PERNIOSIS: AN ENIGMATIC DERMATOLOGICAL ENTITY- STUDY OF ITS DEMOGRAPHIC PROFILE AND NAIL CAPILLAROSCOPIC CHANGES

BACKGROUND: Perniosis is a localised inammatory disorder affecting the unprotected skin regions of individuals exposed to damp, nonfreezing cold. The exact pathogenesis has not been elucidated, however, it is thought to be a microvascular disease. AIMS: To study the demographic prole of patients presenting with perniosis and examine the nailfold capillaroscopic (NFC) changes. MATERIAL AND METHODS: This was an observational, cross-sectional study conducted at a Tertiary care hospital of North India over a period of three months (November 2020- January 2021). Patients with idiopathic perniosis were included in the study. After detailed history and clinical examination, proximal nailfold (PNF) video capillaroscopy was performed in the affected digits. RESULTS: A total of 47 patients with idiopathic perniosis were recruited in the study consisting of 35 females and 12 males with female to male ratio of 2.9:1. A majority of individuals belonged to age group 21-35 years (38.29%). Lesions were localized to both hands and feet in 23 patients (48.9%), only hands in 19(40.4%) and only toes in rest 5 (10.6%) patients. Ten (21.2%) patients had family history of similar complaints and history of smoking was present in 2 (4%) patients. The mean BMI 2 recorded in 37 patients aged >20 years was 20.72+4.32kg/m . Finger nail videocapillaroscopy performed in 42 patients showed dilated capillaries in 42.8%, tortuosity in 40.4% and microhaemorrhages in 28.5% patients. CONCLUSION: In the present study, presence of nailfold capillaroscopic changes suggested that an organic damage to the microcirculation is present in perniosis. Low BMI is an important association for development of perniosis. LIMITATIONS: Long term follow up is required for patients with chilblains to assess permanency of nailfold capillaroscopic changes.

Chemical Gastroenterocolitis after Dental Root Canal Therapy with Camphorated and Mentholated Chlorophenol

A 78-year-old man with a history of pancolitis, after the treatment of dental abscess with oral antibiotics and local application of camphorated and mentholated chlorophenol (CMCP), presented with abdominal pain of 4-day duration, as well as hair loss in the area of moustache and finger nail lifting. He was already treated with rectal application of budesonide because of pancolitis, diagnosed 6 weeks ago and interpreted as an allergic reaction to clindamycin. For further investigation, we performed gastroscopy and colonoscopy, which showed the edematous mucosa with polypus-like changes of the whole mucosa of the stomach, duodenum, first part of the jejunum, distal ileum, complete colon, and rectum. The diagnosis was complicated and was achieved in synopsis with anamnestic details, such as endodontic application of camphorated chlorophenol. The patient symptoms abated after he commenced on mesalazine therapy.

HYBRID CLASSIFIER TO CLASSIFY THE FINGER NAIL ABNORMALITIES

Nail diagnosis is a method to predict the possibilities of organ failures and various systemic diseases. Nail abnormalities are considered as the signs of certain diseases in traditional medicines such as Siddha Medicine, Ayurveda, Yunani and Chinese medicine etc. In this paper, the performance of existing techniques such as SVM classifier and KNN classifiers are compared with the proposed method. The metrics precision, recall, F-measure and accuracy are calculated and compared. The 100 images had taken for study and the proposed novel segmentation method gives the best accuracy. The experiment uses 480 (increase the dataset) images of eight types of abnormalities. 70% of images were used for training and 30% of images were used for testing. (Discuss the performance measure)

Comparative evaluation of therapeutic efficacy of cryotherapy with liquid nitrogen versus oral terbinafine pulse in finger nail onychomycosis

Background: Onychomycosis is a fungal infection of the nail unit and can be caused by dermatophytes, yeasts and non-dermatophyte moulds. None of the treatment modalities yield consistent results. Cryotherapy as a treatment modality has not been studied in its management.Methods: 80 clinically confirmed cases of onychomycosis were enrolled for the study. Cases in group 1 were given liquid nitrogen cryotherapy with dipstick method for 12 weeks at 2 weekly intervals and cases in group 2 were given oral terbinafine in a dose of 500 mg daily for a week/month for 3 months. After 12 weeks cases in both groups were followed up at intervals of 3 weeks till 24 weeks.Results: At week 12 ,40% of the patients in group 1 achieved clinical cure which was comparable to treatment with oral terbinafine pulse which was 45% and G3 response was attained by 20% of the patients in group 1 and 17.5% patients in group 2. The results at 12 weeks were comparable in two groups and p value was insignificant. At the end of study duration, clinical cure was achieved in 32.5% in group 1 and 62.5% of patients in group 2 and p value was highly significant.Conclusions: The results of cryotherapy were inferior to oral terbinafine pulse. Though results with cryotherapy were comparable to oral terbinafine pulse at 12 weeks, at 24 weeks oral terbinafine pulse proved to be a treatment option in finger nail onychomycosis.

A novel clinical applicable bed-side tool for assessing conditioning pain modulation: proof-of-concept

Background and aimsIn recent years, focus on assessing descending pain modulation or conditioning pain modulation (CPM) has emerged in patients with chronic pain. This requires reliable and simple to use bed-side tools to be applied in the clinic. The aim of the present pilot study was to develop and provide proof-of-concept of a simple clinically applicable bed-side tool for assessing CPM.MethodsA group of 26 healthy volunteers participated in the experiment. Pressure pain thresholds (PPT) were assessed as test stimuli from the lower leg before, during and 5 min after delivering the conditioning tonic painful pressure stimulation. The tonic stimulus was delivered for 2 min by a custom-made spring-loaded finger pressure device applying a fixed pressure (2.2 kg) to the index finger nail. The pain intensity provoked by the tonic stimulus was continuously recorded on a 0–10 cm Visual Analog Scale (VAS).ResultsThe median tonic pain stimulus intensity was 6.7 cm (interquartile range: 4.6–8.4 cm) on the 10 cm VAS. The mean PPT increased significantly (P = 0.034) by 55 ± 126 kPa from 518 ± 173 kPa before to 573 ± 228 kPa during conditioning stimulation. When analyzing the individual CPM responses (increases in PPT), a distribution of positive and negative CPM responders was observed with 69% of the individuals classified as positive CPM responders (increased PPTs = anti-nociceptive) and the rest as negative CPM responders (no or decreased PPTs = Pro-nociceptive). This particular responder distribution explains the large variation in the averaged CPM responses observed in many CPM studies. The strongest positive CPM response was an increase of 418 kPa and the strongest negative CPM response was a decrease of 140 kPa.ConclusionsThe present newly developed conditioning pain stimulator provides a simple, applicable tool for routine CPM assessment in clinical practice. Further, reporting averaged CPM effects should be replaced by categorizing volunteers/patients into anti-nociceptive and pro-nociceptive CPM groups.ImplicationsThe finger pressure device provided moderate-to-high pain intensities and was useful for inducing conditioning stimuli. Therefore, the finger pressure device could be a useful bed-side method for measuring CPM in clinical settings with limited time available. Future bed-side studies involving patient populations are warranted to determine the usefulness of the method.

Should the nail plate be replaced or discarded after nail bed repair in children? Nail bed INJury Analysis (NINJA) randomised controlled trial: a health economic and statistical analysis plan

Background Nail bed trauma is one of the most common surgically treated paediatric hand injuries in the UK. Despite surgeons generally expressing a preference to replace the nail plate after repairing the nail bed, there is limited evidence to support this practice. We describe a statistical and health economic analysis plan (SHEAP) for the Nail bed INJury Analysis (NINJA) randomised controlled trial. Methods/design NINJA is a multicentre, pragmatic, superiority, parallel group randomised controlled trial of the treatment of nail bed injury in participants 16 years old or younger. The study aims to evaluate the efficacy and cost-effectiveness of replacing the nail plate compared to discarding it following the repair of a nail bed injury. Surgical site infection at 7–10 days post-randomisation and cosmetic appearance of the nail are the co-primary outcomes for NINJA. Surgical site infection at 7–10 days post-randomisation will be evaluated using a logistic regression model adjusting for site as the sole stratification factor and allowing for intra-site correlation. Cosmetic appearance will be assessed via the newly developed Oxford Finger Nail Appearance Score and will be evaluated by use of a Mann-Whitney U test. An ordinal logistic regression model will also be used to assess the Oxford Finger Nail Appearance Score, adjusting for site and allowing for intra-site correlation. Secondary outcomes are measured at 7–10 days and 4 months and include the EQ-5D-Y questionnaire, pain at first dressing change, cost-effectiveness, late surgical site infection, and participant/parent satisfaction with nail healing. Missing primary outcome data will be summarised by treatment arm and investigated through a sensitivity analysis. Full details of the planned methods of analysis and descriptive statistics are described in this paper. The NINJA study protocol has been published previously. Discussion The planned analysis strategy for the NINJA trial has been set out here to reduce the risk of reporting bias and data-driven analysis. Any deviations from the SHEAP described in this paper will be detailed and justified fully in the final report of the trial. Trial registration ISRCTN, ISRCTN44551796. Registered on 23 April 2018.