PRP therapy in chronic diffuse alopecia areata – A case report

Alopecia areata, an auto-immune disorder characterised by the appearance of non-scarring bald patches affecting the hair bearing areas of the body, it can be extremely difficult to treat and has a poor prognosis despite many therapeutic options. Platelet Rich Plasma (PRP) has been previously used to treat variety of alopecia including alopecia areata. A 21-year old girl presented with asymptomatic loss of hair from the scalp for the last more than two years. On examination, there was diffuse loss of hair all over the scalp with few small, thin light-coloured hair in the occipital region. Histopathological examination showed miniaturised hair follicles surrounded by variable inflammatory lymphohistiocytic infiltrate with a marked reduction in terminal-vellus hair ratio to 1:1.The response to previous treatments was poor at the end of 1 year. A trial of PRP was given with no adjuvant treatment with a total of eight sessions of PRP. Dramatic response was noted after 2 sessions in the form of improvement in hair diameter and total volume. Resistant areas also started showing hair growth. There are a few studies assessing the role of PRP therapy in AA. First report to establish the efficacy of PRP as a treatment modality in AA, showed PRP therapy to be superior to TCA and Placebo in growing pigmented hair in AA patches. A case report with ophiasis type AA resistant to intralesional steroid injections showed excellent response to PRP therapy. Previous studies have demonstrated beneficial role of PRP therapy in cases of patchy alopecia areata, in contrast ours was a case of chronic diffuse AA. Inspite of many treatment modalities tried for more than a year, the response was unsatisfactory. PRP therapy yielded amazing results in the form of hair growth over resistant areas and overall increase in pigmented hair which were sustained at one and a half year follow up. Our case was unique in the way that excellent response to PRP treatment was noted (a) In a case of diffuse alopecia areata. (b) In a case non- responsive to standard modalities. (c) In a case with no other supportive treatment.

Thyroglobulin Levels in Patients who have Undergone Hemithyroidectomy for Differentiated Thyroid Cancer. An Assessment of Levels and Trends at a Tertiary Referral Centre

Serum thyroglobulin (Tg) and thyroglobulin antibody (TgAb) levels are used to monitor patients with differentiated thyroid cancer (DTC) after total thyroidectomy with or without radioiodine (RAI) ablation. However, they are also measured in patients who are treated with thyroid lobectomy (TL)/hemithyroidectomy (HT). Data on the levels of Tg and its trend in those undergoing TL/HT is sparse in India. We reviewed retrospective data of DTC patients who underwent TL/HT and were followed-up with postoperative Tg levels between 2015 and 2020. Out of 247 patients, 17 had undergone either TL or HT, which included papillary thyroid cancer (n = 12), follicular thyroid cancer (n = 4), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 1 patient. All patients with DTC had tumor size < 4 cm (T1/2, clinical N0, Mx). The median follow-up was 15 months (range, 1–125) and the median Tg level was 7.5 ng/mL (interquartile range [IQR]; 3.6, 7.5) and ranged from 0.9 to 36.7 ng/mL. The median thyroid-stimulating hormone (TSH) level was 2.03 IU/L (IQR; 1.21, 3.59) and it ranged from 0.05 to 8.54 IU/L. As of last follow-up, none of them underwent completion thyroidectomy; however, eight patients had a decline in Tg ranging from 8 to 64%, four patients had increase in Tg ranging from 14 to 145%, three patients had stable Tg, and one of them had an increase in TgAb titers. As per American Thyroid Association (ATA) response-to-treatment category, six patients had indeterminate response, five patients had biochemical incomplete response, four patients had excellent response, and two did not have follow-up Tg and TgAb levels. While absolute values of Tg were well below 30 ng/mL in almost all patients with HT/TL, the Tg trends were difficult to predict, and only 23% of patients were able to satisfy the criteria for “excellent response” on follow-up. We suggest keeping this factor in mind in follow-up and while counselling for HT in patients with low-risk DTC.

A Radiomic Model To Classify Response To Neoadjuvant Chemotherapy in Breast Cancer

Background Medical image analysis has evolved to facilitate the development of methods for high-throughput extraction of quantitative features that can potentially contribute to the diagnostic and treatment paradigm of cancer. There is a need for further improvement in the accuracy of predictive markers of response to neo-adjuvant chemotherapy (NAC). The aim of this study was to develop a radiomic classifier to enhance current approaches to predicting the response to NAC breast cancer. Methods Data on patients treated for breast cancer with NAC prior to surgery who had a pre-NAC dynamic contrast enhanced (DCE) breast MRI were included. Response to NAC was assessed using the Miller-Payne system on the excised tumour. Tumour segmentation was carried out manually under the supervision of a consultant breast radiologist. Features were selected using least absolute shrinkage selection operator (LASSO) regression. A support vector machine (SVM) learning model was used to classify response to NAC. Results 74 patients were included. Patients were classified as having a poor response to NAC (reduction in cellularity <90%, n=44) and an excellent response (>90% reduction in cellularity, n=30). 4 radiomics features (discretized kurtosis, NGDLM contrast, GLZLM_SZE and GLZLM_ZP) were identified as pertinent predictors of response to NAC. A SVM model using these features stratified patients into poor and excellent response groups producing an AUC of 0.75. Addition of estrogen receptor (ER) status improved the accuracy of the model with an AUC of 0.811. Conclusion This study identified a radiomic classifier incorporating 4 radiomics features to augment subtype based classification of response to NAC in breast cancer.

Tuberculosis Verucossa Cutis of Hand: A Case Report

Tuberculosis verrucosa cutis (TBVC) is exogenous paucibacillary cutaneous tuberculosis (CTB) and is the third commonest type of CTB. Clinically, TBVC usually begins as isolated or multiple warty papules, and soon acquires a verrucous plaque and are usually located in the extremities. Here we report a case of 41-year-old South Indian woman presenting with occasional pruritus, erythematous scaly nodules and warty plaques on the back of right hand following nail prick. A positive Mantoux test, skin biopsy showing granuloma and related epidemiologic, clinical and histopathologic data with an excellent response of patient to the treatment confirmed TBVC.