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Background: Inflammation is thought to play an important role in hand osteoarthritis (HOA), which is associated with pain and increased limitation of hand function. Objectives: To explore the acceptability of therapy with intramuscular methylprednisolone in HOA among health-care providers (HCPs) and HOA patients. Additionally, the response to a single methylprednisolone injection was investigated. Design: We adopted a mixed-methods design. Methods: In a qualitative study, we asked HCPs and patients for their acceptability of intramuscular methylprednisolone. A prospective observational study was performed afterward in HOA patients who received a single 120-mg intramuscular methylprednisolone injection as part of off-label administration. Average pain, functional impairment, and occurrence of adverse events were assessed at baseline and at 4, 8, and 12 weeks after the injection. Results: Fourteen HCPs and 15 patients participated in the first part of the study. They considered intramuscular methylprednisolone potentially effective, yet expressed concerns about the risk for long-term adverse events. Among the 22 HOA patients who received intramuscular methylprednisolone, 13 patients reported 44 adverse events, with half of them occurring within the first 4 weeks after injection and being classified as nonserious. Mean hand pain decreased the most 4 weeks after injection and this effect persisted till week 12, though less pronounced. Similar results were seen with HOA-related functional impairment, which improved the most at week 4 and to a lesser extent at week 12. Conclusion: We found a good acceptability of intramuscular methylprednisolone treatment among HCPs and HOA patients, as well as a potential to reduce pain and improve hand function with a good safety profile for as long as 12 weeks after a single administration. Plain language summary: Use of methylprednisolone in the muscle for hand osteoarthritis patients: a feasibility study to inform a randomized controlled trial Hand osteoarthritis is very common among adults and older people, and being characterized by high levels of pain, stiffness and decreased function of the hand. Therapeutic options for hand osteoarthritis are limited. Methylprednisolone is sometimes used in clinical practice with good results. However, these results are mainly based on the experience of the physicians and do not rely on properly performed studies. That is why we intend to finally perform such a study. But before starting that, we wanted to see if patients with hand osteoarthritis and healthcare providers would accept the idea of injecting methylprednisolone into the buttocks muscle for the treatment of hand osteoarthritis. That is why we performed interviews with patients and healthcare providers, which brought up six factors to think about when discussing this therapeutic option: how well it works, how safe it is, the overall situation of the patient, how it's given, use of shared decision-making and logistics aspects. Next to this, we examined the effect of methylprednisolone over time on pain and function of the hands, as well as the frequency and nature of side effects. We found a decrease in hand pain and an improvement in hand function persisting for 12 weeks after just one methylprednisolone injection. Half of the patients reported side effects, but they all were non-serious. Eventually, we concluded that the use of methylprednisolone as an injection in the buttocks muscle for the treatment of hand osteoarthritis is accepted by both patients and health-care providers, and could be a safe and helpful therapy. The results will be used in the next study designed to assess the effect and safety of this therapy in a much larger group of patients with hand osteoarthritis. [ABSTRACT FROM AUTHOR]

Purpose: Although the hand only constitutes 2% of the body, it is a site where a wide variety of tumors occur, and the results of surgery substantially impact its function. Therefore, an accurate diagnosis and appropriate selection of individual treatment strategies are very important. This study reviewed the diagnostic characteristics and clinical features of surgically treated hand tumors at our facility. Methods: We retrospectively reviewed 65 patients who underwent surgery for suspected hand tumors at our institution between 2003 and 2020. Data, including patient demographics, diagnosis, pathology, type of surgery, comorbidities, and tumor characteristics (e.g., location and tumor size), were collected from medical records. Results: In total, 59 (90.7%) and six patients (9.3%) were diagnosed with benign and malignant tumors, respectively. Ganglion cysts were the most common tumors (n=11), followed by vascular anomalies (n=10), epidermoid cysts (n=7), and glomus tumors (n=4). There were four cases of bone tumors (6.2%), including one chondroma, one chondrosarcoma, and two giant cell tumors. In 53 cases with an imaging workup, the pathological diagnosis was concordant in 44 cases. Of the nine cases with inconsistent results, eight were tumors located in the finger; this association was significant (p=0.048). Conclusion: In this study, ganglion cyst and squamous cell carcinoma were the most common benign and malignant tumors, respectively, and four cases of bone tumors were found. Radiologic misdiagnosis was more frequent in finger tumors than in other tumors. Thus, hand tumors, especially those suspected to be malignant, should be assessed using a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Aims: Osteoarthritis (OA) and diabetes mellitus (DM) may coexist frequently. The increase in overall OA incidence is correlated with poor glycemic control and disease duration in patients with DM. However, the association between a DM diagnosis and specifically hand OA has not been explicitly determined. We assessed the association between DM and severity of disability in hand OA. Methods: This single-center, case-control study prospectively enrolled outpatients with hand OA who visited a physical therapy and rehabilitation clinic. The patients were grouped according to the presence of DM diagnosis. Pain, hand function, grip strength, and quality of life were evaluated and compared between the two groups. Results: The study included 100 participants [Age: 62.7±10.7 years (33-92); female: 78%]. The mean Australian/Canadian OA hand index of patients with OA with (n=50) and without DM (n=50) was 30.7±10.1 vs. 19.9±9.6, respectively (p<0.001). The mean lateral grip strength of the dominant hand of patients with and without DM was 4.5±2.1 vs. 5.9±2.1, respectively (p=0.002). Lateral grip strength of the non-dominant hand showed a negative correlation with DM duration among women (r=-0.387, p=0.018) and a positive correlation with hemoglobin A1c level among men (r=0.609, p=0.027). Conclusions: This study showed an association between DM diagnosis and severity of hand disability in patients with hand OA, with different patterns among women and men. Nevertheless, the results were unadjusted for relevant confounders. [ABSTRACT FROM AUTHOR]

A 15-year-old boy presented to outpatient dermatology clinic for evaluation of a lesion on the hand. Originally small and asymptomatic, the lesion had rapidly enlarged in the six months prior to evaluation. A shave biopsy was performed and histopathologic evaluation demonstrated a well-circumscribed nodular proliferation of dense, bland, epithelioid to spindle cells on a fibrillary background. Tumor cells were diffusely epithelial membrane antigen positive; SI00 and Melan-A were negative. These findings are consistent with a diagnosis of sclerosing perineurioma. This case illustrates the presentation of sclerosing perineurioma in a pediatric patient and we review the pertinent pathologic and immunohistochemical findings necessary for diagnosis. It is imperative to distinguish this entity from other soft tissue tumors on the hand, both benign and malignant, to avoid overly aggressive surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: To compare levels of grip strength in individuals with hand osteoarthritis (OA) with normative values, and to examine how hand OA severity and other biopsychosocial factors are associated with grip strength.Methods: Levels of grip strength across age groups were compared with normative values from the general population in sex-stratified analyses using 2-sample t-tests. Associations between radiographic hand OA severity (Kellgren/Lawrence sum score) in different joint groups and grip strength of the same hand were examined in 300 individuals from the Nor-Hand study using linear regression. Analyses were repeated using markers of pain, demographic factors, comorbidities, and psychological and social factors as independent variables. We adjusted for age, sex, and body mass index.Results: Individuals with hand OA had lower grip strength than the general population, especially in individuals age <60 years. In thumb base joints, increasing radiographic severity (range 0-8) and the presence of pain were associated with lower grip strength (β = -0.83 [95% confidence interval (95% CI) -1.12, -0.53] and β = -2.15 [95% CI -3.15, -1.16], respectively). Negative associations with grip strength were also found for women, low education, higher comorbidity index, and higher resting heart rate.Conclusion: Individuals with hand OA have lower grip strength than the general population. Our results support the idea that studies on thumb base OA should include grip strength as an outcome measure. However, other biopsychosocial factors should also be considered when the grip strength is being interpreted, because other factors such as sex, socioeconomic factors, physical fitness, and comorbidities are negatively associated with grip strength. [ABSTRACT FROM AUTHOR]

Objective The aim was to examine hand function and performance in activities of daily living (ADL) in patients with SLE vs healthy controls, and any associations with demographic and disease-related characteristics. Methods Hand function (grip strength, pinch strength and dexterity) and ADL performance were evaluated in 240 patients with SLE and 122 age- and biological sex-matched healthy controls. Grip strength, pinch strength and dexterity were measured by Jamar dynamometer, pinch gauge and Purdue pegboard test, respectively. Self-reported ADL performance was assessed by disabilities of the arm, shoulder and hand (DASH) and HAQ. Regression analysis was performed to assess the determinants of hand dysfunction. Results All hand function and ADL performance variables were significantly impaired in the entire SLE cohort and the subgroup of patients achieving lupus low disease activity state (LLDAS; n  = 157) compared with healthy subjects (P  < 0.05). Joint pain, often underestimated in SLE, was the major determinant of hand function and ADL performance in multiple regression models. In addition, age was correlated with grip strength and Purdue scores, gender with grip strength, arthritis with DASH and HAQ, and use of immunosuppressives with DASH, HAQ and grip strength. Likewise, in patients in LLDAS, painful joints were correlated with DASH and HAQ, age with grip strength and Purdue (P  < 0.001), gender with grip strength, and immunosuppressives with HAQ and grip strength. Conclusion Hand function and performance of daily activities are significantly impaired in SLE, even in patients who achieve LLDAS, suggesting the need for their evaluation and management in clinical practice. [ABSTRACT FROM AUTHOR]

The objective of this study was to verify whether women in the initial stages of hand osteoarthritis (HOA) already have impaired grip strength and flexor and extensor torque of the wrist compared to healthy women. It also aimed to correlate these variables with pain, stiffness, and function of the hand. Twenty-six women were divided into a control group [CG, n = 13; 56 (51–61) years old] and a hand osteoarthritis group [HOAG, n = 13; 58 (53–63) years old]. Grades II and III were included in the HOA group according to the criteria of Kellgren and Lawrence. All volunteers answered an initial assessment form, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Australian/Canadian Hand Osteoarthritis Index (AUSCAN). The grip strength and isometric wrist flexor and extensor torque were evaluated by a hydraulic dynamometer. Comparisons between groups used Student's t test for independent samples and the Mann–Whitney test. Spearman's correlation was used to correlate grip strength and flexor and extensor wrist torque to the degree of disease and DASH and AUSCAN scores. There were no differences between the groups in grip strength or flexor and extensor torque values. In terms of the DASH and the AUSCAN, the HOA group had higher scores, indicating worse hand function. A strong negative correlation was found between grip strength and the degree of HOA (r = − 0.70, p = 0.008), and a moderate positive correlation was found between flexor torque and the degree of HOA (r = 0.53, p = 0.05). The pain (r = − 0.61, p = 0.02) and function (r = − 0.66, p = 0.01) sections of the AUSCAN correlated negatively with grip strength. Pain can be an important feature in the HOA rehabilitation process, as it can influence handgrip strength and function. It is important that rehabilitation is implemented as soon as possible to guarantee the maintenance of strength and function since with the severity of the disease, patients tend to have deficits in grip strength and function. [ABSTRACT FROM AUTHOR]

Objective: To describe cross‐sectional associations between features observed on ultrasound (US) or clinical joint examination and hand symptoms among community‐dwelling older adults (n = 519), and to determine whether such associations are independent of age, sex, body mass index, and other imaging features. Methods: Hand pain, function, and stiffness were assessed using a visual analog scale (VAS) and the Australian/Canadian Hand Osteoarthritis (AUSCAN) index. Standardized clinical and US examinations were performed, and grip strength was assessed using a dynamometer. Data were analyzed using hurdle and linear models and adjusted for demographic factors and other features. Results: Abnormal findings on joint examination and on US imaging are common in older adults with and without hand pain. Greater numbers of tender joints were associated with greater pain (VAS: β = 2.63 [95% confidence interval (95% CI) 1.88, 3.39]; AUSCAN pain: β = 10.57 [95% CI 4.00, 17.13]), poorer AUSCAN function (β = 4.07 [95% CI 1.28, 6.86]), and poorer grip strength (β = –0.15 [95% CI –0.27, –0.03]). Power Doppler imaging (PDI) synovitis was associated with greater pain (VAS: β = 2.61 [95% CI 1.03, 4.19]; AUSCAN pain: β = 13.07 [95% CI 3.82, 22.32]), but not function. Joint deformity was associated with poorer function (β = 4.51 [95% CI 1.75, 7.26]) and grip strength (β = –0.23 [95% CI –0.40, –0.05]), but not pain. Gray‐scale synovitis was associated only with poorer grip strength (β = –0.22 [95% CI –0.41, –0.04]). Associations with function and grip strength were partially mediated by pain. Conclusion: Joints that are tender on palpation or have US‐identified PDI synovitis are potential treatment targets for hand pain. Treating tender joints and preventing hand deformity is required to improve hand function in community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

The factors predicting hand osteoarthritis (HOA) in patients remain unknown. We aimed to investigate the usefulness of serum hyaluronic acid (sHA) levels in predicting HOA progression from a 6-year longitudinal epidemiological study. A total of 417 participants in the Iwaki cohort were followed-up over 6 years. Hand and knee radiographs taken at baseline and follow-up were scored according to Kellgren–Lawrence grades and Kallman score. Participants were classified into the HOA group and the non-HOA group. sHA levels at baseline were determined by ELISA. Correlations between sHA levels, the number of involved joints, and Kallman score were estimated. Factors related to the incidence or progression of HOA over 6 years were analyzed. The prevalence of HOA was 19.9% at baseline, and 3.6 ± 2.1 joints were involved. sHA levels in the HOA group at baseline were significantly higher than in the non-HOA group (p < 0.001) and correlated with the number of involved joints (r = 0.399, p < 0.001) and Kallman score (r = 0.540, p < 0.001). The incidence rate was 14.5%, and the progression rate was 46.1% over 6 years. Higher sHA levels at baseline were the risk factor of HOA incidence. Thus, sHA levels predicted the incidence of HOA over 6 years. [ABSTRACT FROM AUTHOR]

Background: Many patients with hand osteoarthritis (HOA) experience reduced health-related quality of life. This study sought to better understand the disease and treatment experience of individuals with HOA, explore any differences in experiences between erosive and non-erosive HOA sub-types, and evaluate content validity of the Michigan Hand Outcomes Questionnaire (MHQ) in HOA. Methods: Thirty subjects from the United States (n = 15 erosive HOA; n = 15 non-erosive HOA) participated in semi-structured interviews: concept elicitation explored symptoms/impacts important to patients; cognitive interviews assessed understanding and relevance of the MHQ. A sub-sample participated in real-time data capture (RTDC) activities via a smartphone/tablet app over 7 days. Verbatim transcripts were coded using Atlas.ti software and thematically analyzed. Concept saturation and MHQ content validity were evaluated. Results: Most participants reported experiencing pain, swelling and stiffness, symptoms that most commonly had a direct impact on physical functioning. Substantial impacts on activities of daily living, emotional functioning, sleep and work were also reported. RTDC findings corroborated concept elicitation findings. There were no notable differences between erosive and non-erosive HOA, except nodules were reported more frequently in erosive disease. Most participants used analgesic treatments, but effects were short-lived. Pain was the symptom most frequently reported as most bothersome and important to treat. Concept saturation was achieved. MHQ items and instructions were well understood and relevant to most participants; stiffness and swelling were reported as important symptoms not included in the MHQ. Conclusions: This study characterizes key symptoms of HOA which are burdensome for patients and not well controlled by current therapies, highlighting an unmet treatment need. Although the study is limited by a small sample size that may not be representative of the broader erosive and non-erosive HOA population, concept saturation was achieved, and our findings suggest that disease experience is similar for patients with erosive and non-erosive HOA. Evaluation of stiffness and swelling items in conjunction with the MHQ may enhance relevance and improve measurement precision to assess important domains of HQRoL in an HOA population. [ABSTRACT FROM AUTHOR]

Between January 2000 and December 2019, three-dimensional computer tomographic (CT) angiography was used in a total of 140 hands (116 patients, mean age 6.8 years) with congenital hand malformation to assess the vascular and bony structures. Analysis showed overall satisfactory three-dimensional CT images for operative planning, including detailed abnormal vascular patterns and bony malformations. Among the 116 patients, six patients with typical findings of a few malformations are reported in detail. Pitfalls in interpretation of the images and the use of three-dimensional CT angiography in surgical planning are discussed. We conclude that three-dimensional CT angiography is useful for preoperative planning of complex congenital hand malformations. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Hand, foot, and mouth disease (HFMD) remains a threat to the Asia-Pacific region. The epidemiological characteristics and pathogen spectrum of HFMD vary with space and time. These variations are crucial for HFMD interventions but poorly understood in Sichuan Province, China, particularly after the introduction of the EV-A71 vaccine. Using descriptive methods, regression analyses, spatial autocorrelation analysis, and space-time scan statistics, we analysed the epidemiological and aetiological characteristics of HFMD surveillance data in Sichuan Province between 2011 and 2017 to identify spatio-temporal variations. The dominant serotypes of HFMD have changed from enterovirus 71 and coxsackievirus A16 to other enteroviruses since 2013. The seasonal pattern of HFMD showed two peaks generally occurring from April to July and November to December; however, the seasonal pattern varied by prefecture and enterovirus serotype. From 2011 to 2017, spatio-temporal clusters were increasingly concentrated in Chengdu, with several small clusters in northeast Sichuan. The clusters observed in southern Sichuan from 2011 to 2015 disappeared in 2016–2017. These findings highlight the importance of pathogen surveillance and vaccination strategies for HFMD interventions; future prevention and control of HFMD should focus on Chengdu and its vicinity. [ABSTRACT FROM AUTHOR]

Objective: To use ultrasonography to study whether the duration of psoriatic dactylitis was associated with different patterns of extracapsular and synovial-based involvement.Methods: One hundred cases of hand dactylitis from 85 patients with psoriatic arthritis (PsA) were consecutively enrolled in a multicenter cross-sectional study and divided into 2 groups according to dactylitis duration (shorter or longer than the median: 20 weeks). All dactylitis fingers were investigated using high-frequency ultrasound both in greyscale (GS) and power Doppler (PD), evaluating the presence of flexor tenosynovitis, soft tissue edema, subcutaneous PD signal (PDS), extensor tendon involvement, and joint synovitis.Results: Cases with a shorter dactylitis duration (< 20 weeks) had a significantly higher prevalence of GS flexor tenosynovitis of grade > 2, PD flexor tenosynovitis, soft tissue edema, and subcutaneous PDS (p = 0.001, p < 0.001, p < 0.05, and p = 0.001, respectively). However, the presence of synovitis in GS and PD mode (in both cases at proximal interphalangeal level) was more frequent in patients with longer dactylitis duration (p < 0.001). When detected in the chronic form, flexor tenosynovitis was grade 2 or lower.Conclusion: In a large cohort of PsA hand dactylitis, we found a predominant extracapsular inflammation (flexor tenosynovitis and soft tissue edema) in early cases and a high prevalence of joint synovitis at proximal interphalangeal level in the chronic form. However, longitudinal imaging studies are needed to clarify these aspects. [ABSTRACT FROM AUTHOR]

Hand eczema (HE) is a heterogeneous and often chronic disease located to the hands and wrist, and frequently associated with eczema on the feet. The aetiology is diverse, and the eczema may present with a variety of clinical symptoms. Acute and chronic stages appear; severity varies from mild to moderate and severe, and flares may be frequently recurrent or rare. The divergent aetiology and varied morphology of HE is sometimes tricky and may be challenging to the dermatologist. This review has focus on epidemiology, prognosis and prevention of HE, and intends to point towards some practical advice on how to diagnose, inform and guide HE patients. [ABSTRACT FROM AUTHOR]

Background: The infectious complications during connective tissue diseases are favored by immunosuppression linked on the one hand to systemic disease and on the other hand to their treatment. The aim of this study was to identify the different infectious complications associated with these systemic diseases. Materials and Methods: It was a multicenter descriptive study over a period of 8 months in two Dermatology departments in Dakar. All patients followed for connective tissue disease who had evidence of infection during the study period were included. Results: We identified 231 cases of connective tissue disease. We had noted the occurrence of an infection in 56 cases. Infections were noted during: systemic scleroderma in 19 cases, systemic lupus in 15 cases, mixed connective tissue disease in 12 cases and dermatomyositis in 10 cases. The different types of infection that were observed during these systemic diseases were fungal (41cas), bacterial (34cas), viral (12cas) and parasitic (6cas). Patients developed an infection before taking corticosteroids in 34 cases (36.6%) and after taking corticosteroids in 59 cases (63.4%). Conclusion: Connectivites are a group of autoimmune diseases that are exposed to an infectious risk during their evolution. The search for these infections at the beginning and during the treatment of these system diseases improves their prognosis. [ABSTRACT FROM AUTHOR]

Acute compartment syndrome of the hand is a potentially devastating and infrequent condition observed after trauma, arterial injury, or prolonged compression of the upper limb. We present the case of a patient diagnosed with compartment syndrome of the hand after laparoscopic surgery for epithelial ovarian cancer. The patient is a 42-year-old woman with incidental finding of high-grade ovarian serous carcinoma after an emergency surgery. On imaging evaluation, the patient was found to have evidence of residual retroperitoneal adenopathy and was taken to the operating room for a staging procedure by laparoscopy. In the immediate postoperative period, she developed compartment syndrome of the right hand that required multiple fasciotomies and multidisciplinary management by plastic surgery, orthopedics, and rehabilitation medicine. The patient was discharged from the hospital 7 days after laparoscopic surgery to undergo rehabilitation. Three months after surgery, she is continuing to recover, with near complete recovery of hand function. The patient has completed a total of 3 cycles of chemotherapy with carboplatin/paclitaxel. Compartment syndrome of the hand is an uncommon event, but it can generate major functional deficits and even death if it is not diagnosed and treated in a timely manner. Strict criteria for patient positioning in laparoscopy surgery may avoid or reduce this complication. To date, this is the first case reporting such complications associated with laparoscopic gynecologic surgery. [ABSTRACT FROM AUTHOR]

Objective. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with involvement of the upper and lower motor neurons. Since the loss of fine motor skills is one of the earliest signs of ALS, the hypothesis was tested if the nine hole PEG test (NHPT) and transcranial magnet stimulation (TMS) with resting-motor threshold (RMT) could be useful in monitoring disease progression. Methods. We examined 28 ALS patients and 27 age-matched healthy controls. ALS patients and healthy controls underwent the nine hole peg test (NHPT) and TMS with RMT. Measurements in patients were repeated after three and six months. Results. At baseline, the median NHPT durations were 1,4-fold longer (p<0.001), and TMS scores showed a significant 0.8-fold smaller score in ALS patients compared with healthy controls (p<0.001). The comparison of three and six months versus baseline revealed significant differences for NHPT durations and ALSFRS-R in patients, whereas TMS scores did not significantly differ in the patients. Conclusion. NHPT seems to be a good tool to evaluate dexterity of the hand and the progression of the disease in ALS patients. TMS RMT to the hand muscles seems to be poorly qualified to evaluate the dexterity of the hand function and the course of the disease. [ABSTRACT FROM AUTHOR]

Therapeutic gloves are an intervention widely recommended and prescribed by rheumatologists and occupational therapists for the management and treatment of hand arthritis. Different models of therapeutic gloves are commercially available, with varying design, construction and materials. However, a systematic classification for therapeutic gloves and their effectiveness has not been well established. In addition, little research has addressed the issue of material choice on glove performance. These knowledge gaps prompted the development of a framework for the design and engineering of functional and comfortable therapeutic gloves. Knowledge from multiple domains was integrated into a single framework and relationships between components were identified and characterised. The framework demonstrates that the design and engineering of therapeutic gloves requires fusion of functional design with comfort design to meet users' demand for wearing comfort, relief of arthritic symptoms and improvement of hand function. [ABSTRACT FROM AUTHOR]

The article present an interview with Ana-Maria Vranceanu, doctor in Boston, Massachusetts. Topics discussed include the role of the positive psychology play in understanding pain intensity and disability among patients with hand and upper-extremity conditions; the variation in pain intensity among patients with upper-extremity conditions after controlling for relevant confounding variables; and also mentions about the caution against inferring causation.

Several technologies applied to the rehabilitation field use devices that provide to physiotherapists different kind of information to improve the assessment about patient evolution during rehabilitation plans. The new trend of these technologies is the development of safe, portable and comfortable wearable devices with wide application in different environments. This paper presents a proposal of a portable and safe device for hand rehabilitation, composed of five thimbles, able to acquire pressure signals during the execution of movements guided by a videogame. The device has a display to show to the users different routines, in order to guide them about its use, and also evaluates pressure signals and response time. Here the design and construction of the device are presented, in addition to results of a pilot test with volunteers. The results demonstrate that pressure signals can be accurately acquired during user movements, and the device was considered safe to perform hand rehabilitation. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) symptoms can precede by many years the motor symptoms of Parkinson's disease (PD) and these patients can show some degree of inflammation associated with abnormal aggregates of alpha-synuclein in the GI tract. The abnormal accumulation of alpha-synuclein and the spreading of the aggregates from the gut to the brain might be promoted by inflammation, rising the hypothesis of a possible relationship between inflammatory bowel disease and PD. Many population-based studies have explored this association, but they have found conflicting results. It is essential to clarify this hypothesis and to try to elucidate the milestones of this relationship. There is no clear concordance between the results and the interpretation of different previous findings, probably due to many confounding factors such as drugs with anti-inflammatory activity, surgery, genetic predisposition and also selection bias. If there is a real association between both diseases, gastroenterologists and neurologists should be able to detect possible triggers of the disease or on the other hand, protective factors, that may be considered in clinical practice. [ABSTRACT FROM AUTHOR]

Background: For early detection of initial skin changes in occupational screenings, only few objective assessment systems are available. Objectives: With the aim of assessing an objective measurement method for hand eczema, we trialed the application of the tissue viability imaging (TiVi) system, quantifying erythema non‐invasively by polarized light spectroscopy. Materials and Methods: In a field study with 625 employees of a semiconductor production company, 411 were exposed to prolonged wearing of occlusive gloves in the clean room. TiVi system and Hand Eczema Score for Occupational Screenings (HEROS), a quantitative skin score for the hands, were used, supplemented by a standardized personal interview. Results: TiVi values of 65 up to 246 for each hand (palm or back), for each participant summed to overall 289 up to 848 (median 389), were measured. Higher TiVi values were noted for men, smokers, and with increasing age. Correlation between TiVi and HEROS was only weak. Several factors like skin pigmentation, thickness of the skin, or tattoos seem to influence TiVi results. Conclusions: The practical relevance of one‐time measurements with the TiVi system in occupational screenings seems to be limited. Specifically, the TiVi system cannot replace dermatological examinations at the workplace. Notwithstanding, the application for other scientific purposes might be useful. [ABSTRACT FROM AUTHOR]

Hand, foot, and mouth disease (HFMD) is caused by various serotypes of Enterovirus genus. Coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71) were known to be the only responsible agents for these epidemics; however, this opinion was challenged after the detection that coxsackievirus A6 (CV-A6) was the responsible species for the outbreak in Finland in 2008. HFMD is frequently seen in Turkey, and no detailed study on its clinical and microbiological epidemiology has previously been reported. The present study addresses this question. Twenty-seven patient samples collected between 2015 and 2017 were included in the study. Typing was conducted by RT-PCR and the sequencing applied directly to patient's samples and as well as to the viral cultures with pan-enterovirus and serotype-specific primers. The presence of Enterovirus in 12 of 27 HFMD samples was shown with RT-PCR. The causative agent for three of these 12 samples was CV-A16, one of the most frequent two serotypes around the world, and the remaining nine samples was CV-A6. The findings of the study are relevant since it pertains to the molecular epidemiology of HFMD in Turkey, a gateway country where different serotypes might be circulating and transmitted. The findings also support the notion that CV-A6 cases are rising in number, which has caused more severe clinical features and widespread rashes in recent outbreaks. [ABSTRACT FROM AUTHOR]

Purpose: Wet work is the most important exposure leading to occupational hand eczema; however, the prevalence and character of wet work in various wet work professions remain not fully covered. Self-reported data are widely used in studies of wet work although the validity of these remains uncertain. The objective of the present study is to provide information on validity of self-reported wet work exposure in different professions by comparing work place observations with self-reported data.Methods: 114 workers from 15 various wet work professions were observed. The observations covered duration and frequency of wet work activities. The observed population as well as a non-observed population from each work place were given a questionnaire covering the same wet work activities.Results: Correspondence analysis between self-reported and observed wet work showed that misclassification was larger regarding duration than frequency. 29.2% overestimated and 23.9% underestimated total wet work with more than 2 h/day. Professions with high wet work prevalence overestimated duration of wet work activities, but underestimated frequency. Females overestimated frequency, but not duration. The observed group (45%) significantly more often, than the non-observed group (32%), reported having more than 2 h of wet work/day (OR 2.8, 95% CI 1.6-4.9). Sensitivity and specificity of the questionnaire regarding total wet work in the observed population showed 51% sensitivity and 59% specificity.Conclusion: Over- and underestimation of wet work were found to be equally distributed. The correspondence analyses illustrate a noticeable misclassification between the estimations and the observations on all wet work variables, but largest for total wet work. [ABSTRACT FROM AUTHOR]

Acute hand infections are often caused by puncture wounds and are generally classified into superficial or deep infections. Superficial infections occur in the skin and subcutaneous tissues, whereas deep infections can involve the tendon sheaths, adjacent anatomic compartments, deep fascial planes, bursae, joint spaces, and bones. Superficial hand infections are more common than deep infections and are typically managed with elevation, warm soaks, splinting in the position of function, analgesics, and empiric antibiotics when indicated. Paronychia, which can be acute or chronic, is an infection or inflammation of the nail fold. Treatment involves warm soaks, topical antibiotics, and abscess drainage, if indicated. A felon is an infection of the distal pulp of the finger. Treatment often involves surgical drainage and empiric oral antibiotics. Herpetic whitlow is caused by herpes simplex virus and typically resolves without intervention. Deep hand infections include pyogenic flexor tenosynovitis and clenched-fist bite wounds. Pyogenic flexor tenosynovitis is a rapidly progressing bacterial infection of the flexor tendon sheaths in the hand, most commonly caused by a penetrating injury to the finger. Clenched-fist bite wounds result from direct contact of the fist on incisor teeth and are associated with polymicrobial infections. Empiric antibiotics and prompt surgical consultation are indicated to reduce long-term morbidity. [ABSTRACT FROM AUTHOR]

Purpose: In the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand-arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field.Methods: Seven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views.Results: Consensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity.Conclusions: A new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes. [ABSTRACT FROM AUTHOR]

Maize lethal necrosis (MLN) is considered an important constraint of maize production in Ethiopia and particularly in southern part of the country. The study was conducted during 2016 and 2017 main cropping seasons to (i) determine the effect of hand weeding and insecticide application against MLN and yield and yield related attributes of maize; and (ii) to determine the economy of additional costs used for the management of MNL. The treatments such as hand weeding, only insecticide applied, hand weeding in combination of insecticide application (HW + InA) and unmanaged were arranged in randomized complete block design with five replications. Results showed that MLN severity was highly significant (p < 0.001) different both during 2016 and 2017 cropping seasons. It was varied among the treatments and between cropping years. In the two years, it was highest on unmanaged plots with 66.33% in 2016 and 56.33% in 2017. This might have been due to severe insect and weed infestation during the growing period over the evaluated plots. Conversely, the lowest MLN severity was recorded on the HW + InA with the value of 26.67% in 2016 and 25.00% in 2017 cropping season. Thus, severity was reduced by 62.31% in 2016, and 52.65% in 2017 in this treatment. As such not much difference in the area under disease progress curve (AUDPC) was observed in the two years. However, in both cropping seasons the lowest (15.96% and 15.01%-days, respectively) mean amount of AUDPC was recorded from plots managed with HW + InA. In 2016 and 2017 cropping seasons, HW + InA proved to be an effective against MLN management and gave the highest yields (4.89 and 5.84 t ha−1, respectively) over the unmanaged (1.06 and 1.39 t ha−1, respectively). Overall, results showed HW + InA was found to be better management option and reduced MLN and increased grain yields. Thus, it is better, as compared to other treatments, to use management option as it gave the relatively higher defense against MLN. However, further studies have to be undertaken in different agro-ecologies elsewhere in Ethiopia for developing solid advice on behalf of stabilizing maize production. Moreover, further research is warranted to confirm the role of insect pests and weeds as vector and alternative hosts, respectively for MCMV, SCMV, MDMV and WSMV causing MLN. [ABSTRACT FROM AUTHOR]

Hand deformities are well-known abnormalities observed in patients with Parkinson’s disease (PD). We determined the frequency and diagnostic accuracy of hand deformities in PD. We studied 44 consecutive patients with PD, 44 age- and gender-matched normal controls and 22 patients with essential tremor (ET). By means of photographs taken in both hands of all participants, the degree of metacarpophalangeal (MCP) joint flexion was quantified by software and by blinded evaluations using a semiquantitative scale from the radial aspect, we grouped hands into four grades. The presence of classical striatal hand deformity (CSHD), defined as MCP joint flexion, proximal interphalangeal joint extension and distal interphalangeal joint flexion was also evaluated. Patients with PD had a higher frequency of MCP joint flexion and CSHD compared to normal controls and patients with ET. Mean MCP joint flexion was higher in both hands in patients with PD: 20.8° vs. normal controls (3.3°-3.9°) and patients with ET (2.8°-6.3°), P = 0.001. Concordance between evaluators for MCP joint flexion was fair: κ = 0.34 (P < 0.001), but poor for CSHD: κ = 0.142-0.235 (P < 0.05). A right hand MCP joint flexion of 12.5° and left hand of 10.5°, showed similar sensitivity (0.70) and specificity (between 0.75 and 0.80) than any degree of MCP joint flexion for the diagnosis of PD. CSHD had a sensitivity (0.60-0.80) and specificity (0.78-0.98) for the diagnosis of PD. Hand deformities are commonly observed in patients with PD, they may aid in the diagnosis of PD when compared to normal controls and patients with ET. [ABSTRACT FROM AUTHOR]

Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema of the dorsal hands. The pathophysiology is believed to primarily be the result of lymphatic blockage from either direct toxicity of the injected drug, drainage of impurities, or infection complications. A woman in her 40's with remote intravenous drug use presented with over a decade of fixed, painless erythema and swelling of bilateral dorsal hands. Owing to an elevated rheumatoid factor, which would later be attributed to patient's untreated hepatitis C, these findings were mistaken for rheumatoid arthritis and unnecessarily treated with methotrexate and prednisone. Upon proper recognition of her underlying Red puffy hand syndrome, systemic medications were discontinued and appropriate care was initiated with lymphedema decongestion and occupational therapy. Red puffy hand syndrome, albeit rare, is an important manifestation of intravenous drug abuse; its recognition will spare patients from unnecessary systemic treatments. [ABSTRACT FROM AUTHOR]

Background: A hand photography protocol was needed to ascertain the presence and severity of dermatitis in a trial testing the effectiveness of a behaviour change intervention to prevent hand dermatitis in nurses. Methods: We developed the protocol in 3 stages: (1) we established a procedure for collecting hand photographs; (2) we conducted a stepwise validation process to agree rules for diagnosing and determining the severity of hand dermatitis; and (3) we trained a research nurse to screen out “clear” cases. Results: We developed and trained fieldworkers (n = 97) in a procedure for collecting hand photographs. Study dermatologists established interpretation rules to diagnose and determine the severity of dermatitis from photographs. Prior to the establishment of the rules, interobserver agreement between the 2 dermatologists on the presence or absence of hand dermatitis was moderate (κ = 0.5). At the final stage of the validation process, the dermatologists agreed on 88% cases from independent assessments, with consensus being reached for the remaining 12% following joint deliberation. Following training, a subgroup analysis of 250 cases screened by the nurse and characterized as “clear” found that 2 (0.8%) “positive” cases were missed. Conclusion: We have developed a hand photography protocol that may be used in other studies or in hand dermatitis health surveillance programmes. [ABSTRACT FROM AUTHOR]

We extend an interesting class of space–time models for infectious disease data proposed by Held and co‐workers, to analyse data on hand, foot and mouth disease, collected in the central north region of China over 2009–2011. We provide a careful derivation of the model and extend the model class in two directions. First, we model the disease transmission between age–gender strata, in addition to space and time. Second, we use our model for inference on effective local reproductive numbers. For the hand, foot and mouth data, for each of the six age–gender strata we consider that transmission is greatest between individuals within the same strata, with also relatively high transmission between individuals of the same age group but the opposite gender. The local reproductive numbers show strong seasonality, and between‐area differences. [ABSTRACT FROM AUTHOR]

Background: Trigger finger is a common cause of disability and pain in the hand and The lines of management of this disease start by conservative treatment as rest, NSAID, local corticosteroid injection under the tendon sheath either blind or by musculoskeletal ultrasound guidance and surgery may indicated in recurrent cases. Aim of the study: The aim of the present study was to evaluate the musculoskeletal ultrasound accuracy to guide the injection of corticosteroid in trigger finger management. Material and methods: 50 cases that complaint from symptoms of trigger digit in this randomized, prospective control study were recorded. All the cases were injected by 1 ml corticosteroid 1ml of 2% lidocaine at the level of the A1 pulley under the tendon sheath. The injection done under control of musculoskeletal ultrasound after a blinded needle insertion. Comorbidities and associated diseases were recorded. Follow up examinations at the 2 week and 6 months, no complications were recorded. The results were assessed according to the green's grading. The pain was assessed according to visual analogue scale. Results: The cases in the present study were assessed according to age, associated diseases and hand dominance. The female patients were more than male patients in the present study. The injection under control of musculoskeletal ultrasound accurate more than a blinded injection even when an expert physician who did it. And It showed the same efficacy according to green's grading at the period of follow up examinations when compared with the pre-injection status. No complications were seen during the period of the follow up. Conclusion: A different technique of injection using musculoskeletal ultrasound guidance all of which gave excellent accuracy superior to a blinded injection even when it is done by expert physician. However, the post injection result was similar to that of a blinded injection. Level one of evidence (randomized prospective study). [ABSTRACT FROM AUTHOR]

Modeling of the human hand provides insight for explaining deficits and planning treatment following injury. Creation of a dynamic model, however, is complicated by the actions of multi-articular tendons and their complex interactions with other soft tissues in the hand. This study explores the creation of a musculoskeletal model, including the thumb and index finger, to explore the effects of muscle activation deficits. The OpenSim model utilizes physiological axes of rotation at all joints, passive joint torques, and appropriate moment arms. The model was validated through comparison with kinematic and kinetic experimental data. Simulated fingertip forces resulting from modeled musculotendon loading largely fell within one standard deviation of experimental ranges for most index finger and thumb muscles, although agreement in the sagittal plane was generally better than for the coronal plane. Input of experimentally obtained electromyography data produced the expected simulated finger and thumb motion. Use of the model to predict the effects of activation deficits on pinch force production revealed that the intrinsic muscles, especially first dorsal interosseous (FDI) and adductor pollicis (ADP), had a substantial impact on the resulting fingertip force. Reducing FDI activation, such as might occur following stroke, altered fingertip force direction by up to 83° for production of a dorsal fingertip force; reducing ADP activation reduced force production in the thumb by up to 62%. This validated model can provide a means for evaluating clinical interventions. [ABSTRACT FROM AUTHOR]

A 35-year-old man presenting with right-sided total hand skin degloving injury due to crushing of printing machine was reported in this study. The superficial vein of forearm was transplanted intraoperatively to reconstruct the blood supply, and the avulsed skin was replanted in situ. The patient was followed-up for 2 years, and satisfactory results and functional recovery were achieved. [ABSTRACT FROM AUTHOR]

Hand, foot and mouth disease (HFMD) is a pediatric disease associated with infection by enterovirus (EV) genotypes. The major HFMD EV pathogens are enterovirus A71 (EVA71) and coxsackievirus A16 (CVA16); however, recently, coxsackievirus A6 (CVA6) and coxsackievirus A10 (CVA10) have also emerged. EV genotypes cannot be distinguished on clinical grounds and a new methodology for the rapid detection of the four major HFMD EV genotypes is urgently required. In the present study, a multiplex real-time PCR assay was established for the simultaneous detection of CVA6, CVA10, CVA16 and EVA71. The specificity and sensitivity of the assay was determined on a validation panel of clinical samples, comprising cerebrospinal fluid (n = 51), blood (n = 39), feces (n = 58) and throat swabs (n = 29). The results showed that the multiplex real-time PCR exhibited high specificity, no cross-reactivity with other EV genotypes, lower limits of detection for CVA6, CVA10, CVA16 and EVA71 were 4 × 10 3 , 4 × 10 2 , 5 × 10 2 , and 3 × 10 3 copies/μL, respectively and had comparable sensitivity to singleplex assays testing clinical samples. The multiplex real-time PCR methodology established in this study can be employed for the rapid detection of the four most prevalent HFMD-associated EVs, for epidemiologic surveillance of circulating EV genotypes and for assessing treatment responses and vaccine studies. [ABSTRACT FROM AUTHOR]

Stroke effects millions of people each year and can have a significant impact on the ability to use the impaired arm and hand. One of the results of stroke is the development of an abnormal shoulder-elbow flexion synergy, where lifting the arm can cause the elbow, wrist, and finger flexors to involuntarily contract, reducing the ability to reach with the arm and hand opening. This study explored the effect of using support at the upper arm to improve hand and arm reaching performance. Nine participants were studied while performing a virtual reaching task under three conditions: while the weight of their impaired arm was supported by a robot arm, while unsupported, and while using their non-impaired arm. Most subjects exhibited faster and more accurate reaching while supported compared to unsupported. For the subjects who could voluntarily open their hand, most were able to more swiftly open their hand when using upper arm support. In many cases, performance with support was not statistically different than the unaffected arm and hand. Muscle activity of the impaired limb with upper arm support showed decreased effort to lift the arm and reduced biceps activity in most subjects, pointing to a reduction in the abnormal flexion synergy while using upper arm support. While arm support can help to reduce the activation of abnormal synergies, weakness resulting from hemiparesis remains an issue impacting performance. Future systems will need to address both of these causes of disability to more fully restore function after stroke. [ABSTRACT FROM AUTHOR]

Occupational hand eczema is a type of eczema specifically affecting the hands and caused by a person's work. It often affects people whose hands get wet a lot or are exposed to chemicals when working, such as hairdressers and cleaners. It can cause a great deal of distress to people, affecting their health-related quality of life (HRQoL) and often meaning they have to leave work or change jobs. It is a major reason for people seeking disability benefit in countries including the UK, so as well as having a negative impact on the patient, it also impacts on society more widely. In theory, occupational hand eczema should heal when the exposure is removed; however, several studies have shown that this is unfortunately not the case in reality, and some patients may continue to have severe hand eczema symptoms. This study involved 1496 people who were suffering from occupational hand eczema in Denmark in 2010 and 2011, who then completed a questionnaire 5 years later, asking questions about their job, their eczema and their quality of life. 48.7% were still in the same profession, 32.6% had changed profession and 18.8% were not working (outside the labour market, e.g. retired, unemployed, on parental leave). Healing of hand eczema (meaning their hands were now clear of eczema) was reported by 19.5% of the participants who changed their profession and 27.3% of the participants who outside the labour market, compared with 15.8% of those still in the same profession. Looking at improvement (but not healing) of their eczema, 64.9% of the participants who had changed profession and 58.2% of the participants outside the labour market reported improvement in their hand eczema compared with 53.1% of the participants still in the same profession. However, health related quality of life was not improved by changing jobs or leaving work, and in fact worsened. Also, the authors did not ask if the participants changed to a profession with more or less exposure than the previous profession, so it is possible that some participants have changed to another high risk profession, thereby diminishing the effect of change. These two points both need further research. [ABSTRACT FROM AUTHOR]

Hand eczema is one of the most common skin diseases with some studies estimating that up to 10% of the European population has some degree of hand eczema at any one time. There are various causes with some people having a genetic tendency and others developing hand eczema due to their jobs, often a result of hand washing in healthcare or hospitality sectors. The initial treatment of hand eczema is to avoid obvious triggers and use plenty of moisturising creams. If problems continue steroid creams are prescribed. These measures are often enough but if the eczema continues patients are then offered either ultraviolet (UV) light based treatments or tablets. This research study investigated two different forms of UV light treatment which are used to treat eczema. PUVA involves soaking the hands in a water-based solution of a photosensitising drug before receiving UVA light for 5-15 minutes whereas NBUVB involves a 1-2 minute exposure to UVB light. PUVA is the traditional treatment and has been used for 30 years. It is time consuming. There are some concerns that excessive PUVA use could increase the risk of skin cancers and indefi- nite repeated treatment is not used. The research study invited patients with hand eczema not improving with steroid creams to receive either PUVA or UVB treatment. The severity of their eczema was scored before, during and after treatment. Due to difficulties in recruiting enough patients it was not possible to say which treatment was better. However, the study did show that both treatments improved the eczema severity. There were more side effects with the NBUVB treatment mainly due to mild episodes of skin redness. This research has provided new information. We now know that NBUVB is a safe and acceptable treatment for hand eczema. It does lead to improvement in hand eczema severity. It takes less time but does produce more side effects than PUVA. We have measured the improvement in patients' eczema with both treatments using official scoring systems which means we are now in a position to design a larger clinical trial to determine which treatment is more effective. [ABSTRACT FROM AUTHOR]

Hand, foot, and mouth disease (HFMD) has spread widely in a continuing endemic in Thailand. There are no specific vaccines or antiviral treatments available that specifically target HFMD. Indirect transmission via free-living viruses from the environment may influence HFMD infections because the virus can survive for long periods in the environment. In this study, a new mathematical model is proposed to investigate the effect of indirect transmission from contaminated environments and the impact of asymptomatic individuals. By fitting our model to reported data on hospitalized individuals of HFMD endemic in Bangkok, Thailand, 2016, the basic reproduction number was estimated as 1.441, which suggests that the disease will remain under current conditions. Numerical simulations show that the direct transmission from asymptomatic individuals and indirect transmission via free-living viruses are important factors which contribute to new HFMD infections. Sensitivity analysis indicates that the basic reproduction number is sensitive to the transmission rate of asymptomatic and symptomatic subgroups and indirect transmission. Our findings suggest that cleaning the environment frequently and healthcare precautions which include the reduction of direct transmission rates should be promoted as effective control strategies for preventing the HFMD spread. [ABSTRACT FROM AUTHOR]

Introduction. Hepatitis C virus (HCV) infection is one of the factors which can lead to a chronic liver disease and hepatocellular carcinoma. There have been several reports on the association of oral lichen planus with hepatic disorders, i.e. hepatitis C infection in particular. Considering the controversies about the association of lichen planus with HCV infection on one hand and considerable impact of hepatitis C on the occurrence of chronic liver disease on the other hand, we investigated the association between lichen planus and HCV infection in Sanandaj City. Methods. This cross sectional study included 168 patients with lichen planus, who were referred to the Dermatology Clinic of Besat Hospital between 2014 and 2016. The diagnosis of lichen planus was made by our dermatologist and HCV antibody titer was determined for every patient. Results. Mean age of the patients was 39.7±13.3 years and mean duration of the disease was 14.8 months. 107 (63.7%) patients were men. The highest frequency of lichen planus was recorded in the housewives (30.4%). In 52 (31%) patients the genital area was involved and it was the most common site. In 6 (3.6%) patients the oral mucosa was involved and it was the least common site in our study. Only 4 (2.7%) patients had family history of lichen planus. None of 168 patients included in this study was found to have HCV infection. Conclusion. In this study, we found no relationship between lichen planus and HCV infection. Yet, the exact mechanism underlying the occurrence of lichen planus in the patients with HCV infection has not been determined. Therefore more studies on this subject are recommended. [ABSTRACT FROM AUTHOR]

Abstract: Psoriasis of the scalp, face, intertriginous areas, genitals, hands, feet, and nails is often underdiagnosed, and disease management can be challenging. Despite the small surface area commonly affected by psoriasis in these locations, patients have disproportionate levels of physical impairment and emotional distress. Limitations in current disease severity indices do not fully capture the impact of disease on a patient's quality of life, and, combined with limitations in current therapies, many patients do not receive proper or adequate care. In this review, we discuss the clinical manifestations of psoriasis in these less commonly diagnosed areas and its impact on patient quality of life. We also examine clinical studies evaluating the effectiveness of therapies on psoriasis in these regions. This article highlights the need to individualize treatment strategies for psoriasis based on the area of the body that is affected and the emerging role of biologic therapy in this regard. [ABSTRACT FROM AUTHOR]

Summary: Background: Preventive skin care programmes have shown beneficial effects on the prevalence and severity of hand eczema, but most trials only report short‐term outcomes. One such trial was the randomized Hand Eczema Trial (HET, 2009) investigating the effects of a secondary prevention programme in healthcare workers. Positive results have been reported at 5‐month follow‐up. Objectives: To examine the long‐term (42–47 months) effects of the HET. Methods: The present study was a follow‐up questionnaire study on the effect of the intervention. Outcomes were the presence and severity of hand eczema, health‐related quality of life (HR‐QoL), skin protective behaviour, and knowledge of skin protection. A supplementary outcome was general improvement/worsening of hand eczema. Results: Comparison of the outcomes at follow‐up showed no marked differences between the two groups. General improvement was reported by 70% in the intervention group and by 54% in the control group (p = 0.25). A small, statistically significant improvement was found regarding HR‐QoL in the intervention group only (p = 0.015). Conclusions: The impact of an intervention that is effective after 5 months is attenuated over time, with no long‐term effect on the outcomes examined. We suggest that skin care education should be repeated at regular intervals. [ABSTRACT FROM AUTHOR]

Summary: Background: An inverse relationship between disease severity and health‐related quality of life (HR‐QoL) in patients with hand eczema is well established, but modifying effects of demographic variables have been less well studied. Objective: To identify the influence of metropolitan versus non‐metropolitan residence on the relationship between disease severity and HR‐QoL in patients with occupational hand eczema. Methods: The city of Copenhagen and the rest of Zealand were defined as metropolitan and non‐metropolitan areas, respectively. Participants were 773 persons with occupational hand eczema. A questionnaire on the severity of hand eczema and HR‐QoL was sent to all participants. Results: The odds for reporting moderate to high severity of occupational hand eczema were significantly lower in the metropolitan population than in the non‐metropolitan population [odds ratio (OR): 0.42; 95%CI: 0.23–0.75], whereas low dermatology‐related quality of life was more prevalent in metropolitan than in non‐metropolitan patients (OR: 1.31; 95%CI: 0.83–2.05), indicating that hand eczema had a more pronounced negative effect in metropolitan patients, in spite of less severe eczema. Conclusion: Our data indicate that area of residence has a modifying effect on the relationship between disease severity and HR‐QoL, with a more negative impact on HR‐QoL in metropolitan than in non‐metropolitan areas. This information is important with respect to fully appreciating the burden of occupational hand eczema. [ABSTRACT FROM AUTHOR]

Summary: Background: Wet work is an important risk factor for occupational hand eczema. Objectives: To examine the effect of job change in workers with occupational hand eczema caused by wet work, and to evaluate the dose–response relationship between intensity of wet work and eczema. Method: The study is based on a subgroup (n = 954) from a descriptive, registry‐based study including all participants with occupational hand eczema caused by wet work recognized by the Danish Labour Market Insurance Authority in 2010 and 2011. A follow‐up questionnaire was sent out 4–5 years later (response 58%). Results: Change of profession and being outside the labour market had a positive effect on healing and improvement of hand eczema. Inverse dose–response relationships were found between the amount of time spent with wet hands at work and healing (p = 0.001) and improvement (p < 0.001), and between the frequency of hand washing at work and healing (p = 0.013) and improvement (p < 0.001). Conclusions: Leaving the profession has a positive effect on eczema; however, even minor changes in exposure to wet work were associated with healing and improvement. This information has implications with respect to advice given to patients with occupational hand eczema caused by wet work. [ABSTRACT FROM AUTHOR]

Hand knob infarction (HKI) is a rare clinical condition which is often misdiagnosed as peripheral neuropathy. This study aimed to identify the clinical characteristics and risk factors of HKI. Nine HKI patients admitted between January 2013 and March 2016 were confirmed by magnetic resonance imaging. Their medical records were collected and analyzed. The modified Rankin Scale was used to assess clinical outcomes. Routine laboratory tests, electrocardiogram, echocardiography, cranial magnetic resonance imaging, magnetic resonance angiography, computed tomography angiography, and Doppler ultrasonography examinations were performed. Seven patients had uniform involvement of all digits. One patient with radial weakness had a lesion in the lateral area of hand knob, and another patient with ulnar weakness had a lesion distributed in the medial area of hand knob. Hyperhomocysteinemia was a most common risk factor for HKI. Most HKI patients had a benign disease course, but three patients (33.33%) with the stroke type of large artery atherosclerosis had disease recurrence. We characterized clinical characteristics and risk factors of HKI which will help the diagnosis and management of HKI. [ABSTRACT FROM AUTHOR]

Background: Hand dermatitis or hand eczema (HD) is one of the most common dermatologic conditions. Lesions, scaling, pruritus and pain are chronic and relapsing. Improved HD has been reported with the probiotic composed of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2 (Bio-K+). Purpose: Investigation of the therapeutic potential of this probiotic as the sole systemic treatment for adults with nonacute HD. Subjects and methods: A single-center study documented clinical ratings and patient-reported outcomes in adults with chronic HD. The probiotic was taken orally for 12 weeks, adjunctive to standard topical treatments and preventative measures. Results: Most of the 30 subjects with mild to severe HD were compliant with the probiotic. Around 22 of the 30 subjects were able to complete the study, and of these subjects, an improvement was noted in 19. One required systemic therapy, and one subject was not able to tolerate the probiotic and therefore discontinued the study. 23% of the subjects achieved clear or almost clear hands by the end of 12 weeks. Pruritus, which was a common complaint at baseline, was improved with 59% of symptomatic patients within 2 weeks. Conclusion: It is feasible and safe to administer Bio-K+ for HD. Clinicians saw an improvement in most subjects' hands, and cases of significant improvement in dermatitis were documented. Pruritus was the most rapidly relieved symptom, as reported by patients. [ABSTRACT FROM AUTHOR]

Objective: To analyze the relationships between seven lifestyle dimensions (eating, living, sleeping & rest, sexual activity, communication, working, and learning) and three common hand diseases (carpal tunnel syndrome [CTS], trigger finger, and de Quervain's disease). These relationships were analyzed from two perspectives: whether each lifestyle dimension affects any of the diseases and whether each disease affects any off the lifestyle dimensions. Materials and Methods: A cross-sectional study was conducted with 80 patients who had been diagnosed with CTS, trigger finger, or de Quervain's disease during 2015 and 2016. The 7 lifestyle dimensions [7LSD] questionnaire and the Thai version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire were used to evaluate the patients. The association between each of the diseases and the 7 lifestyle dimensions as well as the correlation between the 7LSD questionnaire and DASH score were analyzed. Results: The living dimension affected CTS and de Quervain's disease and the working dimension affected trigger finger (p<0.05). On the other hand, all three diseases affected the living dimension and CTS affected the sleeping & rest dimension (p<0.05). The correlation between the 7LSD questionnaire and DASH score regarding the extent to which each disease affected the lifestyle dimension was moderate correlated (p<0.05). Conclusion: There is a relationship between hand diseases and three of the 7 lifestyle dimensions: the living, working, and sleeping and rest dimensions. [ABSTRACT FROM AUTHOR]