Onychomycosis in Ceará (Northeast Brazil): epidemiological and laboratory aspects

Knowledge of epidemiological and mycological characteristics of onychomycosis has been noted by many authors as being an important tool for control of these fungal infections. This study seeks to improve knowledge of onychomycosis epidemiology and mycological features. Samples were taken from infected fingernails and toenails of 976 patients undergoing treatment at a respected Dermatology Center in Ceará, Fortaleza, CE, Brazil. Specimens from 512 patients (52 percent) were positive for onychomycosis. From the culture-positive samples, yeasts of the genus Candida (C. albicans, C. tropicalis, C. krusei, C. parapsilosis) were dominant. The dermatophytes isolated (Trichophyton rubrum, T. tonsurans, T. mentagrophytes var. mentagrophytes) were dominant in 46 patients (12.99 percent). The mould Fusarium spp. was isolated from 29 patients (8.19 percent). Yeast of the genus Candida is the main causal factor in onychomycosis in our region. Also, the study showed the importance of performing direct examination and culture in diagnosis of onychomycosis.

A modification of the surgical correction of the thumb--a long term follow up.

A modification of the commonest surgical procedure to restore Abduction-Rotation using the flexor superficialis transfer with Y-insertion is described. The modification consists of doing a triple insertion at the thumb instead of Y-insertion. After introducing the triple insertion the procedure shows 80-90% or more good results, whereas 50% or more failures are reported in the existing literature, when a Y-insertion only is used which cannot safely prevent 'Z' deformity. 60 cases were followed up.