Risk factors associated with fingernail and toenail onychomycosis and effect of disease on quality of life

Ciljevi ove disertacije bili su: 1) ispitivanje uloge faktora rizika u etiopatogenezi onihomikoze šaka i stopala; 2) upoređivanje kvaliteta života obolelih od onihomikoze (OM) stopala i šaka; 3) procena kvaliteta života obolelih od OM u zavisnosti od težine bolesti i prisustva komorbiditeta. Metod: U studiju je uključeno 157 osoba obolelih od OM i 196 osoba sa dijagnozom nekog drugog oboljenja kože u čijem nastanku ispitivani faktori rizika nemaju uticaj. Ispitivanje je sprovedeno u Beogradu, u periodu od septembra 2009. do februara 2012. godine. Uloga faktora rizika u pojavi OM ispitivana je primenom sudije slučajeva i kontrola. Kvalitet života obolelih od OM procenjen je primenom studije preseka. Za merenje kvaliteta života korišćeni su Specifični upitnik o kvalitetu života osoba sa gljivičnom infekcijom noktiju (engl. ONYCHO), verzija za nokte šaka i verzija za nokte stopala i Opšti zdravstveni upitnik SF-36. Rezultati: Faktori rizika nezavisno povezani sa razvojem OM bili su: starija životna dob (Unakrsni odnos UO=1,022; 95% granice poverenja GP=1,004–1,041), nemanuelna zanimanja (UO=0,492; GP=0,259–0,934) i prisustvo neuroloških oboljenja (UO=3,886; GP=1,384–10.912). Žene i pacijenti koji su imali OM stopala duže od 2 godine imali su lošiji kvalitet života. Manuelni radnici i osobe sa opsežnijim zahvatanjem noktiju stopala gljivičnom infekcijom imali su značajno niže skorove za domen simptomi upitnika ONYCHO. Kod pacijenata starije životne dobi (>70 godina) i kod osoba sa hroničnim oboljenjima kvalitet života meren SF-36 upitnikom je bio značajno lošiji. Upotreba alkohola je bila povezana sa višim skorovima u segmentima emocije i simptomi upitnika ONYCHO u odnosu na osobe koje nisu koristile alkohol. Spirmanov koeficijent korelacije između pitanja upitnika SF-36 i ONYCHO za nokte stopala kretao se u rasponu 0,036 do 0,406. Žene sa OM šaka su imale lošiji kvalitet života u odnosu na muškarce. Veći broj noktiju zahvaćenih OM, bavljenje manuelnim zanimanjem, prisustvo drugih hroničnih oboljenja i udruženost OM šaka sa OM stopala značajno su uticali na smanjenje kvaliteta života procenjeno ONYCHO upitnikom...The objectives of the present thesis were: 1) to examine possible risk factors related to fingernail and toenail onychomycosis (OM); 2) to compare the quality of life (QoL) between patients with fingernail and toenail OM; 3) to evaluate the health related QoL in patients with OM according to disease severity and the presence of comorbidity. Method: A total of 157 consecutive outpatients with OM and 196 outpatients with other skin diseases in which etiopathogenesis the examined risk factors doesn’t have influence have been included in the study. A research was carried out from September 2009 to February 2012, in Belgrade, Serbia. Risk factors for OM were evaluated using the case-control study. The cross-sectional study was conducted to asses the QoL in patients with OM. In evaluating the impact of OM on the patients’ QoL, we used: the Onychomycosis quality of life questionnaire (ONYCHO)–toenail and fingernail versions and a generic instrument, the Medical Outcomes Study Short Form-36 Health Survey (SF-36). Results: Risk factors independently associated with OM were older age (Odds ratio OR=1,022; 95% confidence interval CI=1,004–1,041); white-collar professions (OR=0,492; CI=0,259–0,934) and the presence of neurological diseases (OR=3,886; CI=1,384–10.912). Women and patients who were experiencing toenail OM for more than 2 years were reporting worse disease-specific HRQoL. The patients working in blue-collar occupations and patients with greater involvement of individual nails were more affected by OM regarding symptoms. QoL in the older patients (>70 years) and in the patients with chronic diseases was significantly more impaired as measured by SF- 36. Alcohol consumption was associated with higher QoL scores on the emotional and symptoms scales of ONYCHO. Spearman’s correlation coefficients between SF-36 and ONYCHO scales for toenail OM ranged from 0.036 to 0.406. Women with fingernail OM had more impaired QoL than man. The larger number of the fingernails involved in OM, blue-collar professions, presence of chronic diseases and involvement of both fingernails and toenails in OM significantly influenced on impairment of QoL measured by ONYCHO. Spearman’s correlation coefficients between SF-36 and ONYCHO scales for fingernail OM ranged from -0.020 to 0.456..

Risk factors associated with fingernail and toenail onychomycosis and effect of disease on quality of life

Ciljevi ove disertacije bili su: 1) ispitivanje uloge faktora rizika u etiopatogenezi onihomikoze šaka i stopala; 2) upoređivanje kvaliteta života obolelih od onihomikoze (OM) stopala i šaka; 3) procena kvaliteta života obolelih od OM u zavisnosti od težine bolesti i prisustva komorbiditeta. Metod: U studiju je uključeno 157 osoba obolelih od OM i 196 osoba sa dijagnozom nekog drugog oboljenja kože u čijem nastanku ispitivani faktori rizika nemaju uticaj. Ispitivanje je sprovedeno u Beogradu, u periodu od septembra 2009. do februara 2012. godine. Uloga faktora rizika u pojavi OM ispitivana je primenom sudije slučajeva i kontrola. Kvalitet života obolelih od OM procenjen je primenom studije preseka. Za merenje kvaliteta života korišćeni su Specifični upitnik o kvalitetu života osoba sa gljivičnom infekcijom noktiju (engl. ONYCHO), verzija za nokte šaka i verzija za nokte stopala i Opšti zdravstveni upitnik SF-36. Rezultati: Faktori rizika nezavisno povezani sa razvojem OM bili su: starija životna dob (Unakrsni odnos UO=1,022; 95% granice poverenja GP=1,004–1,041), nemanuelna zanimanja (UO=0,492; GP=0,259–0,934) i prisustvo neuroloških oboljenja (UO=3,886; GP=1,384–10.912). Žene i pacijenti koji su imali OM stopala duže od 2 godine imali su lošiji kvalitet života. Manuelni radnici i osobe sa opsežnijim zahvatanjem noktiju stopala gljivičnom infekcijom imali su značajno niže skorove za domen simptomi upitnika ONYCHO. Kod pacijenata starije životne dobi (>70 godina) i kod osoba sa hroničnim oboljenjima kvalitet života meren SF-36 upitnikom je bio značajno lošiji. Upotreba alkohola je bila povezana sa višim skorovima u segmentima emocije i simptomi upitnika ONYCHO u odnosu na osobe koje nisu koristile alkohol. Spirmanov koeficijent korelacije između pitanja upitnika SF-36 i ONYCHO za nokte stopala kretao se u rasponu 0,036 do 0,406. Žene sa OM šaka su imale lošiji kvalitet života u odnosu na muškarce. Veći broj noktiju zahvaćenih OM, bavljenje manuelnim zanimanjem, prisustvo drugih hroničnih oboljenja i udruženost OM šaka sa OM stopala značajno su uticali na smanjenje kvaliteta života procenjeno ONYCHO upitnikom...The objectives of the present thesis were: 1) to examine possible risk factors related to fingernail and toenail onychomycosis (OM); 2) to compare the quality of life (QoL) between patients with fingernail and toenail OM; 3) to evaluate the health related QoL in patients with OM according to disease severity and the presence of comorbidity. Method: A total of 157 consecutive outpatients with OM and 196 outpatients with other skin diseases in which etiopathogenesis the examined risk factors doesn’t have influence have been included in the study. A research was carried out from September 2009 to February 2012, in Belgrade, Serbia. Risk factors for OM were evaluated using the case-control study. The cross-sectional study was conducted to asses the QoL in patients with OM. In evaluating the impact of OM on the patients’ QoL, we used: the Onychomycosis quality of life questionnaire (ONYCHO)–toenail and fingernail versions and a generic instrument, the Medical Outcomes Study Short Form-36 Health Survey (SF-36). Results: Risk factors independently associated with OM were older age (Odds ratio OR=1,022; 95% confidence interval CI=1,004–1,041); white-collar professions (OR=0,492; CI=0,259–0,934) and the presence of neurological diseases (OR=3,886; CI=1,384–10.912). Women and patients who were experiencing toenail OM for more than 2 years were reporting worse disease-specific HRQoL. The patients working in blue-collar occupations and patients with greater involvement of individual nails were more affected by OM regarding symptoms. QoL in the older patients (>70 years) and in the patients with chronic diseases was significantly more impaired as measured by SF- 36. Alcohol consumption was associated with higher QoL scores on the emotional and symptoms scales of ONYCHO. Spearman’s correlation coefficients between SF-36 and ONYCHO scales for toenail OM ranged from 0.036 to 0.406. Women with fingernail OM had more impaired QoL than man. The larger number of the fingernails involved in OM, blue-collar professions, presence of chronic diseases and involvement of both fingernails and toenails in OM significantly influenced on impairment of QoL measured by ONYCHO. Spearman’s correlation coefficients between SF-36 and ONYCHO scales for fingernail OM ranged from -0.020 to 0.456..

Unilateral multiple lichen striatus treated with tacrolimus ointment: a case report

A previously healthy 11-year-old boy with multiple, unilateral lichen striatus (LS) on the left side of the body is described. The distribution of the lesions corresponded to the lines of Blaschko. Histology of the lesional skin was compatible with LS. Two years after the onset of the linear eruption, treatment with tacrolimus ointment resulted in significant improvement over a short period of time. To our knowledge, this is the first time that the use of tacrolimus for successful treatment of LS with multiple lesions has been reported

Presence, species distribution, and density of Malassezia yeast in patients with seborrhoeic dermatitis - a community-based case-control study and review of literature

Malassezia yeast belongs to the normal cutaneous flora and under certain conditions it causes seborrhoeic dermatitis (SD). There is no culture-based study about the presence and density of the Malassezia in SD patients in Serbia. Aim was to show the presence, species distribution and density of Malassezia in patients with SD on lesional skin (LS) and non-lesional skin (NLS) and healthy controls (HC) and to compare data between Serbia and other countries. The study included 70 HC and 60 patients with SD in the study group (SG). Isolation, identification and examination of density of Malassezia colony-forming units from LS and NLS were performed. Malassezia was found more frequently in the SG than in HC, 90% and 60%, respectively (P lt 0.01). The most frequent isolates in SG on LS were M. slooffiae (26%), followed by M. globosa (17%) and M. sympodialis (17%). The yeast density was much higher on LS of SG than on NLS of SG or in the HC group (P lt 0.05). Higher density of Malassezia was shown on LS of SG than on NLS of SG and HC. M. slooffiae is the most prevalent species in SD patients in Serbia. This study demonstrated a positive relationship between severity of SD and presence of Malassezia spp

The first case of isolation of malassezia globosa in our country

Today is known that genus Malassezia includes seven species: M. furfur, M. sympodialis, M. obtusa, M. globosa, M. restricta, M. slooffiae and M. pachydermatis, but role of each of the species in the pathogenesis of desease has not been eluciated yet, so futher laboratory isolation and identification are necessary. We report the first case of isolation of Malassezia globosa in Serbia (Belgrade), in a patient suffering from Pityriasis versicolor. Identification of M. globosa was based on macroscopic, microscopic and biochemical characteristics. Isolation was done on Leeming and Notman medium and on mDixona agar, at 350C, during 7 days in aerobic conditions. Also the yeast's biochemical phenotype was determined as catalase (+), lipase (+), esculin degradation (-), Tween (20,40, 60 and 80) asimilation (-). M. globosa is a lipophilic yeast of the genus Malassezia and the common member of the skin flora. In concordance with some predis-poning factors M. globosa is implicated in the pathogenesis of several skin diseases (pityriasis versicolor, malassezia foliculitis sebor-rheic dermatitis and some forms of atopic dermatitis). In immuno-compromised patients and neonates this yeast can even cause fatal systemic infections. Because the role of Malassezia spp. in pathogenesis of skin desease is not still determined, we suggest laboratory diagnosis and identification of these species as a routine diagnostic procedure

Mapping the path to excellence: Evaluation of the diagnostic and treatment tools for invasive fungal infections in the balkans

Background: In the Balkans, rising concerns about invasive fungal infections over the past decade stem from various factors. Primarily, there has been a notable uptick in immunocompromised individuals, including those with chronic illnesses like immunological and hematological diseases. Thus, it is essential to assess the region's laboratory capabilities and the availability of antifungals. This evaluation is vital for gauging the preparedness to diagnose and treat fungal infections effectively, thus minimizing their public health impact. Methods: Data were collected via an online questionnaire targeting healthcare professionals specializing in relevant fields across diverse healthcare settings in Balkan countries. The survey covered various aspects, including diagnostic methods, imaging techniques, and available antifungal armamentarium. Results: Responses were obtained from 50 institutions across the Balkans. While conventional diagnostic methods like microscopy (96 %) and culture (100 %) diagnostics were widely available, access to newer diagnostic tools such as molecular assays (61 %) were limited, often relying on outsourced services. Imaging modalities like ultrasound (100 %) and CT scans (93 %) were universally accessible. A variety of antifungal drugs were available, including amphotericin B formulations (80 %), echinocandins (79 %), and triazoles (100 %). However, access to newer agents like posaconazole (62 %) and isavuconazole (45 %) was inconsistent. Therapeutic drug monitoring (53 %) services were also limited. Conclusion: The study underscores the need for equitable access to diagnostic facilities and antifungal treatments across healthcare settings in the Balkan geographic region. Improving access to molecular diagnostic tools and essential antifungal drugs, as well as implementing therapeutic drug monitoring, would optimize the management of fungal infections in the region