Toe Web Spaces Research Articles

A multiplex microbial profiling system for the identification of the source of body fluid and skin samples

Determining the source of body fluids is crucial in forensic investigations, as it provides valuable information about suspects and the nature of the crime. Microbial markers that trace the source of tissues and body fluids based on site specificity and temporal stability are often used effectively for this purpose. In this study, a multiplex system comprising seven microbial markers (Finegoldia magna, Corynebacterium tuberculostearicum, Cutibacterium acnes, Haemophilus parainfluenzae, Streptococcus oralis, Prevotella melaninogenica and Faecalibacterium prausnitzii) was developed to distinguish between skin, saliva, and feces samples. Based on these markers, the system produces electropherograms that are specific for each sample type. We collected 492 samples from six different skin sites (palm, antecubital crease, inguinal crease, cheek, upper back, and toe web space), the buccal mucosa, and stool were collected to further test the system. Beta diversity analysis revealed distinct clustering among the three sample groups. Additionally, skin microenvironment cluster analysis was used to identify skin sites accurately. This analysis classified skin samples into four distinct microenvironments: dry, moist, oily, and foot. Finally, we established a machine learning prediction model based on random forest regression to identify the skin microenvironment, achieving an overall prediction accuracy of 79 %. The multiplex system developed in this study accurately identifies the sources of body fluids, and the skin microenvironment. These findings offer new insights into the application of microbial markers in forensic science.

BACTERIOLOGICAL AND MYCOLOGICAL PROFILE OF TOE WEB SPACE INFECTIONS: A CLINICO EPIDEMIOLOGICAL STUDY

Background: Dermatophytic fungi are more commonly associated with interdigital toe web space infections. However, the disease pertains to other pathogens also. In recent years, there has been an increasing number of reports concerning non-dermatophytic fungal infections and mixed infections with gram negative bacteria. Objectives : 1) To study the clinical prole of toe web space infections 2) To know the aetiology of toe web space infections Materials and Methods : 50 clinically suspected adult cases (18-60 years) of toe web space infections were included in the study. Detailed history was taken and clinical examination was performed. Specimen samples were collected from toe web space and Gram staining, KOH mount, bacterial and fungal culture were done. Majority of study subjects belonged to 40-60 yea Results: rs age group with no gender difference. Housewives by occupation constituted for 34% of study subjects. Diabetes can be considered as an important risk factor in the etiology (21%). 85% participants presented with maceration, 70% with scaling, 65% with erythema, 35% with pruritus. 4th toe web space was commonly involved (40%). Tinea pedis, psoriasis and cellulitis are most commonly associated cutaneous diseases among the study participants. Among the fungal species isolated, candida (39%) fusarium (34%) and trichophyton (30%) were the common ones Staphylococcus aureus (35%) klebsiella (16%) pseudomonas (12%) were the common bacterial organisms isolated. Conclusion: Fourth toe web space infection was most commonly noted and majority of study subjects belonged to 40-60 years age group, among whom housewives were predominantly affected. Candida, Fusarium, Trichophyton, Staphylococcus aureus, Klebsiella and Pseudomonas were the most common species isolated. There are many etiological factors responsible for toe web space infections, which are usually over diagnosed, underdiagnosed/ misdiagnosed. Hence proper clinical approach and laboratory investigations would yield denitive diagnosis resulting in appropriate treatment.

Mono-helix bandage using cotton gauze strip as an easy and inexpensive method for separating interdigital toe web space

Mono-helix bandage using cotton gauze strip as an easy and inexpensive method for separating interdigital toe web space

Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe.

Polysyndactyly of the fused fifth toe with the fourth toe is a common subtype of postaxial polydactyly. The aim of the study was to present an operative technique for cosmetic improvement and reconstruction of polysyndactyly of the fused fifth toe with the fourth toe. We retrospectively reviewed the details of 22 patients with postaxial polydactyly treated from January 2018 to May 2021. The operation involved medial toe excision and web space reconstruction using a dorsal rectangular flap without skin grafting and simultaneous correction of a valgus deformity by chondroplasty and soft tissue balancing without an osteotomy. The web shape, scar, and aesthetic outcomes were evaluated on the criteria of the D'Arcangelo, Vancouver Scar Scale score, and satisfactory questionnaire, respectively. The patients were followed up for 7-43 months. At the last follow-up, valgus deformity was completely corrected without recurrence. On the basis of the criterion of D'Arcangelo, the height and width of the webs were good in 24 of the feet, fair in four of the feet, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.55. All parents and patients were satisfied with the appearance and function. The described medial toe excision technique and reconstruction of the web space without a skin graft corrected the valgus deformity and were able to satisfy functional and cosmetic requirements.

Classic Timothy Syndrome Associated With Bilateral Border Digit Syndactyly: A Case Series

Timothy syndrome (TS) is characterized by congenital long-QT arrhythmia and limb syndactyly. Patients who undergo syndactyly repair with undiagnosed TS may have their abnormal cardiac electrical activity unmasked during surgery. The purpose of this study was to detail the extremity phenotype seen in patients with TS, which may help hand surgeons in their preoperative assessment. This was a retrospective review of all patients with TS seen at our institution from 1998 to 2022. Descriptive statistics regarding their demographics, medical and surgical histories, and syndactyly phenotypes were obtained. Seven patients (5 males and 2 females) with TS were seen at our institution for multidisciplinary evaluation (median age at presentation was 23 months). Six patients had finger syndactyly and 5 had toe syndactyly. One patient did not have any extremity syndactyly and was noted to have a specific TS mutation known to lack musculoskeletal abnormalities. All patients with finger syndactyly had border digit involvement, with 5 out of 6 patients displaying syndactyly of the middle-ring and ring-little finger web spaces. Toe syndactyly was more heterogeneous, with 1 patient lacking any lower extremity syndactyly and others having variable involvement of the second-third, third-fourth, and fourth-little toe web spaces. Complexity ranged from simple to complete. Four patients had intraoperative cardiac events leading to TS diagnoses after surgery. Bilateral border digit hand syndactyly, with or without bilateral toe syndactyly, should raise concerns for TS and prompt further investigation into potential cardiac disease to avoid perioperative cardiac morbidity and mortality. Therapeutic V.

An innovative technique for the separation of toes to prevent and treat intertrigo of toe web space

Interdigital dermatoses can usually be treated by keeping the interdigital web space dry and clean. The web space can be kept dry by keeping the toes separated. Unfortunately, this is difficult in patients having arthritis, obesity, diabetes, etc. A number of techniques have been suggested by different authors to keep toes separated using coiled wire loop,1 a thermocol spacer, etc. Apart from these, many toe separators are available online and can even be customized.2 However, they are not easily available, are often costly, and may not be comfortable to use.

Clinical and microbiological pattern of intertrigo

Background: Intertrigo is a common disorder affecting many flexural areas of the body with significant morbidity.
 Objectives: To determine the clinical pattern of intertrigo. To determine bacterial and fungal pathogens associated with intertrigo. To assess the antibacterial and antifungal sensitivity pattern of the responsible organisms.
 Methods: A total number of 230 patients with intertrigo attending dermatology unit were included in the study after ethical clearance. Laboratory investigations were done to identify the etiologic agent and their sensitivity pattern.
 Results: Majority of patients (75%) belonged to 20-60 years of age. Male to female ratio was 1.15:1. Remarkable proportion (52%) presented with the involvement of more than one intertriginous area. The most common site involved was toe web space (63%) in particular 4th toe web space. Of all positive bacterial cultures 45% revealed Staphylococcus aureus (MSSA+MRSA) followed by CNSA (Coagulase negative Staphylococcal aureus), diptheroids and pseudomonas. The majority of MSSA (Methicillin sensitive Staphylococcus aureus) isolates (91%) were sensitive to cloxacillin and MRSA (Methicillin resistant Staphylococcus aureus) to teicoplanin (85%). CNSA isolates showed considerable proportion of sensitivity to vancomycin (37%) and majority of diptheroids isolates were sensitive to penicillin(87%). All isolates (100%) of pseudomonas were sensitive to gentamicin. Of all positive fungal cultures, candida species constituted the majority (35%) followed by fusarium species (33%) and dermatophytes (30%). Overall fusarium species shows high value of MIC50 and MIC90 for itraconazole, fluconazole and ketoconazole. Fluconazole showed very high MIC50 and MIC90 (256 ug/ml) for dermatophytes and fusarium species whereas itraconazole and ketoconazole showed lower MIC for these fungi.
 Conclusion: Intertrigo can affect various intertriginous areas, among which toe web space is the most common region involved. Intertrigo can be caused by a variety of organisms: Staphylococcus aureus and candida species constituted the majority of cases. Majority of MSSA sensitive to cloxacillin and MRSA to teicoplanin. MIC of itraconazole, fluconazole and ketoconazole are high in fusarium species comparing to candida and dermatophytes. However, itraconazole and ketoconazole had lower MIC than dermatophytes and fusarium comparing to fluconazole.

Cryotherapy with liquid nitrogen for chronic and recalcitrant intertrigo of toe webspaces

<p><strong>Background:</strong> The inflammation of the toe web spaces is known as foot intertrigo. Most commonly caused by candida. Important predisposing factors such as diabetes mellitus, obesity and immunosuppression lead to persistence and recurrence. Cryotherapy is a promising, safe, cost-effective, easily available therapeutic approach to treat recalcitrant intertrigo compared to available topical medications. Aim of the study was to observe the clinical improvement and therapeutic response of recalcitrant intertrigo and to observe treatment response based on photographs.</p><p><strong>Methods:</strong> A total of 30 patients who were clinically diagnosed with chronic candida intertrigo (CI) who fulfilled the inclusion and exclusion criteria were enrolled. Cryotherapy was administered with 3 cycles of freeze and thaw of 30 seconds each, every 2 weeks for a maximum of 3 treatment sessions. Follow-up of patients were done for 4 months.</p><p><strong>Results:</strong> Among 30 patients treated, 21 patients showed excellent clinical response, 6 patients showed good response. Only 2 patients showed poor response. Minimal side effects were observed, of which transient pain at the cryotherapy site is the most common. Diabetes was the most common comorbidity with poor response to treatment and recurrence.</p><p><strong>Conclusions:</strong> Cryotherapy can be used as a safe modality of treatment for recalcitrant CI cases unresponsive to topical therapy by providing faster therapeutic response and improving the quality of life in these patients. </p>

Using 320-detector row computed tomography angiography to investigate the arterial anatomy of the toe flaps on living humans.

Using 320-detector row computed tomography angiography (320-CTA) to investigate the arterial supply for the toe flaps, namely the anatomical characteristics of the dorsalis pedis artery (DPA), the first dorsal metatarsal artery (FDMA), and the arteries of the first toe web space (AsFTWS). This was a prospective study on CTA of 72 intact feet of 36 Vietnamese adults who had sequelae of thumb or metacarpal hand amputation, from June 2017 to December 2019, then preoperative CTA images were compared with surgical findings on 31 feet of 29 patients. 320-CTA was able to investigate the DPA, FDMA, and AsFTWS in 100% of cases. DPA was absent in 6.9% of cases. The average diameters at its origin and termination were 3.22 and 2.56mm, respectively. For FDMA, the rates of Gilbert type I, II, and III were 52.8%, 18.1%, and 29.2%; the average diameters at its origin and termination were 1.98 and 1.67mm, respectively. At the first toe web space, FDMA was dominant in 54.2% of cases; the first plantar metatarsal artery (FPMA) was dominant in 29.2% of cases; both arteries were equally dominant in 16.6%. The average diameter at the origin of the lateral plantar digital artery of the great toe was 1.48mm, of the medial plantar digital artery of the second toe was 1.21mm. Preoperative CTA images resembled the surgical findings in all cases. The survival rate of toe flaps was 100%. The 320-CTA provided proper preoperative images in two and three dimensions, and helped surgeons to establish a preoperative surgical plan, thus increasing the success rate of toe transfer surgery.

Mycological profile of intertrigo of foot in a tertiary care hospital, Mysore, South India

Introduction: Intertrigo is an inflammatory condition of skin folds commonly seen in any age from infancy to old age and one of the major cause for clinical consultations. Intertrigo is due to heat, moisture or lack of air circulation and the infection is most commonly seen in patients with diabetes. Foot intertrigo is the infection of Toe web spaces occurring mainly at interdigital toe web spaces. The friction of skin folds may lead to several complications which includes bacterial or fungal infections. Materials and Methods: A total of 75 clinically suspected cases of foot intertrigo were included in the study. Skin scrapings from the suspected cases of intertrigo were collected with standard precautions and all the samples were subjected to direct microscopy using 10% Potassium hydroxide and observed for presence of fungal elements and simultaneously the sample is processed for culture onto fungal culture media to identify the causative agents of foot intertrigo. Results: A total of 75 skin scrapings from the infected foot for Mycological study were collected among which 38 samples were collected from male patients and 37 samples were from female patients. Of 75 skin scrapings, 31 were 10% KOH positive and remaining 44 were negative to microscopy. On culture 34 samples were culture positive and 41 were culture negative. Out of 34 culture positive samples, Candida albicans were isolated in 15 specimens and Non-candida albicans in 6. Remaining samples yielded growth of moulds in which Dermatophytes (Trichophyton-3, Epidermophyton-1) were 4 isolates and Fusarium yielded growth in 9 samples. Conclusion: From our study, we conclude that intertrigo is a chronic inflammation. This might occur at any age. In our descriptive study, Candida albicans were predominantly isolated followed by other moulds such as Fusarium and Dermatophytes. Keywords: Intertrigo, Candida albicans, Fusarium, Dermatophytes.

Interdigital syphilis: a rare form of secondary syphilis

A 39-year-old man with bilateral painful erosions in his toe web spaces and on the penile shaft was misdiagnosed as having Gram-negative toe web infection, and treated with broad-spectrum oral antibiotics. Further evaluation revealed positive serological tests for syphilis. Pedal interdigital syphilis is a rare manifestation of secondary syphilis.

Evaluation of Wound Closure Rates Using a Human Fibroblast-derived Dermal Substitute Versus a Fetal Bovine Collagen Dressing: A Retrospective Study

A retrospective study was conducted to evaluate the proportion of patients healed and time to healing of DFUs treated with a human fibroblast-derived dermal substitute (HFDS) or a fetal bovine collagen dressing (FBCD). Data from patients with a DFU who received the first treatment in 2014 were extracted from the electronic record database of 93 wound care centers. Baseline demographics (eg, age, gender, body mass index, and number of wounds); wound location, size, and duration; and wound-specific information such as wound size and number of and interval between applications were obtained. Study criteria stipulated patients who received at least one treatment in 2014 with HFDS or FBCD on a DFU with location coded as foot, toe, heel, metatarsal head, toe web space, toe amputation site, or transmetatarsal amputation site; ulcer size ≥1 cm2 to <20 cm2; and ulcer area reduction ≤50% in the 28 days before the first treatment with HFDS or FBCD were eligible for inclusion. Wounds that received an alternate skin substitute treatment up to 28 days before or concurrent with the first HFDS or FBCD treatment or if patient data that lacked baseline or follow-up wound area measurement were excluded. Deidentified data were extracted directly into data files and transferred to a third-party data management and statistical group for analysis. The frequency of DFUs achieving wound closure (defined as area ≤0.25 cm2) by weeks 12 and 24 and median time to wound closure of wounds that healed were analyzed. Baseline characteristics were compared using 2-sample t tests for continuous variables and 2-tailed Fisher's exact tests for difference in proportions between treatments. Frequency of and median time to wound closure were determined by Cox proportional hazards analysis. The frequency of wounds closed at 12 and 24 weeks, median time to wound closure, hazard ratio with 95% confidence interval, and P value were estimated from the Cox model. Statistical significance was defined as P <.05. Records showed 206 patients with 208 DFUs received treatment (108 HFDS, mean age 60.2 years, mean wound duration 8.8 months; 100 FBCD, mean age 65.2 years, mean wound duration 12.8 months) and were included. Mean number of treatment applications was 4.5 and 2.4 for HFDS and FBCD, respectively. After 12 and 24 weeks 44 (41%) and 69 (64%) of HFDS-treated wounds, respectively, and 21 (21%) and 43 (43%) of FBCD-treated wounds, respectively, were healed (at 12 weeks, P = .03; at 24 weeks, P = .03, log rank 2-tailed test, unadjusted). Median time to wound closure for HFDS and FBCD was 14.6 and 25 weeks, respectively (P = .03; log rank, 2-tailed test; Kaplan-Meier analysis). HFDS treatment significantly increased the probability of wound healing compared to FBCD treatment in the Cox proportional hazards analysis after adjusting for treatment terms, baseline wound area, baseline wound duration, baseline wound depth, wound location, and patient age at first treatment (HR = 1.77; 95% CI: 1.06-2.97; P = .03). DFU wounds are more likely to heal when treated with HFDS than with FBCD as used by facilities in this database. Studies examining the efficacy, cost-effectiveness, and patient-centered outcomes of these treatments is warranted. .

Clinical analysis of the double-wing flap for treatment of toe syndactyly

Objective: To explore the clinical effect of double-wing flap for the treatment of toe syndactyly. Methods: Retrospective analysis of 47 patients (60 syndactyly toes) who underwent double-wing flap to reconstruct toe web space in orthopedics department of the Third Affiliated Hospital of Zhengzhou University from February 2010 to October 2017.There were 21 males and 26 females, with an average age of 18.9 months (range: 10-48 months). All patients were treated with zigzag incisions to separate the toe syndactylys without skin grafts.The condition of wound healing and appearance of toes were observed. Results: The average follow-up time was 62.3 months (range: 6 to 80 months). There were no complications such as hematoma, infection, flap necrosis and no flexion contracture and obvious scar hyperplasia in all the 47 cases, 4 of the 60 webs developed web creep.All webs had good appearance with 45 degrees inclination from the dorsal to the metatarsal side and had good flexion and abduction function. Conclusions: The double-wing flap is a simple and safe operation for toe syndactyly which has a good clinical effect.

Validation of the Healthy Foot Screen: A Novel Assessment Tool for Common Clinical Abnormalities.

The purpose of this learning activity is to provide information about the Healthy Foot Screen, a new tool for assessment of common foot abnormalities. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After completing this continuing education activity, you should be able to:1. Recognize prevalence, causes, risk factors, signs, and types of common foot problems.2. Identify the results of this study about the new foot screening tool and its implications in primary care. Foot health is a key component of general health and well-being. Nevertheless, feet are often overlooked by healthcare providers and patients. Common foot problems include infections or inflammatory conditions, abnormal nail disorders (eg, onychomycosis), structural bony abnormalities, circulation disorders, and other conditions. The development of an easy-to-use, rapid, clinical tool to assess foot health can facilitate primary care provider recognition and treatment of common foot problems. This study ascertained interrater item reliability and validity from the preliminary version of one such tool called the Healthy Foot Screen.A total of 18 patients from a community dermatology clinic were individually screened by 11 interprofessional healthcare assessors using the preliminary tool. The assessors included a dermatologist/internist, family physicians, nurses, and podiatrists. The initial draft of the Healthy Foot Screen was created through an extensive literature review, complemented by the clinical judgment of the study team. Cronbach α was calculated for each item to determine interrater reliability. A minimum value of 0.6 was set for an item to be included in the final tool. Where applicable, scores for each item on the screen were calculated for right and left lower limbs and then averaged. Assessors were asked to complete a short survey.Interrater reliability scores for items on the screen were as follows: diabetes and smoking, 1.0; neuropathy, 0.988; palpable foot pulse, 0.916; abnormal fourth to fifth toe web space, 0.905; previous ulcer/amputation, 0.869; pitting edema, 0.872; bony abnormality, 0.804; dry bottom of foot, 0.799; toenail infection, 0.793; other spots/lesions,0.688; and red areas/blisters/pustules, 0.659. Generally, assessors found the tool easy to use, although some areas for improvement were noted.The Healthy Foot Screen can facilitate primary care provider diagnosis and treatment of common foot problems.

Severe Gram-Negative Intertrigo of the Feet

Introduction: Intertrigo is a common disease of the skin usually caused by fungi and/or bacteria, often involving major or minor skin folds. Here, we report a case of severe, ulcerative intertrigo of all interdigital folds of both feet caused by Pseudomonas aeruginosa in a patient with type II diabetes who acquired the infection during a trip to Senegal. Case Presentation: Lesions involved all toe-web spaces and the back of the toes and the soles. Ulcers with a purulent-necrotic bed, with some of them covered by brownish-black eschars associated with a greenish, odiferous discharge were recorded. The patient was treated with piperacillin/tazobactam IM for 14 days, achieving complete remission of the infection. In this article, we underline the importance of an early diagnosis and appropriate treatment to achieve healing of bacterial intertrigo without complications. Topical therapy with antiseptics (potassium permanganate, gentian violet solution, hydrogen peroxide) or antibiotics (gentamicin, amikacin) is effective only in early stages of the infection. Systemic antibiotics must be considered in all extensive and severe cases. The choice of antibiotic should be based on the culture and antibiogram results. When this is not possible, wide-spectrum antibiotics that act on both gram-positive and gram-negative bacteria (such as third-generation cephalosporin or quinolone) should be prescribed. Conclusion: The length of treatment should not be less than ten days. In addiction, all patients should be trained to avoid predisposing conditions and adopt preventive measures to reduce the risk of infection.

Culture characterization of the skin microbiome in Type 2 diabetes mellitus: A focus on the role of innate immunity.

The current study aimed at determining the differences between the cutaneous microbial flora of patients with Type 2 diabetes mellitus (T2DM) and those without, and thus evaluate for cutaneous microbiome dysbiosis in diabetes. We employed a case-control study design with 41 participants in each group. The skin over the toe-web space was swabbed and cultured aerobically. Data was analyzed for differences in microbial prevalences and growths between the two groups. Predictors for heavy colonization by microbes were analysed using logistic regression. We found significantly higher prevalences of Staphylococcus epidermidis among patients with T2DM (77.5% vs. 53.7%, p=0.02). Further, when prevalent, these bacteria showed a significantly greater degree of skin colonization i.e. CFUs/cm2 among these patients, p=0.03. Highly pathogenic bacteria such as S. aureus were more prevalent among patients with T2DM. The regression model determined a significant association between T2DM status and heavy colonization by S. epidermidis (OR - 5.40, p=0.02). Also, agricultural workers were significantly more likely to have heavy colonization by S. epidermidis (OR - 3.75, p=0.02). Other predictor variables did not show significant association with heavy colonization by any of the isolated microbes. Our findings support the existence of cutaneous microbiome dysbiosis among patients with T2DM. Literature suggests that microbiome dybiosis in T2DM could stem from the same activated innate immune response that is thought to be central to the development of T2DM. This dysbiosis could increase the risk of developing skin infections.

Pitted keratolysis - a study of various clinical manifestations.

Pitted keratolysis (PK) is a common bacterial infection of skin characterized by noninflammatory superficial pits. Very few studies have focused on variations in clinical manifestations of PK. We conducted this study so that diagnosis of this treatable condition is not missed when it presents in an uncommonly perceived way. Assessment of PK patients for various sites and morphologies. A total of 30 patients with PK were assessed for various sites and morphologies. Bacterial and fungal cultures along with histopathology were performed. Of 30 patients, 24 were females. Hyperhidrosis and malodour were the most common symptoms. Interdigital interface skin of the toes was the first site affected in most patients. Plantar skin was affected in all patients with involvement of interface skin of the toes in 29 patients. Other sites affected were palms, finger web spaces, nonglabrous skin, paronychium, and nail. Other than classical pits, scaly crusted inflammatory lesions with post-inflammatory hyperpigmentation (PIH) were noted. Associated keratoderma was also reported in some patients. The presence of hyperhidrosis, malodour, and plantar lesions is consistent with previous studies. Interface skin between toes as the first site affected, involvement of toe web spaces, and associated keratoderma have been reported rarely. However, female preponderance, involvement of finger web spaces, nonglabrous skin, paronychium, nail changes, the presence of inflammation with crusting, and PIH have never been reported previously. PK can involve web spaces, nonglabrous skin, and paronychium, and can cause nail changes. The lesions can be inflammatory with crusting and PIH.

Abnormal skin in toe webs is a marker for abnormal glucose metabolism. A cross-sectional survey among 1,849 adults in Finland

Diabetes is undiagnosed disease and easy screening tools for it are warranted. Because foot complications are usual in diabetes, we aimed to test hypothesis that skin abnormalities are found already from patients who are not aware of having diabetes, by studying the possible association between unhealthy toe web skin and abnormal glucose metabolism. 1,849 cases without previously diagnosed diabetes participated to the 46-year follow-up study of the Northern Finland Birth Cohort. A skin investigation was performed for all, and abnormal skin findings in toe web spaces were taken as explanatory variables. Abnormal glucose tolerance was the main outcome and it was tested with an oral glucose tolerance test (OGTT), glycosylated haemoglobin fraction (HbA1c) Values are numbers (percentages) of sub and fasting blood glucose. The participants who had any abnormal skin findings in toe webs were associated with 2.5-fold (OR 2.5, 95% CI 1.3–4.9) and 6-fold (OR 6.2, 1.4–27.6) increased risk of having previously undiagnosed diabetes detected by a 2-hour OGTT and HbA1c, respectively. The predictive power of toe web findings was comparable with FINDRISC score. Abnormal skin findings in the toe webs show increased risk of occult diabetes, and may, thus serve as an additional sign of undiagnosed diabetes.

Extranasal Staphylococcus aureus colonization predisposes to bloodstream infections in patients on hemodialysis with noncuffed internal jugular veincatheters.

Staphylococcal infection of endogenous origin is an important cause of morbidity and mortality in patients who receive hemodialysis (HD). The risk of such infections in nasal carriers of the organism is well defined. Extranasal carriage of the organism at extranasal sites may pose similar risks. A total of 70 patients about to undergo internal jugular vein catheterization for HD were enrolled in this prospective observational study. Swab cultures were obtained from anterior nares, posterior pharynx, axillae, toe web spaces, and vascular access sites at baseline and 1 week later. A patient was defined as a persistent carrier when the same organism was grown in both samples. Staphylococcus aureus bloodstream infections were assessed by blood and catheter tip cultures over a 90-day period. The mean age of the patients was 43.71 ± 16.2 years. Persistent S. aureus carriage at anterior nares, throat, axilla, toe web spaces, vascular access site, and all sites was documented in 27.9%, 11.4%, 40%, 32.9%, 4.3%, and 64.2% of patients, respectively. Fifteen patients developed S.aureus infections. Catheter related S. aureus infections (CRI) were more likely in persistent carriers than nonpersistent carriers with odds ratios (95% CI) of 10.2 (2.8-37.1), 8.6 (1.7-42.2), 17.3(3.4-86.0), 3.0 (0.9-9.8), and 1.9 (0.2-22.4) for anterior nares, throat, axilla, toe web spaces, and vascular access site carriers, respectively. The probability of developing CRI in persistent S.aureuscarriers was 55% compared to none in noncarriers at 90 days (P = 0.04). Extranasal S. aureus carriage is as significant a risk factor as nasal carriage for staphylococcal infections in patients on HD through catheters. The study is limited by lack of molecular phenotyping.

Study of the Etiological Causes of Toe Web Space Lesions in Cairo, Egypt.

Background. The etiology of foot intertrigo is varied. Several pathogens and skin conditions might play a role in toe web space lesions. Objective. To identify the possible etiological causes of toe web space lesions. Methods. 100 Egyptian patients were enrolled in this study (72 females and 28 males). Their ages ranged from 18 to 79 years. For every patient, detailed history taking, general and skin examinations, and investigations including Wood's light examination, skin scraping for potassium hydroxide test, skin swabs for bacterial isolation, and skin biopsy all were done. Results. Among the 100 patients, positive Wood's light fluorescence was observed in 24 and positive bacterial growth was observed in 85. With skin biopsy, 52 patients showed features characteristic for eczema, 25 showed features characteristic for fungus, 19 showed features characteristic for callosity, and 3 showed features characteristic for wart while in only 1 patient the features were characteristic for lichen planus. Conclusion. Toe web space lesions are caused by different etiological factors. The most common was interdigital eczema (52%) followed by fungal infection (25%). We suggest that patients who do not respond to antifungals should be reexamined for another primary or secondary dermatologic condition that may resemble interdigital fungal infection.