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.

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)

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)

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.

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 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 Preexisting Physical Factors in the Development of Dermatological and Muscular Lesions During Hiking.

Hiking has become very popular due to the physical and mental health benefits it provides. Skin lesions may occur with hiking and various factors contribute to their development. Although some lesions may appear to have little importance, something as simple as chaffing can cause serious ulcers in people with at-risk feet. Few studies have analyzed preexisting physical characteristics in hiking and addressed the development of lesions in hikers. This observational and longitudinal study examines the development of foot lesions during hiking, taking into account the influence of existing skin disorders, nail disorders, and/or toe deformities and other intrinsic factors of participants. The feet of 109 hikers doing a 29.6-km hike were analyzed, considering the intrinsic factors of participants and the possible influence of these factors in the development of foot lesions during the walk. The results show that some preexisting physical factors of participants such as gender, existing systemic disease, preexisting keratosis, dermatosis, nontraumatic and traumatic onychopathies, and toe deformities significantly predispose to the development of skin lesions. These factors also predispose to muscle lesions except for nontraumatic and traumatic onychopathies and toe deformities. Due to the influence of preexisting physical factors, such as preexisting keratosis, dermatosis, and toe deformities, in the development of foot lesions in hikers, it is worthwhile and advisable to check these factors before a hike to reduce the incidence of foot disorders. Ensuring adequate podiatry treatment a few days before the walk and warmup of muscles properly before starting are recommended.

Importance of Footwear for Preventing Xerosis and Hyperkeratosis in Older People with Psychiatric Disorders Living in an Institution.

Few studies have focused on the relation between the use and characteristics of footwear and the presence of foot lesions in people with psychiatric disorders. This work analyzes the influence of different footwear habits on the presence of deformities and ungueal and dermal pathologies of the foot of institutionalized people with psychiatric disorders compared to people without these disorders. A transversal and observational study was conducted on 107 participants, divided into two groups who have used different types of shoes throughout their lives. The control group comprised 63 autonomous people who mainly use leather footwear and a study group of 44 institutionalized people with intellectual disabilities and psychiatric disorders who mainly use textile footwear. There were significant differences between populations. The group with psychiatric disorders presented more xerosis and hyperkeratosis. Footwear with inappropriate characteristics is a possible causal agent of skin alterations. Wearing footwear with quality textile uppers, e.g., fabric or felt, could influence the appearance of these alterations. Leather footwear is recommended for institutionalized people to reduce symptoms of xerosis and improve their quality of life.