The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices.

BACKGROUND: Onychomycosis is difficult to treat and a concern for many patients. Prevalence estimates of onychomycosis in North American clinic samples have been higher than what has been reported for general populations. OBJECTIVE: A large, multicentre study was conducted to estimate the prevalence of toenail onychomycosis in the Canadian population. METHODS: Patients were recruited from the offices of three dermatologists and one family physician in Ontario, Canada. Nail samples for mycological testing were obtained from normal and abnormal-looking nails. This sample of 32 193 patients includes our previous published study of 15 000 patients. RESULTS: Abnormal nails were observed in 4350 patients. Of these, the prevalence of culture-confirmed toenail onychomycosis was estimated to be 6.7% (95% CI, 6.41-6.96%). Following sex and age adjustments for the general population, the estimated prevalence of toenail onychomycosis in Canada was 6.4% (95% CI, 6.12%-6.65%). The distribution of fungal organisms in culture-confirmed onychomycosis was 71.9% dermatophytes, 20.4% non-dermatophyte moulds and 7.6% yeasts. Toenail onychomycosis was four times more prevalent in those over the age of 60 years than below the age of 60 years. CONCLUSION: The present data highlights that onychomycosis may be a growing medical concern among ageing patients.

Determination of magnesium at trace levels by isotope dilution.

A mass spectrometric method for the isotopic analysis of magnesium and its determination at low concentrations in the presence of an excess of other elements is described. The lowest level at which magnesium was determined was 1 ppm with a precision and error +/- 1%.

Effects of chemical occlusion of vas deferens on the reproductive organs in gerbil Meriones hurrianae Jerdon.

PIP: Male gerbils were sterilized by giving a single injection of a sclerosing chemicial (5% KMnOH) directly into the vasa. After 3 weeks the gerbils were killed. Testes, accessory sex organs, and thyroid and adrenal glands were removed and weighed. Halves of testis and epididymides were fixed in Bouin's fluid fo r microscopic study. The remaining halves were frozen and total RNA, protein, sialic acid, seminal vasicular fructose, and testicular lipids were later determined. Cholesterol estimations were also made. 2 weeks following vas injections animals were tested by exposing them to cycling estrous females. 21 days later the females were examined for possible implantation sites. It was shown that the males had been sterile. Weights of testicles, accessory sex organs, thyroid and adrenal gland remained normal, except that there was a significant increase in the weight of the ventral prostate. No histological changes were found in the testes. Protein content of the testes, epididymides, and seminal vesicles did not change. A decrease in RNA was noted. Sialic acid levels did not alter. Cholesterol and total lipids were normal. Alkaline phosphatase activity in the testes and epididymides had not changed after 3 weeks. Vasicular fructose was normal. Complete occlusion of the vasa resulted. After 100 days there was no return to fertility. The results appear to be permanent.^ieng

Effects of cyproterone acetate on the testicular function of bat (Rhinopoma kinneari Wroughton).

1-Cyproterone acetate administration (0.2 mg/day/animal for 25 days) caused widespread testicular necrosis. The lumen of the epididymides were devoid of spermatozoa. The RNA, protein, sialic acid and phosphatase enzyme activity of the testes were reduced. Serum transaminase enzyme activity was slightly changed. Haemoglobin, hematocrit, blood sugar, and blood urea levels were in the normal range. Regressed Leydig cell tissue and decreased production of RNA and sialic acid in the testes could be due to the antiandrogenic action produced by cyproterone acetate.

Effects of alpha-chlorohydrin and gonadectomy on the adenohypophysial cells of male rats and gerbils.

PIP: The cytological changes occurring in the gonadotropic cells of the anterior lobe of the pituitary in 30 male rats and 30 male gerbils after administration of alpha-chlorohydrin were compared with those occurring following bilateral gonadectomy. A decline in the weights of testes and accessory sex glands and inhibited spermatogenesis were noted in rats and gerbils following alpha-chlorohydrin administration. Alpha-cholorohydrin changed the appearance of the delta-basilphils, cell cytoplasm showed fine granulation and vacuolization, and castration vacuoles appeared in many delta-basiphils of the anteroir lobe of the pituitary. The compound brought about transient changes resembling those of castration in the anterior lobe of the pituitary of male rats and gerbils. In gerbils, there was also a marked decrease in the number of acidophils. The results show that alpha-chlorohydrin exerts its effects on androgen-dependent structures, e.g., seminal vesicles, ventral prostrate, epididymides, and perineal complex.^ieng

Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists' offices in Ontario, Canada--a multicenter survey of 2001 patients.

BACKGROUND: Questionnaire studies have been used to determine the prevalence of onychomycosis in the United Kingdom and Europe. One disadvantage of this methodology is that the patient self-diagnoses the onychomycosis. There have been very few large studies involving clinical examination of the nails of subjects, followed by mycological confirmation of the onychomycosis. We therefore determined the prevalence of onychomycosis in patients visiting dermatologists' offices in Ontario, Canada. METHODS: In a prospective, multicenter study, the finger- and toenails of all new patients presenting to dermatologists' offices were examined by a board-certified dermatologist. If there was clinical suspicion of onychomycosis, then nail samples were obtained for mycological examination at a central laboratory. Patients referred specifically for the management of onychomycosis were excluded. RESULTS: Toenails appeared abnormal in 455 (22.7%) of 2001 patients. Mycologically-confirmed pedal onychomycosis was present in 182 (9.1%) of the 2001 patients. The estimated value of the prevalence of onychomycosis in Ontario is 6.86% (95% confidence interval (CI): 5.8-8.0%), when corrected for age and sex of the general population using census data. Onychomycosis increased with age (P < 0.0001). The odds of males having onychomycosis was 84.3% greater than females of the same age (P = 0.0003). The distribution of organisms in the 141 patients with pedal onychomycosis who were culture positive was: dermatophytes 131 (92.9%), Candida species 4 (2.8%) and non-dermatophyte molds 6 (4.3%). CONCLUSIONS: The prevalence of mycologically-confirmed toenail onychomycosis was 9.1%, with the estimated prevalence in Ontario being 6.86%. The majority of patients with abnormal-appearing nails were unaware they might have onychomycosis, that it is infectious and potentially treatable, suggesting that there is potential for increased public awareness and education.

Prevalence and epidemiology of onychomycosis in patients visiting physicians' offices: a multicenter canadian survey of 15,000 patients.

A prospective, multicenter study to determine the epidemiology of onychomycosis was performed in the offices of 3 dermatologists and 1 family physician in Ontario, Canada. In the sample of 15,000 patients, abnormal-appearing nails were observed in 2505 persons (16. 7%). There were 1199 patients (8%) with toenail or fingernail onychomycosis confirmed on mycologic examination, with 1137 patients (7.6%) who had only pedal onychomycosis, 40 patients with toenail and fingernail onychomycosis (0.27%), and 22 patients (0.15%) with only fingernail onychomycosis. The condition was more common in male patients (P <.0001) and older persons (P <.0001). The ratio of onychomycosis in toenails/fingernails was 19:1. When onychomycosis was present in toenails, the ratio of distal/lateral subungual onychomycosis (DLSO) to white superficial onychomycosis to proximal subungual onychomycosis was 360:59:1. The extent of DLSO in toenails was mild (< or =25% nail involvement), moderate (26%-74% disease), and severe (> or =75% nail involvement) in 27.6%, 39.9%, and 32.5% of patients, respectively. After adjusting for the age and sex distribution of the general population, the projected rate of onychomycosis in Canada is 6.5% (95% confidence interval [CI], 6. 1%-6.9%). The organisms causing toenail onychomycosis were 90.5% dermatophyte, 7.8% nondermatophyte molds, and 1.7% Candida spp. The corresponding organisms causing fingernail onychomycosis were 70.8%, 0%, and 29.2%, respectively. In a large sample of 15,000 patients, abnormal-appearing nails were present in 17% of the sample with mycologic evidence of toenail or fingernail onychomycosis in 8%. The projected prevalence of onychomycosis in Canada is 6.5% (95% CI, 6. 1%-6.9%).

A higher prevalence of onychomycosis in psoriatics compared with non-psoriatics: a multicentre study.

There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared to non-psoriatics. We therefore measured the prevalence of toenail onychomycosis in psoriatics and non-psoriatics attending dermatologists' offices. None of the patients had a referring diagnosis of onychomycosis. The prevalence of pedal onychomycosis in psoriatics (n = 561) was 13%. The odds of patients with psoriasis having onychomycosis was 56% greater than non-psoriatics of the same age and sex (P = 0.02). In the psoriatics, when the toenails were clinically abnormal, the prevalence of onychomycosis was 27%. The odds of developing onychomycosis increased with age (P < 0.0001) and the odds of men developing onychomycosis was 2.5 times that of women (P = 0.0001). The duration of psoriasis did not significantly affect the odds of developing onychomycosis. The fungal organisms recovered from psoriasis subjects with onychomycosis were similar to those in the normal population with onychomycosis (P = 0.58).