Nail clubbing in laxative abuse: case report and review of the literature.

BACKGROUND: The link between clubbing and laxative abuse has been reported several times in the literature, in all cases in young females. The nature of this relationship is not understood. CASE: A young female, with no history of hepatic, pulmonary or malignant disease was found to have nail clubbing in the context of laxative abuse. A literature review revealed several similar cases. CONCLUSION: Laxative abuse is an important consideration in the assessment of clubbing in populations at risk of eating disorders, to prevent over-investigation and facilitate management of the eating disorder itself. This case highlights a new clinical presentation of an eating disorder. CASE: A 36-year-old woman was being reviewed by a renal specialist for renal impairment and electrolyte disturbances, in the context of a background of multiple renal calculi 4 years prior, hypokalaemia and hypercalcaemia. The attending nephrologist brought attention to her nails, which demonstrated clubbing. She stated that she had had clubbing for 10 years, and that it was of gradual onset and not associated with any pain. There was no history of hepatic, cardoipulmonary or malignant disease.

Mycobacterium abscessus infection following penetrations through wetsuits.

Mycobacterium abscessus is a rapidly growing mycobacterium which is reportedly increasing in prevalence. Infection of the skin and soft tissue with M. abscessus is rare but typically associated with trauma. We present two cases of M. abscessus infection linked by penetration through wetsuits.

Non-invasive measurements to stratify cardiovascular disease risk in psoriasis patients

BACKGROUND AND OBJECTIVES: Psoriasis is associated with cardiovascular disease (CVD) risk factors and mortality. The aims of this study were to identify CVD risk in patients with psoriasis, and to determine their awareness of the comorbidities. METHOD: Patients with psoriasis and controls had their inter-arm blood pressure, weight, height and waist circumference measured at their routine clinic appointment. Those with psoriasis also completed a survey regarding awareness of the comorbidities. RESULTS: A total of 179 patients with psoriasis and 115 control patients participated in the study. Patients with psoriasis were significantly more likely to be obese (odds ration [OR] 6.3). An inter-arm blood pressure difference >10 mmHg was more likely in patients with psoriasis for systolic (OR 1.9) and diastolic (OR 2.3) readings. Survey data showed that 47 (26.3%) psoriasis patients knew that psoriasis was associated with being overweight. DISCUSSION: On the basis of anthropologic measurements, patients with psoriasis have a higher risk of CVD, compared with non-psoriasis patients. There is inadequate knowledge among psoriasis patients regarding the comorbidities of psoriasis.

Nickel hypersensitivity following closure of atrial septal defect: A case report and review of the literature.

We present an unusual case where symptoms of headache and chest pain persisted for 3 years following the implantation of a septal occluder device for an atrial septal defect despite endothelialisation of the device. The patient was found to have nickel hypersensitivity on patch testing. Following the removal of the device the patient had complete resolution of headaches and chest pain up to 10 months post-explantation.

Itching for answers: Prevalence and severity of pruritus in psoriasis.

BACKGROUND/OBJECTIVES: Pruritus is the most frequently reported complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis few studies have evaluated the prevalence of itch in psoriasis with the current use of biological agents. METHOD: This was a multi-site cross-sectional observational study conducted in New South Wales, Australia. Psoriasis patients were approached during their outpatient clinic, phototherapy or private consultations. Data on psoriasis characteristics, severity and treatment were collected. The patients were then asked to complete a survey regarding the frequency, severity and aggravators of their psoriasis. RESULTS: Data were collected from 179 patients with a mean age of 52.3 years, of whom 55% were male. Altogether 63 (35%) had a psoriasis area severity index (PASI) > 10, 42 (24%) were on biological agents and 84 (47%) were receiving phototherapy. The number of patients who reported itch all the time was 40 (22%), most of the time 48 (27%), and never 19 (11%). Patients with nail psoriasis were significantly less likely to have itch all or most of the time (P = 0.01). Itch all or most of the time was significantly more likely in patients with PASI > 10 (P = 0.013). No treatment was associated with reduced itch. Itch was reported to be most frequent in the winter season. CONCLUSION: Few patients with psoriasis do not suffer from pruritus. Despite their promise, biological agents are not associated with reduced itch.

A prospective study of infantile hemangiomas with a focus on incidence and risk factors.

Infantile hemangiomas (IHs) are the most common tumor of infancy and have been estimated to occur in 4% of infants. Only two previous incidence studies of IH in a healthy population have been published, and both of these were performed in the first week of life. The objective was to identify the incidence of IH in an Australian neonatal population and characterize the risk factors. All women who presented to the postnatal ward in a 200-bed maternity hospital were asked to complete a questionnaire. Details of maternal history and birth details were recorded. Two follow-up emails 3 and 6 weeks after discharge were sent to all mothers who consented, asking if their baby had developed an IH. Babies reported to have an IH were seen in clinic to confirm the diagnosis. Details were collected from 1,034 mothers of 1,065 babies; 28 (2.6%) of the infants developed IH. Babies that developed IH were more likely to be female (p < 0.001), have a low birth weight (p = 0.020), be born at a gestational age of <37 weeks (p = 0.005), and be conceived through in vitro fertilization (IVF) (p = 0.001) than those who did not. The incidence of IH at 6 weeks of life was 2.6%.