A 66-year-old man with diabetes and cirrhosis due to chronic hepatitis C infection (HCV RNA >1,000,000 IU/mL) developed a creatinine rise from 0.5 mg /deciliter to 2.6 mg/deciliter. The patient's fingernails demonstrated significant changes compared to a normal fingernail, with a white band (lunula) occupying more than 50 % of the nail bed proximally, suggestive of Lindsay's nail. (Figs. 1 and 2) Renal biopsy demonstrated membranoproliferative glomerulopathy and he was started on hemodialysis.A clinical differentiation between Lindsay's nail (half-andhalf nail) and Terry's nail is difficult. In Lindsay's nail, the proximal part of the nail is white, while the distal portion occupying 20 % to 60 % of nail bed is reddish-brown and does not fade with pressure. 1,2 The cause of Lindsay's nail is unclear, but the distal reddish-brown band might be the result of an increased concentration of β-melanocyte-stimulating hormone. 2 This condition can be found in up to 40 % of patients of chronic kidney disease. 1 On the other hand, Terry's nail is defined as a 0.5-3.0 mm brown to pink distal band with proximal nail bed whiteness occupying approximately 80 % of nail bed. 3 This condition is frequently associated with cirrhosis, chronic congestive heart failure, and adult-onset diabetes mellitus. 3

The combination of a calcium channel blocker (CCB) and a blocker of the renin-angiotensin-aldosterone system (RAAS) is recommended in clinical practice guidelines. L/N- and L/T-type CCBs might provide an additional effect on lowering proteinuria. Therefore, we conducted a meta-analysis to assess the efficacy of L/N- and L/T-type CCBs in hypertensive patients with proteinuria. We searched MEDLINE, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCTs) that examined the effect of L/N- and L/T-type CCBs as add-on therapy compared with standard antihypertensive regimen for proteinuria on hemodynamic and kidney-related parameters in hypertensive patients with proteinuria. Random-effect model meta-analyses were used to compute changes in the outcomes of interest. We identified 17 RCTs, representing 1905 patients. By meta-analysis, L/N- and L/T-type CCB add-on therapy did not yield significant changes in systolic and diastolic blood pressure compared with standard treatment, but there was a significant lowering of the pulse rate. However, L/N- and L/T-type CCBs resulted in a significant standardized net decrease in albuminuria and proteinuria (-1.01; 95% confidence interval (CI), -1.78 to -0.23; P=0.01), and a standardized net improvement in the estimated glomerular filtration rate and serum creatinine (0.23; 95% CI, 0.11 to 0.35, P<0.001; and -0.25; 95% CI, -0.46 to -0.03; P=0.02, respectively). Despite no additional lowering effect on blood pressure, L/N- and L/T-type CCBs combined with a blocker of the RAAS provided a decrease in proteinuria and improvement in kidney function. Further studies are required to establish the long-term kidney benefits of this combination therapy.

Introduction Psoriasis is a chronic inflammatory and immunemediatedskin disease that affects over 7.2 million U.S. adults. Currenttreatment has improved clinical outcomes. Vitamin D is believed toaffect the proliferation and regeneration of keratinocytes; therefore,its deficiency is a possible risk factor; however, there is still no definiteevidence. The objective of this study was to synthesize existing dataon the relationship between hypovitaminosis D and psoriasis. Methods. A meta-analysis of relevant studies was conducted bydoing a comprehensive search in the MEDLINE, EMBASE, and theCochrane Central Register through July 2018 to identify relevantcohort studies and to assess serum 25-hydroxyvitamin D (25(OH)D) levels in adults with psoriasis. The primary outcome was the meandifference in serum 25(OH)D level between psoriatic patients andcontrols. Results The initial search identified 107 articles. Only ten studiesmet the criteria for full-paper review. Meta-analysis was conductedfrom ten prospective cohort studies involving 6,217 controls and 693cases. The pooled mean difference in serum 25(OH)D level betweenpsoriatic patients and controls was -6.13 ng/ml (95% CI, -10.93 to-1.32, p-value = 0.01). The between-study heterogeneity (I2) was98%, p < 0.00001. Conclusion Our meta-analysis was the first study to establish therelation between vitamin D and psoriasis. The result found a significantrelationship between low 25(OH) D levels and psoriasis, but didnot establish a causal relationship. Further studies will be requiredto establish whether vitamin D supplementation benefits patientswith psoriasis.

Background The coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection. Methods A retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed. Results A volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE ® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home. Conclusion Diabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.