International Medical Journal

Amyloidosis is a group of heterogeneous diseases characterized by extracellular deposition of proteinaceous material in various organs.  Multiple dermatological manifestations of amyloidosis have been described, including nodules, papules, plaques and periorbital ecchymosis. We report a case of idiopathic primary systemic amyloidosis presenting with unusual extensive upper and lower limbs ecchymoses along with laryngeocel, lacking the classical presentation of macroglossia, waxy papules, and plaques.

Obesity has been linked with increased morbidity and mortality although the causes of obesity are not well understood. Its’ obvious involvement in the respiratory system causing obesity hypoventilation syndrome (OHS), obstructive sleep apnoea(OSA) and abnormal pulmonary function is well known, but how the presence of excess fat in the body is involved in the various inflammatory or other disease of the respiratory system are not clearly known. In this presentation, we further explore the mechanism involved in alterations in lung function caused by obesity. It is observed that obese individuals have increased respiratory rates, reduced tidal volumes and decreased total lung compliance. The lung volumes are usually reduced, especially expiratory reserve volume. However, in most cases, airway resistance and gas exchange seem to be relatively well preserved. Obese individuals usually have mild hypoxemia due to ventilation- perfusion imbalance in bases of lung fields possibly due to micro atelectasis. Weight loss in such individuals to a large extent may reverse these changes.

Tumor associated macrophages (TAMs) and COX-2 has been reported in association with tumorigenesis, invasion, angiogenesis and metastasis of non-melanoma skin cancer (NMSC). In this study, we used immunohistochemistry on a total number of 30 cases to study histomorphological spectrum and investigate density of TAMs (CD 68) within or at the periphery of tumor along with COX‐2 expression in a series of metastatic tumors of skin i.e. squamous cell carcinoma, basal cell carcinoma and sebaceous cell carcinoma. The maximum patients (33%) were seen in fifth decade with predilection of male gender (60%). The mean age (years) for basal cell carcinoma, squamous cell carcinoma and sebaceous cell carcinoma were 65.59 ± 8.02, 61.17 ± 22.95 and 55.00 ± 0 respectively. Cheek (20%) was more commonly involved site with ulcer (43%) as most common presentation. A significant statistical correlation was found with respect to lesion size (p 0.02) and sun exposure (0.027). Maximum patients were of BCC while maximum association with sun exposure and expression of TAM and COX-2 immunostaining were observed in BCC. In this study, almost 80% and all cases of NMSC simultaneously showed significant expression of COX-2 and TAM (CD 68) respectively but no statistical correlation was found between the various NMSC histological types and differentiation of squamous cell carcinoma as p value was >0.05. Conclusions: We can conclude that both COX-2 and TAM (CD 68) may play role in the development of NMSC as maximum cases showed positivity for both the markers.

ACE2 is a type one transmembrane metallo carboxypeptidase with similarity to ACE. Heart, vessels, gut, kidney, respiratory organ, testicle, brain these are the organ in which ACE2 receptor is widely expressed. It acts as a key player in renin angiotensin system and serves as a target for the treatment of cardiovascular diseases. Angiotensin II, a compound with angiotensin converting enzyme (ACE) activity, regulates vascular tone, stimulates the development of proinflammatory cytokines, inhibits NFkappaB, enhances oxidant stress, and suppresses nitric oxide synthesis. Thus, angiotensin-II is basically pro-inflammatory, thus the ACE inhibitors and ARBs used as therapeutic agents will reverse this effect and will decrease inflammatory mediators. ACE inhibitors and the ARBs will decrease the renal damage of SARS COV nephropathy by reducing the macrophage infiltration. Current evidence does not prove any negative impact of ARB and ACEI on Covid-19. It is clear from the mechanism based evidences that the ACE inhibitors and the ARBs are having much more benefits and show evidence of efficacy and show promise in tackling all the three dangerous comorbidities of SARS COV 2 i.e. Heart disease, glomerular diseases and Diabetes Mellitus, discontinuing them only for the sake of small increase in ACE II expression will be unjustified. Those patients having the indications can be continued for ACE inhibitors and the ARBs with or without SARS COV 2.

Platelet rich plasma (PRP) is an autologously derived biological product from a sample of the patient’s blood. The obtained product after centrifugation consists of a plasma fraction with a platelet concentration higher than that in circulating blood. Platelet rich plasma (PRP) gel is a type of advanced wound therapy of fairly recent interest used for both chronic and acute wounds across various branches of medicine. It is rich in cytokines, growth factors, and chemokines. Not only does it form a fibrin scaffold, accelerating wound healing but also confers antibiotic properties. The well-orchestrated mechanism and products of platelet activation are responsible for these properties. In our study, we discuss a series of 30 cases of wound of varying etiologies wherein PRP gel prepared using cost effective methods was used. Our study included wounds of various etiologies wherein, 8 (26.67%) were diabetic wounds, 8 (26.67%) were due to venous insufficiency, 5 (16.67%) were post-surgical wounds, 6 (20%) were traumatic ulcers and 3 (10%) were pressure ulcers. The mean wound contraction rates achieved after 4 weeks was found to be 91.53%. Autologous PRP seems to be a safe and cost effective biological agent which can be used for treatment of small ulcers of various etiologies with good wound contraction rates.