scholarly journals More than meets the naked eye: an unusual psoriatic arthritis mimicry and the important role of dermoscopic examination

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Lim Jo Anne ◽  
Mohd Jazman Che Rahim ◽  
Wan Syamimee Wan Ghazali ◽  
Wan Aireene Wan Ahmed ◽  
Seoparjoo Azmel Mohd Isa
Keyword(s):  
Psoriatic Arthritis ◽  
Topical Steroid ◽  
Joint Space ◽  
Skin Lesions ◽  
Case Presentation ◽  
Left Hand ◽  
The Past ◽  
Distal Interphalangeal ◽  
Fixed Flexion Deformity

Abstract Background Psoriatic arthritis (PsA) can manifest in various forms. This includes mimicry of other diseases. We describe an unusual mimicry of PsA. Case presentation We report a case of a middle-aged lady who presented with severe pain and morning stiffness over the small joints of the left hand for 3 months and painless deformity of the affected joints 1 year before. She was under treatment for pruritic rash over her ankles and knees for the past 1 year as well. Physical examination revealed a fixed flexion deformity, swelling and tenderness of the left ring and little fingers’ distal interphalangeal (DIP) joints. Left hand radiograph showed sclerotic joint margin, narrowed joint space and marginal osteophytes of the affected DIP joints. Dermoscopic examination showed red- violaceous, flat-topped papules and plaques with minimal scales on both ankles; hyperpigmented scaly plaques over both knees and vertical fingernail ridges. Serum autoimmune screening and inflammatory markers were unremarkable. Left ankle skin biopsy showed features consistent of psoriasis. PsA was diagnosed. Weekly titrated oral methotrexate and topical steroid were started. The patient showed significant improvement after 1 month of treatment. Conclusion PsA is a great mimicker. Dermoscopy is an accessible and valuable tool to assess skin lesions in greater detail. Clinicians should be aware of coexisting diseases or misdiagnosis when patients do not respond to treatment.

Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis

2021 ◽  
pp. annrheumdis-2020-218744
Author(s):  
Irina Gessl ◽  
Mihaela Popescu ◽  
Victoria Schimpl ◽  
Gabriela Supp ◽  
Thomas Deimel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Joint Damage ◽  
Joint Space ◽  
Early Arthritis ◽  
Damage Score ◽  
Established Disease ◽  
Active Inflammation

ObjectivesTo determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04).ConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.

Psoriatic Nail Dystrophy Is Associated with Erosive Disease in the Distal Interphalangeal Joints in Psoriatic Arthritis: A Retrospective Cohort Study

2019 ◽  
Vol 46 (9) ◽  
pp. 1097-1102 ◽  
Author(s):  
Anna S. Antony ◽  
Andrew Allard ◽  
Adwaye Rambojun ◽  
Christopher R. Lovell ◽  
Gavin Shaddick ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Joint Disease ◽  
Nail Dystrophy ◽  
Chi Square ◽  
Convenience Sample ◽  
Radiographic Damage ◽  
Erosive Disease ◽  
Distal Interphalangeal

Objective.To assess whether the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal (DIP) joints.Methods.A convenience sample of patients was collated from the Bath longitudinal PsA cohort. All patients had PsA according to the ClASsification for Psoriatic ARthritis criteria (CASPAR) criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score. Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the DIP joints, and proximal interphalangeal or metacarpophalangeal (non-DIP) joints of the corresponding digits.Results.There were 134 patients included, with a median age of 53 years (interquartile range; IQR 44–61) and disease duration of 7 years (IQR 3–17). The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIP joints of the corresponding digit (OR 1.9, 95% CI 1.23–2.83; p < 0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12–2.62; p = 0.02). Nail subungual hyperkeratosis was more strongly associated with joint space narrowing, erosions, and osteoproliferation at the corresponding DIP joint compared to non-DIP joints (p < 0.001). Nail pitting was not associated with erosions or osteoproliferation.Conclusion.The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIP joints. Subungual hyperkeratosis is more strongly associated with erosive damage at the DIP than non-DIP joints. These findings support the anatomical and pathological link between nail and DIP joint disease.

scholarly journals Giant Olfactory Groove Meningioma in Pregnancy

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Tommy Rizky Hutagalung ◽  
Faisal ◽  
Ridha Dharmajaya
Keyword(s):  
Rare Event ◽  
Third Trimester ◽  
Case Presentation ◽  
Olfactory Groove ◽  
The Past ◽  
The Status ◽  
Gestational Week ◽  
Olfactory Groove Meningioma ◽  
Slow Growing

Introduction: Meningioma is slow growing neoplasm cells that comes from arachnoid cap most common benign intracranial tumours. Olfactory groove meningiomas (OGM) account for 8–13% of all intracranial meningiomas. Intracranial tumors on pregnancy is a rare event, with few reports. Case Presentation: A 36-year-old- female (G11P9A1) 34 gestational week presented to the Adam Malik General Hospital with smelling disturbances for 6 months and lossing smelling sense in the past 1 month. Slowly progression of vision disturbances for 3 months without improvement in using glasses, progressive loss of vision in both eyes for the past 1 month. CT scan and MRI revealead a solid mass lesion, with 6.3 x 4.2 x 3.1 cm. It was a supratentorial in frontal region, olfactory groove mass. The Craniotomy tumor removal was performed in this patient. Discussion: Meningiomas are mostly silent brain tumors with slow growth, however may get detected and mostly become symptomatic during pregnancy and luteal phase of menstrual cycle due to increase in size secondary to either water retention, enhanced vascularity or progesterones are possible etiologies. The majority of meningiomas express progesterone reseptor, which can be detected also by immunohistochemistry. In fact, tumour growth when progesterone concentrations are higher, shows the role of sex hormones in the mechanism. Regardless of the status of pregnancy, symptomatic and large meningiomas require surgical resection. Conclusion: Changes of plasma concentration hormones during pregnancy and their effect on meningioma growth in the second and third trimester are crucial and critical. The management of brain lesions during pregnancy required professional collaboration between neurosurgeons, obstetricians and anesthesiologists.

scholarly journals Resection of a Rare Metacarpal Distal Condyle Osteoid Osteoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Bachar El Fatayri ◽  
Az-Eddine Djebara ◽  
Alex Fourdrain ◽  
Yassine Bulaid ◽  
Mario Sanguina
Keyword(s):  
Osteoid Osteoma ◽  
Young Male ◽  
Joint Space ◽  
Metacarpal Bone ◽  
Common Symptom ◽  
Case Presentation ◽  
Left Hand ◽  
Rare Location ◽  
Inflammatory Drugs

Introduction. Osteoid osteoma is a benign bone-forming tumor with young male predilection. It occurs predominantly in the long bones. In the hand, osteoid osteoma is more commonly located in the phalanges and carpal bones. The metacarpals are the least common site for osteoid osteoma. Pain is the most common symptom. It usually increases at night and responds to nonsteroidal anti-inflammatory drugs. Case Presentation. The authors report the excision of an osteoid osteoma lying at the distal condyle of a metacarpal bone of the left hand. The clinical and radiological findings are exposed as well as the surgical management of the lesion. Pain and swelling disappeared after surgery, and there was no evidence of recurrence at follow-up. Discussion. They discuss this rare location and further radiological examination that was used leading to the diagnosis. The imputation of the traumatic factor has been discussed, along with the different therapeutic possibilities and the advantages of a total excision while preserving the integrity of the adjacent ligament and joint space. Conclusion. The surgical alternative appears to be a satisfying treatment for osteoid osteoma in this particular superficial location. Both the exact pathogenesis and the contribution of the traumatic factor remain unclear.

scholarly journals Improvement of Phantom Pain by the Bioresonance Technology

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mehrdad Imanzade ◽  
Ahmad Shafaeizadeh ◽  
Mosoomeh Dadpay ◽  
Hamidreza Taheri Yegane ◽  
Hamid Keshvari ◽  
...  
Keyword(s):  
Phantom Limb Pain ◽  
The Body ◽  
Lower Limbs ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Case Presentation ◽  
Left Hand ◽  
Positive Results ◽  
Bioresonance Therapy

Introduction: Phantom limb pain (PLP) is a sensation caused by missing an organ in the body, which can be due to amputation. The prevalence of PLP due to amputation is about 82% for upper limbs and 54% for lower limbs. Case Presentation: This research describes the case of a 71-year-old female patient who developed PLP after having three middle fingers on her left hand amputated due to dipping in a meat grinder. She underwent bioresonance therapy for PLP treatment for 19 months and achieved positive results. Conclusions: Regarding the role of PLP in the patients undergoing amputation, bioresonance therapy might be beneficial in managing this condition.

On Future Directions in Pathology

1982 ◽  
Vol 40 ◽  
pp. 274-277
Author(s):  
Benjamin F. Trump ◽  
Irene K. Berezesky ◽  
Raymond T. Jones
Keyword(s):  
Electron Microscopy ◽  
Transmission Electron Microscopy ◽  
Clinical Pathology ◽  
Future Directions ◽  
Diagnostic Pathology ◽  
The Past ◽  
Transmission Electron ◽  
Organ Systems ◽  
The Many

The role of electron microscopy and associated techniques is assured in diagnostic pathology. At the present time, most of the progress has been made on tissues examined by transmission electron microscopy (TEM) and correlated with light microscopy (LM) and by cytochemistry using both plastic and paraffin-embedded materials. As mentioned elsewhere in this symposium, this has revolutionized many fields of pathology including diagnostic, anatomic and clinical pathology. It began with the kidney; however, it has now been extended to most other organ systems and to tumor diagnosis in general. The results of the past few years tend to indicate the future directions and needs of this expanding field. Now, in addition to routine EM, pathologists have access to the many newly developed methods and instruments mentioned below which should aid considerably not only in diagnostic pathology but in investigative pathology as well.

Shall I Move My Right or My Left Hand?

2003 ◽  
Vol 17 (2) ◽  
pp. 69-86 ◽  
Author(s):  
Claudio Babiloni ◽  
Fabio Babiloni ◽  
Filippo Carducci ◽  
Febo Cincotti ◽  
Claudio Del Percio ◽  
...  
Keyword(s):  
Bimanual Coordination ◽  
Central Area ◽  
Eeg Analysis ◽  
Complementary Information ◽  
Left Hand ◽  
Mirror Movements ◽  
Related Potentials ◽  
Motor Acts ◽  
Abstract Event

Abstract Event-related desynchronization/synchronization (ERD/ERS) at alpha (10Hz), beta (20Hz), and gamma (40Hz) bands and movement-related potentials (MRPs) were investigated in right-handed subjects who were “free” to decide the side of unilateral finger movements (“fixed” side as a control). As a novelty, this “multi-modal” EEG analysis was combined with the evaluation of involuntary mirror movements, taken as an index of “bimanual competition.” A main issue was whether the decision regarding the hand to be moved (“free” movements) could modulate ERD/ERS or MRPs overlying sensorimotor cortical areas typically involved in bimanual tasks. Compared to “fixed” movements, “free” movements induced the following effects: (1) more involuntary mirror movements discarded from EEG analysis; (2) stronger vertex MRPs (right motor acts); (3) a positive correlation between these potentials and the number of involuntary mirror movements; (4) gamma ERS over central areas; and (5) preponderance of postmovement beta ERS over left central area (dominant hemisphere). These results suggest that ERD/ERS and MRPs provide complementary information on the cortical processes belonging to a lateralized motor act. In this context, the results on vertex MRPs would indicate a key role of supplementary/cingulate motor areas not only for bimanual coordination but also for the control of “bimanual competition” and involuntary mirror movements.

A literature review on firms' internationalisation through e-commerce

2019 ◽  
pp. 121-143
Author(s):  
Riccardo Resciniti ◽  
Federica De Vanna
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
International Business ◽  
Decision Process ◽  
Foreign Markets ◽  
New Markets ◽  
Integrative Framework ◽  
The Past ◽  
The Relationship

The rise of e-commerce has brought considerable changes to the relationship between firms and consumers, especially within international business. Hence, understanding the use of such means for entering foreign markets has become critical for companies. However, the research on this issue is new and so it is important to evaluate what has been studied in the past. In this study, we conduct a systematic review of e-commerce and internationalisation studies to explicate how firms use e-commerce to enter new markets and to export. The studies are classified by theories and methods used in the literature. Moreover, we draw upon the internationalisation decision process (antecedents-modalities-consequences) to propose an integrative framework for understanding the role of e-commerce in internationalisation

Concealment of Illegally Obtained Assets in Nigeria: Revisiting the Role of the Churches in Money Laundering

2020 ◽  
Vol 28 (1) ◽  
pp. 106-121
Author(s):  
Kato Gogo Kingston
Keyword(s):  
Economic Growth ◽  
Money Laundering ◽  
Financial Crime ◽  
The Past ◽  
Key Drivers ◽  
Nigerian Government

Financial crime in Nigeria – including money laundering – is ravaging Nigeria's economic growth. In the past few years, the Nigerian government has made efforts to tackle money laundering by enacting laws and setting up several agencies to enforce the laws. However, there are substantial loopholes in the regulatory and enforcement regimes. This article seeks to unravel the involvement of the churches as key drivers in money laundering crimes in Nigeria. It concludes that the permissive secrecy which enables churches to conceal the names of their financiers and donors breeds criminality on an unimaginable scale.

Provision of Remedies for Violation of Economic, Social and Cultural Rights: A Comparative Study of the United Nations, Inter-American and African Human Rights Systems

2020 ◽  
Vol 28 (2) ◽  
pp. 298-318
Author(s):  
Roman Girma Teshome
Keyword(s):  
Human Rights ◽  
United Nations ◽  
Comparative Study ◽  
Economic Rights ◽  
Regional Monitoring ◽  
Cultural Rights ◽  
The Past ◽  
The United Nations ◽  
To Receive

The effectiveness of human rights adjudicative procedures partly, if not most importantly, hinges upon the adequacy of the remedies they grant and the implementation of those remedies. This assertion also holds water with regard to the international and regional monitoring bodies established to receive individual complaints related to economic, social and cultural rights (hereinafter ‘ESC rights’ or ‘socio-economic rights’). Remedies can serve two major functions: they are meant, first, to rectify the pecuniary and non-pecuniary damage sustained by the particular victim, and second, to resolve systematic problems existing in the state machinery in order to ensure the non-repetition of the act. Hence, the role of remedies is not confined to correcting the past but also shaping the future by providing reforming measures a state has to undertake. The adequacy of remedies awarded by international and regional human rights bodies is also assessed based on these two benchmarks. The present article examines these issues in relation to individual complaint procedures that deal with the violation of ESC rights, with particular reference to the case laws of the three jurisdictions selected for this work, i.e. the United Nations, Inter-American and African Human Rights Systems.

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