, H and E stained sections revealed epidermal atrophy and there was perivascular inflammatory infiltrate. The immunostaining of HL4-DR was evident with strong expression in the inflammatory cells in dermis [mmmcl epidermis. The immunostaining of active lesions showed CD8+ T cells and CD4 + T cells in both the epidermis and dermis. In healed lesions, CD8+ T cells were detected in 93% in the epidermis and CD4 + T cells were detected in 21.4% of lesions. Serum Ca was statistically decreased in patient than in control group
Conclusions: Activation of T cells residing in the resting FDE lesions, by ingestion of a causative drug can rapidly produce large amounts of IFN gamma followed by localized epidermal injury. Such early IFN gamma production in-situ was only observed in the intraepidermal resident T cells in the lesions but not those in the peri-lesional skin and consequently progressed to localized epidermal injury. The in-situ studies indicated that CD8 + ve T cells persist in a state of activation in the resting FDE lesions and are capable of acquiring potent cytotoxic activity with rapid kinetics on clinical challenge
RESUMO
Objectives: The number of patients with oral lichen planus, [OLP], increases all over the world. The treatment of this disease is not yet definitive. The correlation between OLP and chronic HCV infection is well established. However, the reported frequency of the anti-HCV antibodies in patients with OLP tends to appear quite variable and ranges from 0% to 65%. The aim of this work was to screen asymptomatic carriers in patients with OLP for anti hepatitis C antibodies and HCV-RNA detection and quantitation in seropositive cases and to assess their liver regarding chronic hepatitis through pathological study
Design and Patients: Twenty six patients diagnosed clinically as OLP and 26 normal, sex and age matched, healthy subjects, were included in this study. Blood sample of all patients and controls were tested for anti hepatitis C virus antibodies [anti-HCV Ab]. polymerase chain reaction for hepatitis C virus was done in patients with positive anti HCV Ab. Transcutaneous liver biopsy was performed in 6 patients with positive HCV-RNA. The histopathological results were evaluated. Sitting: Dermatology out-patient clinic, Menoufiya University Hospital and National Liver Institute, Menoufiya University
Results: The results of this study revealed that the frequency of positive anti HCV antibodies in OLP patients group was significantly increased [53.8%] than control group[15.4%]. Regarding the comparison of results of HCV-RNA screening, for positive anti HCV Ab cases in OLP and control groups, it was found that viral load grading of the fourteen cases of OLP patients were 3 high, 9 moderate and 2 low. While the viral load of the sero-positive four cases of the control group were 3 moderate and 1 low, On the different clinical forms of OLP regarding anti HCV antibody positivity it was found that all ulcerative forms were positive in 100%. H and E stained sections of mucus membrane biopsies from sero positive and sero negative HCV patients showed no pathological difference. Four of the liver biopsied patients were diagnosed as chronic hepatitis, with minimal to mild activity and the other two biopsied patients were diagnosed as chronic hepatitis with moderate activity
Conclusion: A significant association between OLP and HCV infection is present and HCV-RNA detection revealed dial the viral load in seropsitive cases was graded as mild, moderate and severe. So, it is prudent to screen all patients with OLP for hepatitis markers and if possible for HCV-RNA detection and quantitation. More studies are recommended to specify different prevalent genotypes of HCV in our locality and their associations with different skin diseases
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Adenosine deaminase (ADA) was estimated in 84 pleural, 140 peritoneal and 136 cerebrospinal fluids to study its diagnostic usefulness as a routine test for tuberculosis. The sensitivity, specificity, positive and negative predictive values for diagnosing tuberculosis in pleural fluids (ADA > 30 U/l) was 67, 92, 78 and 87 per cent respectively, in peritoneal fluids (ADA > 15 U/1) it was 89, 81, 25 and 99 per cent respectively and in cerebrospinal fluids (ADA > 10 U/l) it was 50, 90 21 and 97 per cent respectively. The differences in mean ADA levels between tuberculous (28.0 and 19.5 U/1) and non-tuberculous (9.7 and 4.8 U/1) peritoneal and cerebrospinal fluids although statistically significant (P < 0.001), were of no practical clinical value. A wide scatter in ADA values was seen in both tuberculous and non-tuberculous fluids. ADA estimation in plasma, lymphocytes and cell fractions of fluids was also not diagnostically useful nor did it throw light on the source of elevated ADA in fluids.