Association between CYP4A11 and EPHX2 genetic polymorphisms and chronic kidney disease progression in hypertensive patients.

BACKGROUND: There are evidence indicating that some metabolites of arachidonic acid produced by cytochromes P450 (CYP) and epoxide hydroxylase (EPHX2), such as hydroxyeicosatetraenoic acids (HETEs), epoxyeicosatrienoic acids (EETs) or dihydroxyeicosatrienoic acids (DHETEs), play an important role in blood pressure regulation and they could contribute to the development of hypertension (HT) and kidney damage. Therefore, the main aim of the study was to evaluate whether the genetic polymorphisms of CYP2C8, CYP2C9, CYP2J2, CYP4F2, CYP4F11 and EPHX2, responsible for the formation of HETEs, EETs and DHETEs, are related to the progression of impaired renal function in a group of patients with hypertension. METHODS: 151HT patients from a hospital nephrology service were included in the study. Additionally, a group of 87 normotensive subjects were involved in the study as control group. For HT patients, a general biochemistry analysis, estimated glomerular filtration rate and genotyping for different CYPs and EPHX2 variant alleles was performed. RESULTS: CYP4A11 rs3890011, rs9332982 and EPHX2 rs41507953 polymorphisms, according to the dominant model, presented a high risk of impaired kidney function, with odds ratios (OR) of 2.07 (1.00-4.32; P=0.049) 3.02 (1.11-8.23; P=0.030) and 3.59 (1.37-9.41; P=0.009), respectively, and the EPHX2 rs1042032 polymorphism a greater risk according to the recessive model (OR=6.23; 95% CI=1.50-25.95; P=0.007). However, no significant differences in allele frequencies between HT patients and in normotensive subjects for any of the SNP analysed. In addition, the patients with diagnosis of dyslipidemia (n=90) presented higher frequencies of EPHX2 K55R (rs41507953) and *35A>G (rs1042032) variants than patients without dyslipidemia, 4% vs. 14% (P=0.005) and 16 vs. 27% (P=0.02), respectively. CONCLUSIONS: In this study has been found higher odds of impaired renal function progression associated with rs3890011 and rs9332982 (CYP4A11) and rs41507953 and rs1042032 (EPHX2) polymorphisms, which may serve as biomarkers for improve clinical interventions aimed at avoiding or delaying, in chronic kidney disease patients, progress to end-stage kidney disease needing dialysis or kidney transplant.

Dependency on host vitamin B12 has shaped Mycobacterium tuberculosis Complex evolution.

Human and animal tuberculosis is caused by the Mycobacterium tuberculosis Complex (MTBC), which has evolved a genomic decay of cobalamin (vitamin B12) biosynthetic genes. Accordingly, and in sharp contrast to environmental, opportunistic and ancestor mycobacteria; we demonstrate that M. tuberculosis (Mtb), M. africanum, and animal-adapted lineages, lack endogenous production of cobalamin, yet they retain the capacity for exogenous uptake. A B12 anemic model in immunocompromised and immunocompetent mice, demonstrates improved survival, and lower bacteria in organs, in B12 anemic animals infected with Mtb relative to non-anemic controls. Conversely, no differences were observed between mice groups infected with M. canettii, an ancestor mycobacterium which retains cobalamin biosynthesis. Interrogation of the B12 transcriptome in three MTBC strains defined L-methionine synthesis by metE and metH genes as a key phenotype. Expression of metE is repressed by a cobalamin riboswitch, while MetH requires the cobalamin cofactor. Thus, deletion of metE predominantly attenuates Mtb in anemic mice; although inactivation of metH exclusively causes attenuation in non-anemic controls. Here, we show how sub-physiological levels of B12 in the host antagonizes Mtb virulence, and describe a yet unknown mechanism of host-pathogen cross-talk with implications for B12 anemic populations.

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.

Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass.

PURPOSE: Obesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery. MATERIALS AND METHODS: We conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12-18 months after surgery in 11 of them. RESULTS: We observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium. CONCLUSION: Weight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.

Evaluation of Thermography as a Diagnostic Technique in Asymptomatic or Incipient Onychomycosis.

Onychomycosis is usually diagnosed symptomatically due to the very clear signs caused by the fungus on the nail surface and structure, although the growth of the infecting agent must also be verified by culture in an enriched medium. This procedure is normally lengthy (four weeks), and samples can be contaminated, delaying the prescription of appropriate and effective treatment. Only one previous study has addressed the possibility of using thermography as a diagnostic method for onychomycosis in older people (31-70 years). The present study confirms this use but in individuals aged 18-31 years with incipient mycosis and no pathological signs. Using an FLIR E60 BX camera in a study with 214 samples, we found that men had more onychomycosis than women. We observed a relation between the presence of infection and nail temperature, with a higher temperature in yeast infections (+1 °C) and a lower temperature in dermatophyte infections (-2 °C). A higher temperature by almost 1 °C was also observed in older participants. Thermography can be viewed as a new diagnostic method in asymptomatic or incipient onychomycosis, providing the thermographic camera is sufficiently sensitive and the appropriate procedure is followed, although fungal culture is always necessary to confirm recovery after treatment.

Lesiones de interés podológico en la práctica habitual de deportes de contacto / Podiatrically significant injuries in the regular practice of contact sports

Introducción: El auge en la práctica de deportes de contacto hace que sea necesario que el podólogo conozca las lesiones más comunes que sufren los deportistas que las practican para mejorar así la atención de estos pacientes. Debido a este motivo, nos planteamos como objetivo principal de este estudio analizar el perfil sociodemográfico del deportista de deportes de contacto y conocer las lesiones sufridas en diferentes deportes de contacto para hacer prevención primaria a nivel podológico. Pacientes y métodos: Se analizó una autoencuesta a través de Google Forms, donde se recabaron datos sobre los hábitos y las lesiones deportivas sufridas en la extremidad inferior de 100 deportistas que practican diversos deportes de contacto, además de otras variables como sexo, alimentación, horas de entrenamiento semanal, tiempo que lleva practicándolo, con el fin de conocer si en las diferentes modalidades de los deportes de contacto ocurren las mismas patologías podológicas o son diferentes. Los datos fueron tratados estadísticamente usando los programas Microsoft Office Excel 2013 y SPSS 22.0. Resultados: Las lesiones más comunes en la extremidad inferior en los deportistas de contacto analizados fueron lesiones en partes blandas, en concreto esguinces, contracturas y tendinitis, distensiones, fascitis, rotura de ligamentos pierna y pie, y también lesiones óseas, como fracturas de huesos (costillas, nariz, hombro, metatarsianos). A nivel dérmico se encontraron infecciones bacterianas y fúngicas.Conclusión: Conocer las lesiones y patologías que sufren los deportistas que practican deportes de contacto hace posible que, como profesionales de la salud, actuemos a nivel de prevención primaria, ya que las patologías sufridas pueden conllevar secuelas podológicas en el futuro y al empeoramiento de la calidad de vida del deportista (AU)

Objective: The boom in the practice of contact sports makes it necessary for the podiatrist to know the most common injuries suffered by athletes who practice them, to improve the care of these patients. Due to this reason, our main objective in this study is to analyze the sociodemographic profile of contact sports athletes and to understand the injuries suffered in different contact sports, in order to implement primary prevention measures at podiatry level. Patients and methods: Using a survey, we analyzed the sports injuries suffered in the lower extremity by 100 athletes who practice various contact sports. In addition to other variables such as sex, diet, hours of weekly training, and how long has been practicing it. To know if the same podiatric disorders occur in the different modalities or if they are different. The data was statistically treated using the Microsoft Office Excel 2013 and SPSS 22.0. Results: The most common injuries in the lower extremity in the contact athletes analyzed were soft tissue injuries, specifically: sprains, contractures and tendonitis, strains, fasciitis, leg and foot ligament tears, and also bone injuries: bone fractures (ribs, nose, shoulder, metatarsals) and at the dermal level bacterial infections and mycotites. Conclusion: Knowing the injuries and pathologies suffered by athletes who practice contact sports makes it possible for us as health professionals to act at the level of primary prevention, since the disorders described can lead to podiatric sequelae in the future and by worsening the quality of the life of the athlete (AU)

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)

Síndrome de Angelman

Introducción: El síndrome de Angelman es un trastorno del neurodesarrollo hereditario poco frecuente que afecta a 1 de cada 10 mil a 24 mil nacimientos. Esta condición incluye retraso del desarrollo, discapacidad intelectual, discapacidad severa para hablar, problemas con el movimiento y el equilibrio (ataxia), epilepsia y cabeza muy pequeña. Las personas con síndrome de Angelman parecen estar siempre de buen humor y sonríen mucho. Objetivo: Sistematizar los conocimientos sobre las características del síndrome de Angelman, los aspectos clínicos y genéticos de la enfermedad y las estrategias de tratamientos actuales. Método: Se realizó una revisión bibliográfica en la Universidad Regional Autónoma de los Andes, mediante la búsqueda en bases de datos tanto nacionales como internacionales, como PubMed, Scopus, SciELO, Web of Science y Google Scholar. Para la investigación se empleó una estrategia de búsqueda. Se encontraron 45 artículos, de los cuales 15 fueron seleccionados para esta revisión. Resultados: Se elaboró un texto sintetizado donde se abordaron aspectos tales como: etiología, diagnóstico, principales síntomas clínicos y tratamiento de este trastorno genético. Conclusiones: Por su naturaleza de necesidades clínicas que no son satisfechas en cuanto al área motora, la comunicación, el sueño y el comportamiento, el síndrome de Angelman hace necesario que los profesionales de enfermería desarrollen un plan de acción que permita un diagnóstico precoz y desarrollen un plan de cuidados específico para el individuo y el entorno íntimo de actuación para responder a las necesidades a demanda.

Introduction: Angelman Syndrome is a rare inherited neurodevelopmental disorder that affects 1 in 10,000 to 24,000 newborns. This condition includes developmental desability, intellectual disability, severe speech disability, movement and balance problems (ataxia), seizures and very small head. People with Angelman Syndrome always seem to be in a good mood and smile a lot. Objective: To systematize knowledge about the characteristics of Angelman Syndrome, clinical and genetic aspects of the disease and current treatment strategies. Method: A bibliographic review was carried out at the Universidad Regional Autónoma de los Andes, by searching in national and international databases such as PubMed, Scopus, SciELO, Web of Science and Google Scholar. For the investigation a search strategy was used. Forty-five articles were found, of which 15 were selected for this review. Results: A synthesized text was elaborated where aspects such as etiology, diagnosis, main clinical symptoms and treatment of this genetic disorder were addressed. Conclusions: Due to its nature of clinical needs that are not met in terms of the motor area, communication, sleep and behavior, Angelman syndrome makes it necessary for nursing professionals to develop an action plan that allows an early diagnosis and develop a plan specific care for the individual and the intimate environment of action to respond to the needs on demand.

Introdução: A síndrome de Angelman é um distúrbio hereditário raro do neurodesenvolvimento que afeta 1 em 10.000 a 24.000 nascimentos. Essa condição inclui atraso no desenvolvimento, deficiência intelectual, deficiência grave da fala, problemas de movimento e equilíbrio (ataxia), epilepsia e cabeça muito pequena. Pessoas com síndrome de Angelman parecem estar sempre de bom humor e sorrir muito. Objetivo: Sistematizar o conhecimento sobre as características da síndrome de Angelman, os aspectos clínicos e genéticos da doença e as estratégias atuais de tratamento. Método: Foi realizada revisão bibliográfica na Universidad Regional Autónoma de los Andes, por meio de busca em bases de dados nacionais e internacionais, como PubMed, Scopus, SciELO, Web of Science e Google Acadêmico. Para a investigação, foi utilizada uma estratégia de busca. Foram encontrados 45 artigos, dos quais 15 foram selecionados para esta revisão. Resultados: Foi elaborado um texto sintetizado onde foram abordados aspectos como: etiologia, diagnóstico, principais sintomas clínicos e tratamento desta doença genética. Conclusões: Devido à sua natureza de necessidades clínicas não satisfeitas ao nível da área motora, comunicação, sono e comportamento, a síndrome de Angelman torna necessário que os profissionais de enfermagem desenvolvam um plano de ação que permita o diagnóstico precoce e desenvolvam um plano de cuidados específico para o indivíduo e o ambiente íntimo de ação para responder às necessidades sob demanda.

Novel intravesical bacterial immunotherapy induces rejection of BCG-unresponsive established bladder tumors.

BACKGROUND: Intravesical BCG is the gold-standard therapy for non-muscle invasive bladder cancer (NMIBC); however, it still fails in a significant proportion of patients, so improved treatment options are urgently needed. METHODS: Here, we compared BCG antitumoral efficacy with another live attenuated mycobacteria, MTBVAC, in an orthotopic mouse model of bladder cancer (BC). We aimed to identify both bacterial and host immunological factors to understand the antitumoral mechanisms behind effective bacterial immunotherapy for BC. RESULTS: We found that the expression of the BCG-absent proteins ESAT6/CFP10 by MTBVAC was determinant in mediating bladder colonization by the bacteria, which correlated with augmented antitumoral efficacy. We further analyzed the mechanism of action of bacterial immunotherapy and found that it critically relied on the adaptive cytotoxic response. MTBVAC enhanced both tumor antigen-specific CD4+ and CD8+ T-cell responses, in a process dependent on stimulation of type 1 conventional dendritic cells. Importantly, improved intravesical bacterial immunotherapy using MBTVAC induced eradication of fully established bladder tumors, both as a monotherapy and specially in combination with the immune checkpoint inhibitor antiprogrammed cell death ligand 1 (anti PD-L1). CONCLUSION: These results contribute to the understanding of the mechanisms behind successful bacterial immunotherapy against BC and characterize a novel therapeutic approach for BCG-unresponsive NMIBC cases.

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.

Toe Support Pattern as a New Predictive Factor Associated with Falls in Older People with Psychiatric Disorders.

BACKGROUND: Maintaining autonomy is one of the principal objectives for seniors and people with psychiatric disorders. Podiatric medical care can help them maintain autonomy. This work aimed to characterize and quantify the support of the toes in a psychiatric population by analyzing the influence of psychotropic medications and toe and foot support parameters on the prevalence of falls. METHODS: We conducted a cross-sectional descriptive study in 67 participants (31 people with psychiatric disorders and 36 without diagnosed disorders [control population]). Toe support pattern was analyzed with a pressure platform. Variables were measured in static and dynamic loading and related to falls and psychotropic medication use. RESULTS: The psychiatric population fell more than the control population and presented less toe-ground contact in static measurements, although it has more foot-ground contact time. Maximum toe pressure during toe-off is also less intensive in the psychiatric population and is related to people who take psychotropic medications. CONCLUSIONS: Toe support pattern could be used as a predictive factor for falls and to improve stability in these populations.

Fractional modeling of flexural behavior of toenail plates: First step for clinical purposes.

This work presents an identification procedure of flexural behavior of toenail plates in twenty subjects with no history of feet or nail injury as of in-vivo measurements. In particular, four different mechanical models are considered to describe such properties, ranging from the pure elastic to viscoelastic behavior, the latter from the classical and fractional points of view. The quality of the adjustment of each model is examined by a group of performance indices. Experimental data show that the best identification is achieved by the fractional order viscoelastic model for all subjects. These novel results in modeling flexural behavior of toenails are consistent with the published literature suggesting that viscoelastic materials may be successfully modeled with derivatives of fractional order. This could contribute, together with additional variables, to help health professionals, and more especially podiatrists, to have reliable and quantitative measures of the nail flexural behavior which can be susceptible of treatment or for prevention.

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.

First-year health degree students in the dissection room: Analysis of adaptation to practical classes.

Human anatomy is a core subject that students of all health degrees are required to pass. Practical classes with human cadavers are a widely used educational resource in medicine, but are less frequent in other health degrees. Determining how first-year podiatry, nursing, and physiotherapy students cope with human anatomy practical classes and identifying the presence of physical reactions and possible causes of distress they experience in the dissection room are essential steps in designing a guidance plan to address students' needs. A questionnaire was distributed to 172 first-year students in non-medical health degrees immediately after their first visit to the dissection room. The questionnaire comprised 29 Yes/No questions to determine students' physical reactions, causes of distress and coping methods. The most frequent physical reactions were disgust, uneasiness and nausea. The main causes of distress were the smell of the cadavers, the smell of the dissection room and the sight of the cadavers. The coping methods used were being with friends, eating before the practical class and practicing beforehand with anatomical atlases and CDs. No significant differences were found between gender and the three variables analyzed (number of physical reactions, number of causes of distress and number of coping methods) (p-value >0.216), although differences were found between the type of health degree and the number of physical reactions and causes of distress (p-values = 0.028 and 0.001, respectively).

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.

Prevalence of Potential Drug-Drug Interaction Risk among Chronic Kidney Disease Patients in a Spanish Hospital.

Chronic kidney disease (CKD) is a major health problem worldwide and, in Spain, it is present in 15.1% of individuals. CKD is frequently associated with some comorbidities and patients need to be prescribed multiple medications. Polypharmacy increases the risk of adverse drug reactions (ADRs). There are no published studies evaluating the prevalence of potential drug-drug interactions (pDDIs) among CKD patients in any European country. This study was aimed to determine the prevalence, pattern, and factors associated with pDDIs among CKD patients using a drug interactions program. An observational cross-sectional study was carried out at Plasencia Hospital, located in Spain. Data were collected among patients with CKD diagnoses and pDDIs were assessed by the Lexicomp® Drug Interactions platform. Data were obtained from 112 CKD patients. A total number of 957 prescribed medications were acknowledged, and 928 pDDIs were identified in 91% of patients. Age and concomitant drugs were significantly associated with the number of pDDIs (p < 0.05). According to the results, the use of programs for the determination of pDDIs (such as Lexicomp®) is recommended in the clinical practice of CKD patients in order to avoid serious adverse effects, as is paying attention to contraindicated drug combinations.

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)

Importance of Sock Type in the Development of Foot Lesions on Low-Difficulty, Short Hikes.

Background and objectives: Foot lesions can be developed during hiking because of external factors. This makes it important to study the effect of hiking equipment on lesion development. Materials and Methods: Technical and non-technical socks were given to 109 hikers to wear during a short hike. Participants were examined at three stages of the hike to determine the development of dermal, muscle and nail lesions, temperature and perimeter in various areas of each foot. Results: The percentage of hikers without injuries was significantly higher among those wearing technical socks (p-value < 0.001). Differences were also observed in mean foot temperature, which was higher in participants wearing technical socks (p-value < 0.001). Conclusion: The results indicate that even on a low-difficulty, short-term sport activity, it is advisable to wear technical socks to prevent lesion development and keep the foot temperature more stable. Sock type was identified as an external conditioning factor in lesion development.