scholarly journals Dermoscopic patterns in patients with a clinical diagnosis of onychomycosis—results of a prospective study including data of potassium hydroxide (KOH) and culture examination

2015 ◽  
pp. 39-44
Author(s):  
Miriam América Jesús-Silva ◽  
Ramón Fernández-Martínez ◽  
Rodrigo Roldán-Marín ◽  
Roberto Arenas

Background: Onychomycosis is the most common nail disease, representing 50% of cases affecting the nail apparatus. The diagnosis is made by clinical examination along with the KOH exam of the nail and culture of the sample. However, not all dermatologists have access to a mycology lab. Objective: To determine the correlation between KOH examination and dermoscopic patterns in patients with clinical diagnosis of onychomycosis. Patients/Methods: A descriptive, open, observational, prospective, cross-sectional study of 178 patients with clinical suspicion of onychomycosis was conducted. All patients underwent clinical examination, dermoscopy with a DermLite PHOTO dermatoscope (3Gen, San Juan Capistrano, CA, USA), KOH assessment and culture analysis. The most frequent dermoscopic patterns were identified and their correlation with the clinical subtype of onychomycosis was analyzed. Results: The study included 178 patients with clinical suspicion of onychomycosis. Of these, 155 (87.1%) had positive direct KOH examination for onychomycosis. Eighty-seven patients (56.13%) presented with clinical onychomycosis pattern of total dystrophic onychomycosis (TDO), 67 (43.23%) with distal lateral subungual onychomycosis (DLSO), 1 (0.65%) with trachyonychia). Dermoscopic patterns of onychomycosis showed the following frequencies: the spiked pattern was present in 22 patients (14.19%), longitudinal striae pattern in 51 patients (32.9%) and linear edge pattern in 21 patients (13.55%). We identified a pattern described as “distal irregular termination” in 41 patients with TDO and 26 with DLSO. Conclusions: This is the fist study conducted in a Mexican population that uses dermoscopy as a diagnostic tool along with the KOH examination for the diagnosis of onychomycosis. Dermoscopy may be used as an important diagnostic tool when evaluating nail disease. However, it should not be used as the only diagnostic criteria for onychomycosis.


Author(s):  
Krishnendra Varma ◽  
Ujjwal Kumar ◽  
Praneeta Jain

<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>



2020 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Mohammad Enayet Hussain ◽  
Bithi Debnath ◽  
AFM Al Masum Khan ◽  
Md Ferdous Mian ◽  
Md Nahidul Islam ◽  
...  

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77



2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 508.2-509
Author(s):  
K. Maatallah ◽  
H. Boussaa ◽  
H. Riahi ◽  
H. Ferjani ◽  
M. Habechi ◽  
...  

Background:Foot disease is a common problem in rheumatoid arthritis (RA). Therapeutic decisions are often based on clinical examination (CE) alone, which can be adversely affected by factors such as deformity, obesity, and peripheral edema. Ultrasonography (US) has previously been shown to be more sensitive than CE for detecting synovitis and tenosynovitis in RA forefeet, but few data exist for the hindfoot and ankle.Objectives:The aim of this study was to compare CE and US for the detection of hindfoot and ankle synovitis and tenosynovitis in patients with established RA.Methods:We conducted a cross-sectional study including patients with RA (ACR/EULAR 2010). Demographic data and disease parameters were collected. CE was performed by a rheumatologist for the presence or absence of tenderness, swelling, and mobility restriction of both ankles. The following tendons were examined for tenosynovitis: tibialis anterior (TA) and posterior (TP), fibularis longus (FL), and brevis (FB) (assessed together). In a second time, US examination of the tibiotalar, talonavicular, and subtalar joints and the same tendons as CE was performed by a blinded radiologist experienced in musculoskeletal imaging using a Philips HD11 device with a high-frequency linear transducer. The presence or absence of synovitis and tenosynovitis was recorded, and the composite synovitis score (power doppler / grayscale ultrasound (PDUS)) was measured for each joint. The US score of each patient was defined by the sum of the composite scores of the joints studied (0-30). A p-value <0.05 was considered significant.Results:Sixty-two feet were examined in 31 RA patients (25 women and six men) with a mean age of 54.8±10.8 years old [32-70]. The mean disease duration was 8.5±7.2 years [1-37]. Rheumatoid Factor (RF) and Anti-Citrullinated Peptides Antibodies (ACPA) were positive in 61.3% and 83.8% of cases. The mean DAS28 ESR was 3.8±1.5 [0.6-7].Clinical examination of ankles revealed tenderness in 57.4% of cases, swelling in 38.8% of cases, and restriction in the range of motion in 11.1% of cases. TA tenosynovitis was noted in 14.8% of cases, TP tenosynovitis in 22.2% of cases, and FL and FB tenosynovitis in 31.5% of cases.US showed tibiotalar synovitis in 59.3% of cases, talonavicular synovitis in 64.8% of cases, and subtalar synovitis in 46.3% of cases. TA tenosynovitis was noted in 5.6% of cases, TP tenosynovitis in 22.2% of cases, and FB and FL tenosynovitis in 25% and 11.1% of cases respectively.An association was found between clinical tenderness and US synovitis of the tibiotalar joint (p=0.013) and the talonavicular joint (p=0.027). No association was noted between clinical swelling and US synovitis in these joints.No association was noted between clinical and US tenosynovitis of TA (p=0.279), TP (p=0.436), FB (p=0.495) and FL (p=0.315).Conclusion:Clinical examination of RA ankles may be challenging and needs to be coupled with US, which is more sensitive and accurate in the detection of synovitis and tenosynovitis.Disclosure of Interests:None declared



2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S22-S23
Author(s):  
A E Malango

Abstract Introduction/Objective Stillbirth is defined as fetal death that occurs at gestational age of ≥28 weeks. In our setting clinical assessment is the only method used to determine cause of stillbirths, with no reported proportion of unknown clinical diagnosis. Studies showed that unknown cause of stillbirths can be reduced by examination of placenta. Causal identification aids in the mourning process and identifying recurrence risks. The study aimed to describe pathological changes in the placentas of stillbirths which have risk to cause fetal death Methods A descriptive cross-sectional study done for the period of 6 months, it involved examination of 80 placentas of stillbirths born at gestational age of ≥ 28 weeks, placentas were fixed in 10% neutral buffered formalin for 8–12 hours. Grossing and interpretation of placenta pathology was according to Amsterdam Placental Workshop Group Consensus Statement. Results Out of 80 stillbirths, 32(40%) had unknown clinical diagnosis. Majority of stillbirth placentas 71(91%) found with either one or combined pathologies with the risk to cause stillbirth. Maternal vascular malperfusion was the commonest pathology and was significantly associated with preterm stillbirths. Maternal floor infarction, a placenta pathology with risk to cause fetal death and high risk of recurrence was among the pathologies found, was seen in 4(5%) of stillbirth placentas. Conclusion Findings in this study clearly indicated the importance of pathological examination of placenta in determining cause of stillbirth. Placenta examination in stillbirths can identify more pathology related to stillbirths than clinical assessment alone.



2021 ◽  
pp. 089198872110026
Author(s):  
Sivan Klil-Drori ◽  
Natalie Phillips ◽  
Alita Fernandez ◽  
Shelley Solomon ◽  
Adi J. Klil-Drori ◽  
...  

Objective: Compare a telephone version and full version of the Montreal Cognitive Assessment (MoCA). Methods: Cross-sectional analysis of a prospective study. A 20-point telephone version of MoCA (Tele-MoCA) was compared to the Full-MoCA and Mini Mental State Examination. Results: Total of 140 participants enrolled. Mean scores for language were significantly lower with Tele-MoCA than with Full-MoCA (P = .003). Mean Tele-MoCA scores were significantly higher for participants with over 12 years of education (P < .001). Cutoff score of 17 for the Tele-MoCA yielded good specificity (82.2%) and negative predictive value (84.4%), while sensitivity was low (18.2%). Conclusions: Remote screening of cognition with a 20-point Tele-MoCA is as specific for defining normal cognition as the Full-MoCA. This study shows that telephone evaluation is adequate for virtual cognitive screening. Our sample did not allow accurate assessment of sensitivity for Tele-MoCA in detecting MCI or dementia. Further studies with representative populations are needed to establish sensitivity.



BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e037913
Author(s):  
Mala George ◽  
Geert-Jan Dinant ◽  
Efrem Kentiba ◽  
Teklu Teshome ◽  
Abinet Teshome ◽  
...  

ObjectivesTo evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests.DesignA cross-sectional study.SettingTwo public referral hospitals in Tigray, Ethiopia.ParticipantsA total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study.Primary and secondary outcome measuresA total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done.ResultsThe strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84–0.87) and culture-negative (AUC 0.64–0.69) PTB.ConclusionsOur finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases.



2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Alfonso Romero-Gameros ◽  
Tania Colin-Martínez ◽  
Salomón Waizel-Haiat ◽  
Guadalupe Vargas-Ortega ◽  
Eduardo Ferat-Osorio ◽  
...  

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.



2006 ◽  
Vol 124 (1) ◽  
pp. 42-44 ◽  
Author(s):  
Fabio Luiz de Menezes Montenegro ◽  
Marcos Roberto Tavares ◽  
Marcelo Doria Durazzo ◽  
Claudio Roberto Cernea ◽  
Anói Castro Cordeiro ◽  
...  

CONTEXT AND OBJECTIVE: Adequate management of parathyroid carcinoma apparently relates to the surgeon’s ability to identify it at the first operation. The objective of this paper was to evaluate the role of clinical suspicion in the management of parathyroid carcinoma. DESIGN AND SETTING: Retrospective analysis of parathyroid carcinoma patients treated in Department of Head and Neck Surgery, Faculdade de Medicina da Universidade de São Paulo. METHODS: Cross-sectional study of 143 patients who underwent surgery from 1995 to 2000, due to hyperparathyroidism. These cases were reviewed to ascertain whether preoperative and intraoperative suspicion of parathyroid carcinoma were helpful during the operation, and which factors demonstrated the suspicion of cancer best. RESULTS: Among 66 patients with primary hyperparathyroidism there were four cases of parathyroid carcinoma (6.1%), and one case was found in secondary hyperparathyroidism (1.3%). Palpable nodules were found in five patients with primary hyperparathyroidism, four of them with parathyroid carcinoma. Preoperative levels of calcium in primary hyperparathyroidism with cancer patients varied from 12.0 mg/dl to 18.2 mg/dl. Two patients had gross macroscopic spread of the tumor to adjacent structures. Except for one patient, with extensive disease, tumors were resected en bloc. In secondary hyperparathyroidism, parathyroid carcinoma was found in a fifth mediastinal gland. One atypical adenoma was observed. CONCLUSIONS: High levels of calcium, palpable tumors and adherence to close structures are more common in parathyroid carcinoma. These clinical signs may be helpful for decision-making during parathyroid surgery.



2021 ◽  
Vol 8 (12) ◽  
pp. 1856
Author(s):  
Ganedi Seshu Kumari

Background: Tuberculosis is the leading cause of death in India contributing to 30% of total global burden. Approximately 0.5 million people dies of TB annually and 5% of the incident TB cases in India have HIV. So it is important to understand the effect of tuberculosis and HIV on each other. HIV epidemics have leads to increased number of tuberculosis cases with various presentations.Methods: It is an observational cross-sectional study of patients with HIV positive and pulmonary TB. Patients were investigated for HIV positivity by HIV coomb's test, if positive confirmed by capillaries and tridot method. Some patients, who are diagnosed as having pulmonary Koch, are sent for HIV testing. CD4 cells count as tested in all patients with HIV positive and severity of pulmonary TB and relation with CD count is studied in all patients.Results: In chest x-ray of patients we have observed that upper zone infiltration was found in 10 (16.67%) patients, mid and lower zone infiltration was found in 19 (31.67%) patients, bilateral infiltration and miliary tuberculosis was found in 22 (36.67%). We have found that 9 (15%) patients were presented with fibro cavitary lesion.Conclusions: From present study we can conclude that tuberculosis and HIV is common between 3rd and 5th decade of life with male predominance. It was more common in daily labourer and BMI was 18.22±3.21 kg/m2. Fever, weight loss and cough was most common presentation and present in more than 90% patients pallor and lymphadenopathy was common finding and present in more than 50% patients.



2021 ◽  
Vol 8 (11) ◽  
pp. 3375
Author(s):  
Jaganmoy Maji ◽  
Debjyoti Mandal

Background: Cholelithiasis is a common pathology of the gall bladder affecting about 10 to 15% of the adults in western countries and 2 to 29% in India. More than 80% of the patients with cholelithiasis are asymptomatic. Hypothyroidism may cause gall stone formation due to the hyperlipidemia, motility disorders affecting the bile duct and sphincter of Oddi.Methods: This was a descriptive cross-sectional study conducted at Department of Surgery, Bankura Sammilani Medical College and Hospital, Bankura from March 2019 to February 2020 for duration of one and half year. The sample size was 54 and consecutive non-probability sampling technique was used for the sampling. All the collected data were recorded in a pre-designed proforma and analyzed in MS excel.Results: Out of 54-patients with cholelithiasis, 28% patients were from the age group 45-54 years.40% patients were hypothyroid pre-dominantly females. Among 30-female patients 11 (26.82%) were hypothyroid and among 11-male patients 2 (15.38%) were hypothyroid. Hypothyroidism in male and female was statistically significant.Conclusions: This study was introduced to determine the relationship between hypothyroidism and cholelithiasis. It was concluded that hypothyroidism was more common in female, obese and elder patients. The gender distribution of the hypothyroidism in patients with cholelithiasis was statistically significant while all other variables were statistically not significant.  



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