Multiple Plaques Research Articles

Case Report: Multiple atherosclerotic plaques at its extreme in synchrony

Peripheral vascular disease in association with renal artery stenosis is an important association which predicts the severity of the disease. An increase in the number of vessels affected by peripheral vascular disease increases the chances of renal artery stenosis. In our case, the patient had primarily presented with anginal chest pain with complaints of claudication which on further investigation was diagnosed to be a triple vessel coronary artery disease along with bilateral subclavian and bilateral renal stenosis. On detailed history taking, risk factors like hypertension and chronic smoking was found to be present in our case which predisposed to peripheral artery disease secondary to atherosclerosis which was diagnosed on further investigations. Although the association of renal artery stenosis is not very rare in cases of severe peripheral vascular diseases, the presence of a triple vessel coronary artery disease in synchrony is what makes it unique. Take away lesson from this case report is importance of early diagnosis of dyslipidemia causing atherosclerosis and its complications. Multiple atherosclerotic lesions in synchrony i.e, bilateral renal artery stenosis with bilateral subclavian artery stenosis with coronary artery triple vessel atherosclerotic disease like in our case and its severity should create awareness among health care individuals and early treatment measures including lifestyle modifications should be considered to avoid such drastic events.

ORAL MANIFESTATIONS OF SECONDARY SYPHILIS: A CASE REPORT

Syphilis is a sexually transmitted disease caused by Treponema pallidum infection. Oral manifestations of secondary syphilis can be more extensive and variable than those of primary syphilis. A 57-year-old female presented a one-month history of mouth and throat ulcers. Extraoral examination revealed cervical lymphadenopathy and erythematous spots on her wrists and side of left foot. Intraorally, there were multiple erosive plaques on palatine tonsils, border of the tongue, and lower labial mucosa. Diagnostic hypotheses included erythema multiforme, pemphigus vulgaris, and syphilis. Incisional biopsy was performed and histopathological analysis revealed chronic inflammatory infiltrate rich in lymphocytes and plasma cells. Therefore, infection was suspected and serological tests were performed. VDRL, TPPA, and FTA-ABS tests yielded positive results, indicating a diagnosis of syphilis. Antibiotic therapy was begun, and oral and skin lesions disappeared within one month. Clinicians must be familiarized with the oral manifestations of syphilis, an emerging disease with varied clinical aspects. Syphilis is a sexually transmitted disease caused by Treponema pallidum infection. Oral manifestations of secondary syphilis can be more extensive and variable than those of primary syphilis. A 57-year-old female presented a one-month history of mouth and throat ulcers. Extraoral examination revealed cervical lymphadenopathy and erythematous spots on her wrists and side of left foot. Intraorally, there were multiple erosive plaques on palatine tonsils, border of the tongue, and lower labial mucosa. Diagnostic hypotheses included erythema multiforme, pemphigus vulgaris, and syphilis. Incisional biopsy was performed and histopathological analysis revealed chronic inflammatory infiltrate rich in lymphocytes and plasma cells. Therefore, infection was suspected and serological tests were performed. VDRL, TPPA, and FTA-ABS tests yielded positive results, indicating a diagnosis of syphilis. Antibiotic therapy was begun, and oral and skin lesions disappeared within one month. Clinicians must be familiarized with the oral manifestations of syphilis, an emerging disease with varied clinical aspects.

Association of severely damaged endodontically infected tooth with carotid plaque and abnormal carotid intima-media thickness: a retrospective analysis.

We investigated the association of severely damaged endodontically infected tooth with carotid artery plaque and abnormal mean carotid intima-media thickness (CIMT) ≥ 1.0mm. A retrospective analysis of 1502 control participants and 1552 participants with severely damaged endodontically infected tooth who received routine medical and dental checkup in Health Management Center, Xiangya Hospital was performed. Carotid plaque and CIMT were measured with B-mode tomographic ultrasound. Data were analyzed using logistic and linear regression. Severely damaged endodontically infected tooth group had a significantly higher prevalence of carotid plaque (41.62%) compared to 32.22% of carotid plaque in control group. Participants with severely damaged endodontically infected tooth had a significantly higher prevalence of abnormal CIMT (16.17%) and a significantly increased level of CIMT (0.79 ± 0.16mm) in comparison to 10.79% of abnormal CIMT and 0.77 ± 0.14mm CIMT in control participants. Severely damaged endodontically infected tooth was significantly related with formation of carotid plaque [1.37(1.18-1.60), P < 0.001], top quartile length [1.21(1.02-1.44), P = 0.029] and top quartile thickness [1.27(1.08-1.51), P = 0.005] of carotid plaque and abnormal CIMT [1.47(1.18-1.83), P < 0.001]. Severely damaged endodontically infected tooth was significantly associated with both single [1.277(1.056-1.546), P = 0.012] and multiple carotid plaques [1.488(1.214-1.825), P < 0.001] and instable carotid plaques [1.380(1.167-1.632), P < 0.001]. Presence of severely damaged endodontically infected tooth increased 0.588mm of carotid plaque length (P = 0.001), 0.157mm of carotid plaque thickness (P < 0.001) and 0.015mm of CIMT (P = 0.005). Severely damaged endodontically infected tooth was associated with carotid plaque and abnormal CIMT. Early treatment of endodontically infected tooth is warranted.

Idiopathic facial aseptic granuloma in children: Management and long-term follow-up

AimsThe primary objective was to study long-term outcomes in children with idiopathic facial aseptic granuloma (IFAG). The secondary objectives were to describe the clinical polymorphism of this entity, the different therapeutic options, and the occurrence of rosacea in this population. MethodsWe selected patients with a clinical diagnosis of IFAG seen in two different hospitals in Normandy between March 2016 and February 2021, and we collected clinical and therapeutic data from computerized medical records. A remote consultation based on recent photographs was performed to collect new data, and the children’s parents were asked to complete a questionnaire between February and August 2021. ResultsTen children were included in this study. Nine patients presented with a single red to purplish nodule. One patient presented multiple papulopustular plaques. IFAG healed spontaneously without major sequelae, and this outcome was not influenced by any treatments. During follow-up, two patients developed childhood rosacea. ConclusionAlthough some clinical heterogeneity exists, early diagnosis and follow-up of IFAG is necessary to avoid unnecessary topical or systemic antibiotic treatments that do not shorten the disease course. IFAG appears to be a possible mode of entry for infantile rosacea.

Atrophic violaceous plaques as the first manifestation of a disorder of GNAS inactivation.

We report the case of a 10-month-old girl who presented with failure to thrive and multiple small atrophic violaceous plaques, with no other findings on her physical examination. The laboratory examinations, abdominal ultrasound and bilateral hand radiography performed were unremarkable. The skin biopsy revealed fusiform cells and focal ossification in the deep dermis. The genetic study showed a pathogenic variant of GNAS.

CHALLENGES IN MANAGEMENT OF BORDERLINE LEPROMATOUS LEPROSY COMPLICATED BY DAPSONE INDUCED HEMOLYTIC ANEMIA AND LEPRA REACTION: A CASE REPORT.

Multidrug therapy for Leprosy is currently done with Dapsone, Clofazimine and Rifampicin. Dapsone is known to cause hemolytic anemia and this adverse event during MDT seems to be more frequent than reported. Lepra reactions can occur at presentation, during treatment or even after completion of MDT. Inadequate and interruption of treatment is an obstacle to eradication. 65 year old female clinically diagnosed leprosy, as patient developed multiple hypopigmented plaques on skin and swelling and decreased sensation over right hand initiated on MDT presented with complains of hematuria on Day 4 of therapy. Blood investigation revealed hemolytic anemia. Dapsone was stopped and blood products given. Dapsone inhibits bacterial synthesis of Dihydrofolic acid. The main side-effects usually described are allergic, such as itchy rash and exfoliative dermatitis, hemolytic anemia (HA), jaundice, methemoglobinemia and dapsone syndrome. Type 1 reaction or “reversal reaction" presents with worsening of pre-existing skin lesions, thickening of nerve ber with neuropathy and edema. Type 2 reaction or erythema nodosum leprosum (ENL) have painful erythematous skin nodules. This case highlights fundamental understanding of the treatment options, prompt diagnosis and treatment of reactions which are essential to reduce disease burden and improve patient's quality of life.

Pseudolymphoma to Lymphoma: A Case of Chronic Reactive Lymphoid Hyperplasia Transforming to Primary Cutaneous Marginal Zone Lymphoma.

Primary cutaneous marginal zone lymphoma (PCMZL) is a low-grade malignant B-cell lymphoma that originates from the skin. It often presents as erythematous solitary or multiple papules, nodules, and/or plaques. It is one of the 3 main subtypes of primary cutaneous B-cell lymphomas. PCMZLs are believed to develop from chronic antigenic stimulation such as from tick-borne bacteria, vaccines, tattoo pigment, or other foreign body. In addition, cutaneous lymphoid hyperplasia, a documented precursor to malignant PCMZL, often presents in response to areas of chronic inflammation. Cutaneous lymphoid hyperplasia and PCMZL share several clinical and histological similarities that require clinicopathologic suspicion, immunohistochemical ancillary studies, and histopathologic analysis to accurately differentiate the 2 entities. Although gene rearrangement studies have historically been of limited value in the diagnosis of PCMZL, recent studies investigating molecular markers have identified the presence of multiple genetic abnormalities that have helped to better characterize the disease and aid in diagnosis. In addition, newer studies have found associations between PCMZL and gastrointestinal disorders, including Helicobacter pylori and inflammatory bowel disorders. In this article, we describe a case of a 56-year-old patient with a history of ulcerative colitis presenting with chronic reactive lymphoid hyperplasia that transformed to primary cutaneous marginal zone lymphoma.

Congenital cutaneous mastocytosis mistaken for non-accidental injury.

A previously well male infant presented to his general practitioner (GP) for his routine 6-week check. His parents reported the presence of tan-brown lesions since birth. The marks were uniform in color, were present on the trunk, scalp, and face, and were not overlying bony prominences. The GP was concerned that these lesions represented bruising as a manifestation of non-accidental injury (NAI), and arranged an urgent review at our pediatric department. Following assessment by the pediatric team he was admitted for investigation of potential NAI, and dermatology consultation was sought. On examination, scattered reddish brown to tan macules and papules were noted on the torso and limbs, not overlying bony prominences (Figure 1A, B). Darier's sign was negative, although some reactive cutis marmorata was appreciable on the trunk following the rubbing of multiple lesions. A diagnosis of urticaria pigmentosa (UP), now known as maculopapular cutaneous mastocytosis (CM), a form of CM, was made clinically. Skin biopsies demonstrated an infiltrate of spindled and round mast cells and scattered eosinophils within the superficial and mid dermis, with immunohistochemistry positive for CD117, consistent with CM (Figure 1C–E). Blood tests during admission showed a normal complete blood count and coagulation screen (including von Willebrand factor), normal renal and liver function, normal lactate dehydrogenase, normal immunoglobulins, and normal mast cell tryptase. Cranial ultrasound and abdominal ultrasound (including liver and spleen) were normal. Mastocytosis is a spectrum of disease characterized by the pathologic accumulation of mast cells in tissues, including skin, bone marrow, and the gastrointestinal tract. The World Health Organisation has outlined three variants: CM, systemic mastocytosis, and mast cell sarcoma. CM can be further classified as maculopapular CM, also known as UP; diffuse CM; and localized cutaneous mastocytomas.1 Pediatric CM is regarded as a benign condition limited to skin, most commonly presenting as UP, which usually spontaneously regresses in puberty.2 In contrast, adult-onset mastocytosis is more often associated with systemic involvement, a persistent course, and activating mutations of the KIT gene.1 With UP, children typically present in the first two years of life with multiple reddish-brown macules, papules, and/or plaques distributed anywhere on the body, most commonly the trunk. In darkly pigmented skin, lesions may be hyperpigmented and erythema less appreciable. Darier sign, a transient urticarial response upon gentle rubbing of the skin, is classic and supportive of the diagnosis, though not always demonstrable. Treatment with antihistamines can be helpful.3 UP has rarely been reported to be misdiagnosed as NAI.4, 5 Other ‘bruising’ mimics include disorders of coagulation, Valsalva petechiae, vasculitis, acute hemorrhagic edema, incontinentia pigmenti, phytophotodermatitis, coin rubbing, spooning, cupping, Mongolian spots, morphea, neuroblastoma, and ink stains, some of which may be unfamiliar to pediatricians or dermatologists.5 CM can be differentiated from bruising by the typically monomorphic appearance; the persistence of lesions with very gradual resolution; the development of new lesions without trauma; the presence of lesions on any part of the body, not specifically overlying bony prominences; the presence of itch; and the presence of Darier sign. Dermatologists have a crucial role in recognizing cutaneous manifestations of NAI in children, which commonly includes bruising, particularly in infants who are not yet mobile.4 While consideration of NAI is important in all children presenting for medical care, this case highlights the importance of considering underlying dermatoses to avoid unwarranted distress and unnecessary investigations. Written informed consent was obtained from the patient's parent. None.

Seborrheic Keratosis Caused by Human Papillomavirus Type 20 Ameliorated by Zinc Oxide Ointment

A 91-year-old woman visited our department with scattered small nodule lesions and multiple pules or plaques with a stuck-on appearance. The lesions were intractable and resistant to several treatments. Immunodeficiency was excluded by examinations including a CT scan, white blood cell (WBC) counts, natural killer and neutrophil function assays, and IgG titers against human papillomavirus (HPV) 20. HPV20 was identified using the PCR method. The finding of the skin biopsy showed an irritated type of feature of seborrheic keratosis. Additionally, immunohistochemical staining of the lesion revealed that both TNF-α and IFN-ɤ were produced at the skin lesions. The patient's serum zinc level was slightly low. We noticed that zinc deficiency has been reported to decrease the cytotoxic activity of natural killer cells, which play an important role in eliminating virus-infected cells and tumor cells. Finally, zinc oxide ointment was found to improve the lesions dramatically. HPV20 causes tumors only in immunodeficient patients or in patients with epidermodysplasia verruciformis (EV). In EV, EVER1- or EVER2-encoding membrane proteins, of which are related to zinc transport protein-1 expressed on the membrane of the endoplasmic reticulum, were mutated, leading to increased susceptibility to various viral and bacterial infections due to the decreased intracellular zinc concentration. We speculated that the reduction in local zinc concentration was ameliorated by using zinc oxide ointment, resulting in the recovery from HPV20 infection.

Mycosis Fungoides: A Diagnostic Challenge

Background: Mycosis fungoides (MF) is the most frequent type of cutaneous T-cell lymphomas (CTCL), a heterogeneous group of non-Hodgkin lymphoma of T-cell origin. CTCLs accounts for about 4% of all non-Hodgkin lymphoma. MF mainly involves the skin but in advanced cases it may involve the lymph, blood and other organs. It mimics other skin disorders like erythema necroticans, leprosy, psoriasis etc which leads to delayed diagnosis and subsequent treatment. Case report: A 61 year old male patient visited the OPD of a tertiary care hospital in Eastern India with multiple reddish elevated lesions for last 6 months which later became dome shaped and then ulcerated. He did not have any fever or itching. He informed that he had been taking Homeopathic medicine previously, but the identity of the said medicine could not be confirmed. Physical examination ruled out the presence of pallor, jaundice, oedema and cyanosis. Pulse and BP were within normal range. Systemic examination was unremarkable except mild hepatomegaly. Cutaneous examination revealed multiple erythematous indurated plaques, papules and nodules over chest, abdomen, back, limbs and face. Few of the plaques present on the trunk and left arm had developed ulcers having a necrotic floors. Cervical, axillary and inguinal lymph nodes were palpable, being firm in consistency and mobile in nature. Hair, nail and mucosal examination revealed normal results. Complete blood count (CBC), peripheral blood smear(PBS), serum urea and creatinine level did not deviate from normal findings. Ultrasonography of whole abdomen showed a mildly enlarged liver. A prominent lymph node in the aortocaval groove could be appreciated on the computed tomography(CT) scan of whole abdomen. CT scan of chest revealed bilateral axillary lymphadenopathy. Erythema necroticans, sarcoidosis and CTCL were considered as the differential diagnoses. Lesional biopsy revealed irregular epidermal hyperplasia, parakeratosis and epidermotropism in the absence of spongiosis.There was infiltration of atypical lymphocytes in the epidermis, forming well developed Pautrier’s micro abscesses. The lymphocytes were tagging the dermo-epidermal junction and within the epidermis showing surrounding halo, convoluted nuclei and variable nuclear pleomorphism. Band like papillary dermal lymphoid infiltrate, dermal lymphoid fibroplasia and nodular lymphoid aggregates could be appreciated in the deep dermis. Immunohistochemical tests were performed and the immunophenotypic profile revealed positivity for CD2, CD3, CD5, CD7, CD 8 and TIA1 and negative for CD4, CD20, CD30, CD56 and granzyme B. Based on clinical presentation, histopathology and Immunohistochemical tests, a final diagnosis of MF was made. The patient was then started on systemic antibiotic therapy, due to increased risk of bacterial super infection of lesions due to skin barrier disruption. He was then referred to Oncology department for further treatment. Conclusion: In this case, the male patient was suffering from mycosis fungoides. In the background of its clinical features being similar to other skin disorders like erythema necroticans, clinicians may face a diagnostic dilemma to correctly diagnose it. Timely diagnosis and treatment improves the prognosis in most cases. Histopathological evaluation still remains the investigation of choice.

Penile Intraepithelial Neoplasia (PeIN) in a young man with the clinical appearance of Buschke Lowenstein Tumor

Background: The incidence of penile cancer in the general population is rare. Epidemiologically, penile cancer occurs less than 1% compared to other types of cancer. Penile Intraepithelial Neoplasia (PeIN) is a precancerous lesion of invasive squamous cell carcinoma characterized by dysplastic changes of squamous epithelium with the intact basement membrane. This case report aims to increase understanding of Penile Intraepithelial Neoplasia (PeIN), especially with the clinical appearance of the Buschke Lowenstein Tumor, diagnosis, examination, and appropriate management. Case Presentation: A 21-year-old Balinese man presented with a lump on his genitalia without itching, pain, and a lesion that bleeds easily, which has appeared since January 2022. He complained that the lump was getting bigger and bigger. Physical examination showed multiple hyperpigmented papules and plaques with well-defined oval and corn shapes that vary in size with a dense consistency and a verrucous surface. Laboratory tests showed negative on Hep-B and HIV tests. The patient also had a biopsy of the lump where the results showed Penile Intraepithelial Neoplasia. The patient was treated with 6 cycles of TCA 80% once a week, but it did not improve, so circumcision and surgical excision were carried out on June 2022. Fourteen days after surgery, multiple lumps appeared, recurred, and increased in number and size. On 1-month observation after the second surgery, the patient denied complaints of the genitals. Venerological status was within normal limits. Conclusion: HPV-related Penile Intraepithelial Neoplasia (Warty subtype) with the clinical appearance of Buschke Lowenstein Tumor was reported in a 21-year-old Balinese man treated with Glans Resurfacing surgical excision with satisfactory results characterized by no functional abnormalities both during urination or erection.

Multiple verrucous plaques on the genital and perianal regions of an elderly man

Multiple verrucous plaques on the genital and perianal regions of an elderly man

A CASE OF BLUE RUBBER BLEB NEVUS SYNDROME

We report a 16-year-old Indian boy diagnosed with Blue Rubber Bleb Nevus syndrome, which is a rare venous malformation that goes overlooked in most case scenarios. He had presented with long standing history of fatigue, melena with a past history of surgery for a vascular malformation and also had multiple bluish skin plaques. He was evaluated and was found to have iron deficiency anemia. Considering the history of melena, upper GI endoscopy was done, which revealed multiple vascular malformations, and so did colonoscopy. Patient was offered multidisciplinary team (MDT) approach involving Internal Medicine, Gastroenterology, Dermatology and Plastic surgery

Association of pre-diabetes and type 2 diabetes mellitus with intracranial plaque characteristics in patients with acute ischemic stroke.

To investigate the association of pre-diabetes(i.e., the early stages of glucometabolic disturbance) and Type 2 diabetes mellitus (T2DM) with intracranial plaque characteristics in patients with acute ischemic stroke using three-dimensional high-resolution MR imaging. One hundred and forty-three symptomatic patients with acute ischemic stroke attribute to intracranial atherosclerotic plaque were prospectively enrolled. All participants were further divided into three groups: normal glucose metabolism(non-diabetes) group(n = 41), pre-diabetes group(n = 45), and T2DM group(n = 57) according to glucometabolic status. Culprit plaque characteristics (such as plaque burden, normalized wall index and enhancement ratio), total plaque number, and global plaque enhancement score were analyzed and compared among the three glucometabolic groups. The association between pre-diabetes and T2DM with intracranial plaque characteristics was assessed by logistic regression and multivariate linear regression. Plaque number was higher in patients with pre-diabetes and T2DM compared with those with non-diabetes(3.71 ± 1.83 and 3.75 ± 1.71 vs 2.24 ± 1.46, p = 0.006). Multivariate logistic regression showed a significant association of multiple intracranial plaques with pre-diabetes(OR 3.524, 95% CI 1.082 ~ 11.479, p = 0.037), T2DM(OR 3.760, 95% CI 1.098 ~ 12.872, p = 0.035) and luminal stenotic rate. Both pre-diabetes and T2DM were significantly associated with culprit plaque enhancement ratio(β = 0.527 and β = 0.536; respectively; p < 0.001) and global plaque enhancement score(β = 0.264 and β = 0.373; respectively; p < 0.05). Patients with pre-diabetes and T2DM had similar intracranial atherosclerotic plaque vulnerability, as demonstrated by multiple plaques, increased culprit plaque enhancement ratio and global plaque enhancement score. Pre-diabetes might be a risk factor for intracranial plaque vulnerability. It is necessary to monitor a slight increase in blood glucose in non-diabetes patients with acute ischemic stroke.

Iatrogenic Kaposi’s sarcoma

A 74 year old woman with primary biliary cirrhosis under immunosuppression with azathioprine (50 mg/day) presented multiple violaceous papules and plaques with some associated edema on the distal lower right extremity (Figure 1). Physical examination also revealed multiple right inguinal adenopathies

Spurious Presentation of Pulmonary Kaposi Sarcoma as Unresolved Pneumonia Led to Fatal Outcome.

Acquired immunodeficiency syndrome (AIDS)-associated Kaposi sarcoma (KS) is an angioproliferative neoplasia caused by infection with human herpesvirus 8 (HHV-8). It typically presents with mucocutaneous involvement, but it can be disseminated. Initial presentation with primarily pulmonary KS is rare. We present a case of a 32-year-old male with untreated human immunodeficiency virus (HIV) diagnosed 1 year before presentation who developed progressively worsening cough and shortness of breath for 6 months. He was hospitalized twice and treated for unresolved pneumonia in an outside hospital. The patient concomitantly developed purplish nodules on his face, then the upper trunk, back, chest, and thighs bilaterally that gradually increased in size and number. Histopathology findings from skin lesions were consistent for KS. Bronchoscopy found multiple erythematous plaques throughout the tracheobronchial tree with telangiectasias and inflammation suggestive of pulmonary KS. His imaging findings and positive serum HHV-8 polymerase chain reaction (PCR) were consistent with disseminated KS. He started antiretroviral therapy (ART) to treat his HIV infection, followed by liposomal doxorubicin chemotherapy. But both ART and chemotherapy were interrupted due to adherence and insurance issues. The patient was readmitted with acute respiratory failure requiring mechanical ventilation with multiple vasopressors that led to the patient's demise. The late recognition of KS diagnosis and delayed treatment can lead to worse outcomes.

Squamous Cell Carcinoma Arising in Lesions of Discoid Lupus Erythematosus in a Patient with Overlap Syndrome: A Chronic Rare Complication.

Squamous Cell Carcinoma Arising in Lesions of Discoid Lupus Erythematosus in a Patient with Overlap Syndrome: A Chronic Rare Complication.

Evaluation of Epigenetic Age Acceleration Scores and Their Associations with CVD-Related Phenotypes in a Population Cohort.

We evaluated associations between nine epigenetic age acceleration (EAA) scores and 18 cardiometabolic phenotypes using an Eastern European ageing population cohort richly annotated for a diverse set of phenotypes (subsample, n = 306; aged 45-69 years). This was implemented by splitting the data into groups with positive and negative EAAs. We observed strong association between all EAA scores and sex, suggesting that any analysis of EAAs should be adjusted by sex. We found that some sex-adjusted EAA scores were significantly associated with several phenotypes such as blood levels of gamma-glutamyl transferase and low-density lipoprotein, smoking status, annual alcohol consumption, multiple carotid plaques, and incident coronary heart disease status (not necessarily the same phenotypes for different EAAs). We demonstrated that even after adjusting EAAs for sex, EAA-phenotype associations remain sex-specific, which should be taken into account in any downstream analysis involving EAAs. The obtained results suggest that in some EAA-phenotype associations, negative EAA scores (i.e., epigenetic age below chronological age) indicated more harmful phenotype values, which is counterintuitive. Among all considered epigenetic clocks, GrimAge was significantly associated with more phenotypes than any other EA scores in this Russian sample.

Assessment of carotid arteries in stroke patients by ultrasonography and color Doppler

Background: Prevalence and associated mortality and morbidity rates apprehend stroke as a major health concern worldwide. Atherosclerotic disease of carotid arteries is the most common source of stroke. Quick and effective diagnosis, management and treatment of stroke is essential. Conventional diagnostic imaging techniques lacks the efficacy to rapidly and accurately dragonize stroke. Current investigation is focused towards assessing carotid arteries in stroke patients by ultrasonography and color Doppler to study the locate and study the morphology of lesion in carotid artery and to grade severity and extent of stenosis.Methods: A prospective observational study was performed on stroke patients of more than 40 years of age. The study was conducted at the department of radio diagnosis in a tertiary care center for a period of 18 months. Varied color Doppler parameters were studied and optimized to assess the morphology and surface of plaques and to determine stenosisResults: Mean age of the patients with carotid lesion was observed to be 59.7±9.8 years and male patients outnumbered postmenopausal female patients. Hemiparesis was the most common clinical presentation. Majority of patients exhibited raised intimomedial thickness and single or multiple plaques commonly in carotid bulb. Plaques of type II with irregular surface were most commonly observed which exhibited mostly 50-69% stenosis.Conclusions: The carotid artery embolic occlusion stenosis is the primary cause of stroke. Doppler sonography provides a rapid, noninvasive, relatively inexpensive and accurate means of diagnosing carotid stenosis, to determine the degree of cervical carotid stenosis and plaque morphology.

1427. Correlation of Dermoscopic and Histopathologic Patterns in Leprosy-a Pilot Study

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit skin smear staining. Dermoscopy is a handy easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. Methods A total of 50 patients in different poles of leprosy were evaluated as a single spot observational analysis. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A Lepromatous leprosy showing xerosis and scaling along leg as part of glove and stocking distribution of lesions Dermoscopic pattern in lepromatous leprosy showing partial loss of hair follicles, dry xerotic skin, and white characteristic scaling (Heine Delta® 20 T dermatoscope; 16×; polarizing) Results The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum and a diffuse erythema was a clue towards diagnosing type I lepra reaction. Interestingly clofazimine induced pigmentation was picked up characteristically on dermoscopy as a ‘honey comb pattern’. Borderline tuberculoid leprosy with a hypoaesthetic patch on the left side of face with a thickened greater auricular nerve Dermoscopic pattern in borderline tuberculoid leprosy showing white areas with loss of hair follicles. In between yellow globules can be seen which was the hallmark apart from white areas demonstrating hypopigmentation. Absence of blood vessels rules out lepra reaction (Heine Delta® 20 T dermatoscope; 16×; polarizing) Conclusion Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also patient drug compliance particularly to Clofazimine can also be picked up objectively on Clofazimine. Multiple erythematous plaques on the back depicting type 1 lepra reaction Dermoscopic features of type I lepra reaction showing characteristic diffuse erythematous background and branching telangiectatic vessels along with sparse hair follicles and scaling (Heine Delta®20 T dermatoscope; 16×; polarizing) Disclosures All Authors: No reported disclosures.