Emerging drugs for the treatment of onychomycosis.

Introduction: Onychomycosis is a widespread nail disease, often occurring on the feet. It is a chronic and often recurring disease, which makes it difficult to eradicate. The infection may be caused by dermatophytes, non-dermatophyte molds, and yeasts. Traditionally, systemic antifungal medications have been used to treat this infection, but in recent years topical formulations have been the focus of research.Areas covered: This review outlines the current antifungal market and novel treatments currently in development or in experimental phases. It highlights a shift from systemic treatments to topical options as well as penetration enhancers. There are also several novel systemic options in development.Expert opinion: Although there have been significant developments in treatment options for onychomycosis, it remains a challenging chronic condition with less than desirable cure rates. This may be attributed to the formation of fungal biofilms and limited understanding of the fungal lifecycle. However, when patients adhere to treatment protocols and employ preventative measures, outcomes are generally favorable.

A Systematic Review of Fatigue in Radiology: Is It a Problem?

OBJECTIVE: The purpose of this study was to review current literature regarding radiologist fatigue. MATERIALS AND METHODS: A literature search was performed using PubMed. Key words and Medical Subject Heading terms were used to generate refined queries with inclusion and exclusion criteria, focusing on fatigue and error. Results were selected according to these criteria: examined radiologist fatigue and radiologic error stemming from fatigue; experimental results measured as accuracy, error, or performance; and peer-reviewed publication. The risk of bias was addressed by including both quantitative and qualitative studies. RESULTS: Twenty-seven articles were included, mainly primary research articles. Common outcome measures included subjective self-reports and tests to measure eyestrain. Reaction time was also recorded, accounting for variables such as age and experience. One group recommended that guidelines should be implemented regarding number of hours worked. Most recommended ergonomic interventions, proposing the implementation of tools to measure and standardize fatigue and optimize workflow, in conjunction with considering radiologists individually. Education in appropriate viewing habits and breaks were also suggested. Only one study with seven participants recommended that radiologists should sleep well to improve their performance and overall well-being, despite the undeniable evidence that radiologists are fatigued. CONCLUSION: Fatigue is present in radiology and affects diagnostic accuracy.

Proline as a Sparker Metabolite of Oxidative Metabolism during the Flight of the Bumblebee, Bombus impatiens.

Several insect species use the amino acid proline as a major energy substrate. Although initially thought to be limited to blood-feeding dipterans, studies have revealed this capability is more widespread. Recent work with isolated flight muscle showed that the bumblebee Bombus impatiens can oxidize proline at a high rate. However, its role as a metabolic fuel to power flight is unclear. To elucidate the extent to which proline is oxidized to power flight and how its contribution changes during flight, we profiled 14 metabolites central to energy and proline metabolism at key time points in flight muscle and abdominal tissues. Ultra-high performance liquid chromatography-electrospray ionization-quadrupole time of flight mass spectrometry (UPLC-ESI-QTOF MS) analysis revealed that proline is likely used as a sparker metabolite of the tricarboxylic acid cycle at the onset of flight, whereby it supplements the intermediates of the cycle. Carbohydrates are the major energy substrates, which is evidenced by marked decreases in abdominal glycogen stores and a lack of alanine accumulation to replenish flight muscle proline. The time course of fuel stores and metabolites changes during flight highlights homeostatic regulation of energy substrates and patterns of changes in metabolic intermediates within pathways. This study clarifies the role of proline and carbohydrate metabolism during flight in hymenopterans, such as B. impatiens.

Recent advances in therapies for onychomycosis and its management.

Onychomycosis is the most common affliction of the nail. It may be caused by dermatophytes, yeasts, and non-dermatophyte molds. Traditionally, oral antifungal treatments have been used to treat the fungus, although they can be accompanied by side effects and drug interactions. Topical treatments provide an alternative modality, bypassing the systemic effects of oral drugs; recent research has centered on topical drug improvement and development. Physical and laser treatments are being used in conjunction with topicals, which may help penetrate the thick nail plate. In this review, techniques from all categories are outlined: both novel experimental approaches and progress and effectiveness of recently developed treatments. More long-term studies are required to determine the efficacy of various treatments, but cure rates are improved when patients adhere to treatments and follow preventative measures to avoid disease recurrence.