1340nm LASER THERAPY FOR ONYCHOMYCOSIS: Negative Results of Prospective Treatment of 72 Toenails and a Literature Review

Onychomycosis is an infection of the nail plate by fungal microorganisms. This infection has an important social impact on women and men and poses a major challenge for its treatment. The traditional treatment of onychomycosis involves the use of topical and oral antifungal agents. However, the presence of adverse effects frequently associated with oral antifungals, their high cost, and their potential interactions with other drugs reflect some of the problems associated with conventional therapy. The current report details the evaluation of a 1340nm laser as monotherapy for toenails affected by onychomycosis. A 1340nm, neodymium-yttrium:yttrium-aluminum-perovskite (Nd:YAP) (e) laser (Etherea, Industra technologies, Brazil) was used with the following treatment parameters: a spot size of 6mm, pulse duration of 5ms, fluence of 22 to 25J/cm2, and repetition rate of 1.5 to 2.5Hz. In all, 72 toenails were evaluated in 30 patients who had clinical and laboratory confirmation of onychomycosis. The efficacy of treatment was measured by the degree of patient satisfaction on a scale of 0 to 10 and by mycological cure evidenced by direct mycological exam and culture. Considering three applications of laser therapy and a clinical/laboratory follow-up period of 12 weeks, monotherapy with 1340nm laser was not effective, since 93.3 percent of the assessed patients remained without clinical and mycological cure. Despite reports of variable success rates with the use of different lasers for the treatment of onychomycosis, it is not yet possible to state that this therapeutic alternative is indicated for the treatment of these infections, mainly due to the limited number of patients and/or nail plates evaluated and the controversial results described in the literature.

FACTORS RELATED TO ORAL CANDIDIASIS IN ELDERLY USERS AND NON-USERS OF REMOVABLE DENTAL PROSTHESES

This study examined the association between oral candidiasis in elderly users and nonusers of prosthesis and its predisposing factors. To this end, we performed a cross-sectional study where saliva samples from 48 patients were collected they used prosthesis and 43 patients (control group) who did not use. Among the 91 patients, Candida spp were isolated in 40 (83.3%) who used prosthesis and in 23 (53.5%) in the control group. A statistically significant association was determined between the two groups, the isolation of yeasts and dental prosthesis (p < 0.05, OR = 4.3). The most common etiological agent was Candida albicans (37 isolates), with 23 (62.2%) in the denture group and 14 (37.8%) (control group). Among patients who presented clinical manifestations of oral candidiasis (n = 24), 83.3% (n = 20) belonged to the group that wore dentures, while only 16.7% (n = 4) belonged to the control group. Elderly patients with diabetes had 4.4 times higher estimated risk of developing oral candidiasis when compared with individuals without this condition. There was no statistically significant association between being user prostheses and have diabetes with the onset of candidiasis. No statistically significant association was determined between xerostomia, use of prosthesis and oral candidiasis. The use of prosthetics and poor oral hygiene in elderly patients predisposes to the development of oral candidiasis.

Effective surveillance of vector dynamics of Aedes aegypti in a hospital setting in Cuiabá, Mato Grosso, Brazil

INTRODUCTION

Hospitals are important for vector control of endemic diseases.

METHODOLOGY

To investigate the presence of dengue vectors, 30 locations at a university hospital in Cuiabá, Mato Grosso, Brazil, were monitored from January to December 2009 for mosquito eggs using ovitraps placed in high-traffic internal and external areas.

RESULTS

A total of 2,302 eggs were obtained. Positivity rate at different sites ranged from 50.0% to 0.0%, with the highest indices in external areas. The presence of eggs correlated with increasing humidity (r = 9.81; p = 0.0013).

DISCUSSION

The study aimed to detect and verify the infestation level of the dengue vector and the influence of abiotic factors.

CONCLUSIONS

The results indicate that this hospital may be considered an environment for the spread of dengue and hence strategic actions, including control measures and programs aimed at preventing the transmission of this vector, must be implemented.

Mucormycosis in Mato Grosso, Brazil: a case reports, caused by Rhizopus microsporus var. oligosporus and Rhizopus microsporus var. rhizopodiformis

We identified the etiological agents responsible for two fatal cases of rhinocerebral mucormycosis with the classical risk factor for uncontrolled type II diabetes mellitus. Their initial symptoms did not point immediately to the suspicion of mucormycosis. Case 1, caused by Rhizopus microsporus var. oligosporus, was a 52-year-old man who presented with a painful pimple on his nose, which evolved with swelling, erythema, and a central pustule on his right hemiface suspected to be cellulitis. After 7 days of antibiotic treatment, the patient worsened with signs of sepsis and the lesion evolved to necrosis involving all his right face. Case 2, caused by Rhizopus microsporus var. rhizopodiformis, was a 57-year-old woman placed on continuous therapy with azathioprine and corticoids after a renal transplant due to chronic arterial hypertension and uncontrolled type II diabetes mellitus. Because she was suspected to have sepsis, the patient was treated with broad-spectrum antibiotics and mechanical ventilation, yet she deteriorated. Because Candida spp. were isolated from urine and a BAL, she was treated with fluconazole for 10 days, then substituted by caspofungin. Two weeks later, she presented with exophthalmus of the left eye that was surrounded by a large inflammatory and necrotic area. Both patients were the diagnosed with mucormycosis via direct microscopy of necrotic material prior to their death.