Onychomycosis therapies: strategies to improve efficacy

The combination of relatively high treatment failure rates and infection relapse rates warrants consideration of ways in which antifungal therapy can be delivered so that efficacy rates can be improved. These involve the combination of available therapies and/or a modification of treatment regimens.     

Treatment of diabetic ulcers

Diabetic ulcers are chronic wounds that are the result of repetitive trauma in the insensate foot. The presence of infection and peripheral vascular disease makes the treatment of these wounds demanding and requires a multidisciplinary approach. The main principles of the management include adherence to the principles of good wound care, such as aggressive debridement of all non-viable tissue, adequate off-loading of pressure, prompt treatment of infection and moist wound dressings. Over the last decade, new therapeutic modalities, including growth factors and living skin equivalents, have been available to the practicing physicians. Judicious use of advanced wound care products may provide the best means of treating these challenging wounds in an efficient and cost-effective way.     

Severe hyperphosphatemia and hypocalcemic tetany after oral laxative administration in a 3-month-old infant

A 3-month-old infant presented to the pediatric emergency department with respiratory distress and tetany after ingestion of a phosphate-containing oral laxative. The initial phosphorus level was 38.3 mg/dL. With aggressive fluid resuscitation and intravenous calcium administration, the infant completely recovered. Although the risks of phosphate-containing enemas are well described, life-threatening hyperphosphatemia can also result from administration of phosphate-containing oral laxatives. Aggressive fluid hydration is the mainstay of treatment. Intravenous calcium administration may be necessary to avoid hemodynamic collapse despite the theoretical possibility of metastatic calcifications. Physicians should be alerted to the possibility of phosphate toxicity and hypocalcemic tetany in young children when treated with over-the-counter laxatives. Caregivers should be advised not to administer over-the-counter laxatives to infants without physician supervision.     

Single and Combinative Impacts of Healthy Eating Behavior and Physical Activity on COVID-19-like Symptoms among Outpatients: A Multi-Hospital and Health Center Survey

Background: Healthy eating and physical activity are effective non-pharmacological approaches to boost immune function and contain the pandemic. We aimed to explore the associations and interactions between physical activity and healthy eating behavior with COVID-19-like symptoms (Slike-CV19S). Methods: A cross-sectional study was conducted on 3947 outpatients, from 14 February to 2 March 2020, at nine health facilities in Vietnam. Data collection included sociodemographic characteristics, healthy eating behavior (using the healthy eating score (HES) questionnaire), physical activity (using the short form international physical activity questionnaire), and Slike-CV19S. The associations and interactions were tested using logistic regression models. Results: Frequent intake of fruits (OR = 0.84; p = 0.016), vegetables (OR = 0.72; p = 0.036), and fish (OR = 0.43; p < 0.001) were associated with a lower Slike-CV19S likelihood, as compared with infrequent intake. Patients with higher HES levels (OR = 0.84; p = 0.033 for medium HES; OR = 0.77; p = 0.006 for high HES) or being physically active (OR = 0.69; p < 0.001) had a lower Slike-CV19S likelihood, as compared to those with low HES or physical inactivity, respectively. Patients with medium HES who were physically active (OR = 0.69; p = 0.005), or with high HES and physically active (OR = 0.58; p < 0.001), had a lower Slike-CV19S likelihood, as compared to those with low HES and physical inactivity. Conclusions: Healthy eating behavior and physical activity showed single and combinative impacts on protecting people from Slike-CV19S. Strategic approaches are encouraged to improve healthy behaviors, which may further contribute to containing the pandemic.     

Signalling molecules: clues from development of the limb bud for cryptorchidism?

Recent studies of testicular descent suggest not only that the gubernaculum does not initially attach to the scrotum, but also that it must migrate from the groin. Two findings suggest that the gubernaculum may behave like an embryonic limb bud during this phase. First, the active growth centre is at the distal tip of the gubernaculum. Secondly, the gubernaculum is loose in the subcutaneous tissues beneath Scarpa's fascia. The free protrusion of the gubernaculum from the abdominal wall was so reminiscent of a developing embryonic limb bud, we thought that the biological controls of both processus may be similar. This review examines what is known about vertebrate limb bud development, and compares the mechanisms to what has recently been discovered in the gubernaculum. The hypothesis that both processes may be similar is initially consistent with the current facts, encouraging us to investigate this further experimentally. Jenny Huynh, Natalie S. Shenker and Sophie Nightingale made equal contributions to the paper.     

Where FoxP3‐dependent regulatory T cells impinge on the development of inflammatory arthritis

Objective

Regulatory T cells play a suppressive role in many autoimmune diseases and can potentially affect various steps in the progression of disease. The purpose of this study was to analyze the role of Treg cells in the control of arthritis development.

Methods

Using crosses and cell transfers, we tested the effect of the scurfy loss‐of‐function mutation of the Foxp3 gene in the K/BxN mouse model. In this model, arthritis develops as the result of the production of high levels of pathogenic autoantibodies.

Results

The absence of Treg cells in K/BxN mice led to faster and more aggressive arthritis. Strikingly, disease also spread to joints not normally affected in this model. The absence of Treg cells resulted in an acceleration of the immunologic phase of disease, with significantly earlier autoantibody production. However, the broadened spectrum of affected joints in Foxp3‐mutant mice was not due to the earlier appearance of autoantibodies and could not be reproduced by increasing the anti–glucose‐6‐phosphate isomerase antibody load, which demonstrates an impact of Treg cells on effector phase manifestations. In addition, FoxP3+,CD25+ Treg cells accumulated in inflamed joints, even in nontransgenic animals. This preferential localization mimics that in human arthritides and indicates a preferential homing/retention of Treg cells to sites of inflammation.

Conclusion

These results indicate that Treg cells play a role in antibody‐mediated arthritis at several levels. Treg cells are involved in constraining the immune phase of disease, as well as limiting the articular damage provoked by the pathogenic autoantibodies in terms of severity and of the range of affected joints, which may contribute to the limited distal predominance of many arthritides.

     

Contact dermatitis in tobacco farmworkers

Occupational skin disease is highly prevalent among agricultural workers. Tobacco cultivation and harvest are particularly hazardous for farmworkers. We report 5 migrant Latino farmworkers in North Carolina with contact dermatitis related to tobacco work. These cases show a characteristic distribution of contact dermatitis; the flexural and medial surfaces of the upper extremities were affected in each case, whereas most cases showed some involvement of the torso and axilla. This pattern most likely reflects a common occupational practice of holding the tobacco leaves under the arm and pressed against the body during harvesting.     

Long-term visual outcome of childhood blepharokeratoconjunctivitis

PURPOSE: To assess the visual outcome of childhood blepharokeratoconjunctivitis. DESIGN: Retrospective noncomparative case series. METHODS: We reviewed visual acuity and corneal examination results for 23 patients (mean age 19 +/- 4 years, range, 11 to 26 years) who had healed more than three years previously (up to 15 years). RESULTS: The disease involved 29 eyes and was unilateral in 17 children. Corneal sequelae (neovascularization or scars) involved 18 eyes (62%) of 15 children (65%). Mean best-corrected visual acuity was 20/25 (range, 20/100 to 20/20). Best-corrected visual acuity was no more than 20/30 in seven eyes (24%) of seven children (30%). Fifteen eyes (52%) of 13 children (45%) had astigmatisms of at least 0.75 diopters attributable to corneal scars. CONCLUSIONS: Corneal and visual sequelae are frequent in childhood blepharokeratoconjunctivitis. Early diagnosis and specific treatment are mandatory.