Finger Nails Research Articles

Treatment of idiopathic onychodystrophy with a 1064 nm picosecond neodymium-doped:yttrium aluminum garnet laser: A retrospective study.

Laser treatment has emerged as a novel treatment modality for onychodystrophy. Only a few small series have assessed the efficacy of laser treatment in onychodystrophy, most of which were case reports. The therapeutic effect of the 1064nm neodymium-doped:yttrium aluminum garnet (Nd:YAG) laser for onychodystrophy has been demonstrated. Recently, the picosecond Nd:YAG (PSNY) laser has been introduced to improve various skin disorders. The aim of this study was to verify the efficacy of a 1064nm PSNY in management of idiopathic onychodystrophy. We present a case series of dystrophic nails treated with a PSNY for onychodystrophy improvement. Planimetry using ImageJ software was used to calculate lesion reduction and proximal clear nail growth. Clinical improvement was assessed using a 5-point Global Assessment Scale (GAS). Adverse events were also assessed. Twenty-five patients (11 males and 14 females) with a total of 128 nails (94 finger nails and 34 toe nails) were treated. The mean treatment number was 8.7±6.2, and the mean total duration of treatment was 33.4±34.6weeks. The average proportion of the lesion area decreased significantly (from 65.9% to 46.6%) after PSNY treatment (P<.001). The mean GAS (3.16±1.18) exhibited fair improvement, and there were no serious adverse events. The 1064nm PSNY laser can provide fair improvement for onychodystrophy with a good prognosis at least during the follow-up period and optimal cosmetic results in Asian patients.

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

Background and aims In 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. Methods A 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 5min after delivering the conditioning tonic painful pressure stimulation. The tonic stimulus was delivered for 2min by a custom-made spring-loaded finger pressure device applying a fixed pressure (2.2kg) to the index finger nail. The pain intensity provoked by the tonic stimulus was continuously recorded on a 0-10cm Visual Analog Scale (VAS). Results The median tonic pain stimulus intensity was 6.7cm (interquartile range: 4.6-8.4cm) on the 10cm VAS. The mean PPT increased significantly (P=0.034) by 55±126kPa from 518±173kPa before to 573±228kPa 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 418kPa and the strongest negative CPM response was a decrease of 140kPa. Conclusions The 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. Implications The 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.

Subungual Blue-Gray Linear Discoloration and the Curette Extraction Technique

ABSTRACT Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of blue-gray linear discoloration under the nail of the little finger.

Prevalence of Geohelminthes Infection and its Predisposing Factors among Treatments Seeking Patients at Jimma Town Health Centers Jimma Zone South West Ethiopia

Introduction: Geohelmenthes infections cause serious public health problem in Ethiopia. They were more prevalent among population with low income, poor personal hygiene and environmental sanitation, overcrowding and limited access to clean water. Objective: The Study Was aimed to estimating the prevalence of geohelmenthes infection and its predisposing factors among treatments seeking patients at Jimma health centers. Methods and Materials: Cross sectional study was carried out to determine the prevalence of geohelmenthes infection and predisposing factors among treatments seeking patients from June to August 2018 at Jimma health centers Data collected analyzed by SPSS statistical software was used to analysis data. Association between variables was analyzed using uni-variation and multi-variation logistic regression and p-values. The result was presented with odd ratio. P-value <or=0.05 would take as the acceptable level significance. Results: Regarding to respondents residential area, patients living in urban area had 2.290 times higher prevalence of geohelmenthes infection as compared to patients living in rural area. Respondents who had dirty materials in fingernails were 63.256 times highly contribute for geohelmenthes infection as compared to do not having dirty materials in fingernails .Regarding to unwashed or uncooked vegetable or fruit eating habits, respondents uses unwashed or uncooked vegetable or fruit had 79.16 times highly contribute for geohelmenthes infections as compared those do not uses unwashed or un cooked vegetable or fruit.The overall prevalence of geohelmenthes 21.8% such as Ascaris lumbricoides 55 (14.3%), T. trichiura 16 (4.2%), Hookworm 10 (2.6%) and strongyloides 3 (0.8%). Conclusion and recommendation: The prevalence of geohelminthic infection was 21.8% in this study. Different between geohelminthes infection and poor hand washing practice before meal and after latrine, eating uncooked or unwashed vegetables and fruit, Trimming finger nails, Place of residence, and shoe wearing practice, and all associated factors were statically significant. Therefore, health education and development in sanitary infrastructure could achieve long-term and sustainable reductions in helminthes prevalence.

MgO/CaO nanostructures fabricated from trimmed-off human finger and toe nails

Trimming-off finger and toe nails is a routine personal hygiene process in human life. These thrown away as waste material have extractable content of calcium and magnesium in their chemical composition which has hitherto been ignored. We focus the facile synthesis of significant MgO/CaO nanostructures having valuable applications utilizing wasted remnant nails.

Clinical tools for successful treatment of onychomycosis: a narrative review

Onychomycosis is a difficult-to-treat fungal infection of the human nail plate or bed that primarily affects the natural anatomy of human toe and finger nails, leading to a hard, brittle, and uneven nail surface. The severe structural mutilation of nails restricts the application of conventional formulations and makes onychomycosis therapy a challenging clinical premise. Oral therapy with drugs such as terbinafine hydrochloride and itraconazole may lead to drug interactions and systemic adverse effects, whereas topical treatment with drugs such as ciclopirox olamine and amorolfine are often associated with poor drug permeation through the nail bed. Recent advances in laser/photodynamic therapies and their application in onychomycosis has emerged as a new therapeutic paradigm with global acceptance. The present article is an attempt to provide an insight into onychomycosis and its manifestations, and summarises the various therapeutic modalities, with a greater focus on laser/photodynamic therapy.

SUN-462 Lesch-Nyhan syndrome: A Case Report

Lesch-Nyhan syndrome, a rare inborn error of metabolism, characterized by Hyperuricemia, Spectrum of neurological dysfunctions, and Cognitive and behavioral disturbances, is a rare anomaly caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyl transferase-1 (HGPRT-1), produced by mutations in the HPRT gene located on the X-chromosom leading to the overproduction of purine and accumulation of uric acid. There is no medical treatment to alleviate the symptoms of self-mutilation except dental intervention. The disease affects mainly male child, and females are asymptomatic carriers. We report a case of a 13 year old male child from Ethiopia, Who presented with Worsening of self-injurious behavior and failure to pass urine of 03 days duration. Initially presented with rigidity of the extremities at the age of 4 months and later neck rigidity with intermittent arching of the back. Family noticed passage of whitish grit like material in urine. He had poor appetite, irritability and poor weight gain. For the above complains he was diagnosed to have CP and advised to have physiotherapy. For lack of improvement, family discontinued follow-up. At the age of 3 years, he started to experience a self-injurious behavior by biting initially his lips and subsequently his hands and upper arms with ulceration of the lips and loss of finger nails and later developed head banging and rubbing of the extremities against the floor and nearby object. He developed aggression to his family with biting and pinching. Subsequently started on Clonazepam and Trihexyphenidyl with the diagnosis of dystonic CP, which showed slight improvement. Resperidone was started for the self-injurious behavior, On current presentation, he had poor feeding, low grade intermittent fever, worsening of passage of whitish stone via urine and worsening of self-injurious behavior. He has had recurrent chest and urinary tract infections. His mom and uncle have knee pain and she is taking Allopurinol. There is no history consanguinity in the family. The delivery was in hospital at term, and had uneventful perinatal history. He is the 2nd child to the family, fully vaccinated with adequate nutritional history. Brothers are 17 and 7 years old, grade 10 and 3 students, both apparently healthy. On examination, he is chronically sick looking, irritable. He is severely wasted, stunted and BMI was 17.1. He has ulcerated lips with tissue loss, ulcerated tongue (anterior 2/3 tongue and ulcerated and sloughed nail beds. On CNS he is conscious with intact Cranial nerves; Motor shows wasted muscle bulk but comparable on both sides. Power was 3/5 and had increased tone in all extremities. The DTR was 2/4 in ankle and knee. Plantar reflex was equivocal and there was no clonus or meningeal signs. Sensation to pain and touch was intact. He was admitted and bilateral percutaneous nephrostomy was inserted to relieve ureteric obstruction and medically managed for UTI, multiple electrolyte abnormality due to GI and urinary loss. The AKI resolved with standing ESKD due to obstructive uropathy following nephrolithiasis. In pediatric patients, self-mutilation is seen in genetic syndromes like LNS, Cornelia de Lange, Gilles de la Tourette syndrome, mental retardation, encephalitis, congenital malformation. A careful evaluation is, essential toward making the appropriate diagnosis of LNS.

Prevalence of Soil-Transmitted Helminth and Schistosoma mansoni Infection and Their Associated Factors among Hiruy Abaregawi Primary School Children, Rural Debre Tabor, North West Ethiopia: A Cross-Sectional Study.

Background In Ethiopia, 25.3 and 12.3 million school-age children are living in soil-transmitted helminth and schistosomiasis endemic areas, respectively. The school children are at risk for both soil-transmitted helminths and Schistosoma mansoni due to juvenile activities like walking barefoot, playing with dirty objects that might be contaminated with feces, and fetching of unclean water for drinking. There are no data that indicate the status of soil-transmitted helminths and Schistosoma mansoni among children at Hiruy Abaregawi primary school. Therefore, the main objective of this study was to determine the prevalence of soil-transmitted helminth and Schistosoma mansoni infection among Hiruy Abaregawi primary school children. Methods A cross-sectional study was conducted from March to April, 2019, at Hiruy Abaregawi primary school, Rural Debre Tabor, North West Ethiopia. A total of 340 students were included in the study. Informed written consent was obtained from the children's parent. Systematic sampling technique was used to select the children. About 2 grams of stool samples was collected and transported to Debre Tabor University Microbiology and Parasitology Teaching Laboratory to conduct the Kato-Katz technique. Data were analyzed using SPSS version 23. Variables with a p value < 0.05 were considered statistically significant. Results The prevalence of soil-transmitted helminths and Schistosoma mansoni was 51/340 (15%). Among the identified parasites, Ascaris lumbricoides accounts for 28 (8.2%), hookworm 13 (3.8%), Trichuris trichiura 4 (1.2%), and Schistosoma mansoni 6 (1.8%). In this study, 24 (7%) of Ascaris lumbricoides-, 11 (3.2%) of hookworm-, 4 (1.2%) of Trichuris trichiura-, and 5 (1.5%) of Schistosoma mansoni-infected children showed light infections and no heavy infection in both soil-transmitted helminths and Schistosoma mansoni was observed. Finger nail trimming status, hand washing before eating, availability of toilet at home, educational level of students, and sex of students were factors associated with soil-transmitted helminth infection. Conclusion and Recommendations. In this study, the low prevalence of soil-transmitted helminths and Schistosoma mansoni was observed. The combination of regular mass deworming program and health information on risk factors should be strengthened for the prevention and control of soil-transmitted helminth infection.

Colors challenges in navigating autonomous vehicles

In this paper, we will introduce a novel low-cost, small size, portable nail printer. The usage of this system is to print any desired pattern on a finger nail in just a few minutes. The detailed pre-processing procedures will be described in this paper. These include image processing to find the correct printing zone, and color management to match the patterns’ color. In each phase, a novel algorithm will be introduced to refine the result. The paper will state the mathematical principles behind each phase, and show the experimental results, which illustrate the algorithms’ capabilities to handle the task.

Prevalence of Geohelminthes Infection and its Predisposing Factors among Treatments Seeking Patients at Jimma Town Health Centers Jimma Zone South West Ethiopia

Introduction: Geohelmenthes infections cause serious public health problem in Ethiopia. They were more prevalent among population with low income, poor personal hygiene and environmental sanitation, overcrowding and limited access to clean water. Objective: The Study Was aimed to estimating the prevalence of geohelmenthes infection and its predisposing factors among treatments seeking patients at Jimma health centers. Methods and Materials: Cross sectional study was carried out to determine the prevalence of geohelmenthes infection and predisposing factors among treatments seeking patients from June to August 2018 at Jimma health centers Data collected analyzed by SPSS statistical software was used to analysis data. Association between variables was analyzed using uni-variation and multi-variation logistic regression and p-values. The result was presented with odd ratio. P-value <or=0.05 would take as the acceptable level significance. Results: Regarding to respondents residential area, patients living in urban area had 2.290 times higher prevalence of geohelmenthes infection as compared to patients living in rural area. Respondents who had dirty materials in fingernails were 63.256 times highly contribute for geohelmenthes infection as compared to do not having dirty materials in fingernails .Regarding to unwashed or uncooked vegetable or fruit eating habits, respondents uses unwashed or uncooked vegetable or fruit had 79.16 times highly contribute for geohelmenthes infections as compared those do not uses unwashed or un cooked vegetable or fruit.The overall prevalence of geohelmenthes 21.8% such as Ascaris lumbricoides 55 (14.3%), T. trichiura 16 (4.2%), Hookworm 10 (2.6%) and strongyloides 3 (0.8%). Conclusion and recommendation: The prevalence of geohelminthic infection was 21.8% in this study. Different between geohelminthes infection and poor hand washing practice before meal and after latrine, eating uncooked or unwashed vegetables and fruit, Trimming finger nails, Place of residence, and shoe wearing practice, and all associated factors were statically significant. Therefore, health education and development in sanitary infrastructure could achieve long-term and sustainable reductions in helminthes prevalence.

3D Printed Fingernail Antennas for 5G Applications

3D printing of antennas on removable fingernail for on-body communications at microwave and millimetre waves is proposed. Aerosol Jet technology, a fine-feature material deposition solution, has been used to directly print microstrip patch antennas on an acrylonitrile butadiene styrene (ABS) removable finger nail substrate. Two antennas have been printed and assessed, one operating at 15 GHz and the other at 28 GHz. Nanoparticle conductive silver ink has been employed to create the microstrip patch antennas and corresponding transmission line using an Optomec machine. The inks are then cured using a PulseForge machine. A further copper layer is added to the millimeter wave antenna via an electroplating process. The antennas have been simulated and measured off-the-finger and on-the-finger. Simulated and measured reflection coefficients ( $S_{11}$ ) and radiation patterns are found to be in good agreement. The proposed on-body antennas can find application in the Internet of Things (IoT) where large amount of sensing data can be shared at the microwave and millimetre wave spectrum of future 5G communications. The removable finger nails could include other electronic devices such as on-body sensors, computational, storage and communication systems.

Common Gastrointestinal Symptoms and Associated Factors Among Under-5 Children in Rural Dembiya, Northwest Ethiopia: A Community-Based Cross-Sectional Study

Background:Gastrointestinal (GI) symptoms such as abdominal discomfort, abdominal cramp, nausea, vomiting, gas in the GI tract, changes in bowel habits (e.g. diarrhea), or heartburn are common in the community. However, these symptoms may be misinterpreted and their impact and significance misunderstood, especially in the rural communities. This study was, therefore, conducted to assess common GI symptoms among children in rural Dembiya, northwest Ethiopia.Methods:A community-based cross-sectional study was conducted in May 2017 among 225 randomly selected under-5 children. We primarily used mothers’ report to assess GI symptoms. Health professionals also diagnosed for some symptoms. Direct stool examination technique was used to identify parasitic infections. Bacteriological analysis of drinking water was done to determine the quality of drinking water. Food safety, environmental sanitation, and hygiene condition of children were assessed using observation checklists. Multivariable binary logistic regression analysis was employed to identify factors associated with GI symptoms on the basis of adjusted odds ratio (OR) with 95% confidence interval (CI) and P < .05.Results:The current study depicted that 139 of 225(61.8%) of the children had GI symptoms. Abdominal discomfort (137 of 139 [98.7%]), abdominal cramp (125 of 139 [89.9%]), and diarrhea (118 of 139 [84.9%]) were the highest GI symptoms reported. GI symptoms were significantly associated with childhood intestinal parasitic infections (OR = 13.69, 95% CI = 3.31-56.59), unclipped and unclean finger nails (OR = 2.28, 95% CI = 1.02-5.10), inadequate living environment sanitation (OR = 2.37, 95% CI = 1.08-5.18), unclean living houses (OR = 9.06, 95% CI = 2.60-31.54), and owning livestock (OR = 4.68, 95% CI = 1.82, 12.03).Conclusion:The prevalence of GI symptoms among under-5 children in rural Dembiya, northwest Ethiopia, was found to be high. GI symptoms were significantly associated with childhood intestinal parasitic infections, hand hygiene condition of children, and sanitation condition of the living environment. Therefore, preventing intestinal parasitic infections, improving hand hygiene condition, and promoting environmental sanitation will have overriding contributions to prevent symptoms among children in rural Dembiya.

Knowledge of first aid management of epistaxis among medical interns attending King Fahad Armed Forces Hospital in Saudi Arabia

Aim: The aim of this study is to explore the knowledge of medical interns about first aid in the management of epistaxis. Materials and Methods: An anonymous, cross-sectional, and validated survey-based study was conducted in January 2020 at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Results: A total of 57 medical interns responded to the survey. The vast majority of survey respondents were male (78.9%) and single (80.7%). Around 57.9% of the respondents declared that epistaxis is regarded as one of the emergency situations. A sum of 71.9% of medical interns correctly identified “finger nail trauma” as the most common cause of epistaxis. In addition, while 71.9% of medical interns correctly answered, “sitting with head tilted forward” as the proper management position for a patient with epistaxis, only 52.6% of medical interns correctly answered, “pinching the lower cartilaginous part of the nose” as the primary measure to stop epistaxis. When medical interns were asked about what to do if the patient continued to bleed from the nose in the emergency room after the primary measures had been done, only 50.9% of medical interns correctly answered with “refer the patient to an otolaryngologist to take further care.” Using two-tailed Chi-square test, there were no differences in the percentages of correct answers among the surveyed medical interns according to gender (P > 0.05). With regard to the sources of information about first aid in the management of epistaxis, the top selected source by medical interns was “self-taught” (52%), followed by “medical textbooks” (19%). Conclusion: The surveyed interns had unsatisfactory knowledge about epistaxis first aid. There is a pressing need to establish solid curricular, extracurricular, and institutional measures to increase the intern's awareness of first aid knowledge in the management of epistaxis.

Development of a Regression Model to Determine Tooth Size Dimensions from Finger Nail Beds- An Innovative Approach

Introduction: Teeth selection is a crucial step and reflects the aesthetic quality of complete dentures and the prime responsibility to ensure their selection with maximum precision lies with the dentist. The anterior teeth reflect the overall aesthetic value of the denture, and hence the need to individualise maxillary anterior teeth was recognised, and the study was undertaken to find an alternative method of teeth selection. Aim: To establish an alternate/additional method of teeth selection for edentulous patients using extraoral landmarks. Materials and Methods: This observational cross-sectional study was conducted in School of Dental Sciences, Krishna Institute of Medical Sciences “Deemed To Be University”, Karad, Maharashtra for a time period of three months (April-June 2015). Dimensions of 402 maxillary central and lateral incisors were measured using a vernier caliper. The superior point selected was the gingival zenith of the teeth and the inferior point was the mid-point of the incisal edge. A line connecting these points determined the teeth length. Similarly, width was determined by marking the midpoint of the proximal surfaces and line connecting them. The points considered for recording the dimensions of the finger nail bed were the mid-points of the mesial and lateral surfaces of the nail bed and mid-points of the superior and inferior edges of the nail bed, respectively. The dimensions of maxillary right central incisor were correlated with the dimensions of right nail bed of index, ring and little finger. Similar procedure was followed for the left central incisor; left and right lateral incisors, respectively. The recorded data were statistically analysed using SPSS version 20 to find out Pearson’s correlation coefficient (r) between dimensions of maxillary incisors and finger nail beds. Further regression equation was derived to determine dimensions of maxillary incisors (dependent variable) from dimensions of nail beds (independent variables) for variables with significant correlations. The p-value less than or equal to 0.05 was taken significant. Results: In males, the central incisor length significantly correlated with little finger nail bed width (p=0.01*). The lateral incisor length had significant correlation with index finger nail bed width (p=0.03*), and little finger nail bed width (p=0.02*). The lateral incisor width had significant correlation with index finger nail bed width (p=0.01*). In females, the lateral incisor width had significant correlation with index finger nail bed width (p=0.01*) and ring finger nail bed length (p=0.002*). Further using the correlations for significant variables, regression formulae were developed. Conclusion: The regression model developed for male and female patients can be used to determine the dimensions of lateral incisor width in females, and central incisor length, lateral incisor length and width in males from the dimensions of index, ring and little fingers. The model stands true as a potential method of teeth selection for edentulous patients.

The effect on stress-strain relationship of finger nail by using jelly-type protector

The effect on stress-strain relationship of finger nail by using jelly-type protector

Nail Changes in Leprosy: An Observational Study of 125 Patients.

Introduction:Leprosy is a disease primarily affecting skin and nerve. Nail involvement, although indirect, is observed in several patients. This is a study to determine the pattern of nail changes in leprosy.Methods:It was an observational study involving 125 patients. Apart from cutaneous and neurological examination, nails were examined. Diagnosis was confirmed by previous records in already diagnosed cases, while by slit skin smear and histopathologically in new cases. Patients were grouped as per Ridley-Jopling classification and further subdivided as per age, sex, and duration and reaction status. Nail changes in these groups were summarized and compared.Results:Overall prevalence of nail changes was 80% with 66.6% in TT patients, 79.4% in BT patients 50% in BB patients, 83.7% in BL patients and 84.3% in LL patients. Longitudinal melanonychia and longitudinal ridges were frequent finger nail changes with longitudinal melanonychia being more common among tuberculoid pole and longitudinal ridges among lepromatous pole. Brachyonychia, subungual hyperkeratosis and brown black pigmentation were frequent finger nail changes, with onychorrhexis being commonest among TT patients, subungual hyperkeratosis among BT patients, while brachyonychia among BL and LL patients. Anonychia and rudimentary nails were not found in tuberculoid pole. Beau's lines, terry nails, pterygium, pincer nail, and onychorrhexis were significantly more frequent in ENL patients. Onychomadesis, which is not reported yet in leprosy, was found in one patient after severe ENL.Conclusion:Various changes in leprosy are due to multiple causes like neuropathic, traumatic, vascular, osseous, infections and drugs reflecting extensive systemic morbidity caused by Mycobacterium leprae.

Normative Values for Thumb Length in Young Adult Population

Aim: This study was conducted to identify normal values for thumb length with respect to the index finger. Material and Method: Measurements were taken from dorsal and palmer sides of a totally 164 right and left hands of 82 healthy young adults (47 males and 35 females) aged between 18 and 21 years. Measurements of relative thumb length, girth and nail width were performed with respect to the index finger. Measurement values were classified as Thumb Proximal Phalanx (TPP) index and Thumb Digital Crease (TDC) index. Results: Average values of the TPP and TDC indexes were found 0.82 and 0.59 respectively for right hand and 0.74 and 0.49 respectively for left hand. There is no statistically significant differences indicated between right and left hand averages in terms of gender. Average percentage values of thumb length with respect to proximal phalanx of index finder (AD/AB) were found to be 74% and 77% in right hand for females and males respectively; and 70% and 73% in left hand for males and females respectively. Average percentage values of the thumb length with respect to the length of the whole index finger (AD/AC) were found to be 35% and 34% in right hand and left hand respectively. Comparison of the thumb girth and nail width to index finger girth and nail width indicated the percentage values as 132% and 106% respectively. Conclusion: The provided data could help to the clinician’s as to detect pathologies and analyse aesthetic outcomes of reconstructive surgeries intraoperatively and postoperatively.

P095 The Very Interesting Small Bowel Lesions of Cronkhite-Canada Syndrome

BACKGROUND: Cronkhite-Canada syndrome (CCS) is a non-hereditary disease characterized by the presence of gastrointestinal polyposis and skin symptoms such as hair loss, nail plate atrophy, and skin pigmentation. Approximately 50% of cases of CCS also have small bowel lesions. However, there have been few image reports of the small intestine lesions. METHODS: We examined the findings of small intestine capsule endoscopy (CE) in 3 cases of CCS in our hospital. RESULTS: Case 1 was of a 64-year-old male whose chief complaint was diarrhea, abnormal taste, and weight loss. He had diarrhea for 2 months and aware of finger pigmentation and nail atrophy. Esophagogastroduodenoscopy (EGD) revealed a collection of reddish polyps that expanded in the stomach and duodenum, and colonoscopy (CS) revealed glossy reddish bumps in the colon. CE showed diffuse reddish, edematous mucosa and villi enlargement in the entire small bowel. From these characteristic endoscopic and skin findings, he was diagnosed with CCS and was started on prednisolone (PSL) treatment. The treatment response was good, and there was no relapse. Case 2 was of a 65-year old female whose chief complaint was skin pigmentation. She had been aware of pigmentation on her back, palms, and upper arms, and loss of fingernails for the last 6 years with repeated disappearances and exacerbations. Furthermore, erosive gastritis and gastric hyperplastic polyps had been detected 4 years ago, and she was followed-up for these symptoms. Gradually, she became aware of nausea and loose stools, which prompted her to visit our hospital. EGD and CS revealed multiple reddish polyps predominantly in the gastric antrum, villous atrophy and reddish polyps in the terminal ileum, and scattered reddish polyps in the entire colon. Mucosal biopsies revealed glandular dilation, mucosal edema, and inflammatory cell infiltration. CE showed diffuse mulberry ridges and villi atrophy throughout the small bowel. She was diagnosed with CCS based on characteristic clinical and endoscopic findings, and was started on steroid treatment. There was no relapse. Case 3 was of a 75-year old male whose chief complaint was diarrhea and hair loss. EGD and CS revealed multiple polyps in the stomach, duodenum, and colon. CE showed reddish edematous mucosa and villi mixed with atrophy and swelling in the small bowel. Of note were that these findings were found in the jejunum. He was diagnosed with CCS and started on PSL and immunomodulator. Four years later, the characteristic findings disappeared in the CE. CONCLUSION(S): All patients had lesions in the entire small bowel, but there they were not associated with clinical findings or steroid response. The mucosa of the small intestine were more likely to have various findings as the period from onset to diagnosis became longer.

Prevalence of intestinal parasitic infections and associated factors among street children in Jimma town; south West Ethiopia in 2019: a cross sectional study

BackgroundStreet child is any child whose age is less than 18 years for whom the street has become his or her habitual abode and/or source of livelihood, is inadequately protected, supervised or directed by responsible adults. In Ethiopia the health problems of street children are given poor attention in research. This problem is pronounced when it comes to intestinal parasitic infections, making it difficult to design appropriate interventions targeting this segment of population. The aim of this study was to assess the prevalence of intestinal parasitic infections and associated factors among street children in Jimma town in the year 2019.MethodsCommunity based cross sectional study was employed. Complete enumeration was used to include 312 street children. Pretested questionnaire was used to collect the data. Data was entered to Epidata version 3.1 and exported to SPSS version 20. Stool samples were examined by wet mount and formalin ether concentration techniques. Bivariable and multivariable logistic regression was used to identify factors associated with intestinal parasitic infection. Significance of association was decided by using the 95% confidence interval of AOR and P-value of ≤0.05 in the multivariable model.ResultA total of 312 children of the street were involved in the study making the response rate 96.2%. The prevalence of intestinal parasitic infection was 66.7%. Untrimmed finger nails AOR = 2.03;95%CI (1.02–4.06), eating street food AOR = 2.24;95% CI (1.04–5.02), practice of swimming in unprotected water bodies AOR = 2.5; 95% CI (1.24–5.04), not wearing shoes at the time of data collection AOR = 3.8;95% CI (1.8–8.2) and lacking knowledge of way of transmission of intestinal parasites AOR = 2.5; 95% CI (1.25–5.0) were significantly associated with parasitic infections.ConclusionsThe prevalence of intestinal parasitic infections among street children in the study area was high and require integrated interventions to avert the problem. Several factors were also found to be associated with intestinal parasitic infections. Measures has to be taken to curb the problem by including them in mass drug administration and targeted health education towards identified factors.

A Novel Machine Learning Based in silico Pathogenicity Predictor for Missense Variants in a Hematological Setting

Background: Interpreting the pathogenic potential of an amino-acid changing single nucleotide variant (SNV) in a disease related gene can be challenging, especially for rare variants for which little or no information is available in clinical databases. In silico predictors, tools that predict the functional impact of an SNV algorithmically, can be useful in this scenario, and guidelines for variant interpretation recommend their inclusion in the interpretation process. Resources such as the dbNSFP database, which contains pre-calculated prediction scores for dozens of different algorithms, are readily available today. However, individual predictors rarely come to the same conclusion, and even for well-known disease causing SNVs results can be heterogeneous or even contradictory, which complicates their interpretation. Ensemble predictors such as REVEL, MetaLR/SVM or CADD combine the knowledge/information from multiple individual sources. These predictors use machine learning methods and training sets of pre-defined pathogenic and benign SNVs to integrate individual algorithms into a single, easy to interpret score. However, current training sets are based on pathogenic germline variants, which might cause these predictors to underperform when testing somatic variants. Aim: Development of HePPy (Hematological Predictor of Pathogenicity), an ensemble in silico predictor trained on somatic disease causing variants for use in a hematological setting. Methods: We followed the approach laid out by REVEL and used 10 in silico predictor scores and 4 phylogenetic conservation scores from the dbNSFP data base to train a random forest model. Our training set consisted of 371 unique missense SNVs from 61 hematologically relevant genes that were recurrently identified (in at least 10 patients) during routine diagnostics. All were consistently and unambiguously characterized by hematological experts as either a pathogenic somatic variant (n = 268) or a benign germline variant (n = 103) using a rigorous manual classification process within a data set of 69,879 cases studied between 2005 and 2018. Model accuracy was assessed by 10-fold cross-validation and further evaluated using a test data set consisting of 335 rare missense SNVs from routine diagnostics for which control germline material (buccal swabs, finger nail clippings) from the respective patients was available. Variants originating in the germline were expected to be mainly benign (n = 123), while somatic variants were considered pathogenic (n = 212). We compared the performance of this new tool to REVEL, MetaLR/SVM, CADD and the popular individual predictors SIFT and Polyphen2 by generating receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Model implementation and analysis was performed using the R libraries "randomForest", "caret" and "pROC". Results: HePPy scores range from 0 (benign) to 1 (pathogenic) and cross-validation on the training set indicates a high accuracy of 0.968, which is also reflected by the clear separation in the distribution of obtained scores for benign and pathogenic training SNVs (see figure B). Application of the model to the test data set of rare SNVs shows that HePPy (AUC = 0.873) outperforms all other prediction tools in separating germline from somatic variants (see figure A). Surprisingly, both MetaLR (AUC = 0.717) and MetaSVM (AUC = 0.703) performed worse than the individual predictors SIFT (AUC = 0.794) and Polyphen2 (AUC = 0.821), while CADD (AUC = 0.831) and REVEL (AUC = 0.850) showed better performance. HePPy scores for somatic test variants were heavily skewed towards very high values (mean = 0.917). Germline variants had significantly lower scores (mean = 0.466), but their distribution was much more uniform than for somatic variants (see figure C). This suggests, to consider a significant proportion of the rare germline variants to have pathogenic potential. This is in line with the growing awareness of pathogenic germline variants and familial predisposition and emphasizes the importance of in silico predictions and other tools to replace the simple "tumor vs. normal" comparison. Summary: We developed HePPy, a new in silico ensemble predictor that is trained on 371 well-defined hematopathological somatic missense variants, which outperforms other currently available methods for in silico prediction in a hematological setting. Figure Disclosures Hutter: MLL Munich Leukemia Laboratory: Employment. Baer:MLL Munich Leukemia Laboratory: Employment. Walter:MLL Munich Leukemia Laboratory: Employment. Kern:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Haferlach:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Haferlach:MLL Munich Leukemia Laboratory: Employment, Equity Ownership.