Thumb Nail Research Articles

Babinski reflex evaluation in term neonates with hypoxic ischemic encephalopathy: Across-sectional observational study

Background: Assessment of primitive reflexes is one of the earliest, easiest and most frequently used method among health care workers for newborns and young infants. Babinski reflex is one of the infantile reflexes. Our aim was to study Babinski reflex in a term neonates with hypoxic ischemic encephalopathy (HIE). The incidence of HIE in developed countries is estimated to be 1.5 per 1,000 live births. Estimates in developing countries range from 2.3-26.5 per 1,000 live births. Methods: This study is a cross-sectional observational study. 70 consecutive neonates fulfilling criteria of HIE according to Sarnat and Sarnat classification, admitted in our neonatal intensive care unit (NICU) were included. It was elicited from 12 hours after birth to 72 hours of birth. Babinski response was assessed using thumb nail drag method. Results: 83% babies are born to 18-35 years and 17% to elderly gravid. 55% are delivered through normal vaginal delivery and 45% to LSCS. 52% neonates belong to HIE stage I, 30% and 18% neonates belong to HIE stage II and III respectively. In HIE stage I, planter grasp was elicitable in 89%. It remains non-elicitable in 44% and 91% in HIE stages II and III respectively. Conclusions: Absence of Babinski reflex can be correlated with the increase in severity of HIE. It is important to include the assessment of Babinski reflex along with other primitive reflexes in the newborn generally and especially in HIE.

Doubling Down on Maximizing Functional and Aesthetic Outcomes: Modified Technique for Pediatric Wassel Type I Thumb Duplication: A Case Report

Background: Given the rare occurrence, there is a paucity of literature characterizing surgical management of Wassel Type I thumb duplications, especially at an older age where psychosocial factors become a more significant consideration. Case Presentation: We present a 5-year-old girl with right Wassel Type I thumb duplication with delayed initial presentation for treatment. We performed a modified Wassel Type I radial thumb ablation, percutaneous pinning, and nail reconstruction preserving radial nail fold and transferring to ulnar nail plate and fold. Conclusions: This modified approach maximizes functional and aesthetic outcomes and highlights the significance of considering surgical management to improve quality of life in delayed presentations of Wassel Type I thumb duplication.

The first presentation of a case of nail-patella syndrome newly diagnosed at the onset of rheumatoid arthritis: a case report

/SummaryBackgroundNail-patella syndrome (NPS) is a rare autosomal dominant disorder that is characterized by dysplasia of the nails, hypoplasia and/or dislocation of the patella and the presence of iliac horns. Using the CARE guidelines, we present the first reported case of NPS that was newly diagnosed at the onset of rheumatoid arthritis (RA).Case presentationA 74-year-old man was admitted to our hospital due to an 8-month history of arthralgia in bilateral wrists, elbows and fingers. He had a past history of glaucoma and left patella dislocation that had been operatively recentered at the age of 15 years. Laboratory data showed elevated levels of serum C-reactive protein and rheumatoid factor and an elevated titer of anti-SS-A antibodies, while estimated glomerular filtration rate (eGFR), titers of other antibodies and the results of a urinary test were normal. An X-ray showed deformity of bilateral radial heads and the right elbow, and magnetic resonance imaging (MRI) of his hands showed synovitis and erosion in the multiple swollen joints of the wrists and fingers. In addition to these typical features of RA, he had bilateral thumb nail dysplasia with mild hypoplasia of bilateral patellae and iliac horns as shown by the X-ray. He was diagnosed as having autosomal dominant disorder NPS co-existing with RA and he was treated with methotrexate in combination with an oral Janus kinase (JAK) inhibitor, leading to induction of remission.ConclusionsWe have presented a rare case of NPS that was newly diagnosed at the onset of RA. Clinical and radiographic findings of NPS are highlighted in this case report for diagnosing NPS on the basis of typical manifestations.

Bowen's disease of the nail bed: A case report

We present a case of Bowen's disease of the nail bed in a 32-year-old patient admitted to the traumatology-orthopedics department for a persistent lesion of the right thumb nail. Bowen's disease is often misdiagnosed because of its benign, slowly progressive appearance. The clinical picture of this disease is not uniform and can mimic a number of other dermatological disorders, such as vulgar warts, onychomycosis and various clinical presentations. Therefore, biopsy of any chronic nail tissue lesion is essential. Surgical excision is the treatment of choice for tumours without bone involvement. Our patient was treated with Mohs micrographic surgery. Postoperatively, the patient noticed a sensation of hypoesthesia in the treated area, which regressed almost completely over the following months.

Effect of oral bad habit breath through the mouth with face shape in children

Habit is a pattern of behavior that is repeated; in the oral cavity is also known as oral bad habit and naturally occurs at the age of less than six years. Oral habit cancontinue at the age of more than six years which can cause abnormalities in the dentofacial structure. This article discusses the influence of the habit of breathing through the mouth on the shape of the face in children. With a literature review design, articles were collected using Google Scholar, Pubmed and ScienceDirectusing the keywords oral bad habit, mouth breathing, malocclusion. The selected articles are publications in 2015-2022, research subjects are children aged 6-12years, full-text available, and written in English and Indonesian. It was concluded that oral bad habits often occur in children and even in infants. Oral bad habitsinclude thumb sucking, nail biting, lip sucking, tongue pushing, and mouth breath-ing. Oral bad habits such as mouth breathing have an influence on theoccurrence of malocclusion, especially in children who are still in the growth and development stage, namely elementary school children.

Median canaliform nail dystrophy involving thumb nails and great toe nails

Median canaliform dystrophy of Heller is a rare entity characterized by median or midline split of nails in one or both thumb nails. Treatment of median canaliform dystrophy is at times challenging as no successful therapy is available till date. Recently reported treatments include topical steroids, calcineurin inhibitor tacrolimus 0.1%, and tazarotene 0.05% ointment. We report the case of a 30-year-old man who came to our institute with complaints of nail lesions over both thumb nails and great toe nails from the past 5 years, which was causing cosmetic disfigurement.

Application of a three-dimensional scanner to the quantitative assessment of the nail plate condition after a hybrid manicure procedure-Preliminary study.

About 90% of women worldwide use nail care products, including manicure ones. A manicure procedure results in nail damage, therefore it is necessary to search for new, objective methods of assessing the impact of the procedures and products applied within the nail plate. In this study, an attempt was made to quantify the impact of manicure procedures on the nail plate condition. Twenty thumb nail plates were examined. Before the manicure procedures, alginate casts were prepared for each of the subjects. The analysis of the three-dimensional (3D) nail surface structure included the assessment of the nail sections and the assessment of differences in the nail structure after superposition of 3D images of the nail plates before and after the manicure procedures. The obtained results show that the nail plate structure changed to a similar extent in each measured section after the manicure procedure. A change in the height of the nails is not a desirable phenomenon as it suggests damage to the nail caused by the substances included in the preparations applied to the nails, acetone, or filing the nail plate. This proves the great influence of the technique of removing artificial nails on the structure of the natural plate. The use of a 3D scanner allows for precise, biometric, quantitative, and repeatable measurements of changes in the nail structure after a manicure procedure. The use of the hybrid and gel manicure procedure causes significant damage to the nail plate, especially in its distal portion.

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis.

Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Median Nail Dystrophy due to Habit Tic: A Case Report

Median dystrophy of nails may present with diagnostic difficulty. We present a case of a 30-year old male with multiple serial transverse ridges involving the median part of the bilateral great toe nails and the right thumb nail of approximately 10 years duration. On probing, the patient was found to have the habit of picking over the proximal nail folds. Habit of tic may not be noticed by the patient, however, may be the cause of dystrophy of nails.

Separation and discoloration of thumb nail

Separation and discoloration of thumb nail

Chemotherapy-related striate melanonychia: a case report

BackgroundChemotherapy medications are reported to cause discoloration of the nails known as melanonychia. Depending on the nail structure affected and the severity of the insult, the clinical features can be variable. There are a great deal of unreported cases of pigmentary nail changes associated with chemotherapy treatment. By sharing our knowledge, we hope to raise the awareness of these nail changes amongst clinicians. Early recognition is crucial to allay anxiety among patients and avoid any unnecessary investigations.Case presentationWe present a case of 36-year-old woman of south Asian origin, who developed dark pigmentation in the left thumb nail during neoadjuvant chemotherapy with 5-fluorouracil, epirubicin, cyclophosphamide, and docetaxel (FEC-D) for triple negative breast cancer. Upon examination, the left thumb nail pigmentation was strikingly linear, uniform, and well demarcated extending from proximal nail fold to free margin. Despite the reassuring clinical features, the patient was understandably anxious that this could be a presentation of acral melanoma and was referred to the plastic surgeons for a nail matrix biopsy. Biopsy reassuringly was reported as melanosis and a diagnosis of striate melanonychia was made. The patient was discharged after 2-year follow-up.ConclusionChemotherapy medications have improved survival rates and patient outcomes. It is important for clinicians to be aware of the association of melanonychia with certain chemotherapy medications to reduce anxiety and allow successful management of these patients without delay. Striate melanonychia in this patient was felt most likely due to the synergistic effect of chemotherapy drugs compounded with racial predisposition. Chemotherapy agents most likely to have contributed include cyclophosphamide, docetaxel, and 5-fluorouracil.

Evaluation of Babinski reflex in term neonates with hypoxic ischemic encephalopathy: a cross sectional observational study

Background: Assessment of primitive reflexes is one of the earliest, easiest and most frequently used method among health care workers for newborns and young infants. Babinski reflex is one of the infantile reflexes. Our aim was to study Babinski reflex in a term neonates with hypoxic ischemic encephalopathy (HIE).Methods: This study is a cross-sectional observational study. 100 consecutive neonates fulfilling criteria of HIE according to Sarnat and Sarnat classification, admitted in our neonatal intensive care unit (NICU) were included. It was elicited from 12 hours after birth to 72 hours of birth. Babinski response was assessed using thumb nail drag method.Results: 78% babies are term babies. 22% babies are post term babies. Male to female ratio is 1.5:1. 38% neonates belong to HIE stage I, 39% and 33% neonates belong to HIE stage II and III respectively. In HIE stage I, planter grasp was elicitable in 89%. It remain non-elicitable in 44% and 91% in HIE stages II and III respectively.Conclusions: Absence of Babinski reflex can be correlated with the increase in severity of HIE. It is important to include the assessment of Babinski reflex along with other primitive reflexes in the newborn generally and especially in HIE.

Crowdsourcing the aesthetics of thumb repair in pediatric thumb hypoplasia

Pediatric thumb hypoplasia is a group of congenital hand disorders encompassing gross underdevelopment or complete lack of a thumb. Index pollicization and toe transfer are both reasonable reconstructive options, and there is no clear consensus if either method provides a more functional or aesthetically pleasing result. Considering the psychological distress associated with poor cosmetic outcomes, aesthetics must be considered when choosing reconstructive method. A survey was generated using images of reconstructed thumbs from published papers and educational websites and posted on Amazon Mechanical Turk asking participants to rate the images on their overall aesthetic appearance, identify aesthetic features, rank thumbs according to what appears most natural, and answer a series of hypothetical functional questions. Responses were stratified by reconstruction type and analyzed with chi-square, two-sample t test, and linear regression analyses. Participants in the study were diverse across age, sex, ethnicity, and education. The average rating of the thumbs was 5.8 for index pollicization and 5.6 for toe transfer, ranging from 3.85–8.34 across both reconstructive types. Index pollicization was significantly associated with being ranked as “most natural” but neither reconstructive type was associated with being ranked as “least natural.” Aesthetic factors, including length, width, nail, and position of thumb significantly affected overall aesthetic score but only accounted for around 30% of the variation in overall score. There was no significant difference in response to hypothetical functional scenarios based on reconstructive type or dominant vs. non-dominant hand. Limitations of this study include the lack of granularity in crowdsourcing data and the lack of photographic standardization of the thumbs included in the survey. Reconstructive method should continue to be selected on an individual basis based on individual anatomy. Level of evidence: Not ratable

Thumb sucking or nail biting in childhood and adolescence is associated with an increased risk of Crohn’s disease: results from a large case–control study

Background The hygiene hypothesis suggests that a reduction in microbial exposure contributes to an impaired immune response later in life and increases the incidence of immune-mediated diseases such as inflammatory bowel diseases (IBD). Thumb sucking and nail biting are two early habits that modulate the oral microbiota composition and antigen load. Objective We hypothesized a lower risk of Crohn’s disease (CD) and ulcerative colitis (UC) in adults with prior thumb sucking and nail biting. Methods 918 IBD cases and their 918 siblings without IBD were asked to fill out a survey containing 32 questions on environmental factors in childhood and early adulthood. Prevalence of thumb sucking and/or nail biting at the usually well-remembered time of (1) school enrollment and (2) coming-of-age ceremonies was the predefined combined risk factor of this study. Results 65% of the patients were female and 57% suffered from CD. About 49% of IBD patients but only 44% of their siblings reported thumb sucking/nail biting at the time of school enrollment or coming-of-age (p = .007). Sensitivity analysis revealed that this difference was observed in patients with CD (50% versus 41%; RR= 1.22; 95% CI 1.09–1.37, p = .001) but not in patients with UC (49% versus 48%; RR= 1.02; 95% CI 0.90–1.17; p = .83). Conclusion Contrary to our expectation and challenging the hygiene hypothesis, we found that common oral habits are not protective against IBD. Instead, nail biting at the time of school enrollment and coming-of-age was a statistically significant risk factor for CD in our cohort. Key summary Evidence available before this study: The hygiene hypothesis suggests that a reduction in microbial exposure due to improved health activities has contributed to an immunological imbalance in the intestine and an increased incidence of allergic and autoimmune diseases. A population-based birth cohort study has demonstrated that thumb-sucking and nail biting in children lead to a reduction of the risk of atopic sensitization, asthma, and hay fever. Added value of this study: Contrary to the hypothesis, thumb sucking and nail biting were not associated with a reduced risk of IBD. Instead, thumb sucking and/or nail biting at the usually well-remembered points in time of school enrollment and of religious or secular coming-of-age ceremonies was associated with a higher risk of Crohn’s disease but not of ulcerative colitis. Our data did not support the hygiene hypothesis, one pathogenic concept in the context of IBD.

Mouse Arm and hand movements in grooming are reaching movements: Evolution of reaching, handedness, and the thumbnail

Grooming in the mouse features hand licking and symmetric and asymmetric arm and hand “strokes” over the face and body to maintain pelage. Grooming is syntactically organized but the structure of individualized movements of the arm, hand, and tongue have not been examined. Here spontaneous and water-induced grooming was video recorded in free-moving and head-fixed mice and subject to frame-by-frame video inspection and kinematic analysis using Physics Tracker. All groom arm and hand movements had a structure similar to that described for reach-to-eat movements. The movement included the hand lifting from the floor to supinate with the digits flexing and closed to a collect position, an aim position directed to a groom target, an advance to the target during which the fingers extend and open and the hand pronates, a grasp of a target on the snout, nose, or vibrissae, and a withdraw to the mouth where licking occurs, or a return to the starting position. This structure was present in individual unilateral forelimb groom strokes, in bilateral symmetric, or asymmetric groom strokes, and comprised the individuated components of a sequence of groom movements. Reach-to-groom movements could feature an ulnar adduction that positions the ulnar portion of the hand including and the thumb across the eye and nose, a movement that aids Hardarian fluid spreading. It is proposed that the mouse thumb nail is an anatomical feature that minimizes damage to the eye or nose that might be incurred by a claw. This analysis of the reach-to-groom movement provides insights into the flexibility of hand use in adaptive behavior, the evolution of skilled reaching movements, the neural control of reaching movements and the presence of the thumb nail in the mouse.

Zigzag longitudinal melanonychia: a peculiar dermoscopic pattern.

Longitudinal melanonychia (LM) can present a diagnostic challenge and dermoscopy is of utmost importance for its evaluation and differential diagnosis of LM. This report aimed to describe an unusual dermoscopic pattern in a group of patients that presented with LM. The clinical course and features of five LM patients that presented with an unusual 'zigzag' dermoscopic pattern were analyzed retrospectively. In all, four of the five patients were children (age range: 10-13years). In all five patients, the thumb nail was affected. A nail matrix biopsy was available for only one patient and was reported as lentigo. In two (one child and one adult) out of the five patients, spontaneous total regression of the LM was observed. The peculiar 'zigzag' dermoscopic pattern of LM described herein seems to occur primarily in children. Although this pattern is a benign in nature, it is not clear if it is related to trauma. Further investigation is warranted to clarify the association between the histopathological findings and the zigzag pattern observed via dermoscopy.

Stress associated median canaliform dystrophy of Heller in medical students more prominent on dominant thumb nail: A case series

Stress associated median canaliform dystrophy of Heller in medical students more prominent on dominant thumb nail: A case series

Median canaliform dystrophy of thumb and great toe nails in an 8 years old boy

Median canaliform dystrophy is a rare nail disorder characterized by midline longitudinal ridging or splitting with canal formation in the nail plate of one or both the nails of the thumbs. It is an acquired condition that mimicks habit-tic deformity, resulting in a temporary defect in the nail matrix and cuticle. Treatment is often prolonged and unsatisfactory. Some clinicians have used topical tacrolimus (0.1%) ointment and tazarotene (0.05%) ointment successfully. We report the case of an 8-year-old boy presenting with median canaliform dystrophy of Heller affecting nails of both the thumbs and great toes, respectively.

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.

Prevalence of deleterious oral habits in school going children in Bagalkot region of Karnataka

Oral habits, especially if they persist beyond the preschool age, have been implicated as an important environmental etiological factor associated with the development of malocclusion. This study included 2719 children in age group of 11-14 years in school going children in Bagalkot region of Karnataka. This study aims to find the prevalence of habits, malocclusion and their association with the socio- economic status. The children were examined in the schools and the presence or absence of the thumb sucking, tongue thrusting, nail biting and mouth breathing habit were recorded. Statistical analysis was done using Chi-square test and Fisher’s exact test. On clinical examination it shows Prevalence of Habits of 44.9% with 5.5% of thumb sucking, 31.7% tongue thrusting, 7.3%mouthbreathing and 19.1% nail biting. It is concluded that the prevalence of malocclusion is high showing 51.1% and showing no significant difference in rural and urban areas. prevalence of Oral habits is high showing 44.9%, showing predominantly tongue thrusting and nail biting habits. Oral habits are seen more in rural area compared to the urban area as they belong to different socioeconomic status. Tongue thrusting which is showing statistically significant relationship is more prevalent in rural areas of north Karnataka region of Bagalkot. Keywords: Nail biting, Mouth breathing, Oral habits, Thumb sucking, Tongue thrusting.