scholarly journals Subclinical Onychomycosis in Apparently Healthy Adults

2021 ◽  
pp. 1-3
Author(s):  
Alejandra Angulo-Rodríguez ◽  
Heidi Hernández-Ramírez ◽  
María Elisa Vega-Memije ◽  
Sonia Toussaint-Caire ◽  
Gabriela Moreno-Coutiño
Keyword(s):  
Nail Plate ◽  
Subclinical Infection ◽  
Male And Female ◽  
Nail Changes ◽  
Combined Infection ◽  
The Right ◽  
Nail Infection ◽  
Nail Disease ◽  
Apparently Healthy

<b><i>Introduction:</i></b> Onychomycosis is a frequent chronic nail infection, with a worldwide prevalence of 5.5% making it the most common nail disease, and its incidence increases with age. Clinically, it causes discoloration and thickening of the nail plate and may be accompanied by onycholysis. However, little is known of the subclinical infection. <b><i>Methods:</i></b> We studied adult male and female outpatients auto-referred as healthy and that had healthy appearing toenails. Nail distal clippings were obtained from the right first toenail. This sample was stained with PAS and observed by an expert dermatopathologist searching for fungal structures. <b><i>Results:</i></b> A total of 32 samples were included: 8 from men (25%) and 24 from women (75%), with ages ranging from 27 to 66 years (mean age of 43 years). Twenty-four patients did not present any histopathological finding suggestive of infection (75%), while 7 patients had a single finding (spores or hyphae) (21.8%), and 1 patient had both findings (3.12%). <b><i>Discussion/Conclusion:</i></b> We found 4 patients with yeasts, 3 with hyphae, and 1 patient with a combined infection with both yeasts and hyphae (3.1%). These add up to 25% of the clinically apparent healthy nails. Our results show that we still have much to learn from the initial stages of onychomycosis and that our population probably has higher incidence of this nail disease, so we must be alert to subtle nail changes. As our participants signed an informed consent, we will contact those that resulted positive for follow up consultations.

Nail Changes in Lichen Planus: A Single-Center Study

2020 ◽  
pp. 120347542098255
Author(s):  
Magdalena Żychowska ◽  
Małgorzata Żychowska
Keyword(s):  
Lichen Planus ◽  
Nail Plate ◽  
Hair Follicles ◽  
Common Finding ◽  
Skin Area ◽  
Nail Changes ◽  
Single Center Study ◽  
The Subject ◽  
Nail Disease ◽  
Nail Involvement

Background Lichen planus (LP) is an inflammatory condition that can affect skin, mucous membranes, hair follicles, and/or nails. Nail abnormalities are estimated to occur in around 10% of LP cases. Clinical characteristics of nail involvement have been the subject of very few studies, which have mainly focused on isolated nail LP. Objectives To identify and describe nail alterations in patients with LP. Methods Seventy-five patients with cutaneous lichen planus (CLP) were included in the study. The diagnosis of LP was histologically confirmed in each case. Onychomycosis was excluded in each patient. Results Nail lesions were present in 21 (28%) patients (mean age 58.1 ± 12.55 years) with CLP. On an average, patients had 9.38 nails affected. A slight female preponderance was noted (57%). Nail involvement was independent of age, gender, presence of pruritus, the affected skin area, or the duration of CLP. The most common finding in the fingernails ( n = 122) was longitudinal ridging (85.2%), followed by nail plate thinning (38.2%) and onycholysis (17.2%). Pterygium formation (6.6%) and red lunulae (8.2%) were limited to the fingernails. In the fingernails, matrix involvement (98.4%) was more frequent than nail bed involvement (27%). The most common finding in the toenails ( n = 75) was hyperkeratosis (82.7%) with yellowish discoloration (69.3%). No cases of trachyonychia or anonychia were noted. Conclusions Nail abnormalities in patients with CLP may be more common than initially assessed. Rare formation of pterygium and absence of anonychia in patients with predominant cutaneous involvement might point at mild course of the nail disease in such cases.

Green Nail Syndrome, A Rare Infection of Pseudomonas aeruginosa in The Nail

2020 ◽  
Vol 1 (2) ◽  
pp. 13-16
Author(s):  
Erike A. Suwarsono
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Fungal Infection ◽  
Water Resource ◽  
Nail Plate ◽  
Microbiology Laboratory ◽  
Green Color ◽  
2Nd Generation ◽  
The Right ◽  
Nail Infection

ObjectiveA nail infection is a common case caused by fungal infection, thus can make any bacterial correlated infection in the nail can be under-diagnosed. However, Pseudomonas aeruginosa can cause nail infection known as green nail syndrome (chromonychia). Method  A 3 years old girl presented with greenish discoloration on the nail plate of the right toenail since previous a month. She came from well-educated family, but the water resource at their home was not good enough. The specimen of nail scraping was sent to the microbiology laboratory. The Gram from nail scraping didn’t show any significant result. After 24 hours, a greenish colony, non-lactose fermenter on the Mac Conkey and a dominant blue-green color colony on the blood sheep agar had grown.  The colonies are beta hemolytic, flat and spreading. They were also positive to oxidase and catalase. Result The Gram result from the colony was showed as basil negative Gram. Identification from Vitex 2® concluded as Pseudomonas aeruginosa that resistant to all penicillin derivate and 2nd generation of cephalosporin. However the isolate was still sensitive to ceftazidime, carbapenems, quinolones and amino-glycosides. The treatment was decided using topical fluoroquinolone nadifloxacin, and gave a significant result in a month Conclusion Green nail syndrome that is caused by P. aeruginosa infection could be treated by topical fluoroquinolone for 1-2 months

scholarly journals Dermoscopic evaluation of nail psoriasis: a cross-sectional study

2020 ◽  
Vol 7 (1) ◽  
pp. 53
Author(s):  
Krishnendra Varma ◽  
Ujjwal Kumar ◽  
Praneeta Jain
Keyword(s):  
Clinical Examination ◽  
Nail Plate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nail Psoriasis ◽  
Immune Mediated ◽  
Nail Changes ◽  
The Common ◽  
Nail Disease

<p class="abstract"><strong>Background:</strong> Psoriasis is a chronic inflammatory immune mediated disease that can involve skin, nails, scalp, etc. Nails can be involved in up to 90% of psoriatic patients in their lifetime. Also, psoriatic arthritis is commonly found in patients having nail involvement. Nail changes in psoriasis can be imperceptible to the unaided eye and easily missed on clinical examination. Onychoscopy has helped in improving diagnosing these subtle clinical features. Aim of the research was to study dermoscopic features in nails involved in psoriasis.</p><p class="abstract"><strong>Methods:</strong> 50 patients having clinically evident nail psoriasis, of which 2 were excluded due to positive KOH examination were recruited in the cross-sectional descriptive study. After clinical examination, all the nails were subjected to dermoscopic examination. The findings were tabulated in Excel and comparisons were made.<strong></strong></p><p class="abstract"><strong>Results:</strong> The common dermoscopic findings were pits (79.2%), splinter haemorrhage (72.9%), onycholysis (68.8%), subungual hyperkeratosis (50%), nail plate scales (50%), dilated PNF/LNF capillaries (20.8%), ridges (18.8%), leukonychia (14.5%), salmon spots (10.4%), fuzzy lunula (8.3%), and dilated hyponychial capillaries (6.3%).</p><p class="abstract"><strong>Conclusions:</strong> Dermoscopy is a simple, easy, rapid and an office-based technique. It helps in picking up subtle nail changes not visible to the naked eye. It also precludes from doing painful nail biopsy in nail disease without its skin manifestation. Onychoscopy helps in picking up early nail findings in psoriasis and thereby warning the patients against impending disease severity.</p>

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

2019 ◽  
Vol 1 (4) ◽  
Author(s):  
Yustinus Robby Budiman Gondowardojo ◽  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Left Lung ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
High Mobility ◽  
Early Mobilization ◽  
Cord Injury ◽  
Cardiothoracic Surgeon ◽  
The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

Upper instrumented vertebra to the right of the lowest instrumented vertebra as a predictor of an increase in the main thoracic curve after selective posterior fusion for the thoracolumbar/lumbar curve in Lenke type 5C adolescent idiopathic scoliosis: multicenter study on the relationship between fusion area and surgical outcome

2019 ◽  
Vol 31 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Hiroki Oba ◽  
Jun Takahashi ◽  
Sho Kobayashi ◽  
Tetsuro Ohba ◽  
Shota Ikegami ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Posterior Fusion ◽  
Main Thoracic ◽  
Lowest Instrumented Vertebra ◽  
Line Tilt ◽  
The Right ◽  
Upper Instrumented Vertebra

OBJECTIVEUnfused main thoracic (MT) curvatures occasionally increase after selective thoracolumbar/lumbar (TL/L) fusion. This study sought to identify the predictors of an unacceptable increase in MT curve (UIMT) after selective posterior fusion (SPF) of the TL/L curve in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS).METHODSForty-eight consecutive patients (44 females and 4 males, mean age 15.7 ± 2.5 years, range 13–24 years) with Lenke type 5C AIS who underwent SPF of the TL/L curve were analyzed. The novel “Shinshu line” (S-line) was defined as a line connecting the centers of the concave-side pedicles of the upper instrumented vertebra (UIV) and lowest instrumented vertebra (LIV) on preoperative radiographs. The authors established an S-line tilt to the right as S-line positive (S-line+, i.e., the UIV being to the right of the LIV) and compared S-line+ and S-line− groups for thoracic apical vertebral translation (T-AVT) and MT Cobb angle preoperatively, early postoperatively, and at final follow-up. The predictors for T-AVT > 20 mm at final follow-up were evaluated as well. T-AVT > 20 mm was defined as a UIMT.RESULTSAmong the 48 consecutively treated patients, 26 were S-line+ and 22 were S-line−. At preoperative, early postoperative, and final follow-up a minimum of 2 years later, the mean T-AVT was 12.8 mm (range −9.3 to 32.8 mm), 19.6 mm (range −13.0 to 41.0 mm), and 22.8 mm (range −1.9 to 68.7 mm) in the S-line+ group, and 10.8 mm (range −5.1 to 27.3 mm), 16.2 mm (range −11.7 to 42.1 mm), and 11.0 mm (range −6.3 to 26.9 mm) in the S-line− group, respectively. T-AVT in S-line+ patients was significantly larger than that in S-line− patients at the final follow-up. Multivariate analysis revealed S-line+ (odds ratio [OR] 23.8, p = 0.003) and preoperative MT Cobb angle (OR 7.9, p = 0.001) to be predictors of a UIMT.CONCLUSIONSS-line+ was defined as the UIV being to the right of the LIV. T-AVT in the S-line+ group was significantly larger than in the S-line− group at the final follow-up. S-line+ status and larger preoperative MT Cobb angle were independent predictors of a UIMT after SPF for the TL/L curve in patients with Lenke type 5C AIS. Surgeons should consider changing the UIV and/or LIV in patients exhibiting S-line+ during preoperative planning to avoid a possible increase in MT curve and revision surgery.

Persistent Apical Periodontitis: Bacterial Taxonomic Analysis and Treatment Through Intentional Replantation

2020 ◽  
Author(s):  
Fernando Eduardo Coria-Valdiosera
Keyword(s):  
Antibiotic Therapy ◽  
Root Canal ◽  
Resistance Mechanisms ◽  
Apical Periodontitis ◽  
Infectious Process ◽  
Identification Of Bacteria ◽  
The Right ◽  
Apical Lesions ◽  
Endodontic Retreatment

Introduction: The microorganisms own different resistance mechanisms that allow them to resist the chemo-mechanical cleanliness of root canal and antibiotic therapies causing the persistence of apical lesions. Methods: This clinical case describes a male patient diagnosed with pulp necrosis in the right lower central incisor due to trauma, which developed apical periodontitis manifesting itself extra orally. Root canal treatment along with antibiotic therapy was performed, but because the infectious process persisted, endodontic retreatment and a new antibiotic therapy were carried out, however, the clinical evolution was not favorable. For this reason, the intentional replantation was chosen as the outright treatment, performing apicectomy and curettage of the periapical lesion, from which the isolation and taxonomic study of microorganisms were carried out, with the respective antibiogram. Results: In the 10-day clinical follow-up, the extraoral infectious process disappeared almost completely and 6 months later, a complete repair of the bone tissue was observed on the tomography. Conclusion: A better understanding of the persistence of apical periodontitis was achieved by taxonomic identification of bacteria and the intentional replantation allowed to remove the apical biofilm gaining an excellent wound healing.

Adenoid cystic carcinoma of the labium oris with rare metastasis to the pleural cavity

2021 ◽  
Vol 14 (1) ◽  
pp. e237622
Author(s):  
Osama Mosalem ◽  
Anas Alsara ◽  
Fawzi Abu Rous ◽  
Borys Hrinczenko
Keyword(s):  
Side Effects ◽  
Adenoid Cystic Carcinoma ◽  
Pleural Cavity ◽  
Epigastric Pain ◽  
Asian Woman ◽  
Upper Lip ◽  
Adenoid Cystic ◽  
History Of ◽  
The Right

A 57-year-old Southeast Asian woman with a remote history of adenoid cystic carcinoma (ACC) of the right labium superius oris (upper lip) presented to the hospital with vague epigastric pain. On workup, she was found to have multiple pleural nodules. Histopathology confirmed the diagnosis of metastatic ACC. After 8 months of active surveillance, evidence of disease progression was found and the patient was started on pembrolizumab. Follow-up after starting pembrolizumab showed stable disease with no significant side effects.

Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (5) ◽  
pp. 801-804
Author(s):  
Catharina Gronert ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
Thoracic Endovascular Aortic Repair ◽  
Neurological Symptoms ◽  
Endovascular Aortic Repair ◽  
Hypogastric Artery ◽  
Lower Extremity Weakness ◽  
Aortic Repair ◽  
The Right

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting. Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA. Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.

scholarly journals MAPPING AND ENHANCING DESIGN STUDIES WITH PSI META-THEORETIC DESIGN FRAMEWORK

2021 ◽  
Vol 1 ◽  
pp. 2007-2016
Author(s):  
Yoram Reich ◽  
Eswaran Subrahmanian
Keyword(s):  
Design Research ◽  
The Other ◽  
Design Studies ◽  
Abstraction Level ◽  
Follow Up Studies ◽  
The One ◽  
The Right ◽  
Abstract Framework ◽  
Tools And Methods

AbstractDesign research as a field has been studied from diverse perspectives starting from product inception to their disposal. The product of these studies includes knowledge, tools, methods, processes, frameworks, approaches, and theories. The contexts of these studies are innumerable. The unit of these studies varies from individuals to organizations, using a variety of theoretical tools and methods that have fragmented the field, making it difficult to understand the map of this corpus of knowledge across this diversity.In this paper, we propose a model-based approach that on the one hand, does not delve into the details of the design object itself, but on the other hand, unifies the description of design problem at another abstraction level. The use of this abstract framework allows for describing and comparing underlying models of published design studies using the same language to place them in the right context in which design takes place and to enable to inter-relate them, to understand the wholes and the parts of design studies.Patterns of successful studies could be generated and used by researchers to improve the design of new studies, understand the outcome of existing studies, and plan follow-up studies.

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