Psoriasis is a chronic autoimmune inflammatory disease involving predominantly skin, nails and joints. Two hundred cases of psoriasis were investigated and treated in a hospital of North India and a very high incidence of parasitic infestations was noted among these patients. Deworming therapy along with standard treatment resulted in excellent relief and prolonged remissions in these cases. A new hypothesis is proposed regarding how the deworming therapy helps in improving the results in Psoriasis.

BACKGROUND Nail involvement in psoriasis is likely to influence the quality of life (QOL) because of its highly visible site; however, the impact of this disease on QOL is an underexplored area. Similarly, the relationship between severity of skin involvement and nail involvement has been overlooked. The study was conducted to evaluate the clinico-epidemiological characteristics of psoriasis patients with and without nail changes and assess the health-related quality of life (HRQOL). Furthermore, the correlation of severity of nail involvement with the severity of skin involvement and its impact on quality of life was assessed. METHODS A total of 370 adult psoriasis patients with or without nail changes was studied. Skin severity was assessed by body surface area (BSA) and Psoriasis Area and Severity Index (PASI) while nail severity was assessed using Nail Psoriasis Severity Index (NAPSI). Patients’ quality of life was measured using the Nepali Version of Dermatology Life Quality Index (DLQI). RESULTS Nail psoriasis was more prevalent in males in both the groups; females were having more nail involvement (0.041). There were no significant diff erences in other clinico-epidemiologic characteristics between these two groups except the late onset of psoriasis in the age group > 30 years, scalp involvement and absence of family history of psoriasis (P ≤ 0.05). There was a strong positive correlation between the age of onset of skin changes with age of onset of nail involvement (r = 0.799) and the joint involvement (r = 0.742) as well as the age of onset of joint involvement with nail changes (r = 0.838). The mean PASI was 7.265 ± 7.153 vs. 6.189 ± 7.153 in patients with > 10 vs. ≤ 10 total NAPSI score and it was statistically significant (P = 0.011), however, there was a moderate positive correlation between PASI and NAPSI (r = 0.32). Almost half of psoriasis patients had very large to extremely large effects on quality of life but leisure and treatment domain were affected more amongst patients with nail changes. Early onset of joint involvement, body surface area of > 3 % involvement and PASI score > 5 had significant effect on quality of life. CONCLUSIONS The nail involvement is an important finding in determining the severity of skin involvement and had very large to extremely large effect on quality of life particular on leisure and treatment domain. Therefore, nail examination must be done in all psoriatic patients. KEYWORDS Nail Psoriasis, Quality of Life, Dermatology Life Quality Index, Psoriasis Area and Severity Index, Nail Psoriasis Severity Index

Psoriasis is a common chronic autoimmune inflammatory multisystem disease mainly involving skin, nails and joints. Several studies have reported lower levels of vitamin D and calcium in psoriasis. But there is paucity of literature regarding levels of vitamin D and calcium in nail psoriasis. Objective: To study the level of Vitamin D and calcium in psoriasis patients with nail involvement and to correlate their levels with nail severity using Nail Psoriasis Severity Index (NAPSI). Materials and Methods: A total of 60 psoriasis patients with nail changes were recruited for the study. The severity of nail changes was calculated using Nail Psoriasis Severity Index (NAPSI). All non-specific nail changes which were present in the psoriasis patients were noted as well. Apart from routine investigations, blood calcium level and serum vitamin D levels were also sent for investigation. Results: Majority of the participants were male with male: female ratio of 2.75:1. The mean age at of onset of nail involvement was 42.87 ± 17.19 years. About three-fourth of the patients were hypocalcaemic and vitamin D deficient or insufficient. There was a moderate negative correlation between NAPSI and blood calcium (mg/dL), and it was statistically significant (rho = -0.33, P = 0.011). There was a weak positive correlation between NAPSI and S. Vitamin-D (ng/mL), and this correlation was not statistically significant (rho = 0.11, P = 0.402). However, on multivariate regression analysis of NAPSI, significant association was found between nail psoriasis severity index (NAPSI) with blood calcium level and serum vitamin D levels (P=0.01). Conclusion: Blood calcium and serum vitamin D levels were found low in patients of nail psoriasis. Hence, oral vitamin D and calcium supplementation may aid in the earlier response to standard nail psoriasis treatment and further studies are required to prove the therapeutic effect of calcium and vitamin D in nail psoriasis.

Access to education is considered as an important determinants of women's decision making. Women's increased education is positively associated with autonomy of decision making in different activities. The main objective of this study was to measure the impact of women's education on decision making regarding their children affairs. The study was conducted taking selected women from the study area of Prayagraj city. For finding the object, pretested interview schedule was used for collecting the data. The data was tabulated and statistically analyzed by using appropriate techniques. The result revealed that the majority of the respondents of the educated group had 'high' and 'moderate' level of decision-making whereas only a few respondents from noneducated group had such level of decision-making power. It's observed that woman's decision making increases, when they are empowered with education. Finally, the study suggests that interventions are necessary especially for uneducated women who enjoy less freedom and less power in decision-making regarding their children affairs. These interventions refer to increasing education and income opportunity for women that might increase their decision-making power as well as their empowerment.

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