Differences in Gut Microbiome in Hospitalized Immunocompetent vs. Immunocompromised Children, Including Those With Sickle Cell Disease.

Background: Gut microbial diversity and composition play important roles in health. This cross-sectional study was designed to test the hypothesis that hospitalized children who may be relatively immunocompromised (IC), defined as those with cancer, sickle cell disease (SCD), transplantation, or receiving immunosuppressive therapy) would have decreased microbial diversity, increased Clostridioides difficile colonization and different species composition compared to non-immunocompromised (Non-IC) children admitted to the same pediatric unit. Methods: A stool sample was obtained within 72 h of admission to a single unit at The Children\u27s Hospital at Montefiore, Bronx, NY from March 2016 to February 2017 and the microbiome assessed by 16S rRNA sequencing. C. difficile colonization was assessed by glutamate dehydrogenase antigen and toxin polymerase chain reaction assays. Results: Stool samples were obtained from 69 IC (32 SCD, 19 cancer, 9 transplantation and 9 other) and 37 Non-IC patients. There were no significant differences in microbial alpha diversity and C. difficile colonization comparing IC vs. non-IC patients. Lower alpha diversity, however, was independently associated with the use of proton pump inhibitors or antibiotics, including prophylactic penicillin in patients with SCD. Differences in specific species abundances were observed when comparing IC vs. non-IC patients, particularly children with SCD. Non-IC patients had increased abundance of commensals associated with health including Alistipes putredinis, Alistipes ihumii, Roseburia inulinivorans, Roseburia intestinalis, and Ruminococcus albus (p \u3c 0.005). Conclusions: Antibiotics and proton pump inhibitors, which were more commonly used in IC children, were identified as risk factors for lower microbial diversity. Non-IC patients had higher abundance of several bacterial species associated with health. Longitudinal studies are needed to determine the clinical significance of these differences in gut microbiome

Giant bowen's disease in a paddy field worker

Bowen's disease (BD) is a squamous cell carcinoma (SCC) in situ with the potential for significant lateral spread. Progression to invasive SCC is rare. A 64-year-old female paddy field worker presented with a giant-sized BD on the back of the trunk. Traditional clothing (short blouse with dhoti) which exposed the back of the trunk to long hours of sunlight might explain the location of the lesion. In spite of extensive lateral spread, there were no features to suggest deeper invasion

Dermoscopy of Congenital Hemidysplasia with Ichthyosiform Erythroderma and Limb Defects Nevus with Unilateral Limb Defects

Here, we report the dermoscopic findings of congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) nevus with left-sided ichthyosiform erythroderma and left upper-limb aplasia in a 4-month-old baby. The presence of ptychotropism and strict midline demarcation are unique features described in CHILD nevus. Dermoscopy of the CHILD nevus showed linear and dotted vessels with yellowish waxy scales on a pink background. These characteristic dermoscopic findings would also help us to differentiate it from inflammatory linear verrucous epidermal nevus

Multifaceted adult T-cell leukemia/lymphoma in India: A case series

Background : Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India. Aims and objectives: The objective was to describe skin manifestations in various types of ATL. Materials and Methods: Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases. Results: Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period. Conclusions: ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases