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Journal of Fungi (Basel, Switzerland) Jul 2022Mycetoma describes a heterogeneous group of cutaneous and subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). It is characterized... (Review)
Review
Mycetoma describes a heterogeneous group of cutaneous and subcutaneous infections caused by either fungi (eumycetomas) or bacteria (actinomycetomas). It is characterized by a triad of clinical symptoms: painless subcutaneous tumor-like swelling, multiple sinuses and fistulas, and discharged grains in pus. This predominantly affects the feet in more than 70% of patients. It is endemic in the "mycetoma belt" regions, including Africa, South America, and South Asia. Autochthonous mycetoma is rare in the United States of America (USA). We recently reported a Latin American immigrant with eumycetoma in the State of Maryland, USA. With millions of immigrants from endemic regions, the true number of mycetomas in the USA is most likely higher than currently recognized. With the aim to raise the awareness of clinicians about mycetoma, especially dermatologists and podiatrists, we update the development of the epidemiology, etiology, clinical presentations, pathogenesis, diagnosis, differential diagnosis, and treatment of mycetoma.
PubMed: 35887499
DOI: 10.3390/jof8070743 -
Journal of Foot and Ankle Research Mar 2022Doppler is the most commonly utilised vascular assessment tool by podiatrists in Australia and the United Kingdom. Doppler is a key component of many international...
Doppler is the most commonly utilised vascular assessment tool by podiatrists in Australia and the United Kingdom. Doppler is a key component of many international guidelines for vascular assessment. Used alongside pressure measurements such as ankle and toe-brachial indices, Doppler assists podiatrists to diagnose, triage and subsequently manage patients with peripheral arterial disease. This commentary aims to clarify the importance, technique, and interpretation of continuous wave handheld Doppler in podiatry practice. This commentary presents discussion on the equipment and optimal test conditions for use of Doppler, and guidance on the technique required in podiatry clinical practice. Furthermore, there is a focus on interpretation of the output from Doppler including both audio and visual output. There is in depth discussion about identifying pathology and integration into the clinical management plan.
Topics: Ankle; Ankle Brachial Index; Humans; Lower Extremity; Peripheral Arterial Disease; Ultrasonography, Doppler
PubMed: 35346290
DOI: 10.1186/s13047-022-00530-x -
Skin Appendage Disorders Jul 2022While the Internet remains a popular source of health information, YouTube may contain bias and incomplete information regarding common dermatological conditions.
BACKGROUND
While the Internet remains a popular source of health information, YouTube may contain bias and incomplete information regarding common dermatological conditions.
OBJECTIVE
Our objective was to quantify onychomycosis treatment recommendations on YouTube.
METHODS
We searched YouTube for "nail fungus," "toenail fungus," "onychomycosis treatment," "onychomycosis," and "nail fungus treatment" in separate searches. The top 30 videos meeting inclusion criteria in each search were viewed for video demographics and treatment recommendations.
RESULTS
Analysis was performed on 102 videos. The majority of videos (81.3%) were intended for patient education. Analyzing videos by speaker, 50.0% featured a podiatrist, 13.7% a nondermatologist physician or other medical professional, 10.8% a patient or blogger, 6.9% a dermatologist, and 2.0% a nail technician. Videos recommended FDA-approved therapies, as well as OTC products. The most recommended medical therapies included oral terbinafine and laser therapy, mentioned in 29 and 28 videos, respectively. Various natural remedies were recommended, with tea tree oil being endorsed in 23 videos.
CONCLUSION
YouTube offers patient education on a range of treatment options for onychomycosis. We caution patients against starting treatments based on social media recommendations and encourage dermatologists to utilize social media to educate the public on common dermatological conditions.
PubMed: 35983464
DOI: 10.1159/000521909 -
Revista Espanola de Sanidad... 2023
Topics: Humans; Blue Toe Syndrome
PubMed: 38289167
DOI: 10.18176/resp.00078 -
Journal of Foot and Ankle Research Dec 2022This commentary outlines practical ways of positively incorporating green podiatry, foot health, physical activity benefits, and relevance to climate change into the... (Review)
Review
BACKGROUND
This commentary outlines practical ways of positively incorporating green podiatry, foot health, physical activity benefits, and relevance to climate change into the clinical setting as Conference of Parties (COP27) approaches. Recent reports from the Intergovernmental Panel on Climate Change, the World Economic Forum, and undergraduate curricula concerns, are presented.
MAIN BODY
Climate change is irrefutable, and as health professionals, podiatrists can discuss the benefits and principles of green podiatry with patients of all ages in their clinics, appreciating that people are increasingly worried about the climate crisis. Feet as fundamental for independent, healthy, and carbon-neutral active transport, needs to become a key message. The three pillars for green podiatry are exercise, evidence, and the everyday changes that all podiatrists can make. Likewise, podiatrists can encourage their patients, and in doing so, join with community leadership, alongside other allied health and medical peers.
CONCLUSION
Podiatrists have a shared responsibility to work and live as 'green' as possible, and to share this message with patients. Reducing waste, physically and in the form of unnecessary treatment, and supporting a review of supply chains, are important aspects of reducing health care emissions. Promoting feet as carbon-neutral transport, and physical activity as evidence based and health enhancing, are a sound contribution to twenty-first century public health. Podiatry has a great opportunity for positive legacy.
Topics: Humans; Podiatry; Delivery of Health Care; Foot Diseases; Foot; Carbon
PubMed: 36494832
DOI: 10.1186/s13047-022-00591-y -
Diabetes Research and Clinical Practice Nov 2023To examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment.
AIMS
To examine inequality in dentist, ophthalmologist, and podiatrist attendance among adults with type 2 diabetes in a country with varying degrees of co-payment.
RESEARCH DESIGN AND METHODS
We conducted a cross-sectional study with a population of 41,181 people with type 2 diabetes resident in the Central Denmark Region in 2019, identified through Danish registers using a prespecified diabetes algorithm. Descriptive statistics and multiple logistic regression were used to examine the attendance at dentist, ophthalmologist, and podiatrist, controlling for sociodemographic and clinical factors. Attendance at dentist, ophthalmologist, and podiatrist were examined separately.
RESULTS
The majority (59.7 %) had attended the ophthalmologist at least once in the preceding year, whereas 46.5 % and 34.2 % had visited the dentist/dental hygienist and podiatrist, respectively. Disposable household income increased attendance significantly, with a clear gradient in the OR of attending the dentist (p < 0.001), whereas age significantly magnified the OR of podiatrist and ophthalmologist attendance (p < 0.001).
CONCLUSIONS
This study provides circumstantial evidence that co-payment can increase inequality in health care attendance, especially for dental attendance, and it further shows that there is significant sociodemographic inequality in healthcare utilisation among people with type 2 diabetes.
Topics: Humans; Adult; Diabetes Mellitus, Type 2; Cross-Sectional Studies; Patient Acceptance of Health Care; Logistic Models; Multivariate Analysis; Socioeconomic Factors
PubMed: 37890705
DOI: 10.1016/j.diabres.2023.110982 -
Maedica Mar 2020The Charcot neuro-osteoarthropathy is a devastating complication of diabetes, with negative impact on both prognosis and quality of life. Moreover, the diagnostic is...
The Charcot neuro-osteoarthropathy is a devastating complication of diabetes, with negative impact on both prognosis and quality of life. Moreover, the diagnostic is often missed or delayed. A 50 years old male patient with dyslipidemia, overweight and hypertension was referred to our Diabetes Department in the context of newly diagnosed diabetes (HbA1C=11.7%), four days after left hallux trans-metatarsal amputation and debridement of the dorsal collection, for wet gangrene of the left hallux, with dorsal extension. The diagnostic of diabetic neuro-osteoarthropathy of the left foot was delayed several months. A good glycemic control was achieved with insulin glargine and metformin. We look further to introducing modern antidiabetic drugs with not only proven cardiovascular benefit but also good impact on weight. The patient needs to be managed by a multidisciplinary team, which has to include a podiatrist and a vascular surgeon. This case suggest the importance of rising diabetes and diabetic peripheral polyneuropathy awareness in all medical fields.
PubMed: 32419872
DOI: 10.26574/maedica.2020.15.1.122 -
Journal of Foot and Ankle Research May 20222022 marks a decade since the profession of podiatry secured independent prescribing rights in the UK. Widely viewed as a significant milestone, its advent appeared to... (Review)
Review
BACKGROUND
2022 marks a decade since the profession of podiatry secured independent prescribing rights in the UK. Widely viewed as a significant milestone, its advent appeared to herald a new age of practice, with increased autonomy, a broader scope of practice and improved patient care. Access to any medicine within the British National Formulary (with a few notable exceptions) seemed to signal an end to the perennial difficulties and frequent disappointments in obtaining ease of access to medicines necessary for effective practice.
MAIN BODY
Recent attempts to expand the scope of prescribing practice to include access to a broader range of controlled drugs (CDs) have led to unanticipated complications which may even threaten existing rights. These issues highlight the limitations of current independent prescribing and the continuing inability of podiatrists to access certain key medicines, primarily controlled drugs. Reliance on specified 'lists' of approved medicines, whether a controlled drug list for prescribers or the use of statutory exemptions by non-prescriber podiatrists, remain inflexible and difficult to change. The data underpinning much of this paper is derived from the work undertaken by the authors as representatives of podiatry on NHS England's Chief Professions' Officers' Medicines project, in particular involving submissions to the Commission on Human Medicines and the Advisory Council on the Misuse of Medicines, spanning the years 2017-2021. It describes a complex process, and highlights a misalignment between two legislative frameworks that threaten to unravel existing rights.
SHORT CONCLUSION
Ongoing difficulties relating to controlled drugs illustrate the problematic nature of current supply, administration and prescribing rights in podiatry. Efforts to keep pace with periodic legal reclassifications of medicines are constrained by limited and inflexible legal mechanisms, and formal approval for extended access via prescribing remains unpredictable and complex. For prescriber and non-prescriber (Non- prescriber podiatrists are those who are neither supplementary or independent prescribers, but do enjoy existing administration and supply rights to certain medicines.) podiatrists alike, the profession of podiatry faces a new challenge to its ability to access medicines, and to realise its full clinical potential.
Topics: Allied Health Personnel; Drug Prescriptions; Humans; Podiatry; United Kingdom
PubMed: 35546680
DOI: 10.1186/s13047-022-00541-8 -
Journal of Foot and Ankle Research Nov 2021The eyes of the world will be on COP26 as it meets in Glasgow in November, 2021. Our planet is displaying weather extremes due to climate change which cannot be ignored,...
BACKGROUND
The eyes of the world will be on COP26 as it meets in Glasgow in November, 2021. Our planet is displaying weather extremes due to climate change which cannot be ignored, and which are deleterious for people's health. Ironically, healthcare contributes to climate change, contributing approximately 5% of carbon emissions globally. Climate change due to global warming is 'the biggest global health threat of the 21st century'.
MAIN BODY
The Australian Podiatry Association conference held a sustainability panel, hearing perspectives of industry and science, medicine and sport, fashion, and retail. Content unified a broad planet and human health message, which is highly relevant for podiatrists. Key themes included waste as a resource, exercise as evidence-based intervention, responsibility and circular economy recycling principles for end-of-life product (footwear) purchases, and wider ethical considerations of footwear and clothing. The Anthropocene origin of climate change requires humanity to collaborate and to live more sustainably. Innovation is essential for better energy modes, cleaner air, human health and earth care. Green Podiatry joins the concerted activity of medical and health groups within Australia. The UK's NHS is an exemplar in this area, having already reduced healthcare emissions by 35%, and aiming for net zero by 2045, and perhaps sooner.
CONCLUSION
People are increasingly concerned about climate change, and COP26 is an important and imminent meeting for human and planet health. This commentary on Green Podiatry directs us all to lighten our carbon footprint. A final, and forthcoming commentary will outline practical ways of positively incorporating climate change communication into the clinical setting.
Topics: Australia; Carbon Footprint; Climate Change; Humans; Podiatry
PubMed: 34844653
DOI: 10.1186/s13047-021-00497-1 -
The Cochrane Database of Systematic... May 2021Lower limb muscle cramps are common and painful. They can limit exercise participation, and reduce quality of sleep, and quality of life. Many interventions are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Lower limb muscle cramps are common and painful. They can limit exercise participation, and reduce quality of sleep, and quality of life. Many interventions are available for lower limb cramps; some are controversial or could cause harm, and often, people experience no benefit from the interventions used. This is an update of a Cochrane Review first published in 2012. We updated the review to incorporate new evidence.
OBJECTIVES
To assess the effects of non-drug, non-invasive therapies for lower limb muscle cramps.
SEARCH METHODS
In August 2018 and May 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, and reference lists of included studies. We imposed no restrictions by language or publication date.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) of non-drug, non-invasive interventions tested over at least four weeks, for lower limb muscle cramps in any group of people, except pregnant women. The primary outcome was cramp frequency. Secondary outcomes were cramp pain severity, cramp duration, health-related quality of life, quality of sleep, participation in activities of daily living, proportion of participants reporting lower limb muscle cramps, and adverse events.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials, assessed risk of bias, and cross-checked data extraction and analyses according to standard Cochrane procedures.
MAIN RESULTS
We included three trials, with 201 participants, all 50 years of age and older; none had neurological disease. All trials evaluated a form of stretching for lower limb muscle cramps. A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps (measured on a 10 cm visual analogue scale (VAS) where 0 = no pain and 10 cm = worst pain imaginable) in people aged 55 years and older, compared to no intervention (mean difference (MD) -1.30, 95% confidence interval (CI) -1.74 to -0.86; 1 RCT, 80 participants; low-certainty evidence). The certainty of evidence was very low for cramp frequency (change in number of cramps per night from week zero to week six) comparing the stretching group and the no intervention group (MD -1.2, 95% CI -1.8 to -0.6; 80 participants; very low-certainty evidence). Calf stretching alone for 12 weeks may make little to no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older (stretching group median number of cramps in the last four weeks (Md) 4, interquartile range (IQR) 8; N = 48; sham stretching group Md 3, IQR 7.63; N = 46) (U = 973.5, z = -0.995, P = 0.32, r = 0.10; 1 RCT, 94 participants; low-certainty evidence). This trial did not report cramp severity. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome (N = 24). It was not possible to fully analyse the frequency data and the scale used to measure cramp severity is not validated. No study reported health-related quality of life, quality of sleep, or participation in activities of daily living. No participant in these three studies reported adverse events. The evidence for adverse events was of moderate certainty as the studies were too small to detect uncommon events. In two of the three studies, outcomes were at risk of recall bias, and tools used to measure outcomes were not validated. Due to limitations in study designs that led to risks of bias, and imprecise findings with wide CIs, we cannot be certain that findings of future studies will be similar to those presented in this review.
AUTHORS' CONCLUSIONS
A combination of daily calf and hamstring stretching for six weeks may reduce the severity of night-time lower limb muscle cramps in people aged 55 years and older, but the effect on cramp frequency is uncertain. Calf stretching alone compared to sham stretching for 12 weeks may make little or no difference to the frequency of night-time lower limb muscle cramps in people aged 60 years and older. The evidence is very uncertain about the effects of a combination of daily calf, quadriceps, and hamstring stretching on the frequency and severity of leg cramps in 50- to 60-year-old women with metabolic syndrome. Overall, use of unvalidated outcome measures and inconsistent diagnostic criteria make it difficult to compare the studies and apply findings to clinical practice. Given the prevalence and impact of lower limb muscle cramps, there is a pressing need to carefully evaluate many of the commonly recommended and emerging non-drug therapies in well-designed RCTs across all types of lower limb muscle cramps. A specific cramp outcome tool should be developed and validated for use in future research.
Topics: Activities of Daily Living; Age Factors; Aged; Bias; Female; Hamstring Muscles; Humans; Leg; Lower Extremity; Male; Middle Aged; Muscle Cramp; Muscle Relaxants, Central; Muscle Stretching Exercises; Pain Measurement; Quinine; Randomized Controlled Trials as Topic; Secondary Prevention
PubMed: 33998664
DOI: 10.1002/14651858.CD008496.pub3