Editor's Note, Volume 3 Issue 6

A Strange Looking Toenail

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Green nail syndrome is a paronychia caused by Pseudomonas aeruginosa. The affected toenail may show discoloration that ranges from greenish-yellow, greenish-brown, and greenish-black. Differential diagnosis includes other conditions causing nail plate discolouration such as subungual hematoma, malignant melanoma or infections by other pathogens including Aspergillus, Candida, and Proteus. Gram stain and culture of the subungual scrapings confirm the diagnosis of suspected pseudomonas aeruginoa infection. Topical antibiotics, such as bacitracin, silver sulfadiazine, or gentamicin, applied 2 to 4 times daily will treat most patients within 1 to 4 months. Oral ciprofloxacin for 2 to 3 weeks has been successful in treating patents who fail topical therapies.

Identification of Potential or Preclinical Cognitive Impairment and the Implications of Sophisticated Screening with Biomarkers and Cognitive Testing

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The last decade has seen an enormous growth in the interest in the recognition of and intervention in those diagnosed and living with the whole range of cognitive impairment and frank dementia. In the western world, the recognition of the impact on patients, families, health care systems, and societies that dementia poses has led to great efforts to help define the indicators for current and future dementia with the intention to treat those already afflicted even with the primarily symptomatic medications that exist and to recognize those at future risk with the hope of providing counselling to forestall its future development. The idea of "early diagnosis" appears at first glance to be attractive for the purposes of future planning and research studies, but it is not clear what the benefits and risks might be if screening processes define people at risk when beneficial interventions might not yet be determined. The ethical as well as financial implications must be explored and defined before implementation of such screening becomes a normal standard of practice.practice.
Key Words: cognitive impairment, dementia, screening, biomarkers, cognitive testing.

Cholesteatoma with Right Facial Paralysis A Case Report

P.K. Shenoy, MD, FRCS, DLO, FACS, ENT Service Chief, Campbellton Regional Hospital, Campbellton, NB, Canada.

Dr.K.B.Bali, MBBS, MS, FACS, Senior ENT Specialist, Al Ain Hospital, Al Ain, UAE.

Abstract
Cholesteatoma is a benign growth of skin in abnormal location such as the middle ear or the petrous apex which is located deep in the inner ear and is known to cause a variety of complications. We describe a patient with a cholesteatoma who had right facial paresis that improved after the removal of the cholesteatoma. Review of the literature regarding cholesteatoma is discussed.
Key Words: cholesteatoma, labrynthine fistula, facial paresis, attic defect, primary acquired, secondary acquired.