Ultrasound clinical references of the healthy toenail unit.

The toenail unit, commonly called the nail, is one of the most frequently examined and treated structures in clinical podiatry. Ultrasound is a standard clinical technique because it is a noninvasive, painless, and rapid diagnostic tool. The main objective of this study was to obtain morphometric data of the healthy toenail unit by ultrasound for clinical application. The nails of 76 participants (152 hallux nails; 38 men, 38 women, average age 26.83 ± 12.20) were examined using a VINNO E35 ultrasound system and an X6-16L linear probe with a frequency of 18 MHz. Five ultrasound measures of the healthy toenail unit were obtained, of which only the distance from the center of the distal phalange to the nail plate varied with age, sex, weight, and foot (p-values ≤ 0.050). The other four parameters were less influenced by the variables analyzed, except sex, which influenced nearly all (p-values ≤ 0.050). In one of these variables, indications of significance were observed (p-values = 0.060), with greater distances in the men than in the women, except for nail plate curvature, which showed a higher value. The other variables studied did not influence the parameters analyzed. High-frequency ultrasound can be used to examine the healthy toenail unit and define anthropometric reference measurements that can be used for more accurate and comparative diagnosis.

Evolución del uso en los tratamientos de las verrugas plantares / Evolution of use in the treatments of plantar warts

Objetivo: Las verrugas plantares son lesiones cutáneas causadas por el virus del papiloma humano, teniendo una prevalencia en torno al 12 % en la población general. Sus tratamientos han evolucionado a lo largo de los años, por lo cual el objetivo principal del estudio fue conocer cómo ha evolucionado el uso de los distintos tratamientos físicos y químicos para verrugas plantares en España. Material y métodos: Se realizó un estudio longitudinal mediante una encuesta en dos periodos de tiempo diferentes, a través de un formulario de Google-Forms con 17 preguntas, con el fin de recopilar datos de podólogos en activo que tuvieran experiencia clínica en el tratamiento de verrugas plantares y que trabajasen en España. Se obtuvo un total de 889 respuestas procedentes de los 17 colegios de podólogos de España en ambos periodos. Resultados: Los resultados indicaron un aumento en el uso del láser (6.1 %), pasando a ser tratamiento de primera elección en el segundo periodo, y un aumento en el uso de cantaridina (8.0 %). Además, se mostró una disminución en el uso de crioterapia (14.5 %), ácido monocloroacético/tricloroacético (13.0 %) y ácido nítrico (2.3 %), aunque este último se mantiene como tratamiento de primera elección en ambos periodos. Conclusiones: La aparición de nuevos tratamientos menos invasivos y menos dolorosos, como el láser, provoca que otros tratamientos se vean desplazados, entre los que se encuentran algunos ácidos.(AU)

Aims: Plantar warts are skin lesions caused by the human papilloma virus, with a prevalence of around 12 % in the general population. Its treatment has evolved over the years, so the main objective of the study is to find out how the use of different physical and chemical treatments for plantar warts in Spain has evolved through a longitudinal study. Material and methods: A survey was carried out through a Google-Forms form with 17 questions to collect data from active podiatrist clinicians, who had clinical experience in the treatment of plantar warts and who work in Spain. Results: A total of 889 responses were obtained from the 17 podiatry associations in Spain in both periods. The results indicated an increase in the use of the laser (6.1 %), becoming the treatment of first choice in the second period, and an increase in the use of cantharidin (8 %). In addition, a decrease in the use of cryotherapy (14.5 %), monochloroacetic/trichloroacetic acid (13 %) and nitric acid (2.3 %) is shown, although the latter remains as a first-choice treatment in both periods. Conclusions: The use of the different treatments against plantar warts has been modified over a period of 7 years, increasing in physical treatments such as laser and decreasing chemical treatments such as cryotherapy or monochloroacetic/trichloroacetic acid. The appearance of new treatments, less invasive and less painful, causes other treatments to be displaced.(AU)

Comparative Analysis of Type I Keratin Expression By Nail Consistency: An Immunohistochemistry Study.

The nail plate is one of the essential structures of the nail apparatus and is highly keratinized, making it difficult to handle this tissue experimentally. Different types of nail consistency were identified by applying distal pressure to the nail plate. To analyze the relationship between the keratins expressed in the nail plate and nail consistency, we chose a sample of 32 adult individuals (age 49.81±3.21 y) with the same number of each sex, who had a similar percentage of nail consistency types (56.25% hard consistency nails and 43.75% soft consistency nails). Immunohistochemical analyses showed that hard consistency nails contain more keratin 17 than soft consistency nails (P=0.026). These novel results allow nail consistency to be defined by the differential expression of keratins in the nail plate, and have potential clinical implications for the diagnosis of possible nail disorders and/or systemic disease.

Meta-analysis of the antifungal activities of three essential oils as alternative therapies in dermatophytosis infections.

AIMS: This work examines the available scientific evidence about the efficiency of essential oils (EO) as an alternative therapy to traditional treatment of fungal infections, including onychomycosis, assessing the effect of the three EO most frequently studied for their antifungal activity (thyme, cinnamon and tea tree EO) against three causative agents of fungal diseases in humans: Trichophyton rubrum, Trichophyton mentagrophytes complex and Candida albicans. METHODS AND RESULTS: The PRISMA statement protocol was followed to conduct a bibliographical search and 54 articles that met all the inclusion criteria were retrieved. Differences were observed in the MIC and MFC values depending on the micro-organism strain and the EO used. The lowest MIC were observed with Cinnamomum zeylanicum EO (0.013-1120 µl ml-1 ) against the three micro-organisms. For MFC, the lowest value was found for Thymus vulgaris EO (4.2 µl ml-1 ) against Trichophyton rubrum. CONCLUSIONS: The antifungal effects of EO could be a very promising solution to overcome the therapeutic shortcomings of antimycotic medication. More experiments are needed to examine the properties of these oils to devise effective and nonaggressive therapies for treatment of dermatophytosis. SIGNIFICANCE AND IMPACT OF STUDY: The results indicate that EO remain good candidates for future treatments and could provide a solution for failed medications and/or adverse reactions to current pharmacological treatments.

Differences in Hygiene Habits among Children Aged 8 to 11 Years by Type of Schooling.

Personal hygiene is one of the basic activities in the care of our body. Parents are responsible for their children's hygiene to prevent infections and keep them healthy. However, children must acquire hygiene habits correctly and independently. This study examines the sociodemographic profile, hygiene habits and knowledge, and level of autonomy of children who are starting to perform their personal care autonomously to identify the areas in which their habits could be improved. A descriptive cross-sectional study was conducted concerning 125 children aged 8-11 years attending schools in northern Extremadura, Spain. The children were surveyed with the HICORIN® questionnaire and the resulting data were statistically processed with SPSS 22.0 (IBM, Armonk, NY, USA). The majority of participating children required help to perform personal hygiene activities. Children in preferential schooling (PS) require less help than children in mainstream schooling (MS) but have less knowledge about personal hygiene. Different habits were observed in the frequency and time of day for performing personal hygiene between groups (p-values < 0.005). In general, more than 80% of children aged 8 to 11 years are not autonomous in some aspect of their personal hygiene, and they are not all familiar with personal hygiene. Because of this, it is necessary to conduct theory and practical workshops with children who must acquire correct personal hygiene habits autonomously to prevent infection and promote health.

Predictive Model of Nail Consistency Using Scanning Electron Microscopy with Energy-Dispersive X-Ray.

The nail plate is made up of tightly packed keratin-rich cells. Factors such as the special distribution of the intermediate filaments in each layer (dorsal, intermediate, and ventral), the relative thickness of the layers, and their chemical composition define the characteristics of each nail. The main objective of this study is to determine nail consistency by calculating a predictive model based on elemental composition analysis using scanning electron microscopy. Nail consistency was determined in 57 participants (29 women and 28 men) in two age groups (young people and adults). Elemental composition was analysed in each layer using scanning SEM-EDS, and nail plate thickness was measured by image analysis. A total of 12 elements were detected in nail plates, of which carbon, nitrogen, phosphorus, sulphur, and calcium showed significant differences between layers (p-values ≤ 0.01). The level of calcium in the dorsal layer was the main predictive variable in calculating the predictive model of consistency, with 75.4% correctly classified cases. Elemental analysis in each layer of the nail plate by SEM-EDS can be used to develop a predictive model of nail consistency that will help health professionals to objectively determine nail consistency.

Prevalence of foot disorders according to chronic kidney disease stage.

BACKGROUND: Chronic kidney disease (CKD) is a public health disease that affects 15.1% of the adult population. Although a high prevalence (94.1%) of skin disorders has been detected in people on haemodialysis or with advanced CKD, few studies have analysed foot disorders at initial CKD stages. OBJECTIVES: To analyse the prevalence of foot disorders according to CKD stage. PARTICIPANTS: A total of 209 people with a mean age of 73.2 ± 13.8 years (52.0% women) in the nephrology department of Virgen del Puerto Hospital, Plasencia (Spain) were examined from January 2018 to April 2019. MEASUREMENTS: CKD stages were determined by nephrologists according to the Kidney Disease Improving Global Outcomes Guideline. An expert podiatrist identified foot disorders. Data were statistically treated with the IBM SPSS Statistics. Comparisons between variables were analysed by the χ2  test or Fisher's exact test, with a significance level of less than 5%. RESULTS: The prevalence of foot disorders was high for skin disorders (97.6% dermatopathies and 66.0% keratopathies), nail disorders (98.5% onychopathies) and toe deformities (97.1%). People at initial and intermediate stages presented more keratopathies (hyperkeratosis at G1 and G3a and pinch callus at G3a). Stage G1 showed fewer changes in nail colour and half and half nails. Stage G4 showed more claw toes and hematoma and stage G5 more Beau's lines, changes in skin colour, hematomas and thin shiny skin. CONCLUSIONS: The high prevalence of foot disorders detected in people with CKD requires specific and personalised professional care to relieve symptoms and avoid complications, helping to improve the quality of life of people with this condition.

Adquisición de competencias para el diagnóstico de onicomicosis mediante entrenamiento práctico podológico preclínico y clínico / Competence acquisition for the diagnosis of onychomycosis by preclinical and clinical podiatric practical training

Introducción: Para el correcto diagnóstico de la onicomicosis es fundamental realizar una adecuada toma de muestra. Objetivo: Evaluar la competencia de los alumnos del grado en Podología en la realización de la toma de muestra ungueal como experiencia preclínica y clínica. Métodos: Estudio observacional, descriptivo y transversal, realizado sobre una muestra de 75 alumnos, pertenecientes a segundo (n = 45) y cuarto curso (n = 30) del grado en Podología. Los alumnos de segundo curso no contaron con experiencia previa, mientras que los de cuarto ya habían realizado prácticas preclínicas y clínicas. Se evaluó el procedimiento de toma de muestras ungueales mediante el grado de seguimiento de cada alumno del protocolo preestablecido y explicado. Además, se obtuvo el porcentaje de cultivos contaminados tras el período de incubación de las muestras. Resultados: Los alumnos de cuarto curso siguieron más fielmente el protocolo de toma de muestras ungueales y las contaminaron significativamente menos que los alumnos de segundo curso (23,3 por ciento frente al 51,1 por ciento; p-valor = 0,017). La experiencia previa en toma de muestras ungueales (p-valor = 0,027) y en la realización de quiropodias (p-valor = 0,016) redujo significativamente el porcentaje de cultivos contaminados. Conclusiones: Una sola práctica preclínica no es suficiente para que la mayoría de los alumnos de segundo curso adquieran la competencia de toma de muestra. Las experiencias preclínica y clínica de los alumnos de cuarto curso constituyen un factor determinante para la correcta realización de la toma de muestra ungueal(AU)

Introduction: For the correct diagnosis of onychomycosis, it is essential to take an adequate sample. Objective: To assess the competence of students of the degree in Podiatry in the realization of nail sampling as a preclinical and clinical experience. Methods: Observational, descriptive and cross-sectional study carried out on a sample of 75 students, belonging to the second (n=45) and fourth academic years (n=30) of the degree in Podiatry. The second-year students did not have previous experience, while the fourth-year students had already done preclinical and clinical practices. The nail sampling procedure was assessed by the degree of follow-up of each student of the pre-established and explained protocol. In addition, the percentage of contaminated cultures was obtained after the incubation period of the samples. Results: The fourth-year students followed the nail sampling protocol more faithfully and contaminated them significantly less than second-year students (23.3 percent versus 51.1 percent; p value=0.017). Previous experience in nail sampling (p value=0.027) and in performing podiatry (p value=0.016) significantly reduced the percentage of contaminated cultures. Conclusions: A single preclinical practice is not enough for most second-year students to acquire the competence of sampling. The preclinical and clinical experiences of fourth-year students constitute a determining factor for the correct realization of the nail sampling(AU)