Treating nail psoriasis is often a time-consuming challenge with an unsecure outcome. Response to the treatment is variable and relapses are common. Systemic treatments have multiple systemic side effects and lack of the patient compliance makes intra-lesional therapies not the best choice for treatment of nail psoriasis. We aimed to evaluate and compare the efficacy and side effects of methotrexate versus calcipotriol plus betamethasone two-compound formula when applied topically to psoriatic nails after fractional CO2 laser. This comparative pilot study included 20 patients with nail psoriasis. One side was treated with fractional CO2 laser followed by the application of topical methotrexate (Group A) and the other side with fractional CO2 laser followed by topical (Calcipotriol 0.05 mg/gm + Betamethasone 0.5 mg/gm) (Group B). 4 sessions were done, once every 2 weeks. There was a high statistical significant decrease in total NAPSI score in group A at 1(P = 0.000) and 2 months (P = 0.000). There was a high statistical significant decrease in total NAPSI score in group B at 1(P = 0.001) and 2 months (P = 0.001). There was no statistical significant difference regarding total NAPSI score between both group A and B at 0 (P = 0.271), 1(P = 0.513) and 2 months (P = 0.647). Combined fractional CO2 laser with either topical MTX or topical betamethasone plus calcipotriol two-compound formula is effective treatment for nail psoriasis.

Background Nail psoriasis is a distressing clinical condition as it is known that psoriasis on visible areas of the skin, such as the face, hands and nails, may have a substantial negative impact on physical, psychological, and social dimensions of quality of life. The additional negative consequences of nail involvement in psoriasis are pain, inability to grasp small objects, tie shoe laces or button clothes, and cause an altered sense of fine touch. Objective To evaluate and compare the efficacy, safety and side effects of co2 laser combined with topical methotrexate in one side and topical (calcipotriol +betamethasone) in the other side of the patient for the treatment of nail psoriasis. Patients and Methods This comparative pilot study included 20 patients with nail psoriasis. They were recruited from the dermatology out-patient clinic of Ain–Shams University Hospitals, during the period from March 2019 till October 2019. The study was approved by Research Ethical Committee of Ain Shams University (FMASU M S 71/2019) and fulfilled all the ethical aspects required for a human research. Results Our study revealed that both medications showed marked statistical and clinical improvement of the nail condition in a period of 2 months when applied topically after nail exposure to fractional co2 laser which facilitated the delivery of both medications through the nail plates to the site of the psoriasis inflammation in therapeutic concentrations by creating pores through the nails. There was no statistical or clinical difference between both medications regarding the improvement of the NAPSI scores or the level of patient satisfaction. However, there were some nail symptoms that didn’t show any improvement as (sub-ungual hyperkeratosis and nail ridging). Conclusion Our treatment protocol’s side effects based mainly on the action of fractional co2 laser which caused pain and nail bleeding during sessions for some of the patients in each group, while topical methotrexate caused nail yellowish discoloration for the all involved group. However, these side effects lasted for very short time and didn’t have any impact on the level of the patient satisfaction. There was no statistical difference in the level of the patient satisfaction between both groups.

Introduction: Laparoscopic Sleeve Gastrectomy (LSG) has become the most commonly performed bariatric procedure. LSG is known for its safety and effectiveness, shorter operative time, feasibility, and easiness of revision and conversion to a malabsorptive surgery. Surgeons are tailoring different techniques to avoid complications from arising. Twisting of the sleeved gastric tube is one of the causes of sleeve obstruction and persistent nausea and vomiting. This study aims to compare between the postoperative complications in sleeve gastrectomy with and without posterior fixation. Patients and methods:In this prospective comparative cohort study 643 patients were included; divided into two groups according to the surgical technique. Group 1 included 364 LSG operations without fixation and Group 2 included 279 LSG with sleeve fixation. The operations were performed at Ain Shams University Hospitals between June 2017 and June 2021. Fixation of the sleeve was performed by two or three absorbable stitches to the prepancreatic fascia and root of the mesocolon. Incidence of postoperative complications were compared in each group.Results: There were no statistically significant differences in baseline characteristics between the two groups included in the study. Group 2 showed highly significant increase in operative time (p<0.001) the overall incidence of complications was significantly less in the fixation group (p <0.0001). Incidence of vomiting, bleeding, GERD and re-operation was significantly lower in group 2 (p<0.05).Seven patients from group 1 were diagnosed with gastric twist as post operative complication with one patient suffering from leakage compared to three patients in group 2. There were no mortalities in both groups. Conclusion:Adding posterior fixation to LSG ensures decreases incidence of complications. Many randomized controlled trials are needed to draw a solid outcome.

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