INTRODUCTION AND OBJECTIVES: Onychomycosis is defined as a fungal infection of the nail usually caused by a dermatophyte. This retrospective study will compare the diagnosis of onychomycosis based on clinical exam findings in comparison to laboratory results.
METHODS: Clinical diagnosis of onychomycosis of the nail is made through visual inspection of the nail. The characteristics that define a clinical diagnosis of onychomycosis include but is not limited to: thickness of nail, discoloration (yellow, black, and/or brown), crumbly texture, subungual debris, subungual fluid, splitting of the nail, and/or nail dystrophy. Patients were treated with either a topical or oral drug and this was based solely on the clinical characteristics of the nail with no further lab testing. The most recent 50 charts from the past three years (1/1/2013 to 1/31/2016) were utilized to conduct this retrospective study. The charts were analyzed based on the following criteria: patients that were clinically diagnosed with onychomycosis and also had a positive laboratory results that included a PAS, PCR, or KOH staining.
RESULTS: We found that there was a higher incidence of clinically positive diagnosis vs. laboratory culture positive results.
CONCLUSIONS: As expected fungal nail cultures are sometimes less sensitive than our clinical evaluation. This may be due to false negatives or failure to obtain an adequate sample for culture analysis. This may effect treatment standard of care and accuracy of treatment.
INTRODUCTION AND OBJECTIVES: The benefits of using amniotic tissue in skin regeneration are well documented. Today, cryopreservation technology allows for better availability and maintenance of mesenchymal stem cells. This is of particular interest in treating the diabetic foot ulcer as this population has fewer mesenchymal stem cells. The objective of this case series investigation was to compare the efficacy of cryopreserved human amniotic stem cells in treating foot wounds of different etiologies. We will present data and case photos for a diabetic foot ulcer, venous leg ulcer, arterial ankle ulcer, and a pyoderma gangrenosum ulcer
METHODS: Cryopreserved human amniotic stem cell grafts were applied to patients with chronic ulcers of different etiologies that had been subjected to at least 4 weeks of standard wound care and did not show adequate clinical progress. Wound area was recorded and photographed on weekly basis. Area reduction was charted over time and the results of each individual case were compared to one another.
RESULTS: All ulcers displayed results that well exceeded the established parameters of weekly healing rates for effective wound treatment modalities.
â€¢ Pyoderma gangrenosum displayed the poorest response to treatment. However, it is worth noting that the patient was not compliant in the prescribed adjunctive treatment regimen but managed to achieve 64% wound reduction.
â€¢ All ulcers showed the largest appreciable amount of healing in both total area reduction and week-to- week closure percentage after the first application.
CONCLUSIONS: Cryopreserved human amniotic stem cell grafts can aid in the decreasing the time to closure of various types of lower extremity ulcerations. The therapy is a clinically viable option for physicians to consider when formulating a treatment plan for a patient with an ulcer.