BACKGROUND

Accurate diagnosis of onychomycosis is important because its treatment is long-term, costly, and sometimes with complications. KOH test is quick and cheap but has low sensitivity. Hence, the need for additional tests such as culture and/or PAS. However, these two tests are not readily available and expensive. Dermoscopy is an emerging tool for the diagnosis of nail conditions.

This study aims to evaluate the accuracy of dermoscopy as a point-of-care tool in diagnosing distal subungual onychomycosis (DSO).

This is a prospective, cross-sectional study of 22 clinically diagnosed DSO patients selected via convenience sampling in a tertiary hospital from November 2019 to March 2021. Participants had gross nail examination, dermoscopy, KOH and PAS tests. Measures of diagnostic accuracy for the different dermoscopic patterns were obtained, with KOH and PAS results as reference standard.

Fifty-one nail samples were submitted for processing with only 49 nails accepted for analysis. The most common pattern was jagged edge with spikes (65.3%). Combining all 5 dermoscopic patterns increased the sensitivity to 91.2% (95% CI: 76.3, 98.1).

Dermoscopy may be used as a first-step, point-of-care tool in the diagnosis of DSO. Addition of mycological and histopathological tests is still warranted for confirmation.

BACKGROUND

With the utility of nail dermoscopy to supplement the diagnosis of onychomycosis, studies have been done in describing common findings. However, most of these were based in Europe and the Americas. Given the geographical variation of onychomycosis, a local study is needed.

The general objective of this cross-sectional study is to determine the different patterns among the clinical subtypes of laboratory diagnosed onychomycosis patients seen at the Philippine General Hospital (PGH).

Clinically suspected Filipino onychomycosis patients seen at the PGH - Department of Dermatology, and at the PGH inpatient wards were recruited. All patients underwent the following: direct KOH microscopy, fungal culture studies, and nail clipping with PAS staining.

A total of 75 samples were included; 93.33% of the samples were categorized as DLSO subtype, 5.33% as TDO, and 1.33% as PSO. The three most common onychoscopic patterns were subungual hyperkeratosis (93.33%), chromonychia (85.33%), and longitudinal striae in 81.33%. KOH was positive in 57.33% of the cases, cultures in 38.67% and PAS stain in 80%. Onychoscopic pattern was not associated with clinical type of onychomycosis and causative organism. Negative KOH result was associated with linear edges (p=0.02).

Among patients with clinical and laboratory diagnosed onychomycosis, linear edges and jagged proximal edges were associated with negative KOH microscopy and fungal CS, respectively. Hence, in situations where such examinations are negative despite a strong clinical suspicion of onychomycosis, the above onychoscopic findings can be used for empirical diagnosis.

In this study, a restoration process was developed with potassium hydroxide (KOH), in order to improve each of the structures for their posterior fixation, through the use of new methods such as the Chilean conservative fixative solution (SFCCh), with exceptional results. Restore anatomical pieces corresponding to corpse and organs, being these last set with the SFCCh. In this work dealt with processes of restoration with potassium hydroxide, sodium chloride, and sodium hypochlorite, the process began with the cleanliness and suture of the structures for subsequent fixing in Chilean conservative fixative solution, making use of a corpse and different anatomical parts. Work based on items found in the database, Elsevier, Science Direct, ProQuest, and MEDLINE. At the end of the process of restoration and conservation of the anatomical pieces, was observed an improvement in muscle pigment with decrease of rigidity in the specimen, additionally a recovery of appearance in the vascular-nervous elements was achieved. The organs were much more malleable and the structures facilitate the identification of specific details, its subsequent immersion in SFCCh allows the longer preservation of the obtained results. The restoration with potassium hydroxide allows the improvement in the appearance of the different anatomical structures and simultaneously to facilitate its study. The SFCCh is an alternative that replaces partially the use of formaldehyde. In addition, it presents toxicity reduction.
Cadaver ; Formaldehyde ; Immersion ; Potassium ; Sodium Hydroxide ; Sodium Hypochlorite ; Sutures

BACKGROUND: Oral sodium phosphate (NaP) is currently used for colon preparation prior to colonoscopy or barium enema because of its convenience and efficacy. It can cause transient hyperphosphatemia and should be considered potentially dangerous in the presence of renal impairment. METHODS: A retrospective study was done in 48 patients (32 patients with normal renal function and 16 patients with azotemia : serum creatinine >or= 1.4 mg/dL) with hyperphosphatemia (serum phosphate >or= 6 mg/dL or 50% increase in baseline) who were administered NaP solution as bowel preparation at Seoul National University Hospital in the period of January 2000 to June 2003. RESULTS: The patients' mean age was 60 years (range, 25-85 years). The increase of serum phosphate was 5.3 +/- 3.1 mg/dL (7.6 +/- 4.4 mg/dL in azotemia group vs. 4.2 +/- 1.2 mg/dL in normal renal function group). Serum calcium and potassium concentration decreased significantly, while serum sodium level increased significantly. There were no significant differences in serum chloride, total CO2, blood urea nitrogen and creatinine. The product of calcium and phosphate increased from 33.0 +/- 11.3 mg2/dL2 to 74.0 +/- 28.7 mg2/dL2 (to 93.0 +/- 39.8 mg2/dL2 in azotemia group). Only 8 patients ingested the recommended dose of oral NaP with an appropriate time interval. The symptomatic adverse events were numbness in 3 patients and carpopedal spasm in 1 patient. 12 patients underwent CaCO3 or amphojel administration and 1 patient needed hemodialysis as a treatment of hyperphosphatemia. Serum phosphate returned to baseline level at 1.3 +/- 0.6 day (1.8 +/- 0.8 day in azotemia group vs. 1.0 +/- 0.3 day in normal renal function group). CONCLUSION: NaP is inappropriate for patients who may be at an increased risk for phosphate intoxication, especially patients with impaired renal function. Even to healthy adult without renal disease, NaP should be ingested the recommended dose with an appropriate time interval.
Adult ; Aluminum Hydroxide ; Azotemia ; Barium ; Blood Urea Nitrogen ; Calcium ; Colon ; Colonoscopy ; Creatinine ; Enema ; Humans ; Hyperphosphatemia* ; Hypesthesia ; Hypocalcemia ; Laxatives* ; Potassium ; Renal Dialysis ; Retrospective Studies ; Seoul ; Sodium ; Spasm

PURPOSE: It has previously been reported that citrate, thiazide, allopurinol and magnesium (CTAM) have inhibitory effects on calcium oxalate crystallization, but the effects of CTAM on the matrix proteins of stones in vivo has not been studied. Using an ethylene glycol-induced urolithiasis model, we investigated the effects of CTAM on renal crystallization and the expression of osteopontin (OPN), which is an important stone matrix protein. MATERIALS AND METHODS: Adult Sprague-Dawley rats (200-250gm) were divided randomly into 6 groups of 10 rats. Group 1 was left untreated, and served as a control. Group 2 (CID group) was fed 0.8% ethylene glycol and 1% ammonium chloride (crystal-inducing diet, CID) in drinking water for 4 weeks. Groups 3, 4, 5 and 6 (CTAM groups) were fed the same CID as group 2, but were also treated with either potassium citrate or hydrochlorothiazide or allopurinol or magnesium hydroxide, for 4 weeks, respectively. We biochemically analyzed the 24-hour urine and serum samples. The renal calcium content was measured by atomic absorption. The kidneys were histologically examined for crystal deposit with HandE staining, and for OPN expression with immunohistochemical staining. RESULTS: The grade of calcium oxalate crystal deposits, and renal calcium content, were significantly decreased in the CTAM groups compared to the CID group, which also correlated with the decreased expression of OPN proteins in the kidneys of the CTAM-treated rats. CTAM were all effective in preventing calcium oxalate crystal formation, and decreasing the expression of OPN in rat kidneys. CONCLUSIONS: Our results suggest that CTAM are effective in preventing calcium oxalate stone formation, and that OPN plays an important role in calcium oxalate nephrolithiasis.
Absorption ; Administration, Oral* ; Adult ; Allopurinol* ; Ammonium Chloride ; Animals ; Calcium Oxalate* ; Calcium* ; Citric Acid* ; Crystallization ; Diet ; Drinking Water ; Ethylene Glycol ; Hand ; Humans ; Hydrochlorothiazide ; Kidney ; Magnesium Hydroxide ; Magnesium* ; Nephrolithiasis ; Osteopontin* ; Potassium Citrate ; Rats* ; Rats, Sprague-Dawley ; Urolithiasis*