Comparison between the efficacy of Intense Pulsed Light (I.P.L.) versus Photo-Dynamic Therapy (P.D.T.) with methylene-blue in the treatment of psoriatic nails.

BACKGROUND: Nail affection is seen in up to 50 % of patients with skin psoriasis, although up to 5% of nail psoriatic patients do not complain of skin affection. Various treatment options are emerging for nail psoriasis such as intense pulsed light Tawfik, 2014). Methylene-blue (M.B) is a phenothiazine dye which is suggested to mediate cell cyto-toxicity by the generation of hydroxyl-radicals which change the intra-cellular calcium homeo-static mechanisms (Lee and Wurster, 1995). OBJECTIVES: Evaluation and comparing the efficacy of I.P.L. and methylene-blue assisted photo-dynamic therapy for treating psoriatic nails. PATIENTS AND METHODS: 20 patients with mild to moderate psoriasis with nail involvement. Sessions were performed once every 2 weeks on all the affected nails for a maximum of 3 months (6 sessions). Nail Psoriasis Severity Index (N.A.P.S.I.) score and photo-documentation were done for all the patients to assess the nail status at the first visit, after two, six sessions and three months after finishing the six session (0 m., 1 m., 3 m. and 6 m.). Nails of the right hand were treated with methylene-blue mediated photo-dynamic therapy using the Intense Pulsed Light (IPL) as the light source, while the left hand received conventional IPL (430-1200 nm) alone. RESULTS: The present study showed that both treatments were effective on nail psoriasis, but MB-PDT was more effective in nail-bed lesions. There was no significant difference regarding patient satisfaction. CONCLUSION: Both Intense Pulsed Light and methylene-blue assisted photo-dynamic therapy were safe, nearly pain-free, easy to use, and effective for treating nail psoriasis. MB-PDT is a new promising strategy for the treatment of nail psoriasis.

Massive Cerebral Air Embolism Causing Stroke Secondary to Pulmonary Tuberculosis.

Cerebral air embolism due to pulmonary tuberculosis is an extremely rare cause of stroke. We report an unusual case of a presentation of cerebral air embolism likely due to pulmonary tuberculosis lesions during a severe cough. We discuss the relationship between the pulmonary tuberculosis and the occurrence of the cerebral air embolism. A 55-year-old man with lung tuberculosis suddenly experienced a nontraumatic loss of consciousness after a severe cough. The magnetic resonance imaging confirmed an ischemic stroke due to cerebral air embolism. The thoracic scan revealed tuberculosis with a parenchymatous cavity. Patients with intrapulmonary tuberculosis cavities should be strongly considered for surgical repair and should be warned about the risk of rupture of the cavity in the situation of increasing thoracic pressure. How to cite this article: Bouaggad A, Moussaoui M, Abassi O, Hassen S, Essodegui F. Massive Cerebral Air Embolism Causing Stroke Secondary to Pulmonary Tuberculosis. Indian J Crit Care Med 2021;25(8):942-944.

Assessment of the Effect of Vitiligo on Subfoveal Choroidal Thickness Using Spectral-Domain Optical Coherence Tomography.

BACKGROUND: Vitiligo is a common skin condition affecting 0.5-2% of the population. The exact etiology of the condition is unknown, but the result is autoimmune destruction of melanocytes. The eye is rich in melanocytes, especially in the retinal pigment epithelium and choroid. Little is known about the effect of vitiligo on the choroid of the eye. METHODS: We cross-sectionally examined 31 right eyes of 31 vitiligo patients and 32 right eyes of 32 age- and sex-matched controls for signs of vitiligo affection and then measured the subfoveal choroidal thickness (SFCT) using spectral-domain optical coherence tomography. RESULTS: There was a statistically significant difference between SFCT in the cases group and the control group (Mean ± SD: 251.9 ± 42.0 µm and 296.8 ± 46.4 µm, respectively, p = 0.0002). The thickness correlated negatively with age (r = -0.5) but did not correlate significantly with disease severity or duration (r = -0.201, -0.1781, p = 0.2783, 0.3381, respectively). Additional examination findings included iris and fundus hypopigmented spots, and peripapillary atrophy. CONCLUSION: SFCT is reduced among patients with vitiligo. The clinical implications of such a finding should be studied further, and eye screening programs should be considered.