Interdigital Space Research Articles

A Comprehensive Epidemiological Study on Dermatophytosis in Dogs in Jabalpur, India

Dermatophytosis is a contagious fungal infection of keratinized tissue. The disease is of significant veterinary and public health importance due to its zoonotic potential, posing risks to both animals and humans. The present study was undertaken to investigate occurrence of dermatophytosis in dogs. During the study period, from May to October 2024, a total of 2468 dogs were screened which were presented at Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Jabalpur (M.P.). Among them, 225 dogs were suspected for dermatological disorders and 43 dogs were found to be positive for dermatophytosis. The occurrence of different dermatological disorders was recorded highest in Pyoderma (20.89%), followed by dermatophytosis (19.11%), others (18.67%), Malassezia dermatitis (15.11%), mange in (13.78%) and tick and flea infestation (12.44%). The overall occurrence of dermatophytosis in dogs was recorded as 1.74% and among the suspected dogs, the occurrence was 19.11%. Age wise occurrence was significantly higher in 0-1 years of age (38.10%). Gender wise occurrence was observed significantly higher in males (25.93%). The breed wise highest occurrence of dermatophytosis was recorded in the Labrador breed of dogs (24.39%). The most prevalent clinical signs observed in canine dermatophytosis were alopecia (86.00%), scales (74.40%), crusts (74.40%), circular lesions (72.10%), pruritis (58.10%), erythema (51.20%), hyperpigmentation (46.50) and pustules and papules (34.90%). The lesions were predominantly seen on hind limbs (69.77%) followed by forelimbs (67.44%), dorsum (65.12%), face, head and neck (62.79%), paws (55.81%), interdigital space (48.84%), tail (41.86%) and abdomen (13.95%).

Interdigital and Plantar Foot Infections: A Retrospective Analysis of Molecularly Diagnosed Specimens in the United States and a Literature Review.

Up to one-quarter of the United States population is affected by tinea pedis (athlete's foot). Tinea pedis of the web space (interdigital tinea pedis) is a common clinical presentation causing skin macerations and fissures. A "dermatophytosis complex" (i.e., concomitant bacterial colonization) further complicates treatment. Here, we examined records of 14,429 skin specimens taken from the feet of dermatology and podiatry outpatients over a 4.6-year period; all specimens were subjected to multiplex qPCR diagnosis for the detection of dermatophytes, Candida, Corynebacterium minutissimum, Pseudomonas and Staphylococcus aureus. A literature search was conducted to review the reported prevalence of fungal and bacterial agents. In both interdigital and plantar foot specimens, dermatophytes (33.3-33.8%) and S. aureus (24.3-25%) were found to be the predominate pathogens. In the interdigital space, a higher prevalence of C. minutissimum (15.7% vs. 7.9%) and Pseudomonas (23.5% vs. 9.6%) was found. The detection of Pseudomonas was more likely to be observed in the presence of Candida, reflecting a higher risk of mixed infection. In dermatophyte-positive specimens, the "dermatophytosis complex" variant was observed at 45.5% (SD: 2.3). An analysis of patient characteristics showed male patients exhibiting higher likelihoods for dermatophyte, C. minutissimum, Pseudomonas and S. aureus detections. The elderly were disproportionately infected with Candida. In children, an S. aureus detection was more common, which could be attributed to impetigo. The recent literature lacks reporting on concomitant bacterial colonization in tinea pedis patients, likely due to the reliance on fungal culture supplemented with antibiotics. Geographical variation has been identified in the detection of the Trichophyton mentagrophytes complex. In conclusion, PCR diagnosis serves as a valuable tool for the management of tinea pedis. An accurate and timely detection of fungal pathogens and concomitant bacterial colonization can better inform healthcare providers of appropriate treatment selection.

Interaction of acoustic waves with spin waves using a GHz operating GaN/Si SAW device with a Ni/NiFeSi layer between its IDTs.

A two port surface acoustic wave (SAW) device was developed to be used for the control and excitation via spin waves (SW). The structure was manufactured using advanced nanolithography techniques, on GaN/Si, enabling fundamental Rayleigh interdigitated transducer (IDT) resonances in GHz frequency range. The ferromagnetic resonance of the magnetostrictive Ni/NiFeSi layer placed between the IDTs of the SAW device can be tuned to the SAW resonance frequency by magnetic fields. Using structures with finger and interdigit spacing of 170 nm and 100 nm, fundamental Rayleigh IDT resonance frequencies of 6.4 and 10.4 GHz have been obtained. Coupling of SAW to SW was demonstrated through transmission measurements at the fundamental Rayleigh frequencies in a magnetic field, μ0H from -280 to +280 mT, at different angles (θ) between the SAW propagation direction and the magnetic field direction. For the 6.4 GHz resonator a maximum decrease of about 1.2 dB occurred in |S21|, at μ0H = 30 mT and at θ = 45. Time-gated processing of the frequency domain raw data was used to remove the direct electromagnetic cross talk and triple transit effects. Nonreciprocity associated to the coupling was analyzed for the two SAW structures. The quantitative influence of the magnetic field strength on the phase of the transmission parameters is also presented.

Detection of anti-3AB3 non-structural protein antibodies in foot-and-mouth disease virus vaccinated buffaloes at a semi-organized farm of Madhya Pradesh in India

Foot-and-mouth disease (FMD), one of the most important viral diseases of cloven-hoofed animals in India, is caused by FMD virus (FMDV) which belongs to Aphthovirus in the family Picornaviridae. There are three serotypes of FMDV (O, A and Asia 1) circulating amongst the livestock population of India. FMD is characterized by the formation of vesicles especially over the tongue and in between the interdigital space. FMD-affected animals with tongue lesions are reluctant to feed and subsequently yield less milk as well as affected animals never regain their production status causing huge economic losses to the animal owners. In the present study, random whole blood samples from FMD-vaccinated 38 adult buffaloes were collected in sterile containers of a semi-organized buffalo farm of Madhya Pradesh in India. Purified FMD vaccines only elicit antibodies (that are protective) against structural proteins of FMDV while natural FMDV infection invokes antibodies against both structural and non-structural proteins. Serum samples were employed in recombinant 3AB3 non-structural protein-based enzyme-linked immunosorbent assay (3AB3 NSP-ELISA kit provided by ICAR-Directorate of FMD, Mukteshwar) for differentiation of FMD-infected and vaccinated animals (DIVA). A total of 10.53% (4/38) serum samples tested positive in DIVA. Largely the vaccinated animals remained protected as no clinical signs of the disease were observed reiterating the importance of regular FMDV vaccination in animals at semi-organized dairy farms.

The Danger of Foot and Mouth Disease in Livestock – A Review

The FMD virus, also known as FMDV, is a member of the Picornaviridae family of the genus Aphthovirus. There are seven immunologically distinct FMD virus serotypes, known as Asia-1, A, C, O, South-African Territories (SAT) -1, -2, and -3. The disease's clinical symptoms include the development of vesicles on the lips, tongue, palate, tooth pads, nose, coronary band, gums, and interdigital spaces. There are many viral, host, and environmental factors that affect the epidemiology of FMD, including variations in viral virulence, particle stability in diverse microenvironments, and possible long-term survival. FMD can spread in a variety of ways, including through human contact with contaminated milk tankers or animal transport vehicles, the use of contaminated animal goods, equipment, or vehicles, or by the transmission of windborne viruses. Foot and mouth illness is not considered to be a serious public health hazard because the infection seems to be rare and the effects are self-limiting. Since the cost of disease control is added to the direct economic losses brought on by animal deaths, decreased milk production, and slowed animal growth rates, FMD epidemics indirectly harm the economy. Some of the techniques used to control FMD epidemics include mobility restrictions, quarantines, the death of infected and exposed animals, and cleaning and disinfecting impacted buildings, equipment, and vehicles.

Chronic occupational paronychia secondary to digital pilonidal sinus from dog grooming.

Objectives Pilonidal sinus is a recognized occupational condition sometimes seen in barbers and pet groomers, and it involves most commonly interdigital spaces. We present a previously unreported case of chronic paronychia with two separate digital pilonidal sinuses resulting from multiple embedded hair fragments in the eponychium of a dog groomer, who had been repeatedly treated with antibiotics with no success and ended up to surgical treatment. The objective of this study is to remind readers of this rare but possible occupational disease, particularly among employees working with hair, and to emphasize the importance of preventive measures to prevent its occurrence. Case Presentation Intraoperatively, a crescent of eponychia skin parallel to the proximal nail fold was excised, which incorporated the sinuses. Additionally, the nail plate was removed, and multiple hair fragments were retrieved from the nail folds. At the follow-up, the infection had resolved, and nail growth had resumed. Additional animal hair was found in the nail folds, as the patient continued to work without protective gloves. Conclusions This case highlights the importance of considering embedded hair as a potential cause for chronic paronychia in individuals with occupations involving hair cutting and grooming. Chronic hand infection poses a risk of contaminating infection to clients or patients, e.g., a veterinarian cannot operate on an infected hand. The costs of sickness absences are considerable for all the stakeholders. The use of protective gloves, hand hygiene, skin care, and thorough removal of loose hair fragments should be emphasized for workers in professions dealing with animal or human hair.

Evaluation of ‘In-Parlour Scoring’ (IPS) to Detect Lameness in Dairy Cows during Milking

The objective of this study was to evaluate the potential of ‘In-Parlour Scoring’ (IPS) as an alternative to locomotion scoring in herringbone, side-by-side, and tandem milking parlours in Austria. Between January and May 2023, a total of 990 observations were conducted on 495 cows across eleven Austrian dairy farms by two investigators working simultaneously but independently of each other. The observation criteria included shifting weight, claw conformation, and obvious disorders of the distal limb. Locomotion scoring was conducted on all cows within 24 h of assessment in the milking parlour using a scale of 1 to 5 (LCS 1: not lame; LCS 5: severely lame). Functional hoof trimming was performed within ten days after IPS. The following indicators were identified as useful for predicting lameness (LCS ≥ 3): shifting weight, abnormal weight distribution, swollen heel, hock joint or interdigital space, skin lesion on the lateral hock, claw position score, digital dermatitis lesions, short dorsal claw wall, and hyperextension of one claw. The reliability of the individual indicators for intra- and inter-rater assessment exhibited considerable variation ((weighted) kappa values: −0.0020–0.9651 and −0.0037–1.0, respectively). The specificity and sensitivity for the prediction of lame cows were calculated to be ≥ 96% and ≤ 24%, respectively. It was demonstrated that a one-time IPS has limited suitability for lameness assessment on Austrian dairy farms with herringbone, side-by-side, and tandem milking parlours.

BIOMECHANICAL VARIABLES OF THE FOOT IN SOUND RETICULATED GIRAFFES (GIRAFFA CAMELOPARDALIS RETICULATA) IN HUMAN CARE.

Lameness is an important veterinary and welfare concern for giraffes in human care. To date, there is limited information on the objective weight-bearing characteristics of the foot in giraffes, making evidence-based decisions for foot care and lameness treatment subjective. Eleven young-adult reticulated giraffes (Giraffa camelopardalis reticulata; median age, 3.5 yr [range, 13 mon-13 yr]), with no clinical lameness or visible hoof overgrowth when viewed from standing, voluntarily walked across a commercially available pressure-sensitive walkway. Footfalls were analyzed for force, pressure, surface area, and impulse from each foot. The weight-bearing claw was also determined based on pressure in both the front and hind limbs. The data obtained suggest that the main weight-bearing claw is the lateral claw in both the forelimbs and the hind limbs the majority of the time, but is inconsistent. The forelimbs also had greater values for all biomechanical variables than the hind limbs. The higher force and pressure suggest that giraffe forelimbs are subjected to greater biomechanical stress than the hind limbs. The relative maximum force from front limbs to hind limbs was 59:41. For these clinically sound giraffes, the center of force was consistently located in the interdigital space approximately equidistant from the toe and heel correlating with the center of mass of the limb. Furthermore, foot strikes occurred in a heel-first pattern. A pressure-sensitive walkway was well tolerated by all animals in the study and may be used in future research to help further elucidate factors that contribute to lameness in giraffes.

Benchmarking analysis of computer vision algorithms on edge devices for the real-time detection of digital dermatitis in dairy cows

Digital dermatitis (DD) is a bovine claw disease responsible for ulcerative lesions on the coronary band of the foot. It causes significant animal welfare and economic losses to the cattle industry. Early detection of DD can lead to prompt treatment and decrease lameness. Current detection and staging methods require a trained individual to evaluate the interdigital space on each foot for clinical signs of DD. Computer vision (CV), a type of artificial intelligence for image analysis, has demonstrated promising results on object detection tasks. However, farms require robust solutions that can be deployed in harsh conditions including dust, debris, humidity, precipitation, other equipment issues. The study aims to train, deploy, and benchmark DD detection models on edge devices. Images were collected from commercial dairy farms with the camera facing the interdigital space on the plantar surface of the foot. Images were scored for M-stages of DD by a trained investigator using the M-stage DD classification system. Models were trained to detect and score DD lesions and embedded on an edge device. The Tiny YOLOv4 model deployed on a CV specific integrated camera module connected to a single board computer achieved a mean average precision (mAP) of 0.895, an overall prediction accuracy of 0.873, and a Cohen's kappa of 0.830 for agreement between the computer vision model and the trained investigator. The model reached a final inference speed of 40 frames per second (FPS) and ran stably without any interruptions. The CV model was able to detect DD lesions on an edge device with high performance and speed. The CV tool can be used for early detection and prompt treatment of DD in dairy cows. Real-time detection of DD on edge device will improve health outcomes, while simultaneously decreasing labor costs. We demonstrate that the deployed model can be a low-power and portable solution for real-time detection of DD on dairy farms. This result is a step towards applying CV algorithms to veterinary medicine and implementing real-time detection of health outcomes in precision farming.

Reconstruction of Total Hand Degloving Injury with Combined Free and Pedicled Flaps and Ilizarov Minifixator.

Total hand degloving injuries present a significant challenge in treatment, with no consensus yet on the optimal choice of flap for coverage. Functional reconstruction necessitates careful consideration of syndactyly release, particularly after flap coverage. A 64-year-old woman sustained a total hand degloving injury and underwent extensive reconstructive surgery. Initially, a free superficial circumflex iliac perforator flap was applied to the thumb, whereas pedicled groin and superficial inferior epigastric artery flaps were used for the remaining fingers. However, partial necrosis at the edges of the pedicled flaps necessitated the adduction of the fingers, followed by suturing the skin flaps closed. This led to the formation of adduction contractures, requiring careful release and skin flap extension for effective syndactyly release. Subsequently, the innovative use of an Ilizarov minifixator was used for the dual purpose of interdigital widening and elongation of the flap. At the 27-month follow-up, the patient demonstrated significant functional recovery of the hand and fingers, showing the effectiveness of this multifaceted surgical approach. Despite some residual flexion contractures, the patient regained the ability to write and perform pinching motions with the thumb and middle finger, expressing satisfaction with the surgical outcome. In conclusion, for a functional reconstruction of the thumb and fingers, the thumb and other fingers should be covered separately. When the fingers are in adduction and there is insufficient skin stock for syndactyly release, using an external fixator to expand the interdigital spaces before the syndactyly release proved to be effective.

Genetic Variability and Antibacterial Sensitivity of Dichelobacter nodosus and Fusobacterium necrophorum Infection in Sheep Sulaimani Province, Kurdistan Region, Iraq

Footrot is a significant health problem in ruminants, especially sheep, caused by the bacteria Dichelobacter nodosus and Fusobacterium necrophorum. Infected animals may become lame and lose body condition. The aim of this study was to investigate whether sheep had mixed infections with D. nodosus and F. necrophorum, the global genetic relationships of both target genes (lktA and 16S rRNA genes) with different reference genes, and the degree of genetic heterogeneity between the standard serogroups of D. nodosus were studied. In addition, to detect the antibacterial sensitivity against these two pathogens. One hundred and seventy-five sheep interdigital spaces were investigated (2016-2022). The D. nodosus field isolate (Dn Sul/016-KY399851) showed 96% compatibility with other global isolates (NR_104942/USA, JN008724/India, and DQ016290/Sweden) when its 16S rRNA sequence was compared to some reference genes. The local isolate (Fn Sul/016- KY399852) and other IktA gene strains from other nations (FJ230831/New Zealand, JX678872/Australia, JX648295/India) were compared, and the results showed 99% and 96% identity. Additionally, within the multiple sequence alignment, a single nucleotide variation at position 389 (CA) was seen in the partial lktA sequence when compared to the field isolate (Fn Sul/16-KY399852). This modification corresponds to a switch at residue 130 from alanine (Ala) to glutamic acid (Glu). This study showed the initial molecular identification of D. nodosus and F. necrophorum from sheep with footrot in the Iraqi province of Sulaimani‎‎‎‎‎.

Comparative analysis of computer vision algorithms for the real-time detection of digital dermatitis in dairy cows

Digital dermatitis (DD) is a bovine claw disease responsible for ulcerative lesions on the planar aspect of the hoof. DD is associated with massive herd outbreaks of lameness and influences cattle welfare and production. Early detection of DD can lead to prompt treatment and decrease lameness. Computer vision (CV) provides a unique opportunity to improve early detection. The study aims to train and compare applications for the real-time detection of DD in dairy cows. Eight CV models were trained for detection and scoring, compared using performance metrics and inference time, and the best model was automated for real-time detection using images and video. Images were collected from commercial dairy farms while facing the interdigital space on the plantar surface of the foot. Images were scored for M-stages of DD by a trained investigator using the M-stage DD classification system with distinct labels for hyperkeratosis (H) and proliferations (P). Two sets of images were compiled: the first dataset (Dataset 1) containing 1,177 M0/M4H and 1,050 M2/M2P images and the second dataset (Dataset 2) containing 240 M0, 17 M2, 51 M2P, 114 M4H, and 108 M4P images. Models were trained to detect and score DD lesions and compared for precision, recall, and mean average precision (mAP) in addition to inference time in frame per second (FPS). Seven of the nine CV models performed well compared to the ground truth of labeled images using Dataset 1. The six models, Faster R-CNN, Cascade R-CNN, YOLOv3, Tiny YOLOv3, YOLOv4, Tiny YOLOv4, and YOLOv5s achieved an mAP between 0.964 and 0.998, whereas the other two models, SSD and SSD Lite, yielded an mAP of 0.371 and 0.387 respectively. Overall, YOLOv4, Tiny YOLOv4, and YOLOv5s outperformed all other models with almost perfect precision, perfect recall, and a higher mAP. Tiny YOLOv4 outperformed all other models with respect to inference time at 333 FPS, followed by YOLOv5s at 133 FPS and YOLOv4 at 65 FPS. YOLOv4 and Tiny YOLOv4 performed better than YOLOv5s compared to the ground truth using Dataset 2. YOLOv4 and Tiny YOLOv4 yielded a similar mAP of 0.896 and 0.895, respectively. However, Tiny YOLOv4 achieved both higher precision and recall compared to YOLOv4. Finally, Tiny YOLOv4 was able to detect DD lesions on a commercial dairy farm with high performance and speed. The proposed CV tool can be used for early detection and prompt treatment of DD in dairy cows. This result is a step towards applying CV algorithms to veterinary medicine and implementing real-time DD detection on dairy farms.

Morton's Metatarsalgia: The Current State of the Issue

A typical complaint with Morton's neuroma is a burning paroxysmal pain in the area of the plantar surface of the metatarsal bones with irradiation into the III interdigital space, which forces the patient to take off his shoes and massage the foot in the most inappropriate situations. Given that women are mostly ill, clinical manifestations reduce the quality of life of patients, limit their daily professional and work activities. The paper presents the etiology, pathogenesis and clinical picture of this disease, diagnostic features. A radical method of treatment is surgery, which is relatively simple in technique and consists in dissecting the tissues that compress the nerve and creating optimal conditions for the nerve trunk, preventing its subsequent traumatization.

Estudio de los factores de riesgo de la presencia de los nevus interdigitales de los pies

No studies focused on counting the interdigital acquired melanocytic nevi (AMN) of the foot (IDNf) have ever been conducted. Therefore, our objective was to study the relationship between the presence of IDNf and the total number of AMN in the feet and the rest of the body, the racial phenotypic characteristics, and other risk factors for melanoma. We conducted a cross-sectional observational study with 255 patients ≥18 years old who attended our Dermatology Unit from September 2020 through February 2021, and included all AMN ≥1mm from the feet and ≥2mm from the rest of the bod. The association between the variables was studied using univariate and multivariate logistic regression models. The presence of IDNf was significantly and independently associated with the presence of plantar AMN and body counts ≥50 AMN. However, no significant differences were observed regarding sex, age, personal history of melanoma, presence of nevi on the dorsum of the foot, history of sunburn or UV rays, or racial phenotypic characteristics. The presence of IDNf is associated with a higher count of plantar nevi and total AMN in the body, meaning that interdigital spaces of the foot-anatomical expansions of the sole and other possibly genetic causes-could be responsible for the number of AMN found in this location, as these regions are not photoexposed.

Correlation of lesion severity with bacterial changes in Treponeme-Associated Hoof Disease from free-roaming wild elk (Cervus canadensis)

BackgroundTreponeme-Associated Hoof Disease (TAHD) is a polybacterial, multifactorial disease affecting free-ranging wild elk (Cervus canadensis) in the Pacific Northwest. Previous studies have indicated a bacterial etiology similar to digital dermatitis in livestock, including isolation of Treponema species from lesions. The lesions appear to progress rapidly from ulcerative areas in the interdigital space or along the coronary band to severe, ulcerative, necrotic, proliferative lesions under-running the hoof wall, perforating the sole, and contributing to hoof elongation, deformity, and overgrowth. Eventually the lesions undermine the laminal structure leading to sloughing of the hoof horn capsule. The objective of this study was to characterize the bacterial communities associated with hoof lesions, which were categorized into 5 stages or disease grade severities, with 0 being unaffected tissue and 4 being sloughed hoof capsule. We also wanted to determine if the etiology of TAHD through morphological changes was dominated by Treponema, as observed in hoof diseases in livestock.ResultsThe bacterial 16S rRNA gene was sequenced from 66 hoof skin biopsy samples representing 5 lesion grades from samples collected by Washington Department of Fish and Wildlife as part of a voluntary hunter program. Analysis of the relative abundance of bacterial sequences showed that lesions were dominated by members of the bacterial phyla Proteobacteria, Firmicutes, Spirochaetes, Bacteroidetes and Actinobacteria. In lesion samples, members of the genus Treponema, Porphyromonas, and Mycoplasma increased with lesion severity. Association analysis indicated frequent identification of Treponema with Porphyromonas, Bacteroides and other anaerobic Gram-positive cocci.ConclusionsThe bacterial 16S rRNA gene sequencing confirmed the presence of Treponema species at all stages of TAHD lesions, treponeme specie-specific PCR and histopathology, indicating that the morphological changes are a continual progression of disease severity with similar bacterial communities. Association and abundance of these other pathogenic genera within lesions may mean synergistic role with Treponema in hoof disease pathogenesis. Characterizing bacteria involved in lesion development, and their persistence during disease progression, provides evidence for science-based management decisions in TAHD infected elk populations.

“Morton’s Neuroma” — Term Etymology: A Review

Background. The urgency of the problem is explained by a high morbidity rate and the need to verify the diagnosis with related specialists (ultrasound physicians, radiologists, trauma surgeons, pathologists), as well as by significant difficulties in patient routing and high probability of primary referral to neurologists, neurosurgeons, and general practitioners. In modern Russian literature, neuromas of all interdigital spaces are identified with Morton’s neuroma.
 Aim of the review was to determine the accuracy of modern medical terminology, in particular of the term «Morton’s neuroma», to reveal the spectrum of eponyms unacceptable for communication with related specialists and patients, to fill the historical gap and to attract the scientific medical community to discussion on this topic.
 Methods. We identified 40 articles on this topic published from 1845 to 2022. The search was performed in PubMed/MEDLINE and eLIBRARY databases.
 Results. Evolution, history, and etymology of several terms used for intermetatarsal neuroma are covered in the study, based on the analysis of literature sources. It has been found that a number of eponyms used to designate neuromas are historically inaccurate. In addition, we have discovered that the reports of «nerve fibrosis» were encountered prior to the introduction of the term «neuroma». However, most authors have popularized the nominal term «Morton’s neuromas».
 Conclusions. An obvious contradiction between the etiopathogenesis of neuroma and the term itself can be confusing for clinicians and diagnosticians. In our opinion, the disease known nowadays as «Morton’s neuroma» should be named «fibrosis of the plantar nerve of the third toe», and the name terms denoting the number of the corresponding interdigital space should be replaced by the number of the corresponding common plantar digital nerve.

Gram-Negative Toe Web Infections.

Gram-negative bacterial toe web infection (GNTWI) is a common dermatologic condition affecting the interdigital spaces. The clinical presentation ranges from mild erythema to exudative maceration of the web spaces that may extend to in other areas of the foot and lead to cellulitis in severe cases. Pseudomonas aeruginosa is the most commonly identified etiologic agent. Occlusive and humid environments, pre-existing dermatologic conditions, and fungal infections increase the risk of developing GNTWI. GNTWI has a broad differential diagnosis including erythrasma, tinea pedis, pitted keratolysis, eczematous dermatitis, and malignancies. Diagnosis is performed using bacterial and fungal cultures. There is a lack of a standardized treatment regimen for GNTWI. While GNTWI is fairly common, it may still be under-recognized by dermatologists due to the limited medical literature. This article presents a review of GNTWI, its clinical features, epidemiologic factors, etiologic agents, predisposing factors, diagnostic methods, and therapeutic options.

Instrumental and clinical diagnosis of interdigital Morton neuroma

Background: Interdigital neuroma is one of the most common diseases in foot surgery. It is a common cause of metatarsalgia leading to debilitating pain. At the same time, the diagnosis of neuroma can be a difficult task for an orthopedic surgeon due to the complex anatomy of the forefoot and a large number of soft-tissue and bone structures. Besides, the existing manual testing methods are not pathognomonic specifically for neuroma. The clinical symptoms and history, as well as a physical exam and instrumental evidence are important in assessing and grading the disease. However, there are no recommendations in the modern Russian literature regarding the need for routine visualization of neuroma. The reproducibility of the study, the absence of ionizing radiation and the possibility of obtaining a second opinion, as well as high sensitivity makes magnetic resonance imaging an important diagnostic tool in the diagnosis of neuroma. Aim: To evaluate the importance of the anamnesis and complaints and the sensitivity of clinical tests and magnetic resonance imaging of the foot in the diagnosis of interdigital neuromas. Methods: The study presents a retrospective analysis of the medical histories and outpatient records of 28 patients (8 men and 20 women) treated at the EMC ECSTO in the period from 2017 to 2022. The examination was performed according to a standardized protocol: collection of complaints and anamnesis, palpation, manual testing, including Mulder's click test. As a part of examination, magnetic resonance imaging of the foot was performed for all the patients. The average patient’s age at the time of the surgical treatment was 45 years. The resection of a part of the affected nerve with the subsequent histological examination was considered a gold standard for the treatment and verification of interdigital neuromas. In all the cases, the histopathological study confirmed the diagnosis. Results: The sensitivity of magnetic resonance imaging in the diagnosis of interdigital neuromas was 86%, the sensitivity of the Mulder test was 61%. Pain during the palpation of the affected interdigital space was determined in 100% of cases. Conclusion: The combination of a manual examination and magnetic resonance imaging, along with the analysis of complaints and anamnesis makes it possible to diagnose Morton's neuroma in most cases.

Assessment of scabies and its associated factors in Hawassa Zuria District, Southern Ethiopia: A cross-sectional study.

Scabies is a common but neglected skin disease caused by the parasitic mite Sarcoptes scabiei var. hominis. Globally, the disease affects more than 400 million people. Although Ethiopia is a high-burden country for scabies, its epidemiology has not been well assessed. Therefore, this study aimed to determine the prevalence of scabies, clinical features, and associated risk factors in the communities of the Hawassa Zuria District of the Sidama Region, southern Ethiopia. A community-based cross-sectional study was conducted from September through November 2023 in the Hawassa Zuria District. A multistage random sampling technique was applied to enrol 511 participants. The International Alliance for Control of Scabies Diagnostic Criteria was used for examination. The data were collected electronically using the Open Data Kit application through a pretested interviewer-administered questionnaire. Analysis was performed using STATA software. The binary logistic regression analyses model was used to assess the association between each independent variable and scabies prevalence. During the bivariate logistic regression analyses a variable with a p-value of < 0.25 was a candidate for multivariable logistic regression analyses. In multivariable logistic regression analyses the odds ratios with a 95% confidence interval and a p-value less than 0.05 were used to describe the strength of the association and statistical significance. The median age of the study participants was 19 years (interquartile range: 11-32 years), and 52.6% of the participants were females. The overall prevalence of scabies was 6.3% (95% CI 4.3-8.7%). The majority of individuals with scabies had a moderate degree of severity. The most frequent lesions were intensely itchy papules, vesicles, and pustules that appeared in the interdigital space, flexor wrist surfaces, and elbow. Males were more likely to have scabies [adjusted odds ratio (AOR) = 2.57; 95% CI: 1.10-6.00] than females were and it was not influenced by age. The risk of scabies was higher for households with low (AOR = 3.88; 95% CI: 1.01-14.91) and middle-class wealth index (AOR = 4.43; 95% CI: 1.13-17.33), as well as for individuals residing in households with an overcrowding index >1.5 (AOR = 2.64; 95% CI: 1.13-6.18), in those individuals who washed their hands with water only (AOR = 2.98; 95% CI: 1.23-7.24), in those who used an unimproved water source (AOR = 2.98; 95% CI: 1.25-7.06) and in those who slept on the floor (AOR = 2.70; 95% CI: 1.17-6.18). The observed moderate presence of scabies in the study area stresses the need to strengthen disease management efforts, improve wealth, reduce overcrowding, ensure clean water access, and promote better hygiene practices to reduce the spread of scabies.

Epidermophyton floccosum kao uzročnik Tinea pedis - prikaz slučaja

Tinea pedis or athlete's foot is a surface fungal epidermal infection caused by dermatophytic fungi of the species Trichophyton (T.) rubrum, T. mentagrophytes var. interdigitale, Epidermophyton floccosum or T. tonsurans. It occurs most often in adult men, rarely in women and children. It is estimated that at least 70% of all people have a fungal foot infection at least once in their lifetime. Case report: a 43-year-old male with a clinical picture of Tinea pedis was referred to the Institute of Public Health of Serbia "Dr Milan Jovanović Batut" for laboratory diagnostics of the fungal infection of the right foot. In terms of patient history, he reported having dry, flaky changes to the skin of his right foot for two years, as well as erosion in the III and IV interdigital spaces of the foot. Due to itching, burning, and flaking of the skin on his feet, he reported to the attending physician who put him on betamethasone/gentamicin cream. The itching decreased, but the changes did not recede. Right foot toenails were not showing visible signs of infection. Direct microscopic examination of the right foot scrapings found micellar fibres and arthrospores, while culturing on dermatophyte-appropriate media allowed for the isolation of Epidermophyton floccosum. The isolate was identified based on microscopic morphology of the cultured organism, macroscopic appearance of the culture on dermatophyte isolation media, as well as using MALDI-TOF mass spectrometric diagnostics. Mycological confirmation of foot infection with the Epidermophyton floccosum fungus, with adequate treatment, reduces the risk of developing an onychomycosis, which is harder to treat.