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Profile of Mean Platelet volume, Neutrophil – Lymphocyte Ratio and Platelet – Lymphocyte ratio in patient with Psoriasis

Investigator: Dr Fatema Khatun
Resident (Phase B)
Department of Dermatology & Venereology
Bangabandhu Sheikh Mujib Medical University, Dhaka

Guide: Prof. Zakir Ahmed
Professor
Department of Dermatology & Venereology
Bangabandhu Sheikh Mujib Medical University, Dhaka,
Bangabandhu Sheikh Mujib Medical University
Dhaka, Bangladesh.

The undersigned certified that they have read and recommended to Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh for acceptance for the thesis entitled “Profile of Mean platelet volume, Neutrophil – Lymphocyte Ratio and Platelet – Lymphocyte ratio in patient with Psoriasis.” submitted by Dr. Fatema Khatun in partial fulfillment of the requirement of the degree “Doctor of Medicine” in Dermatology and Venereology.
The thesis is accepted.
Board of examiners:
Convener:

Members:
1.

2.

3.

Date of approval:

List of contents
—————————————————————————————————- TITLE ` Page No
Thesis title page i
List of Content iii
Certificate of guide iv
Declaration of authorship v
List of Table vi
List of Figure vii
Acknowledgement viii
Abbreviation x
Abstract xi
Chapter-1 Introduction 1
Rationale 5
Hypothesis 7
Objectives 8
Chapter-2 Literature Review 9
Chapter-3 Materials and Methods 16
Chapter-4 Results 27
Chapter-5 Discussion 42
Conclusion 47
Limitations of the study 48 Recommendation of the study 49
References 50
Appendices 55

Certificate of guide

This is to certify that Dr. Fatema Khatun has completed this thesis work titled “Profile of Mean Platelet volume, Neutrophil – Lymphocyte Ratio and Platelet – Lymphocyte ratio in patient with Psoriasis.” in the department of Dermatology & Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, under my direct supervision. This work done and the data incorporated in this connection are original. I have gone through this thesis and found up to my satisfaction.

……………………………..
Prof. Dr. Zakir Ahmed
Professor
Department of Dermatology & Venereology,
Bangabandhu Sheikh Mujib Medical University,
Dhaka, Bangladesh.

Declaration of authorship

I humbly declare that this thesis is based on the work carried out by me and no part of it has been presented previously for a higher degree in our country.
The research work was carried out in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh under the guidance of Prof. Zakir Ahmed and Associate Professor Dr. Harasit Kumar Paul.

Dr. Fatema Khatun
MD Phase B
Department of Dermatology and Venereology
Bangabandhu Sheikh Mujib Medical University, Dhaka.

List of Tables
————————————————————————————————–Table no. Title Page No
Table-4.1 Distribution of the study patients by age 28
Table-4.2 Distribution of the study patients by gender 29
Table-4.3 Mean value of MPV, NLR, PLR in cases and control 31
Table-4.4 Distribution of mean MPV, NLR, PLR in cases and control 32 between male and female
Table 4.5.1 Odd ratio for MPV 33

Table 4.5.2 Odd ratio for NLR 34

Table 4.5.3 Odd ratio for PLR 35

Table-4.6 Comparison of MPV, NLR and PLR in psoriasis and 36
Healthy control
Table-4.7 Distribution of psoriasis patient group on basis of PASI score 37 into mild and moderate to severe group
Table-4.8 Psoriasis severity between male and female according to 38
PASI score
Table-4.9 Severity correlation between MPV, NLR, PLR with PASI by 39 Spearman’s correlation test

List of Figures

————————————————————————————————–Figure no. Title Page No
Figure-4.1 Distribution of disease duration in years 30

Figure-4.2 Scatter diagram showing correlation with MPV and PASI score 40

Acknowledgement
First and above all, I praise Allah, the almighty, for providing me this opportunity and granting me the capability to proceed successfully. This thesis appears in its current form due to the assistance and guidance of several people. I would therefore like to offer my sincere thanks to all of them.
I am grateful to my guide, Prof. Zakir Ahmed for his enormous support, encouragement and thorough guidance in this study.
Associate Prof Dr. Harasit Kumar Paul, my esteemed co-guide, my cordial thanks for him for accepting me as a M.D student, the warm encouragement, thoughtful guidance, critical comments, and correction of the thesis.
I want to express my deep gratitude to my teachers Prof. Shaidullah Sikder, Chairman of dept. of Dermatology ; Venereology, Prof. Nargis Akter, Prof. Yakub Ali, and Prof. Akram Ullah Sikder for the trust, the insightful discussion, offering valuable advice, for the support during the whole period of the study, and especially for the patience and guidance during the writing process.
I would like to thank my respected teachers Prof. Dr. Quamrul Hasan Jaigirder, Prof. Lt. Col. (Rtd.) M. A. Wahab and Prof. Munir Rashid for their excellent advises and detailed review during the preparation of this thesis.
I also take the opportunity to thank Associate Prof. Dr. Abida Sultana, Associate Prof. Dr. A.T.M. Asaduzzaman, Associate Prof. Dr. Jamal Uddin, Associate Prof. Dr. Lubna khondoker, Associate Prof. Dr. A.K.M. Rejaul Haque, Assistant Prof. Dr. Abu Hena Chowdhury, Associate Prof. Dr. Saiful Islam Bhuiyan of Department of Dermatology ; Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
I must express my thanks and indebtedness to Prof. Masuda Begum, Professor and Head, Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka for her active support and cooperation.
I greatly appreciate the excellent assistance and supports for me during my MD course from my course mates. I will never forget the time that we were together and discussed about many issues.
I cannot finish without thanking my family.
I warmly thank and appreciate my parents and for their material and spiritual support in all aspects of my life.
I also would like to thank my sister as they have provided assistance in numerous ways.
I want to express my love and deepest affection to my sweet daughters, Farisha and Fariza and my only son Safwan for their great patience and understandings during my thesis work.
And finally I am ever thankful to my beloved husband, Dr. Sazzad Zayed Chowdhury, Registrar-Haematology and Stem cell transplant, Apollo Hospitals Dhaka. Without his supports and encouragements, I could not finish this work.

Dr. Fatema khatun

Abbreviation

MPV Mean platelet volume
NLR Neutrophil lymphocyte ratio
PLR Platelet lymphocyte ratio
ESR Erythrocyte sedimentation rate
CRP C reactive protein
PASI Psoriasis area severity index
BSMMU Bangabandhu Sheikh Mujib medical University
CBC Complete blood count
TNF Tumor necrosis factor
AS Ankylosing spondylitis
RA Rheumatoid arthritis
VTE Venous thromboembolism
MI Myocardial infarction
ITP Immune thrombocytopenia
SD Standard deviation
PMI Platelet mass index
RDW Red cell distribution width
PsA Psoriatic arthritis
IL Interleukin

ABSTRACT

Project Title: Profile of mean platelet volume, neutrophil – lymphocyte ratio and platelet lymphocyte ratio in patient with psoriasis.

Background:
Psoriasis is a chronic, inflammatory, systemic disease. Psoriasis area severity index (PASI) is used to evaluate the disease activity and response to therapy in psoriasis patients. However more objective laboratory tools should be developed beside PASI. Mean platelet volume (MPV), neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are inflammatory biomarkers that are known to be evaluated in various inflammatory diseases.

Objectives:
This study was conducted with the aim to assess the frequency of platelet activation and leukocyte infiltration by measuring mean platelet volume, neutrophil lymphocyte ratio and platelet lymphocyte ratio and to correlate these markers with psoriasis area severity index (PASI) which ultimately helps to identify thrombotic risk factors in psoriasis.

Methodology:
A total of 55 psoriasis cases and 55 healthy controls were included according to inclusion and exclusion criteria. A brief history and physical examination was done and PASI score was calculated in psoriatic individual. MPV, NLR and PLR was measured by an auto analyzer and calculated. All data was analyzed by independent t test to compare between psoriasis and healthy individuals. Spearman’s correlation testing was done to evaluate correlation of disease severity with MPV, NLR and PLR. A P value of

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