and other aspects of factitious wealing (dermographism). Br J Dermatol 1971;85:331-5. 4. Kaplan A.P., Clinical practice: Chronic urticaria and angioedema. N Engl J Med 2002;346:175-9. 5. Mathews CN, Kirby JD, James J, Warin RP. Dermographism: reduction in wheal sizeby chlorpheniramine and hydroxyzine. Br J Dermatolol 1973;88:279-82. 6. Ryan TJ, Shim-Young N, Turk JL, Delayed pressure urticaria. Br J Dermatol 1968;80:485-90. 7. Godse KV. Diagnosis of delayed pressure urticaria. Indian J Dermatol Venereol Leprol 2006;72:155-6. 8. Sukan M. The problems in sexual functions of vitiligo and chronic urticaria patients. J Sex Marital Ther 2007;33:55-64. 9. Estes SA, Yung CW. Delayed pressure urticaria: an investigation of some parameters of lesions induction. J Am Acad Dermatol 1981;5:25.

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Numbness, tingling and burning sensation of extremities, prayer sign, finger pebbling, skin tags, stiff joints and acanthosis nigricans were associated with diabetes mellitus among elderly persons in a village in Kerala.

Context: Assessment of peripheral nerves in leprosy by clinical methods is subject to considerable inter-observer variability. High resolution ultrasonography (HRUS) can assess peripheral nerves more objectively. Aims: To compare the findings of peripheral nerve involvement in newly diagnosed cases of leprosy by clinical and sonological methods. Settings and Design: Cross sectional study in a tertiary care teaching hospital. Subjects and Methods: Four pairs of peripheral nerves of 40 newly diagnosed patients with leprosy were examined clinically and by HRUS. Statistical Analysis Used: Agreement between clinical examination and HRUS using kappa statistic; sensitivity; specificity; and predictive values. Results: Of the 320 nerves examined, 71 (22.18%) were abnormal clinically and 63 (19.7%) sonologically. Sonological abnormalities were increased cross sectional area (n = 63; 100%), hypoechogenicity with loss of fascicular architecture (n = 46; 73%) and increased vascularity (n = 35; 55.6%). There was moderate agreement (Cohen's K = 0.59) between clinical and sonological findings. HRUS findings were abnormal in 18 (7.2%) nerves that were clinically normal. HRUS was normal in 26 (36.6%) nerves which were clinically abnormal. Sensitivity of HRUS compared to clinical examination was 63%; specificity 92.7%; positive predictive value 71.4%; and negative predictive value 89.9%. Increased cross sectional area agreed with clinical findings the most. Conclusions: HRUS has low sensitivity (63%) and high specificity (92.7%) to identify abnormal peripheral nerves in leprosy, compared to clinical examination. It could detect abnormality of some (n = 18, 7.2%) clinically normal nerves, but showed normal findings of some nerves (n = 26, 36.6%), which were considered clinically abnormal.

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