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was searched using the key words 'nail psoriasis' and 'psoriatic arthritis'. Psoriasis involving the nail matrix shows up as changes such as pitting, Beaulines, leukonychia, red spots in the lunula, or nail plate crumbling. Nail bed psoriasis manifests as onycholysis, oil drops (or salmon patches), dyschromia, splinter hemorrhages, or subungual hyperkeratosis. Nail psoriasis and psoriatic lesions in the gluteal cleft and on the scalp usually accompany PsA, especially in adult men.
. vivax infection, the species cannot be determined (v) quantification is not possible (vi) operator misunderstanding or misinterpretation of test line patterns may lead to apparent discrepancy between RDT and blood film results (vii) rarely, a prozone effect may occur with HRP2 based RDTs (Luchavez et al , ). Currently available RDTs cannot specifically identify P. knowlesi . HRP2‐based test lines detect only P. falciparum . Plasmodium lactate dehydrogenase (pLDH) and aldolase‐based test lines may (...) detect P. knowlesi as ‘malaria parasites’ but cannot identify the species. A hospital study in Malaysia detected 74% of PCR‐confirmed P. knowlesi using a pan‐pLDH RDT test line and a pan‐aldolase RDT test line detected 23%. The authors commented that neither the pLDH‐ nor aldolase‐based RDT they tested demonstrated sufficiently high overall sensitivity for P. knowlesi (Barber et al , ). The World Health Organization has produced detailed performance assessment of commercially available RDTs (see
for a median of 6 months after discontinuation of therapy (Faoro et al , ). JAK inhibitors JAK inhibitors may have a future role in the management of splenomegaly (see ‘Novel Therapies’ section) and are the only therapies to have been evaluated in the context of randomized clinical trials. Recommendations: medical management of splenomegaly First Line: Hydroxycarbamide (in the absence of cytopenias). Thalidomide and prednisolone (in presence of cytopenias) – consider lenalidomide (if anaemic with platelet (...) count >100 × 10 9 /l). Second Line: Consideration should be given to the use of JAK inhibitors either as part of a clinical trial, or via patient access protocols. These agents are now approved in the USA for first line therapy which is appropriate following approval (Evidence level 1, Grade A). Surgical management The place of splenectomy in the management of myelofibrosis is well established (Barosi et al , ; Tefferi et al , ). Routine splenectomy is inappropriate and the procedure should
Idiopathic Sporadic Onychomadesis of Toenails Onychomadesis is a clinical sign of nail plate separation due to transient or permanent arrest of nail matrix activities. Onychomadesis can be considered as a severe form of Beau'sline. This condition usually occurs after trauma, causal diseases, or medications, yet it rarely occurs as an idiopathic condition. We report a case of a 38-year-old Thai female who developed recurrence onychomadesis in several toenails in the absence of predisposing
abnormalities in presence of persistent cytopenias of undetermined origin should be considered to support a presumptive diagnosis of MDS when morphological characteristics are not observed. f The diagnostic criteria for childhood MDS (refractory cytopenia of childhood [RCC]-provisional entry) include: 1) persistent cytopenia of 1–3 cell lines with <5% bone marrow blasts, <2% peripheral blood blasts, and no ringed sideroblasts and 2) dysplastic changes in 1–3 lineages should be present. Table 4. Definitions
of heavy users. There are also concerns that a for-profit industry and its lobbyists will fight against regulation and taxation. Thus, serious thought should be given to whether marijuana should be supplied by profit-maximizing firms. Besides home production and cooperatives, other options include limiting the market to nonprofit organizations or “for-benefit corporations,” which typically focus on the triple-bottom line of people, planet, and profits. Jurisdictions could also limit supply to a state (...) in Washington, D.C., and collectives being implemented in Uruguay highlight some of the other non-commercial approaches. While these 10 Ps are not the only choices confronting jurisdictions considering changes in marijuana policy, they cover many of the critical decisions that will determine whether removing prohibition is a good idea. May they serve as fodder for debate and as an outline for jurisdictions seeking guidance if they decide to legalize. Beau Kilmer is the co-director of the RAND Drug Policy
that the increase in marijuana use resulting from legal availability and lower prices will increase dependence and other negative health consequences, such as contributing to a rise in individuals experiencing psychotic symptoms. Opponents also fear that marijuana will be marketed in the same manner as alcohol and that there will be a new industry with lobbyists who would fight against regulation and taxation (or, for that matter, that existing tobacco companies might enter this line of business) The remainder (...) of this commentary is available on . Beau Kilmer is co-director of the RAND Drug Policy Research Center and co-author of " ," (Oxford University Press, 2012). This commentary originally appeared in Britannica Book of the Year on April 21, 2015. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis. Codirector, RAND Drug Policy Research Center; Interim Director, RAND San Francisco Bay Area; Senior Policy
: Mahidol University Information provided by (Responsible Party): Mahidol University Study Details Study Description Go to Brief Summary: Nail surface abnormalities is any conditions that affect the nail matrix or nail bed which cause nail plates grow defectively. Common nail surface abnormalities are pitting nails, longitudinal ridging, and transverse ridging/Beau'sline. Aging nails usually have nail surface abnormalities as well. Nail gels are artificial nails used widely for aesthetic purposes
Nail findings in hand-foot-and-mouth disease. Hand-foot-and-mouth disease (HFMD) is a common self-limited viral illness seen in the United States and around the world. Its classic features are easily recognizable; however, nail changes are not well known or characterized. This case demonstrates onychomadesis and Beaulines in a child following clinical diagnosis of hand-foot-and-mouth disease. In this setting, nail dystrophies should be reassuring to pediatricians and families.
is not well understood but is thought to be due to increased beta-melanocyte stimulating hormone in the nail bed. This does not improve with dialysis. Other changes are also seen in the nails of dialysis patients. Beau'slines are characterized by transverse deep depressions. Mee's lines have a single white band in the nail plate. Terry's nails present with the proximal 2/3 being wide and pale with the distal 1/3 narrow and red. (Image on the left shows Beau'sLines [ ], Image on the right show half
) criteria, the classification of AML is solely based upon morphology as determined by the degree of differentiation along different cell lines and the extent of cell maturation.[ , ] Under the WHO classification, the category “acute myeloid leukemia not otherwise categorized” is morphology-based and reflects the FAB classification with a few significant modifications.[ , ] The most significant difference between the WHO and FAB classifications is the WHO recommendation that the requisite blast (...) dysplasia” as one of the following: AML evolving from an MDS. AML following an MDS. AML with multilineage dysplasia is characterized by 20% or more blasts in the blood or bone marrow and dysplasia in two or more myeloid cell lines, generally including megakaryocytes.[ ] To make the diagnosis, dysplasia must be present in 50% or more of the cells of at least two lineages and must be present in a pretreatment bone marrow specimen.[ , ] AML with multilineage dysplasia may occur de novo or following MDS
MDS (refractory cytopenia of childhood [RCC]-provisional entry) include: 1) persistent cytopenia of 1–3 cell lines with <5% bone marrow blasts, <2% peripheral blood blasts, and no ringed sideroblasts and 2) dysplastic changes in 1–3 lineages should be present. MDS with single lineage dysplasia Unilineage dysplasia: ≥10% in one myeloid lineage 1–2 cytopenias b <5% blasts Blasts <1% c <15% ring sideroblasts MDS with ring sideroblasts (MDS-RS) Erythroid dysplasia only <5% blasts No blasts ≥15% ring
diminished with the introduction of flexible, silastic, silicone rubber catheters; tunneled, cuffed catheters; and improved line care. [ , , ] Less common indications for intestinal transplantation include locally invasive desmoid tumors, premalignant conditions (Gardener syndrome), and fluid and electrolyte losses unmanageable with TPN. [ ] In summary, intestinal transplantation is a salvage procedure applied to patients who have either anatomic or functional diseases that preclude enteral tolerance (eg (...) of the central veins. Intestinal transplantation is considered when the patient has lost 2 or more common venous access sites, such as the subclavian or internal jugular veins, or when unconventional sites such as the right atrial, transhepatic, or direct inferior vena caval catheters are required. Patient history and previous records should reveal the number and type of organisms responsible for previous central venous line infections. Fungal infections requiring mechanical ventilation or vasopressor
, line infection, wound infection, pulmonary infection, urinary tract infection, and viral enteritis. Sepsis is not uncommon with acute rejection, and this should always be remembered when evaluating a septic patient. Approximately 40% of small bowel transplant recipients require further surgery during their original inpatient stay; additional surgery is usually the result of infectious complications. [ ] Furthermore, these complications are primarily responsible for the prolonged hospitalizations (...) of these patients; ISB recipients typically are hospitalized for 3 weeks to 3 months, and LSB recipients typically are hospitalized for 3-6 months. Following small bowel transplantation, typical pathogens are enteric organisms, fungal species, or staphylococci (associated with central venous line infections). Bacterial infection appears to be far more common if the colon is included in the allograft; thus, inclusion of the colon is not the recommended protocol in many centers. [ ] Empiric antibiotic selection
marrow mimicking may be seen. Bone marrow cells display aberrant morphology and maturation (dysmyelopoiesis), resulting in ineffective blood cell production. MDS affects hematopoiesis at the stem cell level, as indicated by cytogenetic abnormalities, molecular mutations, and morphologic and physiologic abnormalities in maturation and differentiation of one or more of the hematopoietic cell lines. [ , , ] See the image below. Blood film (1000× magnification) demonstrating a vacuolated blast (...) published in 2008 and 2016. The 2016 WHO classification of MDS is as follows [ ] : MDS with single-lineage dysplasia (MDS-SLD) – 1 or 2 blood cytopenias; in bone marrow, dysplasia in ≥ 10% of one cell line, < 5% blasts MDS with multilineage dysplasia (MDS-MLD) – 1-3 blood cytopenias, < 1 × 10 9 /L monocytes; in bone marrow, dysplasia in ≥ 10% of cells in ≥ 2 hematopoietic lineages < 15% ring sideroblasts (or < 5% ring sideroblasts if SF3B1 mutation present) < 5% blasts MDS with ring sideroblasts (MDS-RS