The Simultaneous Compression of the Median and Ulnar Nerves by Lipoma: A Case Report and Review of the Literature.

Entrapment syndromes in the hand are very common and usually idiopathic. However, it can be the expression of nerve compression by a nearby structure or tumor. Space-occupying lesions are widely reported as a cause of median or ulnar nerve compression in the wrist. Nevertheless, a simultaneous compression of the median and ulnar nerves by a tumor is a rare condition. To the best of our knowledge, only three cases are described in the English literature. Herein, we present a case of a simultaneous compression in the wrist of the median and ulnar nerves by lipoma in a 79-year-old patient while also elucidating the reasons for the rarity of this condition and reviewing its clinical and therapeutic particularities.

Design of a new palladium(ii) halide complex as a bio-active material: synthesis, physico-chemical studies, DFT-computations and evaluation of anti-inflammatory, antioxidant and anti-gastric damage activities.

Colorless single crystals of the zero-dimensional hybrid compound, (C6H10N2)2[PdCl6]·2H2O were acquired through the slow evaporation technique. The crystal structure was explored using SC-XRD, which demonstrates that the material crystallizes in the centrosymmetric space group P1̄ of the triclinic system. The density functional theory method at the B3LYP/Lan2mb basis set level was employed to establish the optimized geometry and vibrational frequencies of the title compound. An acceptable correspondence was observed between the results obtained through calculation and the experimental data, including the structure, and IR spectra. The optical characteristics revealed a direct band gap energy of 2.35 eV, validating the semiconductor characteristics of this new material. The results suggest strong agreement with the experimental data and validate the involvement of metal orbitals in defining the HOMO-LUMO boundary. Simultaneous TGA-DTA shows that this material remains solid up to 210 °C. Beyond these temperatures, a gradual decomposition process occurs, extending up to 440 °C and unfolding in several steps. This process entails the liberation of diverse compounds, encompassing organic molecules, and the evaporation of chlorine ions, ultimately leading to the formation of palladium oxide (PdO) as the final product. When given to rats with gastric ulcers at a dose of 100 mg kg-1, these compounds inhibit the key enzyme responsible for neutrophil infiltration as myeloperoxidase (MPO) by 38.7%. The compound also alleviates cellular damage induced by free radicals, demonstrated by a notable 48.3% decrease in thiobarbituric acid reactive substance rates (TBARS) compared to untreated rats. Additionally, these compounds bring about a substantial 30.6% reduction in the surface area of ulcers.

Antimicrobial and anti-SARS-CoV-2 activities of smart daclatasvir-chitosan/gelatin nanoparticles-in-PLLA nanofibrous medical textiles; in vitro, and in vivo study.

This study aims at the development of electrospun polylactic acid nanofibers (PLLA NFs) incorporating smart daclatasvir-loaded chitosan gelatin nanoparticles to be used as medical textiles. First, smart nanoparticles were prepared through ionic gelation and optimized using Design Expert® software where daclatasvir (DAC), chitosan (CS), and gelatin (GL) amounts were selected to be the independent variables. DAC was used owing to its reported Anti-SARS-CoV-2 activity, CS was chosen due to its antimicrobial activity and GL was used owing to its sensitivity to be hydrolyzed upon exposure to Papain-like protease enzyme (PLpro). The optimum DAC-CS/TAN NPs possessed 109 nm size and 94.44 % entrapment efficiency in addition to sustained drug release for 14 days. Furthermore, upon exposure to PLpro, smart DAC-CS/GL NPs released the whole DAC amount within 3 h. Then, DAC-CS/GL NPs were incorporated within PLLA NFs through electrospinning. Swellability was found to increase gradually reflecting the controlled release of DAC from nanofibers within 3 weeks. Cell viability assessments using human fibroblasts showed that the developed nanofibers possess high biocompatibility. An in-vivo animal model for skin irritation was carried out for two weeks where visual inspection and histopathological investigations showed that neither edema nor erythema were observed.

Efficacy of rituximab in refractory polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium and small-sized vessels resulting in multiple organ involvement. Refractory PAN requires a different therapeutic approach. We herein report the case of a 42-year-old male presenting a non-virus-related refractory PAN with a favorable outcome on rituximab. He presented significant weight loss, muscle weakness, peripheral axonal neuropathy, and medium-sized cutaneous vessel necrotizing vasculitis. The patient received high-dose corticosteroids and cyclophosphamide with no significant clinical improvement while developing adverse side effects such as hypertension and diabetes. Rituximab was prescribed as an alternative therapy at 1000 mg on day 0 and day 15. This allowed for complete and rapid control of disease activity with regression of cutaneous injury and substantial improvement of neurological symptoms. In conclusion, using chimeric anti-CD20 monoclonal antibodies, such as rituximab, although rarely reported in refractory non-virus-related PAN, may be an effective alternative therapy, as portrayed in our case.

SARS-CoV-2 Papain-like Protease Responsive ZnO/Daclatasvir-Loaded Chitosan/Gelatin Nanofibers as Smart Antimicrobial Medical Textiles: In Silico, In Vitro and Cell Studies.

A significant number of deaths are reported annually worldwide due to microbial and viral infections. The development of protective medical textiles for patients and healthcare professionals has attracted many researchers' attention. Therefore, this study aims to develop smart drug-eluting nanofibrous matrices to be used as a basic material for medical textile fabrication. First, chitosan/gelatin nanofibers were selected as the basic material owing to the wide antimicrobial activity of chitosan and the capability of gelatin to be hydrolyzed in the abundance of the papain-like protease (PLpro) enzyme secreted by SARS-CoV-2. Daclatasvir (DAC), an NS5A inhibitor, was selected as the model drug based on in silico studies where it showed high anti-SARS-CoV-2 potential compared to FDA-approved references. Due to their reported antimicrobial and antiviral activities, ZnO NPs were successfully prepared and incorporated with daclatasvir in chitosan/gelatin nanofibrous matrices through electrospinning. Afterward, an in vitro release study in a simulated buffer revealed the controlled release of DAC over 21 days from the nanofibers compared to only 6 h for free DAC. On the other hand, the abundance of PLpro induced the complete release of DAC from the nanofibers in only 4-8 h. Finally, the nanofibers demonstrated a wide antimicrobial activity against S. aureus, E. coli, and C. albicans.

Correlation of the ultrasound thyroid imaging reporting and data system with cytology findings among patients in Uganda.

BACKGROUND: Ultrasonography is a noninvasive modality for the initial assessment of thyroid nodules. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) has demonstrated good performance in differentiating malignant thyroid nodules. However, the combination of ACR TI-RADS categories and cytology has not been studied extensively, in Uganda. The study aims to correlate ACR TI-RADS with cytology among patients referred for US-guided fine-needle aspiration at Mulago National Referral Hospital. METHODS: This was a hospital-based cross-sectional study that recruited 132 patients with thyroid nodules. Spearman's correlation was used to establish a relationship between TI-RADS and cytology findings. The diagnostic accuracy of TI-RADS was assessed using sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. RESULTS: Of 132 study participants, 90% (n = 117) were females, and the mean age was 41 ± 13 years. One hundred sixty-one thyroid nodules were analyzed. More than half of the thyroid nodules (54.7%, n = 87) were solid or almost solid, 96.9% (n = 154) were shaped wider than tall, 57.2% (n = 91) had smooth margins, 83.7% (n = 133) were hyperechoic or isoechoic, and 88.7% (n = 141) had no echogenic foci. TI-RADS 3 was the most common at 42.9% (n = 69). The proportions of malignancy for TI-RADS 4 and TI-RADS 5 were 73.3% and 85.7%, respectively. The correlation between ACR TI-RADS and the Bethesda system of thyroid classification scores was r = 0.577. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ACR TI-RADS were 90.9%, 98.5%, 90%, 99.3%, 62.3, and 0.1, respectively. CONCLUSION: We found that ACR TI-RADS classification is an appropriate and noninvasive method for assessing thyroid nodules in routine practice. It can safely reduce the number of unnecessary fine-needle aspiration in a significant proportion of benign thyroid lesions. Thyroid nodules classified as TI-RADS 3 should be followed routinely. ACR TI-RADS should be standardized as the screening tool in resource-limited areas.

Energy behaviour and economic analysis of a photovoltaic-thermal (PV/T) collector coupled with a reverse osmosis (RO) desalination unit in Tunisian climatic conditions: a feasibility study.

Water scarcity affects about one billion people in the world. Around two billion people could be living in water-stressed areas by 2050. For this reason, the desalination is always evolving due to the importance of the water resources found in the seas and brackish water. As these systems are generally energy intensive, the use of a renewable energy source is among the most appropriate solution. In this paper, both experimental and numerical investigations have been conducted to evaluate the performances and the economic viability of a photovoltaic-thermal collector intended to supply a reverse osmosis (RO) unit. Experimental study is based on the input-output and dynamic system testing (DST) according to ISO 9459-5 standard method and computations use the energy and mass balances of the PV/T collector and the RO plant. Results of DST testing showed that the loss coefficient of the PV/T, the tank loss coefficient and the total tank heat capacity are 10.46 W.m-2.K-1, 1.596 W.K-1 and 388 MJ.K-1, respectively. The ability to couple the RO technology to PV/T systems has been demonstrated. The complete system has been simulated for a water salinity of 10,000 ppm and climatic data of Borj-Cedria (Tunisia) site (longitude 10° 25' 41″ E and latitude 36° 43' 04″ N). Numerical investigations showed that the electricity needs of a small off-grid desalination unit could be met by using a 6.48 m2 PV/T panel surface area. In this case, the purified water produced has a salinity of 1500 ppm and the flow rate is 24,000 l/day. For a grid connected site, the produced and auxiliary powers are found to be equal to 54% and 21%, respectively. Moreover, the economic cost of adding a PV/T system into an existing RO unit has been evaluated and the results showed that the payback period is 6 years.

Iatrogenic giant subclavian artery pseudoaneurysm following clavicle fracture repair: A case report.

Subclavian artery aneurysms are infrequently observed in clinical settings, and are divided into intrathoracic and extra-thoracic segments. Atherosclerosis, cystic necrosis of the tunica media, trauma, or infections are more common. Blunt trauma or piercing is more frequently the cause of pseudoaneurysms, and broken bones following surgery should be evaluated. A 78-year-old woman attended the vascular clinic with a closed mid-clavicular fracture due to plant trauma before 2 months. Physical examination revealed a well-healed wound and no palpable pain, but a massive pulsating mass with normal overlying skin in the superior side of the clavicle. Thoracic CT angiography and a neck ultrasound revealed a distal right subclavian artery pseudoaneurysm of 50 × 49 mm. Arterial injuries were repaired by a ligature and bypass. The recovery from surgery was successful, and a 6-month follow-up examination revealed a right upper limb that was symptom-free and well-perfused.

Potential of simple and hybrid nanofluid enhancement in performances of a flat plate solar water heater under a typical North-African climate (Tunisia).

This work aims to quantify the long-term performance improvement of solar water heater system by using both simple and hybrid nanofluids. For this purpose, transient system simulations of a flat plate solar collector have been carried out and discussed using titanium oxide, magnesium oxide, and copper oxide/multiwalled oxide-carbon nanotube nanofluid-based nanoparticles. Tunisian climatic conditions with a typical household need has been considered, and the investigations have been established in terms of energy amounts, solar fractions, and harmful CO2 emission avoidance. Results showed an increase in the collector performances using the considered nanofluids. In particular, using 0.2v% and 0.6v% TiO2 homogeneously dispersed in water reduced the auxiliary energy up to 47.6 and 60.9%, respectively, compared to the reference case using water. The flat plate solar collector has an annual production of 1294 kWh for a need of 1998 kWh, which equates to an annual coverage rate of roughly 65%. Additionally, it was shown that when MgO with MWCNT were used instead of MgO nanofluid-based nanoparticles, the solar fraction increased by 5.14%. The use of 0.6 volume percent TiO2 nanoparticles in water reduces hazardous CO2 emissions by up to 0.829 tons annually.

The mediating role of gender in social media shopping acceptance: from the WOM perspective.

Today, online consumers' shopping experiences are wholly transformed because of technology to maximize consumer shopping experiences. However, even after increased online shopping after the Covid-19 outbreak, no study has examined the role of demographics in online shopping acceptance. Thus, we filled this gap by employing a cross-sectional design in the UAE and conducting Structural Equation Modelling (SEM). For data gathering purposes, we used structured questionnaires and randomly selected a sample of n = 320 respondents from Al Ain city. Findings revealed strong relationships between Online Shopping, Social Media Usage, and Electronic Word of Mouth (p > 0.000, p > 0.000). Despite the relationships between Social Media Usage, Electronic Word of Mouth, and online shopping acceptance remaining insignificant (p < .384, p < .425), the relationship between Social Media Usage, Online Shopping Acceptance (p > .004) remained significant. Finally, we conducted the mediating analyses and found a substantial mediation of gender between Social Media Usage, Online Shopping Acceptance (p > .000), and Electronic Word of Mouth and Online Shopping Acceptance (p >. 001). Hence, we conclude that people from Al-Ain city primarily rely on online shopping. For this purpose, they consider different factors, including their demographics, i.e., gender, as highly influential on their online shopping acceptance. However, the major limitations of the current study involve selecting gender as the only mediating variable, rejection o two prominent hypotheses, and geographical generalizability of results. Finally, we recommend that future researchers examine the impact of other demographical variables, i.e., age, income, qualification, residence, and others, to examine their impacts on consumer online shopping acceptance.

Myxoid Dermatofibrosarcoma Protuberans of the Scrotum: Rare Tumor in an Uncommon Location.

Background: Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor that involves the skin with a low metastatic rate; however, this tumor has a tendency to recur locally. Myxoid DFSP is a rare variant, with a few cases mentioned in the literature, and may present diagnostic difficulties on histopathological examination. Case Presentation: We present a 9-year-old male with a history of a left scrotal mass for 3 years. An enhanced computed tomography (CT) scan of the pelvis showed a heterogeneously enhancing mass in the scrotum with extension into both inguinal regions. Histology showed spindle-shaped cells forming a storiform pattern in the hypercellular area and myxoid stroma with prominent thin-walled vessels. Immunohistochemically, the cluster of differentiation 34 (CD34) was positive. The mass was removed by surgical excision with negative resection edges, and then adjuvant radiotherapy of 60 Gy was given. The patient had a good outcome with treatment and was doing well on follow-up. Conclusion: This variant of sarcoma is rare and often presents a diagnostic challenge. Early detection is crucial to prevent both undertreatment and overtreatment.

Non-traumatic myositis ossificans circumscripta in the anterior abdominal wall of a seven-year-old Ugandan child: A case report.

Myositis ossificans circumscripta (MOC) is a benign and self-limiting heterotopic ossification in the subcutaneous fat, tendons, muscles, and nerves. It is commonly due to trauma and is frequently encountered in the arm, shoulder, thigh, and hand which are prone to trauma. Non-traumatic MOC arising from the abdominal muscles is extremely rare. We report a case of 7-year-old male child with a three-year history of progressive painless abdominal swelling in the left hypochondria region with no history of associated trauma. CT scan of the abdomen showed a well-defined hyperdense mass in the left external oblique muscle. Histological diagnosis confirmed myositis ossificans of the external oblique muscle. The mass was removed surgically with no immediate or late complications.

Hyaluronic acid-entecavir conjugates-core/lipid-shell nanohybrids for efficient macrophage uptake and hepatotropic prospects.

Drug covalently bound to polymers had formed, lately, platforms with great promise in drug delivery. These drug polymer conjugates (DPC) boosted drug loading and controlled medicine release with targeting ability. Herein, the ability of entecavir (E) conjugated to hyaluronic acid (HA) forming the core of vitamin E coated lipid nanohybrids (EE-HA LPH), to target Kupffer cells and hepatocyte had been proved. The drug was associated to HA with efficiency of 93.48 ± 3.14 % and nanohybrids loading of 22.02 ± 2.3 %. DiI labelled lipidic nanohybrids improved the macrophage uptake in J774 cells with a 21 day hepatocytes retention post intramuscular injection. Finally, in vivo biocompatibility and safety with respect to body weight, organs indices and histopathological alterations were demonstrated. Coating with vitamin E and conjugation of E to HA (a CD44 ligand), could give grounds for prospective application for vectored nano-platform in hepatitis B.

The impact of virtual reality on pain management during normal labor: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the impact of virtual reality on pain management during normal labor. METHODS: A systematic search was performed in September 2021 through PubMed, Cochrane Library, Scopus, and ISI web of science. We selected randomized clinical trials (RCTs) that compared virtual reality in the intervention group versus placebo or no intervention in the control group among laboring women during their normal delivery. Revman software was used for performing our meta-analysis. Our primary outcome was the pain score evaluated during the labor process by the Visual Analog Scale (VAS). Our secondary outcomes were anxiety and satisfaction scores during childbirth in addition to the duration of the first and second stages of labor. RESULTS: Eight RCTs met our inclusion criteria with a total number of 466 patients. We found virtual reality was linked to a significant reduction in the VAS pain score during labor compared to the control group (MD = -1.40, 95% CI [-1.83, -0.96], p < 0.001). The anxiety score during labor was significantly reduced among the virtual reality group (SMD = -1.15, 95% CI [-2.18, -0.12], p = 0.03). Moreover, virtual reality significantly improved the satisfaction score during labor (MD = 15.58, 95% CI [4.93, 26.22], p = 0.004). However, there were no significant differences between virtual reality and control groups regarding the duration of the first and second stages of labor. CONCLUSIONS: Virtual reality is an effective technique for reducing anxiety, increasing satisfaction, and improving pain management during normal labor.

Should Pharmacists Lead Medication Reconciliation in Critical Care? A One-Stem Interventional Study in an Egyptian Intensive Care Unit.

OBJECTIVES: The main objective was to compare physician-obtained medication histories to the practice of medication reconciliation undertaken by a pharmacist in the intensive care unit (ICU). METHODS: A one-stem interventional study involving 500 adults 18 years and older admitted to the ICU (50 beds) of an Egyptian Joint Commission International-accredited reference hospital was conducted. The primary outcome measure was the proportion of ICU patients with missing medications in the cohorts of physician versus pharmacist-led medication reconciliation. The secondary outcome measure was the percentage of patients who had at least one clinical condition or adverse event (AE) that was left untreated during hospitalization of the 2 arms of patients after reconciliation. RESULTS: A total of 500 patients received reconciliation. Medication discrepancies in the cohort of physician-led reconciliation were greater than that of the pharmacist (26.1% versus 2.6%, P = 0.001). The most common discrepancy was indication with no medication, which was found to be greater in the physician-led cohort of patients than that of the pharmacist cohort (25.2% versus 2.6%, P = 0.001). Untreated AEs in the former cohort were present in 9.1% of cases versus 1.5% in the pharmacist-led reconciliation cohort ( P = 0.001). CONCLUSIONS: The present study revealed that pharmacist-led medication reconciliation in ICU has dramatically decreased medication discrepancies and AEs in adults with acute ICU admissions.

Mesenchymal-Type Neuroblastoma Cells Escape ALK Inhibitors.

Cancer therapy frequently fails due to the emergence of resistance. Many tumors include phenotypically immature tumor cells, which have been implicated in therapy resistance. Neuroblastoma cells can adopt a lineage-committed adrenergic (ADRN) or an immature mesenchymal (MES) state. They differ in epigenetic landscape and transcription factors, and MES cells are more resistant to chemotherapy. Here we analyzed the response of MES cells to targeted drugs. Activating anaplastic lymphoma kinase (ALK) mutations are frequently found in neuroblastoma and ALK inhibitors (ALKi) are in clinical trials. ALKi treatment of ADRN neuroblastoma cells with a tumor-driving ALK mutation induced cell death. Conversely, MES cells did not express either mutant or wild-type ALK and were resistant to ALKi, and MES cells formed tumors that progressed under ALKi therapy. In assessing the role of MES cells in relapse development, TRAIL was identified to specifically induce apoptosis in MES cells and to suppress MES tumor growth. Addition of TRAIL to ALKi treatment of neuroblastoma xenografts delayed relapses in a subset of the animals, suggesting a role for MES cells in relapse formation. While ADRN cells resembled normal embryonal neuroblasts, MES cells resembled immature precursor cells, which also lacked ALK expression. Resistance to targeted drugs can therefore be an intrinsic property of immature cancer cells based on their resemblance to developmental precursors. SIGNIFICANCE: In neuroblastoma, mesenchymal tumor cells lack expression of the tumor-driving ALK oncogene and are resistant to ALKi, but dual treatment with ALKi and mesenchymal cell-targeting TRAIL delays tumor relapse.

Physician Experiences and Perceived Barriers to Providing Quality Infertility Care in the Greater Accra Region of Ghana.

High-quality, patient-centered care is essential to achieving equity and dignity for individuals with infertility, yet few studies have explored quality of infertility care in sub-Saharan Africa. We interviewed 13 non-specialist physicians and 2 medical school faculty to explore experiences in and perceptions of providing infertility care in Greater Accra, Ghana. We used a patient-centered infertility care model to inform our analysis and results. Individualized care and taking time to counsel and emotionally support patients were perceived as the most important things a physician can do to provide quality infertility care. Financial costs and lack of infertility services within a single facility were the most common barriers reported to providing quality infertility care. To the best of our knowledge, our study is the first to explore quality of infertility care provided by physicians in public sector facilities in Ghana, shedding light on existing barriers and identifying strategies for improvement.

Involvement of Goose Parvovirus in Induction of Angel Wing Syndrome in Muscovy Ducks.

Dietary, environmental, and hereditary causes were reported as causative agents of angel wing syndrome in waterfowl. Since 2017, several Muscovy duck flocks at Behira governorate were found to exhibit this syndrome associated with the clinical symptoms of goose parvovirus (GPV) infection. Four strains of goose parvovirus named HS1-HS4 were isolated and identified from diseased ducks at some of these flocks. Phylogenetic analysis revealed clustering of these strains together and within a distinct monophyletic group in relation to GPV strains of Derzsy's disease and short beak and dwarfism syndrome (SBDS). Nucleotide identities with goose parvovirus strain B of Derzsy's disease were 95.7%-96.6%, and with the strain JS1603 of SBDS they were 96.8%-97.4%. However, nucleotide identities with Muscovy duck parvovirus strain FM were 74.1%-74.6%. The disease was reproduced experimentally via oral-route artificial infection with HS1 strain, and both clinical symptoms of goose parvovirus and angel wing syndrome were observed in the artificially infected Muscovy ducks, but with less severity in geese. This study demonstrated clear evidence for induction of angel wing syndrome, at least partially, with GPV infection in Muscovy duck. To the authors' knowledge, this is the first work to mention a viral cause of angel wing syndrome in waterfowl.

Participación del parvovirus del ganso en la inducción del síndrome de ala de ángel en patos reales. Se han reportado causas dietéticas, ambientales y hereditarias como agentes causales del síndrome de alas de ángel en aves acuáticas. Desde el año 2017, se descubrió que varias parvadas de patos reales en la gobernación de Behira presentaban este síndrome asociado con los síntomas clínicos de la infección por parvovirus del ganso (con las siglas en inglés GPV). Se aislaron e identificaron cuatro cepas de parvovirus de ganso denominadas HS1­HS4 de patos enfermos en algunas de estas parvadas. El análisis filogenético reveló el agrupamiento de estas cepas juntas y dentro de un grupo monofilético distinto con relación con las cepas de parvovirus de ganso asociadas con la enfermedad de Derzsy y el síndrome de pico corto y enanismo (con las siglas en inglés SBDS). Las identidades de nucleótidos con la cepa B del parvovirus de la enfermedad de Derzsy fueron del 95.7 % al 96.6 %, y con la cepa JS1603 del síndrome de pico corto y enanismo fueron del 96.8 % al 97.4 %. Sin embargo, las identidades de nucleótidos con la cepa FM del parvovirus del pato Muscovy fueron del 74.1 % al 74.6 %. La enfermedad se reprodujo experimentalmente a través de una infección artificial por vía oral con la cepa HS1 y se observaron signos clínicos de parvovirus del ganso y del síndrome del ala de ángel en los patos reales infectados artificialmente, pero con menor gravedad en los gansos. Este estudio demostró una clara evidencia de la inducción del síndrome del ala de ángel, al menos parcialmente, con la infección por parvovirus del ganso en el pato real. Según el conocimiento de los autores, este es el primer trabajo que menciona una causa viral del síndrome del ala de ángel en aves acuáticas.

Nail changes in systemic amyloidosis.

Nail examination must be an essential part of physical examination in our daily clinical practice, as nail changes may be the revealing sign of systemic diseases in the absence of other alarming signs.