Background It is well established and accepted that fungi are a major contributing factor in nail dystrophy. It has also been recognized that bacteria play a crucial role in onycholysis. However, the bacteria and fungi that can be grown on culture media in the laboratory are only a small fraction of the total diversity that exists in nature. Contemporary studies have revealed that fungi and bacteria often form physically and metabolically interdependent consortia that harbor properties and pathogenicity distinct from those of their individual components. Metagenomic DNA “shotgun” sequencing has proved useful in determining microbial etiology in clinical samples, effective for not only bacteria but also fungi, archaea, and viruses. Methods Thirty-nine consecutive nail and subungual debris samples with suspected onychomycosis were sent for laboratory analysis using three examination techniques: DNA sequencing, polymerase chain reaction analysis, and standard fungal culture. The nail plate and surrounding areas were disinfected with an ethyl alcohol swab before nail sampling. Samples from 16 patients were analyzed for suspected onychomycosis with DNA sequencing, searching a database of 25,000 known pathogens. These results were compared with 15 real-time polymerase chain reaction screening assays and eight fungal cultures sampled with the same methods. Results The DNA sequencing detected 32 species of bacteria and 28 species of fungi: 50% were solely bacterial, 6.3% were solely fungal, and 43.7% were mixed communities of bacteria and fungi. Conclusions Toenails tested with DNA sequencing demonstrated the presence of both bacteria and fungi in many samples. Further work is required to fully investigate its relevance to nail pathology and treatment.
This case study evaluates the use of Extracorporeal Pulse Activation Therapy (EPAT) and Amniotic Extracellular Matrix Injection (AEMI) in a patient suffering unilateral post-traumatic subtalar joint (STJ) osteoarthritis. Following an injury he was not able to work or exercise secondary to subtalar joint pain. He had failed treatment with bracing, physical therapy, and PRP injections and was not interested in surgery. Following serial EPAT and AEMI the patient had a decrease in pain score (from 5/10 at rest, to 2/10 with activity and 0/10 at rest) and was able to return to work and activities. In conclusion, EPAT and AEMI are effective treatments for STJ arthritis, present a viable alternative to surgery, and should be explored for use in other degenerative conditions of the foot and ankle.
Gout is one of the most common etiologies of inflammatory monoarticular arthritis. Recent literature is reviewed to compare a novel advancement in chronic gout medication, febuxostat, to its counterpart allopurinol, through the identification of significant findings and improvements. Literature review concluded that febuxostat serves as a viable alternative when compared to allopurinol.
Talar fractures account for less than 1% of all fractures, yet despite this low occurrence they represent a major reconstruction challenge for surgeons. While total talar replacements are seldom used, there are very few procedures that can simultaneously repair a damaged talus and allow the patient to retain adequate range of motion, joint stability, function and satisfaction. These factors have become the impetus for exploring the role of 3D printing as a relatively novel surgical intervention for reconstructing the talus. Specific indications for a 3D printed total talar replacement include severe osteoarthritis, avascular necrosis, osteomyelitis, and trauma especially in the setting of a juvenile patient. As a relatively new approach, there is still much to be explored in regards to creating a 3D printed talar prosthesis, and the utility of the technology would greatly benefit from further research and development. Based upon our initial review of seven different studies, the use of 3D printed talar implants, when surgically indicated, demonstrates promising results in increasing patient satisfaction and improving postsurgical outcomes when compared to more conventional methods of repair. Thus, 3D printed talar implants represent a potentially viable tool to be considered by surgeons for a more precise and patient outcome-driven solution following talar injury.
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