Nail Changes in Psoriasis: Correlation Between Onychoscopy and NAPSI Scoring

Background: Nail changes in psoriasis can present as a diagnostic challenge especially in the absence of cutaneous features. They occur in approximately 40% of psoriatics and in 5% as the sole presentation. Onychoscopy as a diagnostic tool aids in better visualization of nail matrix and bed abnormalities in psoriasis patients with nail involvement. Aim: To study onychoscopic features of nails in psoriasis and correlate it clinically using nail psoriasis severity index (NAPSI). Materials and Methods: A total of 60 patients of psoriasis with nail changes were recruited in this hospital based cross-sectional study over a period of one year. Cutaneous severity was assessed using psoriasis area severity index (PASI). NAPSI was used to determine the severity of nail involvement. Nails of the patients with psoriasis were examined clinically and onychoscopically. Statistical analysis was done using the software R i386.3.6.3. Results: Pitting was the most common nail change observed on clinical and onychoscopic examination, seen in 90% and 95% patients respectively. Leuconychia, red spots in lunula, onycholysis, and splinter hemorrhages were better visualized on onychoscopy. A statistically significant higher NAPSI (P < 0.05) was obtained on onychoscopy. There was a positive co- relation between the cutaneous severity of psoriasis and the extent of nail involvement. Conclusion: Onychoscopic examination coupled with NAPSI in nail psoriasis serves as a useful guide to assess the nail involvement and provides a better insight into the subtle nail changes in psoriatics which could have been missed clinically. Limitations: Small study population, lack of age and sex matched control group.

Download Full-text

Prevalence, clinical profile, and severity of nail involvement in psoriasis – A hospital-based cross-sectional study from a tertiary care center in North Kerala

Journal of Skin and Sexually Transmitted Diseases ◽

10.25259/jsstd_27_2019 ◽

2019 ◽

Vol 1 ◽

pp. 72-76

Author(s):

Vivek Prabhakar ◽

Bifi Joy ◽

Anoop Thyvalappil ◽

Rajiv Sridharan ◽

Ajayakumar Sreenivasan ◽

...

Keyword(s):

Age Of Onset ◽

Late Onset ◽

Tertiary Care ◽

Severity Index ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Nail Psoriasis ◽

Nail Changes ◽

Nail Involvement

Objectives: Nail changes are present in 25–50% of psoriatic cases. Nail Psoriasis Severity Index (NAPSI) assess the extent of the involvement of the psoriatic nail unit. This study was conducted with the aim of finding the prevalence, clinical characteristics and severity of nail psoriasis. Methods and Materials: In this cross-sectional study, a thorough clinical examination was done to determine the type and extent of skin disease including PASI (psoriasis area severity index) score, and all the fingernails and toenails were examined in a well-lit environment, under a magnifying lens to visualize the nail findings, and NAPSI score was calculated for each patient. Statistical Package for the Social Sciences (SPSS v. 11.0) software was used to analyze the data collected. Results: Of the100 patients studied, 73% of patients with psoriasis had nail involvement. Mean total NAPSI was 30.97 ± 30.79. Mean age of onset of psoriasis was 43.62 ± 15.31 and 33.04 ± 12.80 in those with and without nail involvement respectively (P-value 0.002). The majority without nail involvement (77.8%) belonged to the early- onset group, while 22.2% of those without nail involvement had late-onset psoriasis (P-value 0.001). The most common nail pattern in our study was Pitting (93.2%). Limitation: Nail changes in severe forms of disease could not be studied since patients receiving systemic drugs for the disease were excluded from the study. Conclusion: The mean duration of psoriasis in those with nail involvement in our study was 5 years more than in those without nail disease. Our study demonstrated a significant association between higher PASI scores and nail involvement. All patients with severe psoriasis (PASI >20) in our study had nail involvement.

Download Full-text

Role of Functional Biomarkers to Identify Early Vitamin B12 Deficiency in Patients with Sleeve Gastrectomy: A Cross-Sectional Study

Medicina ◽

10.3390/medicina56030142 ◽

2020 ◽

Vol 56 (3) ◽

pp. 142

Author(s):

Osama Y. Al-Dirbashi ◽

Charu Sharma ◽

Nahid Al Dahouri ◽

Anas Al Aidaros ◽

Shamma Al-Muhairi ◽

...

Keyword(s):

Sleeve Gastrectomy ◽

Vitamin B12 ◽

Cross Sectional Study ◽

Control Group ◽

Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

B12 Deficiency ◽

One Year ◽

Functional Biomarkers

Background and objectives: Although laparoscopic sleeve gastrectomy (LSG) is effective for obesity management, postoperative vitamin B12 (B12) deficiency is of major concern. In this cross-sectional study, we assessed the levels of B12 and its related functional biomarkers, namely, total homocysteine (tHcy), methylmalonic acid (MMA), folate, methylcitric acid (MCA), and hemoglobin (Hb), in one-year postoperative LSG patients and matched controls. Materials and Methods: Plasma B12, tHcy, MMA, folate, and MCA were measured in matched controls (n = 66) and patients (n = 71) using validated liquid chromatography-tandem mass spectrometry techniques and protocols in the United Arab Emirates (UAE). Results: The median B12 concentration in patients (177 pmol/L) was significantly lower (p < 0.001) than in the controls (334.7 pmol/L). The tHcy and MMA levels were significantly increased (p < 0.001 and p = 0.011, respectively) and folate levels were significantly decreased (p = 0.001) in the LSG patients compared to the controls. Interestingly, no significant difference in MCA levels were observed between the two groups. The levels of tHcy and MMA were concomitantly increased with the decreased folate levels in postoperative LSG patients when compared with the controls. The Hb levels were significantly lower in males and females in the patient group compared with those in the control group, respectively (p = 0.005 and p = 0.043). Conclusions: This is the first report of serum levels of B12 and its functional biomarkers in postoperative LSG patients among a local population from the UAE. Our findings revealed significant alterations of the B12 biomarkers, total B12, MMA, and tHcy in one-year postoperative LSG patients.

Download Full-text

The incidence of anxiety in patients with chronic subjective tinnitus

Биомедицинска истраживања ◽

10.5937/bii2101019k ◽

2021 ◽

Vol 12 (1) ◽

pp. 19-28

Author(s):

Ljiljana Krsmanović ◽

Siniša Šolaja ◽

Nenad Arsović ◽

Bojan Joksimović ◽

Zoran Dudvarski ◽

...

Keyword(s):

Brain Structures ◽

Acoustic Stimulation ◽

Cross Sectional Study ◽

Control Group ◽

Sectional Study ◽

Cross Sectional ◽

Subjective Tinnitus ◽

One Year ◽

Moderate Hearing Loss

Introduction. Tinnitus is a perception of a sound in the ears in the absence of acoustic stimulation whose pathophysiological mechanisms have not been evaluated yet. Approximately, 1-2% of people report distress which can negatively affect their daily performance. Our study aimed to assess the incidence of anxiety in patients with tinnitus. Methods. The study was designed as a cross-sectional study. The participants were divided into two groups: a group of 73 patients with tinnitus (with two subgroups in relation to the duration of tinnitus-less than one year and more than one year) and a control group of 43 patients without tinnitus. We examined the presence of anxiety in all patients using the Burns Anxiety Inventory (BAI). The quality of life of all patients was estimated by Tinnitus Handicap Inventory (THI). Results. In the group of patients with tinnitus, 56.2% of them had mild and 24.7% moderate hearing loss, while 27.7% of respondents from control group had mild and 8.5% moderate levels of hearing impairment. THI results showed that patients with tinnitus less than 1 year had a significantly (p= 0.002) higher level of disorders in daily life, compared with the group who had tinnitus for more than 1 year. The 30.8% of respondents had minimal anxiety, 26.7% borderline anxiety, 17.5% mild anxiety, the same percentage of respondents moderate, 5% severe, while 2.5% had extreme anxiety based on BAI. Conclusion. Anxiety can be considered as potentially significant modulators of changes in brain structures observed in people with tinnitus.

Download Full-text

Serum Levels of TNF-α, IL-12/23 p40, and IL-17 in Psoriatic Patients with and without Nail Psoriasis: A Cross-Sectional Study

The Scientific World JOURNAL ◽

10.1155/2014/508178 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Aikaterini Kyriakou ◽

Aikaterini Patsatsi ◽

Timoleon-Achilleas Vyzantiadis ◽

Dimitrios Sotiriadis

Keyword(s):

Plaque Psoriasis ◽

Serum Levels ◽

Cross Sectional Study ◽

Sectional Study ◽

Chronic Plaque Psoriasis ◽

Cross Sectional ◽

Nail Psoriasis ◽

Median Serum ◽

Nail Disease ◽

Nail Involvement

Nail involvement has started playing a major role in the overall assessment and management of psoriatic disease. Biologics indicated for moderate to severe chronic plaque psoriasis are shown to be beneficial in nail disease. This study aimed to assess and compare the serum levels of TNF-α, IL-12/23 p40, and IL-17 in psoriatic patients with and without nail involvement. 52 consecutively selected patients with chronic plaque psoriasis were included in this cross-sectional study. Patients were studied and analyzed after they had been divided into 2 groups regarding the presence (n= 24) or not (n= 28) of nail psoriasis. The mean serum levels of TNF-αwere significantly higher in the group of psoriatic patients with nail lesions compared to those without (t-test; 5.40 ± 1.17 versus 3.80 ± 1.63,P= 0.026). However, the median serum levels of both IL-12/23 p40 (Mann-Whitney; 92.52 (34.35–126.87) versus 150.68 (35.18–185.86),P= 0.297) and IL-17 (Mann-Whitney; 28.49 (0.00–28.49) versus 8.59 (0.00–8.59),P= 0.714) did not significantly differ between the 2 groups. These results confirm the important role of TNF-αin the pathogenesis of nail psoriasis and may suggest that anti-TNF agents could be more beneficial in psoriatic nail disease than agents targeting IL-12/23 p40 or IL-17 and its receptors.

Download Full-text

Clinico-Epidemiological Characteristics and Impact on Quality of Life in Psoriatic Patients with and without Nail Changes - A Nepalese Experience

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/60 ◽

2021 ◽

Vol 8 (06) ◽

pp. 306-312

Author(s):

Shikha Khare ◽

Sudha Agrawal

Keyword(s):

Quality Of Life ◽

Age Of Onset ◽

Severity Index ◽

Joint Involvement ◽

Skin Involvement ◽

Nail Psoriasis ◽

Nail Changes ◽

Epidemiological Characteristics ◽

Nail Involvement

BACKGROUND Nail involvement in psoriasis is likely to influence the quality of life (QOL) because of its highly visible site; however, the impact of this disease on QOL is an underexplored area. Similarly, the relationship between severity of skin involvement and nail involvement has been overlooked. The study was conducted to evaluate the clinico-epidemiological characteristics of psoriasis patients with and without nail changes and assess the health-related quality of life (HRQOL). Furthermore, the correlation of severity of nail involvement with the severity of skin involvement and its impact on quality of life was assessed. METHODS A total of 370 adult psoriasis patients with or without nail changes was studied. Skin severity was assessed by body surface area (BSA) and Psoriasis Area and Severity Index (PASI) while nail severity was assessed using Nail Psoriasis Severity Index (NAPSI). Patients’ quality of life was measured using the Nepali Version of Dermatology Life Quality Index (DLQI). RESULTS Nail psoriasis was more prevalent in males in both the groups; females were having more nail involvement (0.041). There were no significant diff erences in other clinico-epidemiologic characteristics between these two groups except the late onset of psoriasis in the age group > 30 years, scalp involvement and absence of family history of psoriasis (P ≤ 0.05). There was a strong positive correlation between the age of onset of skin changes with age of onset of nail involvement (r = 0.799) and the joint involvement (r = 0.742) as well as the age of onset of joint involvement with nail changes (r = 0.838). The mean PASI was 7.265 ± 7.153 vs. 6.189 ± 7.153 in patients with > 10 vs. ≤ 10 total NAPSI score and it was statistically significant (P = 0.011), however, there was a moderate positive correlation between PASI and NAPSI (r = 0.32). Almost half of psoriasis patients had very large to extremely large effects on quality of life but leisure and treatment domain were affected more amongst patients with nail changes. Early onset of joint involvement, body surface area of > 3 % involvement and PASI score > 5 had significant effect on quality of life. CONCLUSIONS The nail involvement is an important finding in determining the severity of skin involvement and had very large to extremely large effect on quality of life particular on leisure and treatment domain. Therefore, nail examination must be done in all psoriatic patients. KEYWORDS Nail Psoriasis, Quality of Life, Dermatology Life Quality Index, Psoriasis Area and Severity Index, Nail Psoriasis Severity Index

Download Full-text

Six-Minute Walk Test in Pediatric Cardiac Patients

Clinical Cardiology and Cardiovascular Medicine ◽

10.33805/2639.6807.103 ◽

2017 ◽

pp. 13-17

Author(s):

Mohammed Sayed Elyan ◽

Salah El-din Amry Ahmed ◽

Hekma Saad Farghaly

Keyword(s):

Functional Capacity ◽

Chronic Conditions ◽

Pediatric Patients ◽

Cross Sectional Study ◽

Control Group ◽

Cardiac Diseases ◽

Healthy Children ◽

Cross Sectional ◽

Daily Life Activities ◽

One Year

Background The 6MWT (6MWT) is a self-paced walking test generally used to assess the functional capacity in people with chronic conditions the main outcome is the distance that a person can walk in 6 minutes. The 6 MWT is originally developed to measure the submaximal level of functional capacity in adult patients with moderate to severe heart or lung diseases and has been extensively used in other patient populations. Because the test reflects an exercise level close to that of daily life activities, it is easy to administer, is well tolerated by patients, and is increasingly being used as a functional outcome measure for people with chronic conditions, including pediatric populations. Patients and methods Our study is a cross sectional study to discuss the effect of cardiac diseases on the functional capacity of pediatric patients suffering from cardiac diseases compared with control group via 6MWT. The study included pediatric patients admitted to pediatric cardiology unit at Assiut University children hospital from age of 5 to 18 years at duration of one year from 1/8/2016 to 31/7/2017. The Patients One hundred cases (100) cases (52 males and 48 females) were suffering from cardiac diseases (42 suffering from CHD, 38 suffering from RHD and remaining 20 cases suffering from cardiomyopathy). The Control Hundred healthy children (50 males and 50 females). From primary, preparatory and secondary schools from the same age category of the patients. Results: 34 cases of congenital adrenal hyperplasia were included, of whom 8 cases were newly diagnosed on admission while 26 cases were previously diagnosed and came for follow up, 41.2% were males, 58.8% were females.

Download Full-text

Quality of life issue in psoriasis: A study from western Nepal

Nepal Journal of Medical Sciences ◽

10.3126/njms.v3i2.13455 ◽

2015 ◽

Vol 3 (2) ◽

pp. 116-120

Author(s):

A Kumar ◽

S Neupane ◽

PR Shrestha ◽

J Pun ◽

P Thapa ◽

...

Keyword(s):

Quality Of Life ◽

Negative Impact ◽

Severity Index ◽

Cross Sectional Study ◽

Psoriasis Area Severity Index ◽

Cross Sectional ◽

Psoriasis Disability Index ◽

Chisquare Test

Background: Psoriasis may have negative impact on a patient’s quality of life. Very few studies have examined this aspect in Nepalese population. Aim of this study was to evaluate the Quality of life (QOL) in chronic psoriatic patients by modified version of psoriasis disability index (PDI).Methods: Present cross sectional study was conducted in three major hospitals in western Nepal. One hundred chronic psoriatic patients of 18 years or more of age, with disease duration of six months or more and body surface area involvement of 10% or more were recruited. Clinical assessment was done with psoriasis area severity index (PASI) and quality of life was measured by modified version of PDI. Patients were managed as per indication. At the follow up at four weeks, improvement in PASI and improvement in QOL was measured. Statistical analysis by Chisquare test was done to assess the relation between severity of psoriasis and different items of quality of life.Results: Psoriasis has negative impact on all aspect of quality of life in Nepalese patients, as shown by score of modified version of PDI, which was 39.27% of total. There was significant improvement in PASI at follow up visit, from 23.29% to 15.35% of total. There was significant improvement in quality of life after treatment (modified version of PDI) from 39.27% to 32.66% of total.Conclusions: Psoriasis has negative impact on all aspect of quality of life in Nepalese patients.Nepal Journal of Medical Sciences Vol.3(2) 2014: 116-120

Download Full-text

Immunological evaluation of the crevicular fluid in patients with gingivitis, periodontitis, and peri-implantitis: a 1-year cross-sectional study

Research Society and Development ◽

10.33448/rsd-v10i13.20756 ◽

2021 ◽

Vol 10 (13) ◽

pp. e41101320756

Author(s):

Juliana Barbosa de Faria ◽

Taíssa Cássia de Souza Furtado ◽

Thaís Soares Farnesi de Assunção ◽

Douglas Reis Abdalla ◽

Fabiane Minin Andrade ◽

...

Keyword(s):

Gingival Crevicular Fluid ◽

Cross Sectional Study ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Cross Sectional ◽

Implant Placement ◽

Before And After ◽

One Year ◽

Crevicular Fluid ◽

Immunological Evaluation

Objective: To assess the levels of IL-12, IL-15, IL-18, and IL-32 in the gingival crevicular fluid (GCF) and peri-implant crevicular fluid (PICF) in patients with gingivitis, periodontitis, and peri-implantitis before and one year after implant installation. Material and Methods: Forty-nine samples of GCF and PICF were collected from March 2018 to March 2019. The patients were classified: patients with gingivitis (n=7), patients with periodontitis (n=14), patients with peri-implantitis (n=4) and healthy patients (n=24). The crevicular fluid from the 49 patients was collected before implant installation (n=8) and one year after implant placement (n=8). The Enzyme-Linked Immunosorbent Assay (ELISA) was used to evaluate the levels of cytokines in crevicular fluid. Results: Patients with gingivitis, periodontitis, and peri-implantitis showed higher concentrations of IL-12, IL-15, IL-18, and IL-32 when compared with control group. In general, the levels of IL-12 and IL-15 increased when compared to the moments before and after implant installation. There was also an increase in the concentration of IL-18 in the control group volunteers after implant installation. Conclusion: The results and methodology of this study showed that there was no difference in the synthesis of IL-12, IL-15, IL-18, and IL-32 in healthy individuals or in those with periodontal injuries. However, there was an increase in the cytokines IL-12, IL-15, and IL-18 one year after implant installation, which would be increasing the inflammatory activity in peri-implantitis.

Download Full-text

Efficacy of apremilast in psoriasis: a cross sectional study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20190243 ◽

2019 ◽

Vol 5 (1) ◽

pp. 187 ◽

Cited By ~ 1

Author(s):

Jayakar Thomas ◽

Shreya Srinivasan

Keyword(s):

Side Effects ◽

Severity Index ◽

Cross Sectional Study ◽

Sectional Study ◽

Psoriasis Area Severity Index ◽

Cross Sectional ◽

Long Run ◽

Immunological Effects ◽

Final Score ◽

Male Patients

Background: This study was done to evaluate the efficacy of apremilast in patients with psoriasis.Methods: A total of 20 patients clinically diagnosed with different forms of psoriasis were prescribed apremilast 30 mg twice a day. A psoriasis area severity index (PASI) scoring was done every 4 weeks with a final score taken at the end of 12 weeks.Results: Of the 20 (eight female and 12 male) patients prescribed apremilast 30 mg, 8 patients achieved 75% and more PASI reduction, 10 patients achieved 50% and more PASI reduction at the end of 12 weeks. One patient did not show any significant PASI reduction, while another patient dropped out from the study after 3 weeks of apremilast due to intolerable vomiting and diarrhoea.Conclusions: Apremilast, a relatively safe drug, has no effect on the haematological, renal, hepatic systems as well as no major immunological effects like other drugs used in the treatment of psoriasis, making monitoring of laboratory parameters inconsequential. It is also well tolerated with very few side effects in comparison, making it a welcome drug in the long run.

Download Full-text

Dermoscopic evaluation of nail psoriasis: a cross-sectional study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20205595 ◽

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

Background: 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.Methods: 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.Results: 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%).Conclusions: 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.

Download Full-text