Effectiveness of finger reconstruction using nail flap anastomosing nerve branch of the first toe nail bed / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed.@*METHODS@#Between January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases.@*RESULTS@#All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes.@*CONCLUSION@#The application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.

Research progress on evaluation methods for head-neck nail position in femoral intertrochanteric fractures / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress on the evaluation methods of head-neck nail positions in femoral intertrochanteric fractures.@*METHODS@#The literature about the evaluation methods of head-neck nail positions for femoral intertrochanteric fractures in recent years was extensively reviewed, and research progress in the aspects of evaluation methods, clinical applications, and limitations were summarized.@*RESULTS@#The position of head-neck nails in femoral intertrochanteric fractures is closely related to postoperative complications of head-neck nail cutting. Currently, the tip-apex distance (TAD) and femoral head zoning are widely used to evaluate the position of head-neck nails. The main opinion in the literature is that the use of TAD and femoral head zoning can effectively reduce the incidence of head-neck nails cutting. Parker's ratio, as one of the evaluation methods, has been controversial in subsequent studies and has not been widely used in clinical practice. The TAD as referenced to the calcar (CalTAD), which was modified based on TAD, has been gradually accepted by the clinic, but whether it is better than the TAD has not yet been conclusively determined. In recent years, new evaluation methods have been proposed to supplement the previous evaluation methods, such as the tip-neck distance ratio (TNDR) and the standardized TAD (STAD) to avoid the limitations of the TAD and the CalTAD by the volume of the femoral head, and the axis-blade angle (ABA) to supplement the direction of the head-neck nails channel, but at present the clinical application is relatively underutilized, and the validity of the method needs to be further verified.@*CONCLUSION@#Currently, there are many methods for evaluating the position of head-neck nails in femoral intertrochanteric fractures, TAD<25 mm combined with head-neck nails placed in the middle-middle quadrant or lower-middle quadrant of the femoral head division is currently a highly recognized assessment in the literature, but the optimal assessment is still controversial, and further research needs to be studied.

Subungual squamous cell carcinoma of the great toe presenting as a pyogenic granuloma-like mass in a 64-year-old Filipino male: A case report

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Subungual squamous cell carcinoma is rare, though it is the most common primary malignant neoplasm in the nail unit. Fingernails are more commonly involved than toenails with nonspecific and mild features. Histopathologic presentation may be difficult to distinguish from other tumors. With this, there is often a delay in diagnosis.</p><p style="text-align: justify;"><strong>CASE REPORT:</strong> A 64-year-old male presented with a subungual yellowish granulomatous plaque, eventual dystrophy, and persistent bleeding on the fi rst digit of the right foot of two years' duration. Initially diagnosed as pyogenic granuloma through skin punch biopsy, debridement with ungiectomy was done. Upon recurrence, he underwent wide excision with matricectomy, wherein deeper sections revealed features of basosquamous carcinoma. A positive Epithelial Membrane Antigen and negative BerEP4 staining later confirmed a diagnosis of SCC. Since bone involvement was repeatedly suspected in magnetic resonance imaging after postoperative radiotherapy, amputation was eventually done.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> We report a case of subungual SCC initially diagnosed as a pyogenic granuloma. Full-thickness biopsy should be done in persistent nail conditions using special stains to confirm the diagnosis. Surgical treatment or radiotherapy with or without systemic therapy is the first line of treatment for subungual SCC. In cases of bone involvement, amputation may be warranted.</p><p style="text-align: justify;"><strong>KEYWORDS:</strong> nail, pyogenic granuloma, squamous cell carcinoma, tumor</p>

Novel transdermal device for delivery of triamcinolone for nail psoriasis treatment

INTRODUCTION@#Nail psoriasis treatment is challenging due to difficult drug delivery and systemic therapy toxicities. Self-dissolvable microneedle patches embedded with corticosteroids offers a potentially rapid, minimally invasive drug delivery platform with good efficacy and minimal adverse side effects.@*METHODS@#We conducted a 4-month prospective randomised controlled trial. Subjects with psoriatic nails were randomised to receive microneedle device delivered topical steroids on one hand and control treatment (topical Daivobet gel) on the other. Two independent dermatologists blinded to the treatment assignment scored their Nail Psoriasis Severity Index (NAPSI) during visits at baseline, 2 and 4 months. All treatment was discontinued after 2 months. Average NAPSI score on each hand was analysed.@*RESULTS@#A total of 25 participants were recruited, aged 22 to 73 years. Majority were Chinese (72%), followed by Indian and Malay. There was equal randomisation of treatment to the left and right nail. While there was a rapid significant improvement in average NAPSI score for the control arm at 2 months, the treatment arm had a greater, more sustained improvement of the NAPSI score at 4 months. The average NAPSI score improved for both treatment and control group at 4 months compared to baseline. However, only the NAPSI value improvement in the controls at 2 months compared to baseline was statistically significant (P=0.0039). No severe adverse effects were reported.@*CONCLUSION@#To the best of our knowledge, this is the first prospective randomised control trial comparing microneedle technology against conventional topical steroids in nail psoriasis treatment. Our findings demonstrate microneedle technology is as efficacious as topical therapy.

Etiopatogenia de las uñas frágiles / Etiopathogenesis of brittle nails

Las uñas frágiles se caracterizan por ser quebradizas, de superficie áspera y descamativa, es una entidad que predomina en mujeres y afecta principalmente las uñas de las manos. En condiciones normales las uñas estás compuestas por agua, cuya concentración oscila entre 7 % al 18 %, lípidos entre 0,1 % y 5%, siendo el colesterol su principal componente, además están compuesta por células queratinizadas sin descamación, dando origen a tres capas histológicas llamadas dorsal, media y ventral. Estas también contienen trazas de elementos como hierro y zinc. La alteración y disminución de estos componentes favorecen está condición. La causa puede ser idiopática o secundaria a enfermedades sistémicas, pueden estar presentes en algunas patologías dermatológicas. Una correcta anamnesis e historia clínica son necesarias para un correcto abordaje terapéutico. Su implicación cosmética nos obliga a tener un conocimiento claro de su etiopatogenia para así poder establecer un tratamiento efectivo y oportuno(AU)

Brittle nails are characterized by being brittle, witha rough and scaly surface, it is an entity that predominates inwomen and mainly affects the fingernails. In normal conditions the nails are made up of water, whose concentration ranges from7% to 18%, lipids between 0.1% and 5%, with cholesterol beingits main component, they are also composed of keratinized cellswithout desquamation, giving rise to three histological layerscalled dorsal, middle and ventral. These also contain traces ofelements such as iron, and zinc. The alteration and decreaseof these components favor this condition. Yhe cause may beidiopathic or secondary to systemic diseases, they may be presentin some dermatological pathologies. A correct anamnesis andmedical history are necessary for a correct therapeutic approach.Its cosmetic involvement forces us to have a clear understandingof its pathogenesis in order to establish an effective and timelytreatment(AU)

Síndrome de la uña verde: revisión actualizada de una patología emergente en la era COVID-19 / 19Green nail syndrome: updated review of an emerging disease in the era of COVID-19

El síndrome de la uña verde o cloroniquia corresponde a la infección por Pseudomonas aeruginosa de una lámina ungueal dañada en pacientes con algún factor de riesgo identificable, siendo los más frecuentes la inmunosupresión, el ambiente húmedo constante y la patología ungueal preexistente. Su diagnóstico es relativamente sencillo si se logra observar la tríada característica de coloración verdosa de la lámina ungueal, paroniquia proximal crónica y onicolisis distal; en casos de duda diagnóstica se puede enviar una muestra de la uña afectada para cultivos o estudio histopatológico. El pilar de su tratamiento corresponde al uso de antibióticos tópicos o sistémicos en conjunto con medidas generales que protejan de la humedad. Es muy importante enfatizar la prevención de esta patología en el personal de salud, especialmente en el contexto del lavado de manos frecuente y riguroso implementado durante la pandemia COVID-19, ya que existen reportes de transmisión nosocomial de P. aeruginosa por profesionales de la salud con infección ungueal.(AU)

Green nail syndrome or chloronychia is the infection of a damaged nail plate by Pseudomonas aeruginosa in a patient with an identifiable risk factor; the most frequently described are immunosuppression, a persistent moist environment and preexisting nail disease. Its diagnosis is relatively simple if the characteristic triad of green discoloration of the nail plate, chronic proximal paronychia and distal onycholysis can be observed, in cases of doubt a sample of the affected nail can be sent for cultures or histopathology. The cornerstone of treatment is the use of topical or systemic antibiotics along with measures to protect the nail from moisture. Prevention of this disease must be emphasized in health care personnel, especially in the context of frequent and rigorous handwashing practices implemented during the COVID-19 pandemic, since there are reports of nosocomial transmission of P. aeruginosaby health care professionals with nail infection.(AU)

Associação de hábitos parafuncionais e DTM em pacientes classe II / Association of parafunctional habits and TMD class II patients

Introdução: A Disfunção Temporomandibular (DTM) é a dor orofacial crônica mais comum, encontrada por dentistas e outros profissionais de saúde. Sua etiologia tem caráter multifatorial, e pode envolver, desde fatores hereditários, hábitos parafuncionais, maloclusões, até ansiedade e estresse. Objetivo: Este estudo investigou a frequência da DTM e a sua relação entre hábitos parafuncionais em uma população de pacientes classe II esquelética. Método: Uma amostra composta por pacientes classe II esquelética foi selecionada de forma não probabilística. Setenta e três indivíduos concordaram em participar da pesquisa, se submetendo ao exame físico que consistia na aplicação do Eixo I do (RDC/TMD). Resultados: Quarenta e seis por cento dos pacientes examinados apresentaram diagnóstico positivo. A média de idade dos pacientes foi de 27 anos+ 8,73 anos, 82% do gênero feminino e 80% brancos. Trinta e quatro pacientes referiram alguma atividade parafuncional. Desses a onicofagia representou o grupo com maior frequência, seguido pelo bruxismo, interposição de objetos entre os dentes e por último o apertamento. As variáveis não apresentaram associação estatisticamente significante com o desfecho primário estudado. Conclusão: Na amostra estudada não se observou associação entre a ocorrência de DTM e hábitos parafuncionais em pacientes classe II esquelética... (AU)

Introduction: Temporomandibular disorder (TMD) is the most common chronic orofacial pain, found by dentists and other health professionals. Its etiology has a multifactorial character, and may involve, from hereditary factors, parafunctional habits, malocclusions, to anxiety and stress. Objective: This study investigated the TMD frequency and its relationship among parafunctional habits in a population of skeletal class II patients. Method: A sample composed by a class II patients was selected in a non probabilistic manner. Seventy-three members agreed to participate in the research, submitting themselves to a physical examination that consists in the application of Axis I (RDC/TMD). Results: Forty-six percent of patients diagnosed with a positive diagnosis. The average age of the patients was 27 years ± 8.73 years, 82% female and 80% white. Thirty-four patients reported some parafunctional activity. Of these, biting nail represented the group most frequently, followed by bruxism, interposition of objects between the teeth and lastly clenching. As variables did not present a statistically significant association with the primary outcome studied. Conclusion: In the sample studied, it is observed that there is no association between TMD occurrence and parafunctional habits in skeletal class II patients... (AU)

Six steps to standardize the surgical approach for ingrown toenail

Abstract Background: Dermatologists don't have a good knowledge of the surgical treatment for ingrown toenails and there is no consensus on which is the best approach. Objective: To develop an easy and effective surgical approach to solve the problem of ingrown toenails. Methods: We identified 67 patients with ingrown toenails in varying degrees of severity which were treated with the standardized approach. Results: All the patients had a completely recovery from the disease and none complained about the cosmetic result. Study limitations: The number of cases is limited. Conclusion: The standardized surgical approach is easily learned and very effective. The recurrence rate is lower than with other treatments.

Onicomicosis en paciente inmunocompetente por Aspergillus sección Candidi / Onychomycosis in immunocompetent patient by Aspergillus section Candidi

Introducción: los hongos miceliales no dermatofitos (HMND) pueden causar un gran número de infecciones, entre ellas, la onicomicosis. Su implicancia como agentes patógenos y su significado clínico en esta afección, se encuentran sujetos al cumplimiento de los criterios de Walshe y Mary P. English. Presentamos un caso de onicomicosis causada por un hongo hifomiceto poco frecuente, del género Asper-gillus sección Candidi, en una paciente inmunocompetente y su estrategia terapéutica. Materiales y métodos: se estudió una paciente inmunocompetente, de 43 años de edad, con lesión en uña de primer dedo del pie derecho, de 10 años de evolución. Se realizó toma de muestra para examen micológico. Resultados: el examen directo reveló la presencia de hifas hialinas irregulares, ramificadas y tabica-das, compatibles con HMND. En muestras seriadas, desarrollaron colonias blanco algodonosas, cuya micromorfología fue concordante con Aspergillus sección Candidi. La identificación fue confirmada en la Unidad de Micología del Hospital de Infecciosas Francisco Javier Muñiz de la Ciudad Autónoma de Buenos Aires, Argentina. Allí también se realizaron pruebas de sensibilidad a antifúngicos, resultando sensible a itraconazol y terbinafina. Conclusión: exponemos un caso de onicomicosis causada por Aspergillus sección Candidi, HMND no queratinolítico, de escasa frecuencia de aparición, siendo el primer caso descripto y publicado en Argentina. También se planteó una estrategia terapéutica efectiva, que condujera a la cura clínica y microbiológica, de la uña de la paciente.

Introduction: non-dermatophyte mycelial fungi (HMND) can cause a large number of infections, including onychomycosis. Its implica-tion as pathogens and its clinical significance in this condition are subject to compliance with Walshe's and Mary P. English's criteria. We present a case of onychomycosis caused by hyphomycete rare fungus, of the genus Aspergillus section Candidi, in an immunocompetent patient and its therapeutic strategy. Materials and methods: a 43-year-old immunocompetent patient with a 10-year-old right-toe nail lesion was studied. Samples were taken for mycological examination. Results: the direct examination revealed the presence of irregu-lar, branched and tabulated hyaline hyphae, compatible with HMND. In serial samples, they developed white cotton colonies, whose micromorphology was consistent with Aspergillus, section Candidi. The identification was confirmed at the Mycology Unit of Francisco Javier Muñiz Infectious Hospital in the Autonomous City of Buenos Aires, Argentina. Susceptibility to antifungals was also tested there, resulting in susceptibility to itraconazole and terbinafine. Conclusion: we present a case of onychomycosis caused by Aspergillus section Candidi, non-keratinolytic HMND, of rare occurrence, being the first case described and published in Argentina. An effective therapeutic strategy was also proposed that led to the patient's toenail's clinical and microbiological cure.

Melanonychia associated with subungual follicular inclusions: report of three cases

Abstract Melanonychia is the change in the coloration of the nail plate resulting from the deposition of melanin. Among its causes are melanocytic hyperplasia, melanocytic activation and nail melanoma. Subungual follicular inclusions are histological findings of unknown etiology, possibly related to trauma. We present three cases of melanonychia of different etiologies with subungual follicular inclusions, an association that has not been well described and with an indefinite pathogenesis.

Assessing quality of systematic reviews in dermatology from the Philippines using AMSTAR 2 Part 1: Methodologic quality of dermatological systematic reviews from the Philippines

@#BACKGROUND: Quality systematic reviews (SRs) are essential in the practice of evidence-based dermatology. We assessed the methodologic quality of SRs in dermatology from the Philippines. METHODS: We searched databases (MEDLINE, CDSR, PROSPERO, HERDIN; from inception until June 30, 2019), and secondary sources. We included SRs, authored by Filipino primary authors, which included clinical trials on any intervention for the treatment or prevention of a dermatologic disease or for maintenance of healthy skin, hair or nails. Two reviewers independently extracted data and appraised the methodological quality of each included SR using the AMSTAR 2. The 16-item AMSTAR 2 has 7 critical items and 9 non-critical items. The number of critical items mainly determine the overall confidence in the results of the review. Descriptive analysis using means and standard deviation for continuous data, and frequency and percentage distribution for categorical data were employed. RESULTS: Twenty SRs were included in this review, and were mostly published in the 2010s. Majority of SRs had three authors, who belonged to a single institution, with at least one dermatologist. The most common topic was infections and both oral and topical interventions were used. Majority had 5 included studies in the SRs, with a median number of 425 participants. The median number of critical flaws in the included SRs was 4.5, and non-critical flaws, 5. Overall confidence was critically low in majority (19/20 ) of included reviews, with only one review rated as low. CONCLUSION: The methodologic quality of the dermatology SRs from the Philippines based on the AMSTAR 2 tool was poor with a rating of critically low in majority. There is a need to improve quality of conduct and reporting through dissemination of the reporting guidelines such as the PRISMA

Caso de paraqueratosis pustulosa: entidad poco frecuente y síntoma de enfermedad inflamatoria del aparato ungueal en pacientes pediátricos / Case of pustular parakeratosis: a rare entity common and symptom of inflammatory disease of the nail apparatus in pediatric patients

La paraqueratosis pustulosa es una entidad poco descrita en la literatura y se define como un proceso inflamatorio cutáneo, ungueal y periungueal en el área distal de un dedo habitualmente pulgar o índice, frecuentemente en la infancia. Su evolución suele ser benigna y la respuesta a emolientes tópicos es favorable. A continuación, se presenta un caso de esta enfermedad con el objetivo de resaltar su consideración en patologías ungueales pediátricas.

Pustular parakeratosis is an entity scantly described in literature. It has been described as a skin, nail, and periungual inflammatory process in the distal area of a finger, usually the thumb or index finger, frequently in childhood. Its evolution is usually benign and management is favorable with topical emollients. A clinical case is presented, to raise awareness of this entity in pediatric nail pathologies.

Relationship between antifungal susceptibility profile and virulence factors in Candida albicans isolated from nail specimens

Abstract INTRODUCTION: The aim of this study was to evaluate some virulence factors in Candida albicans isolates from patients with onychomycosis and determine the correlation between these factors and the antifungal resistance profile. METHODS: Seventy species of C. albicans were confirmed using polymerase chain reaction amplification of the HWP1 gene. According to the Clinical & Laboratory Standards Institute guidelines, the susceptibility profile of four antifungal agents was investigated, and the production of aspartyl protease, phospholipase, haemolysin, and biofilm was determined. The correlation between these profiles was also investigated. RESULTS: The isolates indicated different levels of resistance and production of virulence factors. Significant correlations were observed between the minimum inhibitory concentration (MIC) of fluconazole/itraconazole and biofilm production, between phospholipase production and fluconazole/itraconazole MIC, and between fluconazole MIC and hemolytic activity in C. albicans isolates. The results also showed significant correlations between phospholipase activity and biofilm production. CONCLUSIONS: Our findings will contribute to a better understanding of the pathogenesis of C. albicans and characterize the relationship between virulence factors and antifungal resistance, which may suggest new therapeutic strategies considering the possible involvement of the virulence mechanism in the effectiveness of treatment.

Abnormalities of the hallux skin and nail in the course of very rare arteriovenous malformation / Anormalidades de unha e pele do hálux no decorrer de malformação arteriovenosa muito rara

Abstract Arteriovenous malformations (AVMs) are usually found in the pelvic area and the brain. These vascular anomalies are rarely reported in the toes. AVMs in the toes may be asymptomatic, but can also cause atypical symptoms. Congenital AVMs can expand as patients age and manifest in adulthood. They may be provoked by injury. Acquired AVM might be caused by iatrogenic factors, venous or arterial catheterization, percutaneous invasive vascular procedures, surgery, or degenerative vascular disorders. An AVM can damage surrounding tissues and can cause destruction of skin, nails and bones. The course of the disease is often unpredictable and diagnosis is usually delayed as a result.

Resumo As malformações arteriovenosas (MAVs) são geralmente encontradas na região pélvica e no cérebro.. Essas anomalias vasculares raramente são relatadas nos dedos dos pés. A MAV nesse local pode ser assintomática ou apresentar sintomas atípicos. MAVs congênitas podem evoluir com a idade e se manifestar na idade adulta. O fator provocante pode ser uma lesão traumática. Uma MAV adquirida pode ser causada por fatores iatrogênicos, cateterismo venoso e arterial, procedimentos percutâneos vasculares invasivos, cirurgias e alterações degenerativas vasculares. A MAV pode danificar tecidos adjacentes e pode causar destruição de pele, unhas e ossos. O curso da doença é muitas vezes imprevisível, e como resultado, atrasar o diagnóstico.

Relationship of the low-density lipoprotein (LDL)/high-density lipoprotein (HDL) index with antioxidant enzymes and with the oxLDL/HDL index

Introduction: The low-density lipoprotein (LDL)/high-density lipoprotein (HDL) index is a predictive factor for atherosclerosis, which is associated with oxidative modifications. Objective: To assess the association of the index with oxidative stress markers. Methods: 444 subjects were included and were clinically, anthropometrically and biochemically characterized; superoxide dismutase, glutathione peroxidase 3 (GPx3), magnesium and oxidized LDL (oxLDL) index (oxLDL/HDL) were quantified. Results: A decrease of 1.014 units in the LDL/HDL index was associated with a superoxide dismutase increase of 1 unit/mL (p = 0.030), while a decrease of 0.023 units was associated with a GPx3 increase of 1 nmol/min/mL (p < 0.0005). An increase of one unit in the index was associated with an increase of 0.831 in the oxLDL/HDL index (p < 0.05). After controlling for the effect of gender, age, smoking, obesity and insulin resistance, a reduction of 0.001 per index unit was associated with an increase of 1 µg/g of magnesium in the nails (p = 0.020). Conclusions: The LDL/HDL index shows an inverse relationship with the antioxidant status and a direct relationship with oxidation status, regardless of other cardiovascular and oxidative stress risk factors.

Occurrence of dermatophytoses in patients from the Sistema Único de Saúde

Abstract: Background: Dermatophytosis is a cutaneous disease caused by filamentous keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton, which present a high prevalence in the general population, being among the most common mycoses affecting about 20% of the world's population. Objective: To carry out the epidemiological survey of cases of dermatophytosis in patients from the Sistema Único de Saúde in a regional Laboratory in the period of 5 years (2009 to 2013). Methods: A retrospective study (January 2009 to December 2013) was carried out with a qualitative and quantitative design, through the registry book of the laboratory, Mycology Sector, where cases of patients with suspected dermatomycosis were analyzed. Results: In a 5-year period, a total of 4467 cases were suspected of having a fungal infection. Of these, 68.74% (3071) cases were of dermatomycosis. In relation to cultures with fungal growth, 12.54% (385 cases) were dermatophyte fungi and 7.97% (245 cases) non-dermatophyte fungi were isolated. Among the species identified, there was a higher prevalence of T. rubrum complex (75%), T. mentagrophytes complex (11.68%) and M. canis (7.01%). Regarding the sites analyzed, nail involvement was the most frequent in 75% of the cases. Study Limitations: This work is representative in the studied region. Conclusions: Dermatomycosis samples are the most frequent among all samples of fungal infections from these patients, with the nail being the most affected area and the fungi T. rubrum complex and T. mentagrophytes complex the most frequent.

Nail clipping in onychomycosis and comparison with normal nails and ungual psoriasis

Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.

Congenital Onychodysplasia Involving the Left Second Toenail / 대한피부과학회지

No abstract available.

Quantificação de fluoreto ingerido pela dieta utilizando questionário de frequência alimentar e concentração de fluoreto nas unhas em crianças de 1 a 3 anos de idade / Quantification of fluoride ingested by diet using a food frequency questionnaire and fluoride concentration in the nails in children aged 1 to 3 years

Objetivo: Avaliar a ingestão de fluoreto (F) por crianças de 1 a 3 anos de idade pela dieta e a concentração de F nas unhas. Método: Crianças (n=202) de 12 meses de idade, participantes de um programa preventivo para bebês, tiveram a ingestão de F monitorada por meio da aplicação de um Questionário de Frequência Alimentar semiquantitativo (QFA), composto por 70 itens, divididos em 9 grupos de alimentos frequentemente encontrados na dieta de crianças nesta faixa etária. O QFA foi aplicado durante 2 anos, a cada 3 meses, juntamente com a coleta das unhas e de água usada para beber ou preparar comida. A concentração de F da dieta, nas unhas e na água foi determinada com eletrodo íon-específico, após microdifusão facilitada por hexametildisiloxano ou pelo método direto. Os dados obtidos foram submetidos à análise de variância a dois critérios, seguida pelo teste de comparação múltipla de StudentNewman-Keuls , bem como coeficiente de correlação de Sperman (p<0,05). Resultados: A média da ingestão de F pela dieta e água aumentou significativamente dos 12 aos 24 meses (0,015 mg F/Kg/dia e 0,09 mg F/Kg/dia) (p<0,05) declinando após 27 meses (0,011 mg F/Kg/dia e 0,05 mg F/Kg/dia) (p<0,05). Aos 36 meses um pico foi observado na ingestão de F pela dieta (0,013mg F /Kg/dia) (p<0,05). Houve crescente aumento nos níveis de F nas unhas dos pés e mãos, com diferença significativa em alguns períodos de estudo (18 à 27 meses, p<0,05), sendo que maiores concentrações de F foram vistas nas unhas das mãos em relação aos pés (3,7 µg F/g; 3,4 µg F/g, respectivamente p<0,05). Entre a estimativa de ingestão de fluoreto em função do peso da criança (mg F/kg/dia) e o fluoreto nas unhas da mão (Sperman?s r = -0,024; p=0,396) ou unhas do pé (Sperman?s r = -0,002; p=0,957), nenhuma correlação foi observada. Conclusão: A ingestão de fluoreto por meio da dieta em crianças de 1 a 3 anos de idade ficou dentro de limites considerados como seguros e o QFA parece ser uma boa ferramenta para estimar a ingestão de fluoreto de crianças.. Pequenas variações na ingestão diária de F pela dieta foram detectadas nas unhas ao longo dos períodos de estudo (após 30 a 60 dias)(AU)

Objective: To evaluate fluoride (F) intake by 1-3 year-old children from the diet, as well as F concentrations in fingernails and toenails. Methods: Children (n=202) 12 months old, participants in a preventive program for infants, had their F ingestion monitored by means of the application of a semi-quantitative food frequency questionnaire (FFQ), composed of 70 items, divided into 9 groups of foodstuff. The FFQ was applied during 2 years, every 3 months, along with the collection of nails and water samples used for drinking and food preparation. The concentration of F in the diet, nails, and water was determined with an ion-specific electrode, after hexamethyldisiloxane-facilitated microdiffusion or by the direct method. The data obtained were submitted to the 2-way analysis of variance criteria followed by the Student-Newman-Keuls, and by Spearman correlation coeficiente (p<0.05). Results: The average ingestion of F by diet and water was significantly higher from 12 to 24 months (0.015 mg F/Kg/day and 0.09 mg F/Kg/day) (p<0.05), decreasing after 27 months (0.011 mg F/Kg/day and 0.05 mg F/Kg/day) (p<0.05). At 36 months, a peak of F ingestion from the diet (0.013mg F /Kg/day) (p<0.05) was observed. There was a continuous increase in F levels in finger- and toenails, with a significant difference in some periods of the study (18 to 27 months, p<0.05); higher F concentrations were observed for fingernails over toenails (3.7 µg F/g; 3.4 µg F/g, respectively, p<0.05). No significant correlation was observed between the estimate of ingestion of fluoride related to the weight of the child (mg F/kg/day) and the fluoride in fingernails (Spearman?s r = -0.024; p=0.396) or toenails (Spearman?s r = -0.002; p=0.957). Conclusion: The ingestion of fluoride from the diet in 1-3 year-old children was shown to fall within safe limits, and the FFQ appears to be a satisfactory tool to estimate the ingestion of fluoride. Small variations of daily ingestion of F by diet were detected in the nails through the periods in the study (after 30 to 60 days)(AU)

Chumbo e cádmio em unhas das mãos como biomarcadores de exposição subcrônica na biomonitorização de pré-escolares / Lead and cadmium in fingernails as subchronic exposure biomarkers in preschool children biomonitoring

Introdução - Crianças estão expostas diariamente a diversos fatores de risco que podem afetar sua saúde, desde condições socioculturais e fisiológicas, até exposições endógenas e exógenas. Elementos Potencialmente Tóxicos (EPT) podem ser mais absorvidos por crianças em comparação a adultos. Os efeitos crônicos surgem mesmo com exposição a baixas doses, pois as crianças estão em fase de desenvolvimento e, portanto, são mais vulneráveis. Níveis desses EPTs em matrizes biológicas são comumente usados como biomarcadores de exposição ambiental. Objetivo - Explorar o uso de biomarcadores de exposição subcrônica a chumbo e cádmio em unhas das mãos. Métodos - Foram analisadas e comparadas amostras de sangue e unha de 592 indivíduos, as quais foram coletadas em estudo prévio. A população de estudo foi composta por pré-escolares entre 1 e 4 anos de idade que frequentavam 50 Centros de Educação Infantil (CEI) da cidade de São Paulo na época da coleta. As análises de ambas as amostras foram realizadas por espectrometria de massa com plasma indutivamente acoplado (ICP-MS). Para avaliar se a intensidade da exposição a chumbo e ao cádmio impacta nos níveis dos elementos analisados em unhas, os resultados dos metais no sangue foram estratificados por níveis de exposição ao chumbo e ao cádmio. Para baixa exposição foram consideradas as amostras com níveis sanguíneos menores do que os valores de referência do Centers for Diseases Control and Prevention (CDC) (< 5 µg.dL POT. -1 para chumbo e < 0,24 µg.L POT.-1 para cádmio). No grupo de alta exposição, foram incluídas as amostras com níveis sanguíneos acima dos percentis 97,5 para o chumbo e 95 para o cádmio, encontrados nas crianças anteriormente estudadas (> 13,9 µg.L POT.-1 e 2,97 µg.L POT.-1, respectivamente). O intervalo entre os valores de referência e os percentis ficou estabelecido como faixa de exposição intermediária. Testes de correlação de Spearman foram aplicados entre as concentrações de ambos os metais no sangue e na unha (p < 0,05), considerando fatores de risco potenciais (localização do CEI por densidade de tráfego veicular e zona geográfica, e existência de fumante no domicílio). Resultados - A média geométrica dos níveis de chumbo nas unhas foi de 0,02 µg.g POT. -1 (IC 95%: 0,02-0,03 µg.g POT. -1). Para o cádmio, a média não foi calculada devido ao alto percentual de valores abaixo do limite de detecção (LD). Correlações positivas foram encontradas entre os níveis de chumbo nas unhas e no sangue (r = 0,08; p = 0,04), entre os níveis do elemento nas unhas e CEI localizado em rua com alta densidade de tráfego de veículos (r= 0,23; p <0,0001). Houve correlação positiva entre os níveis de chumbo e cádmio nas unhas (r = 0,31; p <0,0001) e no sangue (r = 0,35; p <0,0001), sendo mais expressiva nas unhas do grupo de pré-escolares de escolas localizadas na zona leste (r = 0,44; p <0,0001). Conclusão - Chumbo na unha pode ser eleito como biomarcador de exposição, quando se pretende iniciar um screening de exposição ambiental, sobretudo em áreas de alta densidade de tráfego de veículos. Os pré-escolares sofreram coexposição entre chumbo e cádmio. O uso da unha na biomonitorização de pré-escolares pode auxiliar no delineamento de estudos posteriores de exposições ambientais aos EPTs, redirecionando recursos com maior precisão.

Introduction - Children are daily exposed to several risk factors that can affect their health, from sociocultural and physiological conditions to endogenous and exogenous substances exposure. Potentially toxic elements (PTE) can be more absorbed by children than adults. Chronic effects can appear even at low exposures, because children are in development phase and, therefore, are more vulnerable. PTE levels in biological matrices are commonly used as environmental exposure biomarkers. Objective - To explore the use of lead and cadmium sub chronic exposure biomarkers in fingernails. Methods - blood and nail samples of 592 individuals will be analyzed and compared, which were collected in previous study. The study population was composed of preschool children aged between 1 and 4 years old who attended 50 day care centers (DCC) in the city of São Paulo at the sampling time. Both sample analysis were performed by inductively coupled plasma mass spectrometry (ICP-MS). To assess if lead and cadmium exposure intensity impacts in analyzed nail element levels, the results of blood metals were stratified by lead and cadmium exposure levels. As low exposure was considered samples with blood levels lower than the Centers for Diseases Control and Prevention (CDC) reference values (<5 µg.L POT.-1 for lead and <0.24 µg.L POT.-1 for cadmium). High exposure group included samples with blood levels above the 97.5th percentile for lead and 95th for cadmium found in the previously studied children (> 13.9 µg.L POT.-1 and 2.97 µg.L POT.-1, respectively). The interval between the reference values and the percentiles was established as the intermediate exposure range. Spearman's correlation tests were applied between the concentration of both metals in the blood and the nail (p <0.05), considering PTE exposure risk factors (DCC location by vehicle traffic density and geographic region, and smoker in the home. Results - The geometric mean of nail lead levels was 0.02 µg.g POT. -1 (95% CI: 0.02- 0.03 µg.g POT. -1). Cadmium means are not calculated because high percentage of values below limit of detection (LD). Positive correlations were found between nail and blood lead levels (r = 0.08; p = 0.04), between nail lead level and DCC located in high vehicle traffic density street (r = 0.23; p <0.0001). Positive correlation also found between nail and lead and cadmium levels (r = 0.31; p <0.0001) and between blood (r = 0.35; p <0.0001), being more expressive in nails of DCC east region preschool children group (r = 0.44; p <0.0001). Conclusions - Nail lead can be elected as biomarker of exposure, when are intend to start a screening of environmental exposure, especially in high traffic vehicle areas. Preschool children suffered co-exposure between lead and cadmium. Nail use in preschool children biomonitoring can assist in later PTE environmental exposure studies design, redirecting resources more accurately.